A decade of health care reforms heralded as a “fix for a generation” has yielded disappointing results and deluded Canadians into thinking their system of care is better than it really is, a report says.
The report, to be released on Thursday, is the latest from the Health Council of Canada, an oversight panel created to monitor the progress of health accords introduced in 2003 and 2004. The federal government announced this year that it will end the group’s financing.
The council found the accords failed to usher in the “transformative change” politicians promised because of an absence of federal leadership, a lack of clear metrics to measure progress, and inertia fuelled by a risk-averse public.
“Health care isn’t as good as you think it is in Canada,” Jack Kitts, an anesthesiologist and chairman of the panel, told The Globe and Mail editorial board. “Most Canadians think they have good health care; yet, the evidence suggests the system is not as good as they think it is.”
The report found that changes ushered in with the accords failed to keep pace with the evolving needs of the greying and diversifying population, noting that income, education and cultural factors affect access to care.
Whereas 76 per cent of Canadians rate the quality of care they receive from their primary doctors as excellent or very good, less than half of the most frequent users of the system, those with chronic conditions, have the same assessment of their care.
While the report reads in places like an indictment of the health care system and efforts to improve it, the findings are not surprising. Since its inception, the council has been tepid about progress in health care, and harshly critical at times. Previous reports highlighted shortcomings in home care, access to treatment for the chronically ill, and inequities in delivery of services among provinces.
At the same time, the report strikes a tone of optimism that the system can be changed for the better. It contends that politicians and key stakeholders must scrap what it calls “disparate, tentative approaches to health care reform” and adopt a unified approach with clear goals. The report called for strong federal leadership with provincial collaboration and metrics to measure improvements.
“A high-performing health system is possible in this country,” the report concluded.
Dr. Kitts cited the pact to reduce waits as a good example of co-operation with defined and measurable aims. He speculated that the same effort could be applied to reducing hospital admissions for the chronically ill, a growing segment of the population that relies too much on emergency departments because of a lack of options.
One of the more striking findings was that for all the talk of transformation, the country’s pattern of health care spending hardly budged over the past decade. The proportion of health-care dollars allocated to hospitals, long-term-care facilities, drugs and medical equipment, and primary care was virtually identical in 2003 and 2011, the last year for which data were available.
By contrast, the Netherlands, which the council cited as providing outstanding health care, radically shifted its spending pattern over the same period to reflect the changing needs of its aging population. For instance, it nearly doubled funding of long-term-care facilities to 24 per cent of all spending between 2003 and 2011, and cut back in areas like hospitals, primary care and drugs.
“If we’re going to succeed, we do have to do things differently,” Dr. Kitts said. “We cannot continue the status quo and fund it and expect more money to reform the system.”
The council was established in 2004 and had a budget of about $6.5-million. The Harper government announced in April that, since the accords it was created to monitor expire in 2014, the council was no longer necessary. It is expected to operate through early next year.