If you want to know why the Canadian health system is mired in mediocrity, look no further than the predictable, braying response to news that the Health Council of Canada is winding down.
In Canada, we love our rhetoric, and we defend nothing more fiercely than the status quo.
The Canadian Health Coalition described the health council as "the guardian of national standards and universal access to care for all Canadians" and said its shutdown "could mean the end of Canada's last and most-loved social program." The Friends of Medicare called the end of the group's funding a serious attack on medicare and "a clear indication that the federal government is not interested in the health of Canadians."
Wow. This Health Council of Canada sounds pretty amazing, so let's examine what it does.
When it was created in 2003, the mandate was to monitor the implementation of the $24-billion first ministers' accord on health-care renewal. When a new health accord worth $41-billion was signed the next year and deemed to be the "fix for a generation," the health council was, once again, assigned to monitor progress. In addition, the new independent body – funded by the federal government but administered by the provinces – was to "report on Canada's health system, focusing on best practices and innovation."
Given its vague assignment and modest budget ($6.5-million a year), the health council has done an admirable job. But it's not exactly a cornerstone of medicare. In fact, it is fairly ineffectual at monitoring: For example, in analyzing whether the provinces had delivered on their promise to cut waiting times using the $5.5-billion set aside in the accord, the conclusion every year was "maybe." This is not the fault of the council, but of the provinces, who transformed data-tinkering and vague target-setting into an art form. In other words, it was ineffectual by design.
Where the health council really shone, however, was in highlighting innovative health-care projects across the country. But again, there is little evidence provinces actually used the information to improve the delivery of health care, so what's the point?
As people trip over each other to decry the death of the health council, let's not lose sight of its limitations.
The Canadian Medical Association, in a press release, made perhaps the most salient observation, saying Canada needs a national body to report on the performance of the health system. Be that as it may, the Health Council of Canada did not play that role, at least not adequately.
The 2004 health accord was a 10-year deal. It expires in 2014, and the health council should expire along with it.
That being said, if we need and want a body that monitors the quality of health-care in Canada, let's create one; if we want national standards on the delivery of health care, let's formulate and enforce them.
But the Health Council of Canada never has and never will do so.
If we want an organization that promotes innovation in health care, let's create one. But let's not limit it to publishing reports that nobody acts on. Let's give it some real purpose and some muscle.
In bemoaning the death of the health council, many have described it as a watchdog. Again, it was no such thing. It had a charming little bark, but absolutely no bite.
The provinces are lining up to say the health council is essential (as long as Ottawa pays the bills, of course). But that's disingenuous.
The Conservative government of Stephen Harper is often criticized for its hands-off attitude to health care, for its desire to transfer health dollars to the provinces and be done with it.
We too often forget the flip side of the coin: The provinces – regardless of whether the party in power is Conservative, Liberal or New Democrat – don't especially want national standards, they don't want independent oversight, and they don't want their money to come from Ottawa with strings attached.
Ottawa imposed a new deal, extending the funding provisions of the health accord, including an increase of six per cent a year, until 2016, then three per cent afterwards. It also removed all the conditions, meaning there really isn't anything for the Health Council of Canada to monitor.
No point in keeping it for show. The organization should either be beefed up considerably or scrapped.
Either we make a commitment to monitoring, to information sharing, to national standards, to innovation, or we don't. Either you invest in co-operation to ensure there is a semblance of a national health system, or you don't.
Our governments, federal and provincial, through their actions if not their words, have opted to not do so. Maintaining the Health Council of Canada in its current incarnation and in the absence of that commitment would amount to putting lipstick on a pig.
André Picard