Without much ado, Canada’s health ministers have gathered in Halifax. While there has been little fanfare, their meeting, which began Thursday
On the agenda is the next health accord, the agreement by which Ottawa transfers money to the provinces and territories for health care. We hope, though, that the larger goal is for ministers to arrive at a meeting of the minds on what kind of reform they want to bring about after the current 10-year accord expires in 2014.
Make no mistake: Everyone agrees on the need for change. While it may seem daunting to take on something as large and complex as health care, there’s a surprising degree of common ground on how to embark on this change, whether by introducing efficiencies, expanding the use of technology or creating more chronic-care facilities and improving access to community-based care.
But, as the adage goes, a journey of a thousand miles starts with a single step. The Canadian Medical Association recommends that this first step be the adoption by ministers of a set of principles to help guide transformative change. For decades, the medicare principles of universality, portability, accessibility, comprehensiveness and public administration, as set out in the Canada Health Act, have served Canadians well.
But as it closes in on 30 years, the act, adopted in 1984, applies only to physician and hospital services, which once comprised the lion’s share of health-care spending. Health care has changed: New advances in surgery and pharmaceuticals mean less time spent in hospitals and physicians’ offices as patients are able to be treated at home or in their communities. An aging population requires a new paradigm with a greater focus on long-term, chronic care.
Earlier this year, Canada’s nurses and doctors, through their national associations, developed a new set of principles that would apply to the entire continuum of health-care services. With polls telling us that Canadians believe national standards are important, these principles would serve as a common framework to ensure we have a health-care system that is bound together by pan-Canadian standards and a shared commitment to accountability and quality. These principles are:
Patient-centred: Patients must be at the centre of health care, with seamless access to the continuum of care based on their needs;
Quality: Canadians deserve quality services that are appropriate, respectful of individual choice and delivered in a manner that is timely, safe, effective and based on the latest evidence;
Health promotion and illness prevention: The health system must support Canadians in illness prevention and the enhancement of their well-being, with attention paid to the social determinants of health – the broader social factors that also determine health outcomes;
Equitable: Canadians deserve equitable access to quality care and multisectoral policies to address the social determinants of health;
Sustainable: Sustainable health care requires universal access to quality health services that are adequately resourced and delivered across the board in a timely and cost-effective manner;
Accountable: The public, patients, families, providers and funders all have a responsibility for ensuring the system is effective and accountable.
Beyond the Canadian Medical Association and the Canadian Nurses Association, these principles have been endorsed by more than 60 medical and health-care organizations. Together, they represent upward of 250,000 health-care providers who offer care to patients every day.
Rather than an end in itself, the next health accord will serve as a means to an end. Medicare requires transformative change, but Canadians shouldn’t expect it to turn on a dime. We believe our country should aim, by 2025, to rank among those with the best health and health care in the world, as measured against OECD indicators.
It’s not as much of a stretch as it may seem. Canada once had one of the best health-care systems in the world. No less than before, we have the resources – the people, the education, the wealth, experience and expertise – to restore our system to its former stature. Further, we know that Canadians value medicare and hold dear the underlying values of fairness, compassion and equality it represents.
This week’s meeting of health ministers marks an important turning point as they turn their attention to the next iteration of medicare. Canadians now need to pay attention to make sure that the transformation so urgently required, and that they deserve, actually comes to fruition.
Dr. John Haggie is president of the Canadian Medical Association.
