It is impossible to say whether Canada’s medicare system is providing value for money because governments are making little effort to measure performance, the federal Auditor-General says.
Similarly, there is no way of knowing if the health system is sustainable because there has been a failure to invest in long-term projections, Sheila Fraser told delegates to the Canadian Medical Association general council meeting in Niagara Falls, Ont., on Tuesday.
“Will governments have the cash to meet the health needs of our aging population without increasing debt to unsustainable levels?” she asked. “Frankly, I’m not sure the government of Canada has all the information it needs to answer this important question.”
Ms. Fraser said the “answer lies in long-term financial projections” that lay out scenarios 25 to 75 years in the future. While many other countries do so, currently in Canada, she said, the government limits itself to projections of three-to-five years, which is not enough, said Ms. Fraser, to “understand the implications of policy choices on spending, taxation and debt.”
Ms. Fraser stressed that the role of the Auditor-General is to conduct financial and performance audits of government programs, not to evaluate whether public policies are cost-effective or sustainable. Nevertheless, she noted that there are “significant gaps in performance reporting so, no, we don’t know if we’re getting good value for money.”
For example, Ottawa will transfer $25.4-billion to the provinces and territories this year through the Canada Health Transfer. (That accounts for a little less than 20 per cent of the $128-billion in public spending on health care; private spending accounts for another $55-billion annually.) Ms. Fraser noted that those massive cash transfers come with no strings attached and little monitoring.
The accord that sets out the health dollars Ottawa transfers to the provinces and territories expires in 2014.
Anne Doig, president of the Canadian Medical Association, said that improving accountability should be a precondition for future cash transfers.
“Public reporting on the performance of the health system in Canada is piecemeal at best and non-existent at worst,” Dr. Doig said. “Without this critical ‘report-back’ function, Canadians have virtually no information about how well – or how poorly – their health system is working.”
Delegates to the CMA general council – which is commonly described as the parliament of Canadian medicine – also tackled the issue of sustainability head on, saying it should become the sixth principle of the Canada Health Act.
The act sets out five conditions that provinces and territories must respect in return for receiving federal health dollars: public administration, comprehensiveness, universality, portability and accessibility.
“The original conditions are part of a funding agreement, but they have morphed over time to become a statement of belief and fundamental values that Canadians hold in their health-care system,” Dr. Doig said.
Similarly, she said, the renewal of the health accord can serve as a launching point for enshrining sustainability as a fundamental principle of medicare.
“There are two camps talking about sustainability: One group, like ourselves, are concerned with getting best value for money and ensuring we spend money wisely for patients. But the other uses sustainability, or unsustainability, as code for giving up on publicly funded health scare,” she said. “The CMA needs to make clear what camp they’re in.”
