Ottawa will not content itself with merely transferring health dollars to the provinces and territories, and plans to play an active role in improving Canada's health system, the federal health minister says.
"We have an obligation as a federal government to do more than throw open the federal wallet," Dr. Jane Philpott told the general council of the Canadian Medical Association in Vancouver on Tuesday.
"I believe an engaged federal government has a role to facilitate the changes that can move Canada from the middle of the pack to out in front."
Dr. Philpott said there is a "rare opportunity" to begin making changes in the coming months as Ottawa negotiates the terms of a new Health Accord. The provinces and territories have complained that the talks are lagging but the minister hinted that they could last as long as another six months.
This year, the federal government will transfer $36-billion to provinces and territories to help pay for health care, with no strings attached. (In total, public spending on medicare is $155-billion.)
In 2004, Ottawa signed a 10-year Health Accord that provided an injection of $41-billion into medicare. Dr. Philpott said the problem with that agreement is "it didn't buy change."
Since 2004, the annual transfer has grown by 6 per cent per annum, but that is set to drop to 3 per cent as part of a deal unilaterally imposed by the previous government.
The Liberals have not made many firm financial promises but have stressed that they want to bolster home care (to which they have promised $3-billion over four years) and mental-health services, and make prescription drugs more affordable.
Dr. Philpott reiterated those priorities in her speech to CMA delegates. She also disappointed many by refusing to make a firm commitment to pharmacare (making essential prescription drugs available at no cost).
"We have a number of pressing priorities like home care and mental-health care," she said. "I don't want to promise anything I can't deliver."
Dr. Philpott, the first medical doctor to serve as federal health minister since 1928, received a warm welcome from her fellow physicians. She, in turn, heaped praise on the CMA for its leadership and, in particular, for speaking up on important public-health issues such as indigenous health and climate change.
Her address focused on the state of the health system – past, present and future – by identifying four major myths and misconceptions that need to be challenged and then by offering solutions for reform.
The first myth is that the aging population is going to bankrupt medicare. There is no "grey wave or silver tsunami" that is going to bankrupt medicare, Dr. Philpott said. Rather, the health system needs to be restructured to reflect demographic realities, notably by shifting care to the community;
The second myth is that Canada has the best health system in the world. In fact, many countries have better outcomes and lower costs, and Canada should learn from them, she said.
The third myth is that we're stuck with the system we have. "That is small thinking, and we need to think big," Dr. Philpott said.
The final myth is that more money is the only answer: Again, the health minister stressed that the health system needs profound structural reform, not merely throwing money into the current way of doing things.
Dr. Philpott also briefly offered up four solutions to improve the delivery of care and the health of Canadians:
- Prioritize the socio-economic determinants of health: The key to a sustainable health system is addressing social inequity, notably in indigenous communities;
- Uphold the Canada Health Act: “If it is our goal to have a fair and just society,” the principles of the law must be upheld, the minister said;
- Strengthen primary care: “Canada has never sufficiently grounded its system in primary care,” and the result is that it’s disjointed, inefficient and costly, Dr. Philpott said;
- Build seamless systems with patients at the centre: While the quality of care in Canada is excellent, the biggest frustration of patients is that the system is fragmented and slow.
"The solutions are not mysterious," Dr. Philpott said. But the system will not be improved unless there is co-ordinated action by all the main players, including Ottawa, the provinces, health practitioners and patients.
She also added, to stress her view that Ottawa has to be hands-on, that "there has never been a major development in the history of health care in Canada where the federal government was not there."
The Canadian Medical Association represents Canada's 83,000 physicians. Its annual general council meeting, being held in Vancouver this week, is often referred to as the "Parliament of Canadian medicine."