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The Royal Victoria Hospital in Barrie, Ont., has one of the busiest emergency rooms in Ontario.

Health care and the economy are the two issues Canadians consistently say mean the most to them, but they're not getting that much substantive air time in the campaign. With this primer, The Globe and Mail addresses that. In this special feature, public-health reporter André Picard frames the problems and politics reporter Steven Chase tries to pin down the parties.

1. The Canada Health Act

The iconic 1984 law sets out the conditions the provinces and territories must meet to get federal health dollars and, de facto, spells out the principles of medicare. But there is near-universal agreement that the legislation, which defines "medically necessary" care only as hospital and physician services, is terribly outdated. Scrap it? Amend it? Or create complementary legislation? There is an opportunity here to fundamentally reshape medicare, but also the risk of opening a political Pandora's box.

Question: Would you scrap, alter or leave the Canada Health Act as it is?

  • Conservatives: Stephen Harper and the Conservative Party strongly support the Canada Health Act and its objective of a universally accessible, publicly funded health-care system in Canada. That is why he has increased funding for health care to record levels and why we will continue to increase funding for health care at 6 per cent a year to ensure that all Canadians have access to high-quality health care regardless of ability to pay.
  • Liberals: A Liberal government passed the Canada Health Act, and we are firmly committed to enforcing the act in government. The reforms we will pursue in government do not require changes to the act itself, and can be accomplished through companion agreements arrived at through collaboration with the provinces and territories.
  • NDP: New Democrats are committed to preserving public, not-for-profit universal health care. We would strengthen the act to bring out-of-hospital services such as home care and long-term care inside the public health-care system, helping to get costs under control.

2. Pharmacare/catastrophic drug insurance

Medicare was created in the 1950s and 1960s because families were being bankrupted by the cost of hospital and physician care. Today, families, particularly in poor provinces, are facing financial hardship (and sometimes ruin) paying their drug costs.

Question: How will you bring some fairness and affordability to the provision of essential drugs?

  • Conservatives: We recognize the importance of affordable access to drugs as part of our high-quality health-care system. Provinces and territories are responsible for deciding which drugs are publicly covered. That is why we have increased funding to provinces and territories by 33 per cent since we formed government so that they continue to meet the health-care needs of their residents. How they use these funds is their decision, but the money can help provinces and territories with the costs of their drug plans, including catastrophic coverage.
  • Liberals: We would engage provincial and territorial governments in a co-ordinated action on drugs, including measures to cover financially catastrophic drugs, cost-reducing bulk purchasing strategies, and improving access to breakthrough pharmaceuticals. These measures were included in the National Pharmaceutical Strategy established under the 2004 Health Accord, which was abandoned by the Harper Conservatives in 2006.
  • NDP: We will work with the provinces to establish a universal prescription-medications insurance plan - saving billions from health-care budgets - and immediately create an independent Pharmaceutical Research Council to ensure that research dollars are spent in accordance with expert-driven, patient-centred research priorities.

3. Health human resources

There are more than one million health workers in Canada and the number keeps growing. We added 5,000 new doctors in the past five years and 27,000 new nurses in the past decade. Yet, there still seem to be shortages and growing waits for care. Are health professionals working to their full scope of practice? What is the best staff mix for timely, cost-effective delivery of care? Labour is, by far, the biggest health expense, yet there is no cohesive labour strategy.

Question: To deal with wait times and shortages, what do you propose other than hiring more doctors and nurses?

  • Conservatives: We will continue to work collaboratively with the provinces and territories to renew the Health Accord and to continue reducing wait times. Since 2006, we have made progress on reducing wait times in priority areas through investments such as the Patient Wait Times Guarantee Trust, but more needs to be done. That is why we continue to increase funding for health care to record levels and have committed to continuing to increase it by 6 per cent each year.
  • Liberals: Investments in health promotion and delivery of care in the home will help relieve pressure on the health-care system, while reducing health-care costs. Expanding the rural health work force is critical, and must be accompanied by broadband expansion, which will allow heath-care providers to connect to patients digitally.
  • NDP: Helping provinces and territories train more doctors, nurses, nurse practitioners, midwives and other health-care professionals is Job 1. We also must get smarter in how we deliver primary care, such as opening up spaces in hospitals through improved home-care services and creating more long-term-care spaces.

4. The private-public mix

Every health system in the developed world has a mix of private and public health insurance and private and public care delivery. Canada is peculiar in that its system is bifurcated: There is virtually no private insurance or private delivery in areas such as hospitals and virtually no publicly insured or delivered care in other areas such as dentistry. One of the keys to keeping medicare sustainable and affordable will be defining what is medically necessary (and hence covered by public insurance) and what should be covered by private insurance or out-of-pocket.

Question: How would you more clearly define what is "medically necessary" - that is, covered by medicare - and what should be covered by private insurance?

  • Conservatives: Canadians deserve and expect timely access to high-quality health-care services. To help achieve that goal, we will work collaboratively with the provinces and territories to renew the Health Accord and to continue reducing wait times. In our discussions with the provinces, we will emphasize the importance of accountability and results for Canadians, including better reporting from the provinces and territories to measure progress, and guarantees covering additional medically necessary procedures.
  • Liberals: Decisions about what is medically necessary must be driven by scientific evidence and recognized best practices. However, this information is often not effectively shared across the country, which limits broad adoption. We would energize a national effort to improve collaboration on and adoption of best practices in health care.
  • NDP: Objective clinical evaluation of therapy and new technologies, along with co-ordination among practitioners, is essential to defining what should be covered by medicare. We need to be vigilant in making sure the public/private mix ensures accessibility to essential services is preserved.

5. Aboriginal health

Ottawa has direct responsibility for health-care services for aboriginal people living on reserves and Inuit. The health coverage afforded these isolated groups is the most comprehensive in the country (it includes prescription drugs and dental in addition to medical care), but the actual delivery of care is poor at best. Worse yet, these groups tend to live in such abysmal socio-economic conditions - a lack of clean water and sanitation, for example - that good health is virtually impossible. On the health-care file, the federal government should be leading by example and that begins by providing decent health care to first nations, Inuit and Métis peoples.

Question: What will you do to improve the health status of first nations and Inuit people?

  • Conservatives: Stephen Harper and the Conservative Party have invested heavily in improving health care for aboriginal people by building new health clinics and nurses' residences on-reserve, renewing key health programs for maternal health, Head Start, and diabetes, and improving water on reserves. While significant challenges remain, our Conservative Government is committed to improving health care for aboriginals on-reserve.
  • Liberals: We are committed to working in full partnership with aboriginal communities to improve aboriginal health by addressing the root causes of differential health outcomes, including inadequate housing and infrastructure, and a persistent gap in learning outcomes. These actions will be paired with new investments in health workers for aboriginal communities.
  • NDP: We would end the 2-per-cent cap on social and health spending that has meant health services in aboriginal communities has fallen even further behind. We would work with first nations, Métis and Inuit communities on a holistic approach to both living conditions and health-care delivery.

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