The federal government should attach strings to health transfers it provides to provinces and take a leadership role in driving transformative change, says a Senate report that reads more like a manifesto for 21st-century medicare.
"I strongly believe that the federal government cannot just put the money on the table and walk away," said Art Eggleton, deputy chair of the Standing Senate Subcommittee on Social Affairs, Science and Technology. "…The federal government has got to be a key partner in all of it."
The 122-page, 46-recommendation report is seen as the definitive word on evaluating the 10-year health accord that was to be a fix for a generation when former Prime Minister Paul Martin brought it in; it ends in 2014.
The accord saw $41.3-billion poured into health care over a decade, indexed at 6 per cent, that included monies for hospitals to burn through waiting lists for procedures, including hip and knee replacements, cataract surgery, cancer radiotherapy and diagnostic imaging.
More recently, there were concerns that the Conservative government's "hands off" and "take it or leave it" approach to funding to the provinces would put medicare forever adrift with no strong federal leadership role.
When the federal government asked the Senate to undertake the mandatory review of the accord – instead of Parliament's health committee – it prompted some to charge the Conservatives were shirking their role in the country's $192-billion health-care system.
Tuesday's report didn't call for more money – it said money has to be spent more efficiently. It pointed out the health accord's successes in the form of meeting targeted waiting times in four of the five areas – all except diagnostic imaging – and also its failures, including the lack of a national pharmaceutical strategy.
Partial failures include slow progress in both implementing electronic health records and providing improved patient access to primary care. Despite an $800-million fund aimed at systemic change in primary care, access today remains uneven.
The health accord "moved the ball along," Mr. Eggleton said in a telephone interview from Ottawa. "It helped but it didn't do as much as those premiers who sat around the table intended it to do. And I think we've got to get back to it."
John Abbott, chief executive officer of the Health Council of Canada, said he thought the Senate committee, "called it right," adding that he hopes the health ministers "use this report as a basis for discussion going forward."
And Canadian Medical Association president John Haggie labelled it "another series of wakeup calls about health care."
"I would urge the federal government to not treat this like other governments have treated previous reports and simply shelve it because they are afraid to do anything with health because it's too complex," said Dr. Haggie.
Steve Outhouse, director of communications for federal Health Minister Leona Aglukkaq, said she could not comment without having read the report. He added, however, that "since the beginning of the year, she has been meeting with her provincial and territorial counterparts on how improvements can be made."
Key recommendations from the Senate review of the 2004 federal-provincial health accord:
A strong federal role, with strings attached
Money provided by the federal government should be used to establish incentives for change, focusing on transforming health care and helping establish measurable goals, timetables and annual public reporting.
Tracking wait times
Provinces and territories should continue to develop strategies to address waiting times in specialty care, access to emergency services and long-term care and publicly report them. The true waiting time – the moment the patient first seeks help – should be tracked, not just the time from when a patient first sees the specialist.
Home, end-of-life care
The federal government should work with the provinces and territories to increase access to palliative care as part of end-of-life health services in a broad range of settings, including residential hospices.
Comprehensive drug coverage
A national pharmacare program – based on principles of universal and equitable access for all Canadians – should be established.
Better access to doctors
By 2014, 50 per cent of Canadians should have 24/7 access to multidisciplinary health-care teams, something only 32 per cent of patients now have.
With files from Justine Hunter, Tamara Baluja and Karen Howlett