Canada’s premiers have an opportunity to do something novel and overdue on the health care file this week – demonstrate that they can do more than simply demand more money from the federal government.
Six months after the last meeting of the Council of the Federation – when Ottawa promised $196-billion in additional health funding over 10 years, including $46.2-billion in new money – all the provinces and territories (except Quebec) have signed new deals.
The money isn’t flowing yet because none of them have met the one condition for new funding: creating targets and timelines to show the money will be used to improve access to care.
At their meeting this week in Winnipeg, the premiers need to commit to some semblance of a coherent, co-ordinated plan.
The most visible problems in Canadian health care – overflowing/closed ERs, a dire shortage of primary care providers, painfully long wait times for everything from psychological care to surgery, and lack of real choice in elder care options, like home care and long-term care, to name only a few – are similar in every jurisdiction.
More importantly, they have the same root causes, a combination of non-existent health human resources policies and fundamentally flawed structures.
For far too long, provinces and territories have addressed their staffing woes by poaching workers like nurses and doctors from other jurisdictions. With the shortage of health workers increasingly becoming a global problem, that approach is failing miserably.
Similarly, when problems have arisen in particular areas – for example, unacceptable wait times in cancer care – the approach has been to pump money into that one area, and neglect others. That rearranging-the-deck-chairs-on-the-Titanic approach is also catching up with us.
Over the years, a lot of effort has been put into dealing with surgical wait times and we were doing fairly well on that count until the pandemic upended things. But, with so much focus on specialty care, primary care was woefully neglected to the point where more than six million Canadians are now without a primary care provider.
So where do they go for care? Mostly to emergency rooms which, in turn, have become de facto walk-in clinics with horrible wait times.
While ERs are supposed to be a place where the most serious and urgent cases end up, they have instead become the front door of the system.
That is a costly structural and engineering failure.
Solving these massive problems is going to take time, but it’s not going to happen unless all provinces and territories work together, not in isolation or at cross-purposes.
This week, the premiers need to convince Canadians they are up to the task. The way to do that is to agree on some common priorities, targets and timelines.
The Canadian Medical Association has provided provinces and territories with a good template of how this can be done. In a report released last week, the CMA proposed adopting 13 indicators and targets for improving accountability in the health care system. For example, it calls on governments to increase the percentage of Canadians with access to routine primary care from the current 85 per cent to 90 per cent by 2028, and 95 per cent by 2033.
This is realistic and essential; rebuilding the health system begins by creating a solid foundation of primary care.
Another recommended target is zero ER closures within three years. (In 2022, there were 210 documented closures across the country.)
The CMA also proposes that 75 per cent of Canadians should have access to their health records electronically within five years, rising to 90 per cent within a decade. (Currently, it’s 27 per cent.)
Of course, the group representing the interests of physicians should not have the lone nor final say on these matters. But their approach is the right one: spoon-feed our so-called leaders with policies they can implement.
Right now, the provinces and territories have all published individual action plans, road maps and strategies. (All available on the Council of the Federation’s website.) What’s wrong with these documents is that they are full of vague promises and based on the false premise that jurisdictions function in isolation. Provinces and territories do handle the specifics of distributing health funds to their populations, but they must negotiate collectively for the money. What the health system needs right now is swift and collective action from the premiers in identifying problem areas and setting clear goals for longer-term changes.
You can’t measure progress without targets and timelines. Nor can you have any accountability.
And if we’re going to have hope that the health system can be revived and renewed, all these things are essential. So, too, is the premiers acting swiftly and decisively.
André Picard