For $41-billion, Canadians deserve a straight answer.
Seven years into Canada's 10-year, $41-billion health accord - the "fix for a generation" - we should know how we're doing. Especially as we head towards another exhausting national discussion about health care, and another opening of the national vault.
But the Health Council of Canada, whose job it is to monitor achievements under that accord, can't seem to make up its mind whether it's happy or unhappy with the results.
The centrepiece of the accord was a $5.5-billion fund to reduce waits for five key services: hip and knee replacement, diagnostic imaging, cataract surgery, radiation therapy, and heart-bypass surgery. "Have governments actually achieved meaningful reductions in wait times since the accords?" the health council asks in its second major progress report since the 2004 accord. "The answer is not straightforward."
Is it too much to ask that $41-billion buy a straight answer?
The muddied picture - one step forward, two steps sideways - should tell us why Ottawa needs to do more than hand the provinces the keys to the vault, when the current 10-year accord lapses in 2013-14. In return for the money, Ottawa needs to be able to hold the provinces to measurable improvements in key areas - easing emergency-room delays, filling in gaps in catastrophic drug coverage and working together to lower pharmaceutical costs (to name a few).
As for the money . . . Jack Kitts, the council's chair, says the system already has enough. "Most health experts would agree that there's probably enough money in the system, there's enough human resources in the system, there's enough capacity in the system, if we were to change transformatively how we deliver the service to maximize the use of those resources." This quote should be uppermost in the mind of Prime Minister Stephen Harper in his talks with the provinces.
Muddling along isn't worth $41-billion. It took years to set benchmarks (or targets) for wait times - let's face it, mostly easy ones - and progress has been uneven. (Wait times are now published, which is good.) Electronic records have been created for half of all Canadians, in line with the accord's goal; but that achievement cost Ottawa and the provinces the not-trifling sum of $4-billion, and it's not clear what the benefits have been for patient care. The wait for magnetic resonance imaging is still long.
But mostly what the accord bought wasn't good enough, because it didn't prepare the system for where we are now - when government revenues won't grow the way they did in the boom years, and when the demands for health care will rise in an aging society. Instead, it fostered the illusion that 6-per-cent increases in annual funding from Ottawa would be eternal.
There really isn't a major "success story" the Health Council could point to, though it said wait-time reductions could become one (if we do better). Money bought breathing room. Next time, Ottawa should insist on spending less, and buying more.