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The Right Honourable Paul Martin is photographed at Nelson Education in Scarborough, Ont., September 13, 2011. Martin speaks about his views on health care reform. (Photo by Yvonne Berg for the Globe and Mail)

Yvonne Berg/The Globe and Mail

At no other time has the sustainability of Canada's health-care system been so much in question. The population is aging, health care consumes a huge portion of provincial budgets, and patients remain passive recipients of treatment that is often difficult to obtain.

At $192-billion a year, Canadians have the right to ask if they are getting value for money. When compared with seven other countries, a study by the Commonwealth Fund found, patients here experience far more access problems including lengthy waits to see family physicians and specialists.

In 2004, prime minister Paul Martin brought in what he called a "fix for a generation" with his 10-year, $41-billion health accord. In 2014, it will come up for renewal. Mr. Martin says the federal government should be sitting down with the provinces to work on the agreement.

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The legacy of his accord is mixed. There have been improvements on wait times in five areas, including joint replacements and diagnostic tests such as CT scans, but there is still no national pharmaceutical strategy. Reports on how the provinces used the money and what was achieved remain scant.

John Abbott, chief executive officer of the Health Council of Canada, said the new accord should be more detailed, on what is to be achieved and what improvements are expected in the health of Canadians. Access to primary-care physicians, wait times for access to specialty care, and co-ordination of care are all problem areas.

"This is less a money issue," says Mr. Abbott. "We need the government to say we are really going to roll up our sleeves here and develop a framework."

During this year's election, the Conservatives said they intend to continue the 6 per cent annual increase in health transfers until at least 2016. They need to do far more to press for reform.

The federal government should get down to the hard work of setting the parameters for the new health accord, and do it soon, once the current provincial elections are over. If it can't insist on accountability measures – putting conditions on money in return for performance results – then the fix for a generation will turn out to have been only a temporary reprieve.

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