OPINION | Sunny ways to better healthcare: Taking the pulse on medicare

Contributed to the Sixth Estate

The good news for Canadian Medicare enthusiasts is that Ottawa now has a pulse! Following more than a decade of disentanglement or laissez faire federal health policies, we have a federal government and have had a Minster for Health that cares about Medicare. The federal government has committed to a minimum 3% growth in the Canada Health Transfer (CHT) and, as per the October 2015 federal election platform, we have a health accord, of sorts.

A series of bilateral agreements have been struck with provinces and territories that provides for an additional $11.5 Billion in net new federal health dollars spread over the next ten years to address two areas of real concern: mental health and addictions plus home and community care services. There is also agreement on three overarching core principles to guide joint action:   collaboration, innovation and, importantly, accountability. Canadians need to see their federal tax dollars making a difference. We have also seen federal leadership under (former) Health Minister Philpott on many other fronts, including: funding a national opioid action plan, a plan to deal with superbugs or antimicrobial resistance, passing medical assistance in dying legislation and leading stepped-up efforts to address health inequalities among indigenous peoples.

That said, it is still far too early to declare “mission accomplished” as the federal government’s Mandate Tracker seems to suggest: “Completed. Fully Met”. The reality is that the health accord was borne more out of the spirit of Bon Cop, Bad Cop than the Sunny Ways of Sir Wilfred Laurier: Minister Morneau guarding the federal purse strings against a full court press by Premiers while Minister Philpott worked behind the scenes to buy change, not just peace, this time around. The first year of funding under the Accord is secured for all PTs but only two provinces (New Brunswick and Newfoundland) have agreed to a standard set of indicators as a precondition to receiving funds going forward.

It’s also too early to declare success because Canada continues to languish at the back of the back of the bus in terms of international comparisons of health system performance, managing to still outperform our neighbours to the south and just nosing out France for second last spot in the most recent Commonwealth Fund comparisons. Canadians also continue to register some very real concerns about access to healthcare, especially primary care. Ipsos recently reporting that healthcare still tops the list of concerns (at 35%)…ahead of poverty and unemployment (28%), and with twice as many Canadians worried about access to healthcare than worried about terrorism (18%).

Looking ahead, with a new Minister of Health now at the helm, and looking toward the next federal election, healthcare is unlikely to disappear as a political preoccupation. A just-released CD Howe study underscores the need to do a better job of scaling up and spreading healthcare innovations across Canada. We also expect shortly the recommendations of an external review of pan-Canadian healthcare organizations to provide better pathways for innovation. Provinces and territories will quite legitimately argue for the one-off federal investments to be folded into the CHT and escalated over time. The Canadian health research community continues to fall behind with a freeze in 2017 in the Canadian Institutes of Health Research. And, as the only country to have universal health insurance but no coherent Pharmacare program, we are all looking forward to the next report of the Standing Committee on Health on the need for a pan Canadian pharma strategy.

So, while the Medicare pulse is stronger than in recent memory it will require ongoing monitoring, attention and remediation going forward. Above all, it will take the kind of open, authentic leadership on display over the first half of this electoral cycle by the Minister of Health.

Bill Tholl is a former CEO of Heart and Stroke, Canadian Medical Association and HealthCareCAN. He is now a national commentator, advisor and thought leader on health policy.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Sixth Estate.

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