No new federal funding promised for health accord

By Lauren Vogel | CMAJ | Aug. 23, 2016

Federal Health Minister Dr. Jane Philpott sidestepped questions about new funding under a renegotiated health accord with the provinces and territories. (Mark Holleron/CMA)

A federal cash injection won’t fix Canada’s health system, said Health Minister Dr. Jane Philpott in an address to the Canadian Medical Association (CMA) General Council on Aug. 23.

“This year the Canada Health Transfer reached a historic high of over $36 billion, but I am firmly convinced that we have an obligation as a federal government to do more than simply open up the federal wallet,” Philpott said.

Upcoming negotiations of a new health care accord between the federal government, provinces, and territories present a “rare opportunity” to reshape the system to meet the demands of an aging population, she added. However, Philpott stopped short of making any new funding promises beyond existing commitments in home care, health care information and indigenous health.

“It’s not something that I will decide myself,” she said, in reference to provincial and territorial health ministers. “I’m one of 14 people having these conversations.”

Philpott pointed to England and Australia as examples of countries that transformed their poorly performing health systems to the point that they now outperform ours, despite spending less on health care per capita. “These are not stories about the infusion of cash. These are stories about countries deciding to do things differently.”

One major difference is that these systems emphasize comprehensive primary care, including care delivered in the community, Philpott said. “Canada has never sufficiently grounded its health system in primary care.”

To this end, the federal government has agreed to spend $3 billion on home care over the next four years. “Care at home in my province of Ontario costs $55 per day, a small percentage of the cost of a hospital bed. But despite this cost efficiency … home care represents about 5% of provincial health budgets.”

We are absolutely committed to upholding the principles of the Canada Health Act, and that means having universal, publicly funded health insurance for all medically necessary care.

Philpott argued that it’s a myth that Canada’s aging population will overwhelm the health care system, but noted significant strain from attempting to meet their growing needs in hospitals. “Some 14% of hospital beds are not appropriately used in Canada.”

The fact that Philpott drew examples of an ideal system from countries with parallel public and private systems wasn’t missed, however. Asked during a press conference whether she saw a similar funding model coming to pass in Canada, Philpott underscored the government’s commitment to the Canada Health Act.

“We are absolutely committed to upholding the principles of the Canada Health Act, and that means having universal, publicly funded health insurance for all medically necessary care,” she said.

Following her address, doctors repeatedly questioned whether the government’s commitment to necessary care would extend to a national pharmacare plan. They cited a CMAJ research paper that estimated Canada could save $7.3 billion by introducing such a plan.

“There are few policy actions that are so widely supported that do have cost savings and access for vulnerable patients in mind,” said Dr. Vanessa Brcic, a delegate from Vancouver.

The federal government is working with the provinces to lower drug costs through a pan-Canadian pharmaceutical alliance, but Philpott said other issues, such as indigenous health, currently take top priority.

“There are some big considerations that need to be taken in the coming years if we are going to really address the horrendous and unacceptable gaps in the care delivery and outcomes for Indigenous people in Canada,” she said. “We need to have frank conversations about where our priorities should be.”

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