Update: Trudeau promised to increase annual health care transfer payments to provinces, but not until after the pandemic is over. He also announced the federal government will fully cover the costs of COVID-19 vaccines. Read the full story here.
Canada’s premiers are meeting with Prime Minister Justin Trudeau today to ask Ottawa to increase its annual health care transfer payments to the provinces and territories. Discussions are also expected to focus heavily on Canada’s COVID-19 response and vaccine rollout. CMAJ reached out to health experts for their take on the most pressing issues heading into the talks.
Dr. Sacha Bhatia says COVID-19 vaccine logistics are a top priority, after Health Canada’s recent approval of the Pfizer and BioNTech vaccine, with 249,000 doses expected to be shipped to Canada by the end of the month.
Provincial premiers “want to know when they are getting the doses, how they are getting them,” says Bhatia, director of the Institute for Health System Solutions and Virtual Care at Women’s College Hospital. “I think every premier is going to want to come out of that meeting looking like they did well for their province… getting their fair share of the vaccine.”
British Columbia Premier John Horgan is lobbying the federal government for a pan-Canadian approach to non-essential travel within the country. According to Horgan, “The people of Quebec and Ontario and Manitoba need to know that they should stay in Quebec, Ontario and Manitoba until we get to a place where we can start distributing the vaccine across the country.”
Meanwhile, Alberta Premier Jason Kenney is urging immediate additional support in offsetting the economic fallout of the pandemic, after Canada’s energy sector took a hit when oil prices dropped dramatically earlier this week.
Federal healthcare transfers
This year, the federal government will send nearly $42 billion in annual transfer payments to the provinces and territories for healthcare. But the premiers say that only accounts for 22% of the cost of delivering care, much below the 50% the federal government agreed to cover when Medicare was established. The premiers want Ottawa to increase its share to 35%, which would add $28 billion to this year’s transfer. The federal government has already given the provinces an extra $10 billion this year toward pandemic-related healthcare costs.
Trudeau said he’s open to negotiating more health funding for provinces. Quebec Premier Francois Legault said he doesn’t expect one meeting will resolve the issue but hopes a deal can be hammered out soon. A spokesperson for Ontario Premier Doug Ford said he is pushing for an answer no later than the spring federal budget.
Bhatia expects premiers will face pressure to increase hospital capacity in the coming months. “In the post-Christmas season, provinces might end up being in a situation where they have a real bed crunch [ due to rising hospitalizations related to COVID-19].” Provinces may need targeted federal funds to increase system capacity in the short-term, “until we have a whole vaccine rollout to get to herd immunity,” Bhatia says.
Dr. Robyn MacQuarrie, president of Doctors Nova Scotia, says increased investment would help that province improve and sustain virtual care, integrated primary care, and the eHealth and clinic infrastructure those services require. “Additional funding allows us to improve access to care and support family physicians to provide primary care in ways that best meet patient needs,” says MacQuarrie. “Federal partnership in fully funding health care in Nova Scotia is essential to positive healthcare outcomes, now and in the future.”
In May, the federal government invested more than $240 million in virtual care infrastructure, expanding tools and creating new platforms for mental health and primary care. Bhatia says that while this funding is for capital, provinces may need funding toward actual operations. Many provinces have not yet signalled if they will cover virtual care beyond the pandemic.
Long-term care facilities have been hardest hit by COVID-19, with outbreaks in homes across the country and thousands of deaths. Experts say the pandemic has exposed widespread pre-existing problems within the industry.
The Registered Nurses’ Association of Ontario has called on Ontario Premier Doug Ford and Prime Minister Trudeau to push for national standards for long-term care. RNAO’s Nursing Home Basic Care Guarantee calls for improved labour standards within homes and a dedicated registered nurse for infection prevention and control.
Douglas Angus, professor emeritus at the University of Ottawa’s Telfer School of Management, agrees that seniors care is a critical issue for ministers to address, including “greatly enhanced home care.”
“That would require more resources, financial and human, but that is where deficiencies have existed for quite a while. COVID-19 just shone a big spotlight on it,” says Angus. However, he doesn’t expect home care to make the agenda. “I’m not holding my breath to see much progress in this regard.”
Bhatia says Trudeau might leverage ongoing negotiations over federal health transfers to make progress on national pharmacare, a key election commitment that has met with resistance from some premiers. Persisting multibillion-dollar disagreements about cost-sharing calculations between the federal government and provinces have created a difficult backdrop for new cooperative initiatives like pharmacare that involve large outlays of public funds.
“The federal government could use [the example of] the COVID-19 vaccine procurement to say, ‘If we had a way to nationally source and negotiate prices with pharmaceutical companies, rather than a patchwork of 13 different drug plans, maybe we could do really well,’” says Bhatia. “Certainly, you could say that the federal government’s response on vaccines has been very successful. If every province was trying to negotiate with Pfizer about vaccine distribution [individually], we would be in a very different place.”
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