August 29, 2011 - http://hilltimes.com/page/printpage/health-08-29-2011
PM should convene first ministers meeting on health, say opposition critics
By D'ARCY MCDONELL, CHRIS PLECASH
The federal government should begin negotiations on a post-2014 health care accord soon, say opposition critics. The calls come on the heels of a new Canadian Medical Association report calling for major system-wide changes, including a mix of public and private options, if the country is to avoid "throwing out everything we have" and adopting a "U.S. style model."
"We need a leader," said Liberal MP Hedy Fry (Vancouver Centre, B.C.), her party's health critic and a medical doctor.
She told The Hill Times last week that the federal government needs to start moving on a first ministers conference. "We need a prime minister that will sit down with first ministers and bring that top level of involvement that was seen in 2003, in 2004 and 2005."
She said the fact that Prime Minister Stephen Harper (Calgary Southwest, Alta.) has never held a first ministers conference on health since assuming office in 2006 is indicative of the "lack of interest in the health accord and sustainability of Medicare." She said it signals a very "troubling pattern."
NDP MP Libby Davies (Vancouver East, B.C.), her party's health critic, agreed, saying the Tories are "dragging their feet," and called the mystery surrounding the government's plan to tackle health care reform the "elephant in the room."
A blue-ribbon panel reviewing the sustainability of Canada's public health care system released its report last week at the CMA's annual general meeting in St. John's, Nfld. Report of the Advisory Panel on Resourcing Options for Sustainable Health Care in Canada, found that if Canadians don't stop treating the private sector as totally separate from health care, more services and procedures will continue to be excluded from government funding. That means "privatization [will] continue to creep in through the back door," the report said.
Incorporating both public and private elements while managing demand can be safely done without "wholesale privatization" said the advisory committee, composed of former Quebec health minister Philippe Couillard (also a neurosurgeon), Tony Dagnone, Sister Elizabeth Davis, former Finance ADM Don Drummond, Dr. John Horne and Dr. Wendy Thomson.
The report noted models used in a number of European countries as successful examples. It called for innovative payment mechanisms, and competition among providers "within a publicly determined pricing system." Mechanisms such as user fees, franchise and various insurance schemes are widely used by other governments, and according to the report could work for Canada as well.
The mere mention of looking to user fees, however, elicited rebuke from outgoing CMA president Jeff Turnbull.
"CMA policy does not support user fees for patients," Mr. Turnbull said in a press release following the advisory panel's report. "There is no evidence to suggest that such fees improve patient care, in fact some evidence suggest that they may well be detrimental to accessing care."
Mr. Turnbull emphasized that the "CMA supports the Canada Health Act and its principles." He also pointed to a Canadian Doctors for Medicare report on the 10 best and worst ways to transform the system. "Unfortunately many panel recommendations fell squarely in the bottom 10," he said.
University of Ottawa health policy and economics professor Douglas Angus said that as a country, we need to be able to get over our disdain for certain medical services being privitzed.
"There are unique ways of making this happen," Prof. Douglas said, adding that Canadians need to improve their system. "If only we'd get over our fixation that we're going to end up with the U.S. system. Nobody in their right mind wants the U.S. system. Even the Americans don't really want their system."
While Canada's current model of health care provision worked for a young country with acute health issues, it is simply "not designed for Canada's current needs," the report said.
Increases in chronic diseases, an older population combined with burgeoning opportunities and challenges with technologies and pharmaceutical discoveries "all dictate the need for a system that provides affordable access to a continuum of care." This means a wider range of supports and services are needed "such as health promotion and disease prevention, counseling, therapies delivered by other health care professionals." Ian Jones, president of the Canadian Association of Physician Assistants, said spreading the care out between professionals who are capable of providing appropriate treatment would alleviate financial and resource pressure on the system. This will allow doctors to be more efficient with their time.
"Physician assistants make the health care system more efficient, and more economical," said Mr. Jones. "If you can increase the physician productivity, then the health care system benefits. Patients are seen sooner, they get timely access to care."
Prof. Douglas also advocated a more extensive continuum of care, one that moves health care provision out of hospitals and into other, less congested locations. He said that Canada is currently "forcing hospitals to be everything to everybody" and that it's impossible to maintain.
It is a "complete waste of resources" to allow patients to be stuck in a hospital when they could be receiving better care in other places, Prof. Douglas said.
"I think if we're talking about a health accord, we should be talking about money that's actually earmarked for the non-hospital sector—for primary care, for home care, for things outside of the system," he said.
The advisory panel's report called for the feds to take a "loose-tight" approach in managing health care—Ottawa would stop being micromanagers, and instead tightening focus on desired outcomes while allowing provinces to achieve them however they need to.
Health Minister Leona Aglukkaq (Nunavut) told the CMA conference the government's approach is a "non-negotiable" plan to establish "one national accord" instead of individual provincial pacts. She noted also that any federal government funding to provinces for health care would clearly come with strings attached for accounatiblity purposes. "We want to be able to ensure the dollars we invest in health care will go where they're most needed," Ms. Aglukkaq said. "We want accountability and we want results."
Green Party Leader Elizabeth May (Saanich-Gulf Islands, B.C.) agreed that there should be a first ministers meeting "to actually sort out what's wrong with the system."
In doing so, the negotiations between ministers will provide the opportunity to work through the proposals brought forth by the CMA's advisory panel and flesh out the most viable strategies, she said.
Ms. Aglukkaq said that the federal government would not be looking to even initiate a process of renewing the health accord before at least December of this year.
Mr. Turnbull said this is disconcerting. "Time is passing very quickly," he said. "We would like to see a first ministers meeting very soon."
The Hill Times