Health Accord is welcome, but national standards still in jeopardy

Author(s): 
September 1, 2000

The federal government deserves credit for finally acknowledging that a decade of health spending cuts has taken a toll on medicare. And provincial, territorial and federal ministers deserve credit for finally getting an agreement this week. Of course, everyone else in the country has been focused on health care since at least 1990.

However, acknowledging that federal spending cuts have had a negative impact on the health system is one thing. Providing the national leadership needed to move forward is quite another. Yes, we needed and got more money. But we also need bold reforms, and that remains elusive.

When Canada's first ministers began talking, they got bogged down in the question of who would control medicare: Ottawa or the provinces? The problem is that the people of Canada have been focused on the question of who will control health care: the public or the private sector?

Earlier this year, the federal health minister showed promising signs of pushing through important reforms to public health care, such as establishing a national home care and prescription drug plan. This would have responded to the greatest barrier to access facing ordinary Canadians--user fees for those services. It also would have taken pressure off the hospital system.

Now, sadly, in a desperate effort to get a health accord before a federal election, the federal government threw these bold ideas out the window. It also relinquished the demand for clear provincial reporting about the health care system.

Last November, Denis Desautels, Canada's Auditor General, warned Parliament that "Health Canada does not have the information it needs to report to Parliament on the extent to which each province and territory has satisfied the [Canada Health] Act's criteria and conditions," including the Act's ban on user charges and extra billing. Without such information, he said, the federal health minister is unable to enforce the Act.

Provincial reporting is itself a requirement--not an option--under the Canada Health Act, which says, in effect, that if provinces don't report to the federal health minister about how they are upholding national standards, they won't get any federal money. Reporting is necessary to ensure that the principles of the Act are upheld, and that user fees are not creating a barrier to access.

However, the provinces, for their part, do have legitimate grievances. From their point of view, if Ottawa isn't going to put money into the system, what right does it have to make any demands? The federal government's contribution to health care fell from 50 cents of every dollar spent in the 1970s to about 13 cents today. After these funding cuts, Ottawa's ability to enforce the Canada Health Act plunged.

Federal spending cuts throughout the 1990s resulted in inadequate investments in equipment, long-term care, and education and training for the health care workforce. These cuts also led to increased health care privatization.

Most provinces decided to pass Ottawa's health care cuts on to hospitals, communities, and individuals. In 1999, the people of Ontario each spent $1,015 directly out-of-pocket for health care, while Albertans spent $850. These two provinces have the highest out-of-pocket expenditures, and their governments are the loudest proponents of privatization. But all provinces are struggling to maintain a comprehensive public health insurance system in the face of reduced federal spending.

In every province, acute care and outpatient services are being shoved out the hospital door and into the arms of for-profit providers who charge ever-higher user fees for services. In Alberta, a for-profit hospital is now open for business. In every province, doctors are practising on both sides of the medicare fence at the same time.

Private health care is not the solution. According to the prestigious New England Journal of Medicine, "For decades, studies have shown that for-profit hospitals are 3-11 percent more expensive than not-for-profit hospitals; no peer reviewed study has found that for- profit hospitals are less expensive." Similar studies have reached similar conclusions regarding for-profit home care.

In most provinces, the movement of services from the hospital to the community was a good initiative. But if people cannot get services in their communities on the same terms and conditions they get them in the hospital, they are going to head for the end of a growing line-up for a hospital bed. This is how user fees act as a barrier to access, and this is how people respond. The first ministers should have resolved to interpret the Canada Health Act in a generous and progressive manner, defining home care, long-term care and outpatient rehabilitation as services covered by the no-user-fee rules of the legislation.

Canadians deserve to know what's going on in the health sector, but we also deserve provincial and federal commitments to uphold the Canada Health Act, and to support a strong public health care system.

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