The documents, prepared for Ms. Ambrose (Edmonton-Spruce Grove, Alta.) following her appointment to the file in last summer’s Cabinet shuffle, offer a grim assessment of the 10-year accord that is set to expire at the end of March.
One July 2013 briefing note prepared for the minister says that the Health Accord “fell short in meeting expectations for lasting change.” Among the shortfalls identified, the briefing states that the accord’s priorities “were not geared towards sustainable reform,” nor did the accord achieve “large-scale system transformation.”
“In retrospect [the accord] created undue pressure on the [Government of Canada] to deliver in an area of [provincial and territorial] jurisdiction without levers to affect change,” the briefing states, adding that the structure of the agreement “lacked incentives, flexibility, and accountabilities” necessary for achieving changes in health-care delivery at the provincial and territorial level.
The Hill Times obtained the documents under the Access to Information Act.
When the accord was struck in 2003 it was meant to be the “fix for a generation” that would ensure access to equal quality of care for all Canadians.
The Liberal federal government and provincial and territorial leaders of the day agreed to a 10-year funding agreement and committed to achieving improvements in wait time reductions, health human resources management, aboriginal health care, home care and primary care, pharmaceutical procurement, and accountability and reporting.
Under the agreement, the annual federal Canada Health Transfer (CHT) to provinces and territories increased from $15.3-billion to $20.1-billion between 2004 and 2007, with a six per cent annual escalator taking effect in 2007-2008. Under the escalator, the Canada Health Transfer grew to more than $30-billion in 2013-2014.
The Conservatives maintained the escalator after forming government in 2006, but have been criticized by health advocacy groups and political opponents for abandoning many of the goals set out under the accord. Successive Conservative federal health ministers have avoided engaging on the Health Accord’s commitments, instead selectively partnering with their provincial and territorial counterparts on issues like health human resources, medical research, and innovation.
In 2011, Finance Minister Jim Flaherty (Whitby-Oshawa, Ont.) informed his provincial and territorial counterparts that beginning in 2017-2018, the CHT would be indexed to GDP growth, with a minimum annual increase of three per cent. Beginning this year, the CHT will be allocated on a per capita basis to provincial and territorial governments.
The CHT is expected to reach $40-billion by the end of the decade, but according to the Parliamentary Budget Office, the changes to the CHT will reduce total federal investments in health care by $31-billion between 2014 and 2024.
Last year the federal government announced that it was eliminating funding for the Health Council of Canada, the independent research body that was established to track the accord’s progress over the last decade. The council will cease to operate as of March 31, 2014.
One Question Period briefing note prepared in September for Ms. Ambrose states that there are “currently no plans for a new [federal-provincial-territorial] health accord.”
“In renewing the Canada Health Transfer, the government has been clear that it respects provincial jurisdiction in health care delivery,” the note states. “Budget 2013 confirmed the government’s long-term health funding plan, which provides provincial and territorial governments with the predictability and flexibility they need to respond to priorities and pressures in their respective jurisdictions, while supporting the principles of the Canada Health Act.”
Ms. Ambrose’s office declined an interview request from The Hill Times, but in a speech to the Economic Club of Canada last week the minister said that the federal government’s priorities are innovation in health-care technology and delivery, and reaffirmed the government’s commitment to universal health care under the Canada Health Act.
“Let me be clear that our government remains committed to a universally accessible system,” she told the audience. “Even through the recent economic downturn our Government has increased health transfers to the provinces and territories to unprecedented levels.”
Liberal MP Hedy Fry (Vancouver Centre, B.C.), her party’s health critic, said that the briefing notes prepared for Ms. Ambrose fail to mention that the Health Accord “fell short” because the Conservative government didn’t attempt to follow through on the benchmarks that the previous government had agreed on with the provinces and territories.
“It fell short under their government because they weren’t interested in the accord,” said Ms. Fry, who took issue with the document’s suggestion that the accord failed to improve accountability. “To say there was no accountability is ridiculous. The point is that in 2005 the Liberals lost, the Conservative government came in in 2006, and they did not follow through on one of these commitments.”
Ms. Fry added that under the new funding arrangement and transition to per capita health funding, the Conservatives would “preside over the death of medicare.”
“If the minister got a proper briefing on the accord, she would know that the accord set up tables with a federal and provincial co-chair to look at eight different areas for transformative changes,” she said. “The whole idea was to work on issues and develop strategies — that did not happen under this Prime Minister. We’re seeing smaller provinces getting per capita funding under the federal government and they’re not going to be able to sustain the system.”
Another Question Period briefing note prepared for the minister in September states that the government is committed to “publicly funded, universally accessible health care,” but also notes that the Canada Health Act “does not preclude the use of private or for-profit facilities, and/or providers, in the delivery of insured services, as long as there are no charges to patients for insured services.”
The documents prepared for Ms. Ambrose also outline a number of priorities during her first 100 days on the file, including the new medicinal marijuana regulations, the development of a strategy to address prescription drug shortages, regulatory harmonization with the United States on chemical labelling, collaboration with the provinces and territories on a prescription drug abuse strategy, and ongoing research in bee mortalities in eastern Canada by Health Canada’s Pest Management Regulatory Agency.
Original Article
Source: hilltimes.com/
Author: CHRIS PLECASH
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