Sunday, March 18, 2012

Spur provinces to be innovation incubators

The Chronicle Herald 
March 14, 2012

Globe and Mail health care reporter André Picard was in Halifax recently to talk about the sustainability of medicare. He raised several points of interest — and did argue that medicare is entirely sustainable. What was surprising were his thoughts on the division of provincial and federal responsibilities.

Prime Minister Stephen Harper has declared that health care is a "provincial jurisdiction." But this is simply untrue. Under the Canada Health Act, both the federal and the provincial governments have clear roles to play in protecting and strengthening universal health care. The federal government is responsible for funding health care through the Canada Health Transfer and ensuring that provinces comply with the principles of the health act. Those principles: public administration, universality, portability, comprehensiveness, and accessibility, ensure that Canadians can move across the country and receive the same high standard of care.

In the past, the federal government has exercised its responsibility for health care by setting national standards, creating benchmarks of care, and recommitting to the Canada Health Act through health accords. In the last accord, which was signed in 2004, federal, provincial, and territorial governments committed to strengthening medicare through the creation of catastrophic drug coverage, new benchmarks for surgical wait times, expanding access to home care, and increasing the supply of health professionals, etc.

It is important to note that several of the programs mentioned above were never implemented. In 2011, the Health Council of Canada produced a report showing that the federal — and many of the provincial — governments did not follow through on agreed-to commitments. And when some provinces, like Ontario, tried to move ahead on items like a pharmaceutical plan, they were unable to get other provinces on board without Ottawa’s leadership.

It is clear that health care across Canada is becoming much less equitable with some provinces progressing much faster than others. In Halifax, Picard responded to a question about the federal government’s role in health care by calling on provincial governments to work together to create a national system since, as he put it, "Ottawa wants nothing to do with health care." He went on to clarify that "I’m not suggesting that Alberta send pity cheques to Nova Scotia," but added that Alberta’s wealth could be used to transfer knowledge on innovative techniques to Nova Scotia and other poorer provinces.

This sounds almost utopian: a Canada where all provinces follow what the others are doing; where they commission pan-Canadian reports to see what innovations are succeeding, and where they come together to help implement science-based solutions. This would bring fiscal and social benefits to all Canadians.

Wouldn’t it be great if someone — or something — were leading this charge? These solutions would reveal best practices. They would reveal that the best way forward is when we pool knowledge, talent and resources so we can eventually expand medicare to cover chronic care, pharmacare, dental care and mental health needs. This would require major collaboration between the provinces and territories, and not only legislation at a federal level, but also leadership. Isn’t this the raison d’être of a federal government?

We need a federal government that can look at the best science-based practices being implemented in provinces and territories and tie funding to encourage other provinces and territories to adopt these practices. We need a federal government that can act as a single-purchaser and negotiate with drug companies and save us $10.7 billion a year by implementing a universal pharmacare plan.

And we need a federal government that is committed to strengthening the Canada Health Act and bring it into the 21st century with innovations such as team-based practices and better management of chronic care patients by expanding home care, community care and long-term care.

It is clear that Canadians want universal public health. In a 2011 poll conducted by Nanos Research, 96 per cent of Canadians supported public health care. However, if the federal government chooses to abdicate its responsibilities under the Canada Health Act, our public health care will be without national leadership and increasingly threatened by for-profit interests. Canadians fought for medicare, we want to keep medicare, and it is the Harper government’s responsibility to protect and strengthen medicare now and for future generations.

Adrienne Silnicki, health Care campaigner for the Council of Canadians, is based in Halifax. She can be followed on Twitter at @Asilnicki.

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