Feds set to clash with provinces over healthcare overhaul

Federal and provincial governments are likely to clash over new terms of Canada’s Health Accord

by Leo Almazora

This coming autumn should bring a change much more significant than the annual browning of the maple leaves.

With preparations underway for a milestone summit to renew the Health Accord – the means by which Ottawa injects funds into Medicare with health-care transfers to the provinces – the federal government is preparing to push for change that territories are likely to resist.

The major point of contention is that of targeted funding. Dr. Jane Philpott, the federal health minister, has long championed the idea that federal money should be spent on the liberal party’s priority areas of improved home care, palliative care and mental health treatment. A recent poll by the Canadian Medical Association (CMA) shows that Canadians are strongly supportive of reforms in these areas.

However, the provincial governments are opposed to targeted funding, which they denounce as a federal intrusion on their bailiwicks. They would rather receive money from Ottawa and decide how to spend it themselves.

The question Dr. Philpott asks in response is whether the provinces, left to their own devices, would spend funds effectively. She has condemned the Canadian healthcare system as plodding and uncoordinated, noting that the $41 billion Ottawa transferred to the provinces during the previous 2004-2014 Health Accord did not bring healthcare reform.

The costs of the current system are substantial. Canada has been ranked by the World Health Organization (WHO) as 30th in quality of health care – behind Colombia, Cyprus and Morocco. Total Canadian healthcare spending has doubled over the past 15 years without a commensurate increase in quality of health. Absenteeism, most of which is health-related, costs the economy around $16.6 billion a year.

These and other problems are supposedly in large part due to provincial violations of the Canadian Health Act. The Canadian Health Coalition (CHC) has noted examples such as Bill 20 in Quebec, which forces patients to pay for medically necessary treatment; multiple cases of extra-billing and user charges in Ontario; and private clinics charging illegal membership fees and double-billing patients and the healthcare system in BC.

A way to improve things would be to implement a more holistic approach to health, which Dr. Philpott has suggested as one of several solutions. This would likely involve increased federal authority in healthcare spending decisions – which, some assert, the federal government should obtain by shouldering a bigger share of sub-government healthcare spending.