Provinces don’t want/want to meet with feds over health care

Provinces are sending mixed messages. First they meet but reject previously negotiated terms. A month later, they want to meet but are unwilling to negotiate.

Make up your mind. Meetings require negotiations, not a hand-out.

It seemed like a done deal when provincial and federal health ministers met in Vancouver in November.

Federal Health Minister Jean-Yves Duclos had negotiated in advance of the meeting with his provincial counterparts and all seemed to be going well. In a proposed deal, the feds would give the provinces more money in exchange for two things: a human-resources action plan which would see the credentials of health care workers recognized from province to province; and the sharing of health care statistics across Canada.

Provincial health ministers had voiced no objections just days before the meeting.

Image: CTV Montreal

Then the premiers got involved.

It’s hard to know just which premiers pulled the rug from under the proposed agreement.

British Columbia Health Minister Adrian Dix, co-chair of the get-together, seemed disappointed. He told a news conference that the federal offer had moved the parties “a sound bite further ahead.”

New Brunswick Premier Blaine Higgs was ready to deal. He said there should be talks and “let’s see where the discussion goes.”

Other premiers categorically dismissed the federal plan. Quebec Premier François Legault rejected any transfer from the feds that came with conditions.

It seems reasonable to me that data on diseases and successful treatments be shared nationally. It’s reasonable to make the movement of health care workers across the country as seamless as possible.

Now, only a month after rejecting the fed’s modest proposal, premiers want to meet again to ask, again, for money without conditions. It would be a short meeting because the feds won’t, and shouldn’t, hand over money unconditionally.

Even before any new money is negotiated, the provinces and territories are already on track to get a 9.1 per cent boost next year – a $4.1-billion increase.

Federal Health Minister Duclos is ready to talk but belligerent premiers only have their hands out. What the feds want to talk about is data and indicators that measure results. “The problem is, until now, the premiers refuse to speak about those results,” Duclos said.

The problem is that money transferred to the provinces is not necessarily spent on health. The feds can specify targeted transfers for things such as mental health but provinces will do what they want with it. Ontario Premier Doug Ford was candid. He said provinces need flexibility to move money between different “buckets.”

In other words, provinces will do want they want with federal transfers.

“All that premiers keep saying is that they want an unconditional increase in the Canada Health Transfer sent to their health ministers,” said Duclos. “That is not a plan; that is the old way of doing things.”

Money alone will not fix our health care. More national data would make the system more efficient by putting resources where they are needed. Health care workers should be able to move easily from province to province where the need is greatest.

Bluffing on the part of premiers is so tedious, as Alberta Premier Smith has demonstrated so well. Let’s get past the BS and get down to honest negotiations.

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Provincial health ministers should stop bickering

The provincial health ministers should resolve in the New Year to stop bickering, take the money from the feds, and use it as intended.

 

It’s a recurring bad movie says Canadian Medical Association president Granger Avery: “The Groundhog Day-type discussions where political leaders bat around percentages and figures at meetings in hotels have to stop. Our system needs better, and most important, our citizens deserve better (Globe and Mail, Dec.19, 2016).”

The provinces have had thirteen years of increases from the feds at 6 per cent a year to improve health delivery. “The transfers have been growing quite generously,” says Livio Di Matteo, a health-care economist at Lakehead University in Thunder Bay. “If you go back to about 2007, if you look at public-health spending, which is largely provincial, it’s grown about 40 per cent. The Canada Health Transfer to the provinces has grown about 70 per cent.”

We need to spend smarter. Canada spends more on health care than Australia, for example, with poorer outcomes as measured by life expectancy and infant mortality.

The provinces have not fixed the problem during times of plenty and now are faced with problems of an aging population. In addition to increased funding at 3.5 per cent a year, the feds have offered $11.5 billion for home care and mental health. I don’t know who writes the province’s absurd scripts: let’s refuse the offer, even though it’s what we want, because we want more.

Provincial health ministers don’t get it. B.C. Health Minister Terry Lake worries that if B.C. were to take the money offered, and start home-care programs, that the programs wouldn’t be sustainable when funding dries up. That would be true if hospital costs remain the same when home-care programs are added.

Home-care programs would reduce hospital costs. Hospital beds cost $1,100 per day whereas home care is one-quarter that cost according to the Canadian Institute for Health Information. Seniors take up 85 per cent of those expensive hospital beds and one-half of them remain in beds even though they are well enough to be moved because there are no long-term care facilities or home care.

Take the money spent on hospitals and spend it in the community. That would mean that four seniors would be cared for at the same cost as one in a hospital -and they would be happier.

The politics and perception of health care would have to change. Hospitals have become a measure of a politician’s success because they are highly visible monuments to health care; something that you can be sure the B.C. minister will point to often in the campaign leading up to the provincial election next May.

It’s a problem of perception, too. Home care is virtually unseen except by the few affected. It’s hard to point to the thousands of seniors happily living at home as a measure of success. British Columbians will have to change perceptions of health, from hospitals as shrines were doctors are the high priests, to a flatter hierarchy where care is diffuse and in the hands of other professionals.