Provinces come to their senses and accept healthcare money

Ordinarily, provinces only want one thing from the feds –money.

So when the feds offer money in exchange for something, provinces are reluctant to accept.

All that has changed now that Canada is facing a shortage of health care workers and operating rooms.

image: Canada’s premiers

Other than universal health care, Canada has no central control of health delivery. It’s delivered by the provinces and overseen by the feds.

The provinces provide most of the funding for health care whereas the feds only contribute 22 per cent. It used to be greater. At the inception of health care in 1957 the feds paid 35 per cent. In the late 1970s, it dropped to 25 per cent.

The provinces do the heavy lifting while the feds try to initiate county-wide programs like dental care.

It’s a recipe for tension, an awkward and inefficient way to run a universal health system. Medicare would be easier to administer if it wasn’t fractured into fiefdoms. Other countries do a better job.

In Australia, the federal government funds and controls health care, There, the feds control the purse and the programs.

However, the crisis in our health care system has caught everyone’s attention, federally and provincially.

Conditions which the provinces rejected are now being reconsidered. It’s a new era of reciprocity; more of a forced marriage than cooperation.

The new era has left health ministers unfamiliar with the new terrain. First, they were willing to accept federal money last November when provincial health ministers met with their federal counterpart in Vancouver.

Then premiers nixed the deal, presumably because they didn’t like being told what the money would go for.

Now provinces are sensibly reconsidering the federal offer in exchange for some reasonable national goals.

In recent negotiations, Federal Health Minister Jean-Yves Duclos said there has been a “change in tone and direction” from the provinces and territories to accept Ottawa’s demands to modernize data sharing, reduce backlogs in surgeries and diagnostics, retrain and hire more nurses and use medical clinics to handle millions of Canadians without family doctors.

It’s an offer the provinces can’t refuse.

Duclos is using a divide and conquer strategy. Ontario’s premier Ford was the first to break from the pack of provinces. Ford announced that Ontario is willing to accept Ottawa’s key demands, including a national health data system.

In addition to that compromise on Ford’s part, the feds are negotiating special deals with Ontario that would see Ottawa transfer $70-billion to the province over the next decade.

And now Ontario is willing to have transfers for specific programs. Some of this money would be earmarked under a bilateral agreement for home care and building long-term care facilities to reduce the stress on hospitals,

Ford insists that he is not breaking in solidarity with other provinces. He insisted that any bilateral agreement would not come at the expense of other provinces and territories.

Then Quebec Premier François Legault said he also is ready to share data on the province’s health care systems.

Just wait, the rest of the provinces will come to their senses and follow.



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.