A commentary by a former deputy health minister in B.C. and Saskatchewan who served on two royal commissions on health care and was awarded the Order of Canada for innovative leadership and dedication to overcoming the most challenging issues in our health system.
The 6.5 million Canadians with no access to a primary care provider, or the thousands waiting for a surgical procedure, or the hundreds enduring a painful wait in the ER this week, may be momentarily relieved to learn that Canada’s premiers concluded their annual meeting in Winnipeg committed to “ensuring Canadians have timely access to high-quality, sustainable, public-funded health care.”
Wait a minute! Canadians heard similar statements in communiques from the premiers’ meetings in December 2022, December 2021, and July 2015.
Indeed, in 2015 the premiers made positive observations regarding primary care and team-based care that have been shown to improve patient outcomes. In contrast, this month’s communique states that the premiers are committed to holding another meeting, a dedicated health summit.
Provincial governments seem unwilling or unable to move beyond platitudes to commit to a plan to reform primary health and fix our health system. This reminds me of the early 1980s when extra billing by physicians in some provinces seriously threatened the values of fairness and equity, long established in Canada’s health system.
At that time, some provinces were unwilling, unable, or too fearful, to act to protect fairness and equity. The federal government provided leadership, introduced legislation, and with all-party support passed the Canada Health Act in 1984.
The act updated the federal hospital and medical insurance acts and reinforced the single-payer system. It explained the essential principles of portability, accessibility, universality, comprehensiveness, and public administration. All parties supported the updates to continue the most cost-effective approach to providing hospital and medical care and ensure equity and fairness for Canadians.
For many years, Canadians were rightly proud that in Canada, acute health care was a right and not a privilege. Our health care was among the best in the world while expenditures were comparable to other developed countries and much less than United States.
We also prided ourselves for having a pan-Canadian health system, supported by the principles of the Canada Health Act.
Today’s reality is that health needs have changed, and lack of meaningful reforms have undermined Canadians’ confidence in governments’ ability to manage health services.
While provinces have reformed acute-care services to be some of the best in the world, we have 13 provincial and territorial health systems with insufficient standards, differing licensing requirements for health professionals, disparities of insured services, and unacceptable waiting for needed services.
Citizens should not be required to wait beyond a quality-established time for impactful medical, surgical, mental health, addictions, or diagnostic procedures. It is in our national interest for Canadians to have the “right” to services when needed.
The federal government must act! It has nationwide responsibility to provide leadership, legislative frameworks, financial resources, and conditions on how the money is spent for services considered to be of a national interest.
Canada needs to modernize the Canada Health Act to address current health issues. Insured services are needed beyond hospitals and physicians to include additional primary health providers for home and community services.
This action would establish primary health services as the foundation for the health system, address the current issues and position Canada to deal with the poly-threats of heat domes, respiratory illness, and pandemics associated with climate change.
While the Canada Health Act served Canadians well for many years, the Commission on the Future of Health Care in Canada in 2002 emphasized, “it is time to restore Canadians’ confidence in their health care system” and recommended strengthening the Canada Health Act by confirming the current principles and establishing a new principle of accountability.
Today, Canadians are losing confidence in the provincial governments’ ability to manage health reform. Don Drummond and Dr. Duncan Sinclair from the C.D. Howe Institute advised the premiers in 2023, “Canadians’ long-standing tolerance for health-care shortcomings has worn dangerously thin.”
To address Canadians’ concerns, the federal government must provide leadership as it did in 1984 and update the Canada Health Act to include a framework for reform to primary health services, the principle of accountability, and ensure federal responsibility for enduring measurable standards.
Updating the Canada Health Act after 40 years is needed to uphold Canadians’ values and modernize health services. If provincial governments, during these 40 years, had been able to reform the health system, we would have primary health services 24/7, staffed with team-based primary care providers, relief from substandard waiting for surgical procedures and ER services, measurable standards, and transparent reports.
Leadership, not platitudes, is needed to reform Canada’s health system. As in 1984, it is time for leadership by the federal government to provide the legislation and framework for reform.
Platitudes, the invisible enemy of reform, fail to uphold Canadian values and fail to regain the confidence of Canadians.
