Justin Trudeau could finally rejoice that an agreement was at hand to settle the issue of health transfers paid to the provinces, but he found himself almost immediately caught up in the increasingly frequent recourse of many of them to private clinics. At first shy on this issue, the Prime Minister ended up changing his tone. However, he has few means to convince his counterparts to slow down the shift, especially if he wants to avoid derailing the talks and reigniting months of federal-provincial disputes over health.
Justin Trudeau’s reaction to Doug Ford’s announcement of an increase in the number of interventions that Ontario will entrust to the private sector was surprising. After condemning the idea of opening this healthy door during the last election campaign, Mr. Trudeau is now telling the Toronto Star that “some level of innovation” should be looked upon favorably, as long as the provinces comply with the Canada Health Act.
New Democrat Leader Jagmeet Singh was outraged. He has been making public statements or outings almost every day for two weeks, and denounces a “major volte-face” by the Prime Minister, whom he accuses of being in the same boat as the Conservatives he criticized there is two years.
Above all, a few elected federal Liberals from Ontario took the liberty of publicly disavowing their boss’s remarks. A “disappointing comment”, lamented Judy Sgro, MP since 1999. It is in Ontario that citizens are most worried about seeing the use of the private sector harm the health care system – 57%, compared to 50% overall. Canada and 36% in Quebec, according to an Angus Reid poll last September.
This week, Justin Trudeau now assured that his government would “always defend the principles of the Canada Health Act. It’s non-negotiable […] Even during current negotiations to improve health care for Canadians across the country.”
The Liberals would prefer that the additional funds that they will grant to the provinces be sent only to the establishments and personnel of their public health network. This request will be part of the discussions at the first ministers’ working meeting next Tuesday, according to our information.
Few levers
The Trudeau government has been discreet, despite its discomfort, so as not to threaten the progress made in recent weeks in negotiations on health funding.
And it must be said that the provinces that turn more to private clinics—such as Ontario, Quebec or Alberta—are not in fact violating the Canada Health Act, which simply establishes five main principles that must respect provinces to take advantage of federal funds (including “universality” and “accessibility”). The medical care they entrust to the private sector remains covered by health insurance, and not the credit card, as Doug Ford repeats.
Started before the pandemic, this shift has been accentuated since. The crisis allows the provinces to argue that they must do things differently. And patients, tired of waiting, want above all to have better access to primary care. “The advances and drawbacks of private health care remain the same,” explains Maude Laberge, professor of health economics at Laval University. What has changed is the volume of patients waiting to be treated. This may have had an impact on the social acceptability of these approaches. »
Professor Laberge confirms an increase in the volume of interventions delegated to the private sector. The share of the total budget of the provinces devoted to the private sector “remains quite marginal”, she qualifies however.
If a province were to contravene the Health Act, the federal government could cut off its transfers as it has done in the past, as Justin Trudeau likes to remind us. Health Canada is monitoring billed diagnostic services in six provinces, including Quebec, and may reduce their transfers in mid-March. But these sums, equivalent to each dollar billed to patients, have sometimes been paltry — from $4,500 for Newfoundland to $65,000 in New Brunswick in 2020-2021. Or ended up being reimbursed, when the provinces took corrective measures – Quebec thus recovered the 8.2 million deducted in 2018-2019.
The purse strings
Marie-Claude Prémont, a jurist specializing in health at the National School of Public Administration, believes that the political debate is misdirecting itself by relying solely on the federal government. “There is this myth that the public health care systems in Canada, in the different provinces, are basically protected by the Canada Health Act. It’s an analytical error,” she points out, recalling that the provinces have their own laws governing their health care system.
A private clinic in British Columbia, Cambie, has also challenged the provincial law prohibiting it from billing for medical care when wait times are too long, notes Lynne Golding, health lawyer at Fasken.
Colleen Flood, director of research in health law at the University of Ottawa, is of the opinion that the Trudeau government, since it is preparing to offer an increase in transfers to the provinces, should simply attach the condition that these sums do not go to private clinics or personnel. Otherwise, the provincial premiers could use this first open door to then allow patients to pay for treatment more quickly.
The Trudeau government has not decided whether it will go that far or whether it will simply make a simple request to the provinces.
This financial lever is in fact the only one available to Justin Trudeau, even if he would perhaps like to force the hand of the provinces more. Next week’s meeting will tell us whether or not he will be able to stay in restraint. But even if that’s the case and an agreement on health funding emerges from these talks, it will obviously not be the end of the disputes between Mr. Trudeau and his health counterparts.