In Canada, a wealthy country, provincial health systems are cracking everywhere, so that you often have to wait weeks or even months to access care. Investing billions more won’t solve all the problems, but it’s necessary nonetheless. This money is the federal government that has it. Unfortunately, Ottawa is trying to twist the arm of the provinces into agreeing to its terms before securing any additional funding. In this case, the Trudeau government is wrong.
Although there is, as always, a war of numbers between Ottawa and the provinces, it is undeniable that the federal share of public spending on health has decreased over the years. The provincial premiers are calling for this proportion to rise immediately from 22% to 35%, which would cost the federal government $28 billion in the first year, and would put Ottawa in a deficit position of $50 to $60 billion a year for the foreseeable future. Obviously, the provinces’ request is unreasonable.
During the most recent meeting of health ministers, last week, the Canadian minister, Jean-Yves Duclos, refused to talk about figures, contenting himself with paying lip service to the fact that federal health transfers should increase.
Mr. Duclos was especially eager to talk about the conditions that the federal government wants the provinces to accept before the additional billions are paid to them.
Publicly, the federal minister contented himself with empty phrases, so that it is difficult to have a precise idea of Ottawa’s demands. However, we know that these revolve around the sharing of health data. In particular, the federal government would like to keep a bank of statistics on the workforce in the health networks, the ultimate goal being that the requirements relating to professional training be standardized from coast to coast. The mobility of personnel from one province to another would be facilitated.
In addition, Jean-Yves Duclos would like to see the provinces participate in a “world-class health data system”. However, if we rely on the most recent report of the group of experts mandated by Ottawa to advise it in the establishment of such a system, the bug would be terribly complex. I quote from that report: “The implementation of the Strategy by the various jurisdictions would be informed by a skills-based Health Information Stewardship Council (the Council) and facilitated by one or more or Learning Health System (LSS) Table(s), accountable to the Conference of Federal-Provincial-Territorial Deputy Ministers of Health. The SSA Council and Table(s) will support the data sovereignty of First Nations, Inuit and Métis communities and ensure that their representative bodies and governments are duly engaged. The SSA table(s) will work with the Board to establish integrated roadmaps for implementing the learning health system and secure investments and funding for the Strategy. »
Phew! If it was this hydra that Mr. Duclos spoke to his counterparts, they were right to protest.
Solutions will not come from Ottawa
Is the Trudeau government right to be worried about the problems undermining the country’s health networks? Sure. Are federal politicians correct in saying that money alone will not solve these problems? Absolutely. However, they are in the field when they claim that the solutions will come from the bureaucrats sitting in their offices in Ottawa, especially when we know the difficulties that these same bureaucrats face in managing areas of federal jurisdiction, from issuing passports to immigration management, to government employee payroll.
With regard to data sharing, there is already a Canadian Institute for Health Information (CIHI), which is doing excellent work.
Certainly, to improve the efficiency of the country’s health care systems, provinces must produce more data, not only on their expenditures, but on the effects of these investments on patient care. As much as possible, these data should be standardized to facilitate interprovincial and international comparisons. The provinces should commit to doing this work, and Ottawa should mandate CIHI to coordinate it all. The statistics thus produced would not be used to render accounts to the federal government, but would promote the accountability of the governments of the provinces with regard to their population.
As for the sinews of war, financing, the Trudeau government should stop beating around the bush and table without delay a quantified proposal that takes into account its fiscal room for maneuver. The total amount and rate of growth will need to be substantial. However, the provinces know full well that they will not get the huge sums they are asking for publicly.
In short, leaving aside the effects of politicians’ robes, a compromise can be found. It is urgent to act. It is not excessive to recall that lives are at stake.