Looking ahead to a new Health Accord

With the Health Accord set to fully expire in 2017, Federal Health Minister Jane Philpott has said, “that she would like a new Health Accord to be signed, sealed and delivered by year’s end. If that’s going to happen, negotiations have to begin in earnest now and the two (or more) sides have to make their positions clear by the time the First Ministers meet in Whitehorse in July.”

The last federal budget pushed healthcare spending down the road (which we wrote about in depth here), but it looks like serious and tough negotiations are about to begin on the matter (2017-2018 budget projections have the health transfer at an abysmal 2.8%).  As the globe notes, “There is much work to be done to negotiate a new Health Accord (or accords), and it’s pressing. If there are to be monies and specific allocations in the winter 2017 federal budget, decisions have to be made now, during budget-building season.”

This week the CBC reported the held rumour that Ottawa favours targeted health-care spending over increased transfer to provinces.  Minister Philpott stated, “I'm not convinced that putting more money in through the transfer is the most effective way for us to transform the health-care system in the way that it needs to be done.”

There are two important pieces here.  The first is that Ottawa wants to make sure the money they are giving the provinces for healthcare end up in specified areas.  This is something the Council of Canadians has called for (for more information see our blog on the last health ministers’ meeting we attended). The rub is that this needs to be done to strengthen patient outcomes and the public health care system not just the federal government’s pet projects (although they may be included if evidence based data shows a need).  We know from the last health accord that provinces often do not spend the federal transfer dollars in the areas that have the most impact, so until good faith is restored we agree with no more blank checks.  

The important piece is in regards to the Canadian Health Transfer (CHT). The Liberal government has taken a page out of the Harper government’s playbook and wants to keep their proposal of an escalator drops to three per cent a year or the equivalent of GDP growth, whichever is greater.  So in times of economic hardship when people need healthcare the most, there is less money for our medicare.  Interestingly, while the Saskatchewan government was diligent sycophants to the Harper government remaining largely silent on this matter, recently Saskatchewan health minister, Dustin Duncan has stated, “If the federal government is serious about seeing the continuation of the medicare system in Canada, they need to be partners at the table.”  In this regard Duncan is correct, the federal government needs to put some skin in the game.  When medicare began the federal government vowed to cover 50 per cent of costs, but that never fully materialized.  Currently, the federal governments share of public health spending in the provinces and territories is around 22 per cent.  The Council of Canadians supports the call by many groups and the premiers for the federal government to cover a minimum of 25 per of health funding. The 3% escalator the federal government seems set on with a new health accord just won’t cut it. 

In a CBC interview Philpott also highlighted that any deal negotiated with the provinces will address home care, a pharmacare strategy, improved mental health services and a commitment to bolstering palliative care. "We will come to those agreements, and the money will be there," she added.  What the final product will look like is anyone’s guess at the moment.  Will the homecare commitments be based on a rational continuum of care, or will it simply be infrastructure spending for private long-term care services (when patients in long-term care leave the hospital or public facilities they are no longer covered under the Canadian Health Act, so this commitment could be a Trojan horse).  As well, it remains to be seen if the federal government is invested in a universal, comprehensive pharmacare program with first dollar coverage, or if they are more interested in playing the shell game with insurance plans and using the ‘some drugs’ approach (i.e. only picking the low hanging fruit while the larger issue of access to medicines and price gouging remain).  Lastly, will the federal government implement stronger penalties to violations of the Canadian Health Act or sit by and watch as more two-tiered American style health care creeps into Canada’s public health system.

The remainder of this year will be incredibly important for the future of medicare in Canada and will set the policy framework for years to come.  Stay tuned....

To learn more about the Council’s of Canadians priorities see here