And so the impasse continues. At the first ministers’ meeting in Ottawa on Dec. 9, Prime Minister Justin Trudeau failed to increase health-transfer payments to the provinces and territories.
While British Columbia anticipates a $1.9-billion surplus, most other provinces are not so fortunate. Ottawa faces an annual deficit of about $30 billion.
Clearly, the health system cannot be sustained by arguing about federal-provincial transfer payments. There is only one taxpayer, and new sources of income must be found. To accomplish this, the Canada Health Act needs to be updated.
At the health ministers meeting in Toronto last October, Federal Health Minister Jane Philpott refused to restore the original six per cent escalator in the annual increase in federal transfers, cutting it to three per cent. She did promise extra funding targeted to home care, mental health and system innovation.
The CHA was passed unanimously so that all Canadians — even those in remote areas — would have access to the newest technologies, even if it required treatment in another province. This was universal, minimized administrative costs and covered all persons regardless of pre-existing medical conditions or changes in medications.
When it passed in 1984, it was understood that the federal government would pay half of health costs; now it covers less than a quarter. Thanks to Ottawa’s admission of refugees and migrants, overall growth of an aging, sicker population, new diseases and new technologies, the provinces must shoulder an increasing burden.
Philpott has promised to do more than just “open the federal wallet.” Yet thanks to strict enforcement of certain parts of the CHA, provinces cannot experiment with a greater role for the private sector, or use co-payments and user fees (with exemptions for the poor and elderly). As a result, we deprive ourselves of the efficiencies enjoyed in most of Europe.
A “two-tier” system has always existed. Federal prisoners, workers’ compensation patients, members of the military and RCMP, politicians and professional athletes usually obtain more timely care — often at private facilities.
For those not a member of a “special group,” the main option for timely care might be to go to the U.S. This provides employment to American doctors and nurses and profits to U.S. hospitals. Would it not make more sense to allow all Canadians to spend their after-tax discretionary income on their own health in their own province?
Frozen hospital global budgets have caused excessive wait times for joint replacements, as operating rooms are often not functioning at full capacity. At Vancouver General Hospital, 30 per cent of scheduled elective surgery time ends up being used for emergencies.
The Fraser Institute recently reported that over the past 25 years, wait times for certain procedures had increased by 115 per cent. Waits in B.C. were up for the fourth year in a row — now a median of 25.2 weeks across all specialties.
According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves under-employed and 64 per cent cited poor access to ORs. Hence, if orthopedic surgeons had access to additional “private” OR time, wait times could be shortened.
Also, if hospitals were permitted to operate electively on Americans and other foreign patients, this would bring in extra revenue for hospitals and help relieve the financial strain on provincial health ministries. To encourage MDs not to abandon the public system, they could be required to work — perhaps 25 to 30 hours per week — in the public system in order to receive government reimbursement for malpractice insurance.
Most doctors would confine their practice to the public system. They deserve fair treatment. Thus, Philpott should amend the CHA to mandate binding arbitration when provincial negotiations fail, as they have in Ontario.
Where wait times are excessive, certain diagnostic services and surgical procedures should allow for private access for all Canadians — not just a select few. This would provide extra revenue — from both inside and outside the country — that would help to keep universal public health care accessible and sustainable for all Canadians.
When the finance and health ministers meet on Monday, besides discussing the amount of the Health Accord annual escalator, they should begin talks on how to amend and modernize the Canada Health Act.
Ottawa physician Charles Shaver is chair of the Section on General Internal Medicine of the Ontario Medical Association.
