Patients, caregivers and doctors say the ending today of Canada’s 10-year-old, $41-billion health accord highlights the growing inequity that threatens to fracture medicare.
The deal between Ottawa and the provinces and territories provided stable funding and set common goals on wait times, home care and prescription drugs.
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"Ten years down the road, we’re looking back, and it’s pretty difficult to find any substantial progress," said Dr. Chris Simpson, chairman of the Wait Times Alliance and president-elect of the Canadian Medical Association.
To mark the end of the accord, the left-leaning Canadian Health Coalition organized a national day of action on Monday with 40 events planned across the country. The group said it wants to alert Canadians to how the lack of federal leadership in health care could fragment services and access to care depending on location and ability to pay.
Michael McBane, executive director of the Canadian Health Coalition, said the end of the health accord means the “end of any rational planning for the [health] system.”
“As of today, no more planning. We lose momentum. No more wait time planning,” McBane said in an interview with CBC’s The Lang & O’Leary Exchange.
He said a federal voice is needed to keep some equality of access from province to province, rather than let the richer provinces get more and better care.
“The voice of Canada is the federal government, not the provinces. So national standards, to ensure equity of access not based on where you live or your ability to pay, is a strictly, uniquely federal role. Nobody else can play that role,” he said.
McBane also decried the loss of the Health Council of Canada, which reported to Canadians on problems in the system and identified best practices to fix them. Without the council, no one is doing that work, he said.
Shirley Douglas speaks at rally
Actress Shirley Douglas, daughter of politician and medicare champion Tommy Douglas, spoke at a rally in Toronto. Tommy Douglas’s grandson, actor Kiefer Sutherland, also released a video to rally Canadians on the need for federal leadership to negotiate a new accord with a continuing care plan such as home and respite care, a universal public drug plan and adequate and stable federal funding.
On wait times, Simpson said there have been small successes in areas such as heart bypass surgeries and initially cataract waits in Ontario, but he adds the money didn’t really buy the change that doctors expected.
Stubborn wait times in areas such as hip and knee replacements may reflect an aging population with degenerative diseases and needs that greatly outpace resources, Simpson said.
Simpson sees a common failure to recognize the interconnectedness of all the pieces needed to provide health care, from providing long-term care beds to building surgical suites or alleviating poverty among seniors.
Home care struggle
Susan Bosak of Stouffville, Ont., said the stress of providing home care to two frail, elderly patients was exacerbated by the bureaucratic and unpredictable nature of the home-care system.
For Bosak, caring for her father paralyzed by a stroke and mother with advanced dementia was a meaningful act of love, but it was also an isolating experience with little support and training. The home care struggle extends beyond a financial issue to quality of life and dignity, she said.
"Just because we get old, do we lose all our rights to how we want to live?" Bosak asks.
"We really have to ask ourselves as Canadians what kind of society we want to be? When it comes to those of us who are oldest and most frail, it's a really big question that we're not even discussing."
The health-care system needs to respond as more people are at home with chronic diseases such as stroke or heart failure, said Dr. Jeff Turnbull, chief of staff at the Ottawa Hospital. Turnbull also spoke at the coalition’s luncheon event in Ottawa.
Like Simpson, Turnbull fears that without Ottawa’s leadership, inequity between provinces and territories will grow.
"I’m going to have to have health insurance when I go from P.E.I. to Vancouver to cover the difference in care," Turnbull said. "That’s not what Canadians expect."
The federal government has said it will continue to increase health transfers to the provinces by six per cent a year until 2017-18. At that point, the transfers will be tied to the rate of economic growth and inflation. Ottawa says the annual rate of increase won’t fall below three per cent.
There are no strings attached to the funding.
"On the health accord, yes I am concerned about it," B.C. Premier Christy Clark told reporters. "It is $250 million out of British Columbia's health budget, so obviously we are focused on it. We want to try and find a solution to it. We haven't found that solution yet."
Saskatchewan Premier Brad Wall said large, annual health-care funding increases from the federal government aren't sustainable.
"I do think, though, it's important for all of us to recognize that regardless of what money's coming from the federal government, we better be finding efficiencies here in a way that does not hurt patient care," said Wall.
The Canadian Health Coalition is seeking to continue the six per cent funding escalator.