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Surgical nurse Christine Simone (right) reaches for equipment as Dr Ken Thomas (left) and Dr Jacques Bouchard during a back operation at a private Canadian health care facility in Calgary, Alberta. Roy Romanow has recommended a $15-billion cash infusion by 2006 for a sweeping expansion of medicare that would stop the growth of private medicine Thursday Nov. 28, 2002. (CP PHOTO/ Adrian Wyld)
INDEPTH: HEALTH CARE
Introduction
CBC News Online | August 22, 2006

One Supreme Court decision may have done more to change health care in Canada than three major reports and a first ministers conference that ended with a $41-billion infusion into the system.

On June 9, 2005, the high court struck down a Quebec law that prohibited people from buying private health insurance to cover procedures already offered by the public system.

"Access to a waiting list is not access to health care," two of the justices wrote in their decision.

The Quebec and federal governments asked the high court to suspend its ruling for 18 months. Less than two months after its initial ruling, the court agreed to suspend its decision for 12 months, retroactive to June 9, 2005.

In the provincial government's response in February 2006, Premier Jean Cherest said the private sector could play a role in health care in Quebec, but said he remained committed to public health care. He also said Quebec will introduce guaranteed wait times for procedures including some radiation treatments and cardiac surgery, as well as knee and hip replacements and cataract operations.

The ruling has impact only on Quebec, but it could eventually lead to some of the biggest changes since former Saskatchewan premier Tommy Douglas was credited with fathering medicare. Most Canadians take government-funded health care for granted today, but when it was first introduced in Saskatchewan in 1962, most of the province's doctors responded by going on strike to protest against "creeping socialism."

The strike lasted three weeks - public support for the doctors had collapsed, persuading the doctors to accept a deal with the government. Within five years, government-funded health care spread across the country.

While most Canadians - 80 per cent according to Statistics Canada - are satisfied with their access to the health care system, many experience long waits to see a specialist, get diagnostic tests and undergo elective surgery. Others find themselves facing huge bills for prescription drugs they need to survive.

A long wait for hip replacement surgery was what prompted the Quebec case that wound up before the Supreme Court.

George Zeliotis argued his yearlong wait for surgery was unreasonable, endangered his life, and infringed on the charter's guarantee of the right to life, liberty and security. The second plaintiff, Dr. Jacques Chaoulli, wanted the court to overturn a Quebec provision preventing doctors who don't operate within the medicare plan from charging for services in public hospitals.

Once upon a time, there were few complaints about lengthy waits for treatment. It was a time when the federal government provided about a third of the money the provinces spent on health care.

But as government belts tightened to deal with record budget deficits in the early 1990s, complaints about access to health care increased. The federal government drastically cut the amount of money it transferred to the provinces to cover health-care costs.

By the time another former Saskatchewan premier - Roy Romanow - released his landmark report on fixing medicare in 2002, Ottawa had slashed its share to about 16 per cent of the total. Romanow recommended an immediate infusion of federal dollars, to bring Ottawa's share up to 25 per cent.

With Romanow's landmark report under their belts, the nation's first ministers gathered in Ottawa in February 2003 for a meeting that was described as the most important session on health care since Canada adopted medicare. The prime minister, premiers and territorial leaders got together to try to turn some of Romanow's recommendations into action.

In the end, they agreed on several improvements:
  • $16-billion, five-year Health Reform Fund for primary care, home care and catastrophic drug coverage
  • $13.5 billion in new federal funding to the provinces over three years
  • $2.5 billion cash infusion for 2003
  • $600 million for information technology
  • $500 million for research
The premiers said they were signing on reluctantly and that much of the money had already been promised. In the end, they said, they were getting about half of what Romanow recommended. The territorial leaders, on the other hand, didn't even sign the agreement. They argued that Ottawa was being inflexible - the north would be receiving the same amount of money per capita as the rest of the country, despite the much higher costs of delivering health care in Canada's most remote regions.

To a large degree, the 2004 federal election turned into a debate about the future of health care in Canada. The Liberals accused the newly united Conservatives of plotting to turn medicare into a two-tiered system where those who could afford to pay more would be able to buy speedier access to the system.

In 2004, the federal government and the premiers agreed to a $41-billion infusion into the system over 10 years.

Among the key parts of the agreement:
  • Ensuring stable, predictable long-term funding.
  • Implementing a National Waiting Times Reduction.
  • Creating a National Home Care Program.
  • Developing a national strategy for prescription drug care.
  • Respecting the Canada Health Act.
Less than two months after the election, Prime Minister Martin convened a first ministers conference on health care. It was to last three days. Alberta Premier Ralph Klein stuck around for only the first day.

In the end, the conference lasted longer than planned, with most of the work done behind closed doors. There was a deal that provided for a $41-billion infusion into the system over 10 years.

Among the key parts of the agreement:
  • $3.5 billion over two years in additional transfers to the provinces and territories.
  • An "escalator clause" that automatically boosts transfers by six per cent a year to keep up with rising health costs.
  • $4.5 billion over six years for a special fund to reduce waiting times for treatment.
In addition, a National Wait Times Strategy was developed for five priority areas: cancer care, cardiac treatment, diagnostic tests such as MRIs, joint replacements and cataract surgeries.

There may have been smiles and handshakes around the table, but the deal may not have been enough to persuade the Supreme Court that the health-care system was off the critical list.

In response in 2006, the federal government said it was moving toward what it called "patient wait-time guarantees" by 2008.

If maximum acceptable wait times aren't met, patients would have "recourse," or another way of getting that medical care, such as going to another facility or province, federal Health Minister Tony Clement told the Canadian Medical Association's annual meeting in Charlottetown.

Funds for the recourse could come from the remaining $1 billion not yet allocated from the $5.5 billion pledged for reducing wait times in 2004, the CMA proposed.




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Canadian Institute for Health Information - Health Care in Canada 2005

Canadian Health Coalition � Found: Federal funding. Lost: A plan to stem privatization [pdf]

Canadian Institute for Health Information

Report: National Health Expenditure Trends [pdf]

Organization for Economic Co-operation and Development Public Expenditure on health, % of GDP [Excel file]

The Romanow report [pdf]

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