When it comes to health care, government tend to be followers, not leaders, says Dr. John Haggie, president elect of the Canadian Medical Association.
Speaking at the Canadian Health Professional Secretariat in Ottawa May 19, Haggie says the CMA is trying to become a catalyst of change through its current consultation process.
“We decided to leave Ottawa and talk to people,” he said.
The CMA and Maclean’s magazine have been holding a series of regional forums on health transformation. Forums have already been held in Halifax, Toronto, Edmonton, and Vancouver. One more forum is scheduled to take place in Ottawa during the month of June.
The CMA is trying to frame a series of principles by which Canada’s health system should evolve, recognizing that the present system does not always fulfill its present obligations under the Canada Health Act. The CMA is looking for a framework that would build upon the five principles of the Act – universality, accessibility, portability, comprehensiveness and public administration – principles that at present only apply to hospital and physician services.
That includes such issues as developing a system that is more patient-focused, that is quality driven, that supports prevention initiatives (including social determinants of health), is equitable, sustainable and accountable.
Haggie has been asking what kinds of services should be covered under Medicare “basket,” including whether gaps should be filled in such areas as pharmacare and dentistry.
“The health care sustainability debate has focused on money,” he says. “It has not gone back to first principles. What are we trying to sustain?”
The CMA has heard from Canadians who have a strong commitment to Medicare and said he was surprised at how well-informed those who have been attending the forums are.
The public have told them that the system needs adequate resources, including good IT to not only provide information, but to monitor outcomes. They want coordinated health human resources, evidence-informed decision-making at policy and clinical levels, and active involvement of the public.
“We are abysmal at sharing excellence,” he said, noting many initiatives are already taking place that provinces could be learning from.
Haggie says the CMA has studied other international systems of which universality is a consistent feature. He questions whether Canada is spending its health care funding wisely, especially when European countries often have a greater scope of public coverage.
With the expiry of the current Health Accord in 2014 these discussions are very timely. Haggie says he would like to see a commitment to a Health Action Plan that would mimic the current Federal Economic Action Plan.
The CMA President-elect says there is a need for an evaluation of the current health accord, and that Canadians still favoured a strong bilateral accord – something the new Harper government may need some convincing to do.
“The Federal government spends more on direct health care than six provinces,” he says. “They need to be constantly reminded of this.”
The new accord should look ahead to provide stable and predictable funding, include a strategy for “plugging the holes,” and some level of accountability.
“Canadians want to know where the dollars went,” he said.
Haggie suggested that while the Federal government has made a commitment to renew the Accord, it may instead take the form of a series of bilateral agreements with provinces.This may be an attempt to divide and conquer, putting the first province to sign such an accord in a difficult situation.
He doesn’t believe that much will happen until after a series of provincial elections take place in the fall, predicting the Harper government will prefer to wait and see who is in office.