July 1 is the unofficial 50th anniversary of medicare -- it was a half-century ago that the Saskatchewan government introduced universal medical insurance in the province. Saskatchewan doctors immediately went on strike to protest the law, and it seems Canadians have been squabbling over medicare ever since.
As a country we have spent a vast amount of time and money studying the health care system. The pace of debate has picked up in the past 15 years, and more debate is expected. Health care costs are now consuming more than 40 per cent of all provincial government expenditures, and will continue to soar if the system is not transformed. Without substantive reform, we will not be able to preserve, let alone improve, the quality of our health care.
Sustaining and improving the system while respecting its core values -- appropriate, timely, accessible, safe and affordable care for all Canadians -- is extraordinarily complex. No wonder that since the mid-1990s, at least 18 major national and provincial studies have reported on how to reform health care. In a review of these studies prepared for the Canadian Alliance for Sustainable Health Care (CASHC), The Conference Board of Canada assessed the proposed reforms, the response to the recommendations, and some of the reforms that ensued. There is a substantial degree of agreement on what needs to change. But consensus on how to make health care reform happen is not the same as agreement on what should change.
More than half of the 432 recommendations from these 18 reports fall into just two categories: system management processes (30 per cent), and funding and financing (23 per cent). There was consensus that financing models must change -- to control costs, drive changes in patient and provider behavior, and shift resources improving health outcomes for any given level of spending. But there is little agreement on how best to move forward, especially when it comes to the thorny issue of funding.
The most contentious funding issue remains the role of the private sector. Some reports suggested that more private delivery of publicly funded services would enhance competition, benefit consumers and payers, and decrease wait times. Other studies suggested that more funding must come from private health insurance, since the single-payer model is already over-stretched.
Since the delivery of public health care is largely the responsibility of provincial governments, there is considerable room for experimentation with new approaches. Diversity, however, can also lead to reforms that are not aligned and inadequate sharing of better practices across jurisdictions.
At times, reforms have taken opposite approaches. There are few more telling examples than the Ontario government setting out to delegate more responsibility to its regional decision-making bodies, at the same time as Alberta consolidated nine regional health authorities into a centralized administration.
Given such a complex and even polarized system, how do we move forward on health care reform? Through CASHC, the Conference Board is sorting options into three categories.
First, where there is a strong consensus on the need for health care reform, and where the evidence is compelling on the policies that should be implemented, the Conference Board will focus on ways to remove the practical barriers to more rapid progress. Journalist Andre Picard, who has spent the past year as the Conference Board's Scholar-in-Residence, is examining the nexus between policy and politics in health care, and how these obstacles can be overcome.
Second, where there remains substantive disagreement about what should be done and how to proceed, fresh evidence and perspectives will be offered to help resolve these tensions and enable effective reforms.
Third, several important aspects of the health system have been under-emphasized or even ignored in recent studies. One such element is the importance of health and wellness in Canadian workplaces; another is the role of Canada's health care system in creating wealth and boosting national productivity growth. Research through CASHC can help to create new lenses for examining and improving the full health care system.
As noted in a recent report by the Canadian Medical Association, Canadians are demanding health system reform now more than they ever have before -- and seem to be coalescing around a "moral imperative" to create a system that will be sustainable for years to come.
Sustaining and improving the health care system while respecting its core values is extraordinarily difficult. Canada has some of the solutions in hand, and others can be developed. We now need the political will to move health reform from debate to action.