By P.G. Forest and Danielle Martin
Canadian medicare would not exist without the actions of the federal government. But in recent years, there has been an atrophy of the imagination about Ottawa's role in health policy, as if federal transfer payments to the provinces and territories were the beginning and the end of everything. Recently, we submitted a report to the minister of health that is intended to re-animate that imagination.
We have spent the last six months carrying out a review of eight federally funded organizations in the health sector. These bodies amount to several hundred million dollars of annual federal spend, and while each has accomplished important things over the last few decades, our overriding recommendation is that the status quo cannot continue if the dollars spent in Ottawa on health care policy are to accelerate progress in health for all Canadians.
There is an overwhelming consensus across the country and internationally that the future health systems of Canada must have people at the centre. In concrete terms, this means that each of us should feel cared for as a full person with our values and preferences taken into account in every part of the health system. Furthermore, every Canadian, wherever they live and whoever they are, must be able to access high-quality health care, without the kinds of unjustifiable variations in the nature and effectiveness of services that are still too common across the country.
This vision would serve every Canadian.
Strong primary care should offer an entry door into the system, as it does now; in the future, primary care teams will also take charge of most of the health needs of patients, from the coordination of treatment to concrete action to improve the social conditions in which they live.
This vision would serve every Canadian. It does not belong to any one province or territory, though we know that all our provincial and territorial leaders, as well as patient groups and health care providers, are anxious to see it become a reality. To get there, change needs to come not only from the local level but also from our national government: action is urgently required in Ottawa to help bring this vision into being.
We put forward 10 recommendations in our report that — if implemented — would result in a complete overhaul of these organizations, leaving a smaller number of larger bodies better designed to meet the needs of 21st century health systems. We presented the federal minister of health with different plausible scenarios for change, each combining three core elements:
- A strong national drug agency to provide the necessary machinery to support universal pharmacare in Canada and stand up to the important global trends around drug pricing, innovation and appropriate use of prescription medicines.
- In every scenario we recommend a strong data and technology agency that will be able to help collect and link information, feeding it back to patients and the people who deliver care to them so that healthcare can learn and improve.
- In every scenario we suggest a "signature" agency, one that will embody the value the government wishes to pursue most aggressively — be it efficiency, innovation, engagement or equity.
A gain for this vision of the future will mean hard change ahead for the organizations of the present. Transforming organizations that have well-established stakeholder communities and a history of legitimate accomplishments behind them will not be easy. Arms-length bodies can easily become symbols of a government's commitment to a cause, and any suggestion of sunsetting them is too easily interpreted as a retreat from a commitment to a problem or a population.
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While the federal minister reflects on our advice and consults with her provincial and territorial counterparts about next steps, there are a few recommendations in our report that could be implemented immediately. The most important of these is a call for the government of Canada to sit down with national Indigenous organizations and begin a discussion about how the pan-Canadian health organizations can support Indigenous health in Canada.
It is time for change: what has gotten Canadian health systems to their present state will not be sufficient to get them where they need to go for the future. The federal government, and the arms-length bodies it funds, are important partners in the work ahead for Canadian health care.
Dr. PG Forest is the director of the School of Public Policy at the University of Calgary.
Dr. Danielle Martin is a family physician and Vice President at Women's College Hospital in Toronto. They are both expert advisors with EvidenceNetwork.ca.
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