Put patients not pocketbooks at centre of health reform: advocates

OTTAWA – Canada’s national health organizations are renewing their call for the country’s politicians to shift their focus to from the size of health budgets to how they are used, after the federal government unveiled its controversial new health-care funding plan.

Many provincial politicians were crying foul on Tuesday over the federal government’s plan to cut the rates of Canada Health Transfer payments in the future, saying it wouldn’t be enough money to do the job.

Groups like the Canadian Medical Association say the political barbs miss the target when it comes to improving the health-care system, a goal that isn’t necessarily linked to growing budgets.

“The stability of funding is important, but on the other hand it is what you do with that funding that is even more important,” said Dr. John Haggie, president of the Canadian Medical Association.

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Canada’s health-care spending is on track to reach $200 billion by December 31. An OECD study ranks Canada sixth when it comes to per capita health-care expenditure at $4,363, but several health outcomes are lower when compared to similar countries. In particular, Canada had the longest wait times in a survey of 11 countries.

“We need to go back and turn the system so it actually works for the patient. Patient-centred, quality care in other jurisdictions has been shown to be cheaper care,” he said, adding that with the financial framework a done deal, politicians should focus on patients.


Federal Finance Minister Jim Flaherty shook up health-care funding on Monday, announcing that the current six per cent annual increases will stay in place through 2017, but future increases would be tied to the rate of nominal GDP. Flaherty pledged the transfers would never fall below three per cent.

The unilateral nature of the decision coupled with the reduction in the rate of increase infuriated politicians in six of Canada’s 10 provinces, who argued it would hamper their ability to provide adequate services.

The plan sets the tone for looming negotiations on how to renew the country’s health accord, which expires in 2014.


There is fear the funding announcement will thwart attempts to make Canada’s health-care system more responsive to citizens.

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“Let’s have a conversation about what we need to do to transform the system and then let’s see how we do it financially,” said Judith Shamian, president of the Canadian Nurses Association. “By reversing the order it will be very difficult to have substantive conversation with the provinces because they will be busy figuring out how to downsize to meet the bottom line.”

Shamian said there are ways to fix the health-care system without increasing spending, for example, clinics run by nurse practitioners or investing in health care, both of which will keep people out of hospitals and emergency rooms.

The federal government missed an opportunity to focus debate on what kind of health care transformation it expects from the next health accord whether or not budgets grow, according to Shamian.

Pamela Fralick makes the same diagnosis. 

The president of the Canadian Healthcare Association said the federal government essentially abandoned its role in healthcare by failing to outline how the provinces would be held accountable for spending the money.

“The basis of the Canada Health Act is about universality and portability and really providing comparable services across the country. We don’t have that,” she said. “There is a role for the federal government to facilitate these debates in making sure all Canadians are treated fairly and equitably.”

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Balancing patient outcomes with financial efficiencies has to be central to that debate, she said.

Canadians will get their first hint at where patients and pocketbooks will figure in the debate this January when the premiers meet in Victoria at the Council of the Federation.

In a letter sent on Tuesday, Health Minister Leona Aglukkaq proposed to provincial and territorial health ministers they meet on ways to improve health care in the new year after the meeting.

With files from The Canadian Press  


Here’s a look at some of the things Canada’s national health organizations say Aglukkaq and the provinces should look at to improve health care, with or without bigger budgets.

Nurse practitioner-led clinics: Facing a shortage of family physicians, Ontario has been leading the way in establishing clinics headed by nurse practitioners. The first one opened its doors in 2007 in Sudbury, where 30,000 people were without a primary-care physician at the time. In just four years the clinic is carrying a full patient load. Since nurse practitioners can’t do everything family doctors can, the clinics work closely with doctors who can do consults where necessary.

Surgery checklists: These checklists are meant to cut down on adverse in-hospital incidents by ensuring safe surgical processes are followed. The checklist helps ensures all critical steps are completed in each surgery, facilitates communication between members of the surgical team and has almost no cost.

Expanding the role of rural paramedics: Alberta Health Services expanded the role of paramedics working in rural areas to include suturing and taking bloodwork as a way to address workforce shortages. The paramedics back-filled in a clinic fulfilling tasks like patient assessments and lab draws. The tasks didn’t require any extra training, but simply transferred skills into another location.

Advanced access to family doctors: Some clinics have a doctor reserved to take urgent patients who do not have a scheduled appointment. The goal is to keep people from taking up emergency room space for routine medical matters.

More home care: With an aging population homecare may be a feasible solution to keep seniors healthier and at home longer.

Electronic prescribing: Reduce medication issues by having e-prescriptions tied into a patient and their medical history (other drugs they are taking, allergies). The whole med history available real-time at any pharmacy.

Lifestyle intervention: Preventing people from getting sick is the ultimate health-care efficiency. The Saskatchewan Association of Health Organizations runs a multi-week program for First Nations communities meant to equip participants with information about exercise, healthy eating, chronic disease and available health professionals.