Canada’s premiers are dialing up the political heat in their efforts to get Ottawa to increase federal health transfers to the provinces and territories.
The premiers have launched a new advertising campaign through the Council of the Federation, which comprises all 13 provincial and territorial premiers, aimed at ratcheting up public pressure on Prime Minister Justin Trudeau to meet with them and negotiate a higher federal contribution to health-care costs.
“As federal health care disappears, so do our doctors,” one ad says, pointing to the provinces’ stance that federal health funding levels “continue to decline.”
“Provinces and territories are doing their part, but we need the federal government to restore health care funding now to keep our systems strong,” the ad continues.
The campaign, which launched Monday and includes online, print, radio and billboard ads, comes as provinces have been facing their own calls for urgent action on significant pressures within health systems across the country.
An exodus of health-care workers, particularly nurses, from the public system, nationwide shortages of family doctors, ongoing waves of COVID-19 and surges of patients in need of mental health, home or long-term care are all factors that have led to ER closures, health worker burnout and calls to address a “crisis” in health care.
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Health care delivery is a provincial responsibility, but the Council of the Federation, made up of Canada’s 13 premiers, is using its new ad campaign to toss the health care hot potato over to Ottawa, saying the long-term sustainability of Canada’s health care systems “cannot be maintained while the federal government’s share of health-care funding continues to decline.”
“To ensure the tests, procedures and other health care services Canadians across the country need — when they need them — they should not have to wait any longer for federal action,” Manitoba Premier Heather Stefanson said in a statement. Stefanson is currently serving as chair of the Council of the Federation.
The premiers have been demanding a $28-billion increase to the Canada Health Transfer, which they say will bring the federal contribution toward health costs from 22 per cent currently to 35 per cent.
Ottawa argues the premiers’ figures do not represent the full scope of the federal government’s total investment in health care, as tax points to provinces and other specific bilateral deals on mental health and home care are not being factored in.
“If you look at the numbers and you do the calculations right, the actual percentage of public health expenditures funded by the federal government is about 35 per cent, we’re already there,” Health Minister Jean-Yves Duclos told reporters during a press conference in Manitoba last month.
He said arguing over percentages is a “futile debate.”
“The more important debate is the important fight for (health) workers… it’s the results for health-care workers that matter because when we do that, we get the right results for patients,” he said.
In addition, Trudeau has said he wants to see more “tangible results” from the $45.2 billion provinces and territories will already receive this year for health care before discussing any increase to the Canada Health Transfer.
In the past, “huge investments” by provincial and federal governments haven’t always delivered necessary improvements, Trudeau told reporters in July.
But that hasn’t stopped the premiers from calling for a “first ministers’ agreement on sustainable health care funding” as part of their ad campaign.
While it’s not surprising to see premiers trying to unload some political heat onto Ottawa over an issue that has become a significant pressure point, the campaign is somewhat “disingenuous” as it oversimplifies a complex issue, says Katherine Fierlbeck, the McCulloch professor of political science at Dalhousie University and chair of the department.
“It’s just not a matter of throwing more money at the system,” she said. “It’s how the money is used.”
If, for example, Ottawa does give the provinces more funding and they use it to increase salaries of doctors and nurses, they will end up competing for the same shrinking pool of health workers, Fierlbeck said.
It also doesn’t address Ottawa’s concerns that an increase to the Canada Health Transfer would not include specific targets or performance measurement tools to ensure the money is spent where it’s needed most, she added.
Provinces often balk when Ottawa tries to attach strings to health-care funding, which is what leads to political stalemates like the one currently at play between the provinces and the feds over health funding.
That’s why it could be time to think about bringing in a different mechanism to provide more accountability over health spending and take politics out of the equation, says Haizhen Mou, a health policy expert and professor at the Johnson Shoyama Graduate School of Public Policy at the University of Saskatchewan.
She pointed to Australia’s Commonwealth Grants Commission, an independent body that advises the Australian government on how federal funding should be distributed to ensure equitable access to services.
Ottawa wants to see “tangible results” from provinces on health care but has remained vague about who would measure those results and how they would be evaluated.
If Canada had its own independent body to collect data from the provinces, measure the performance of provincial and territorial health systems and advise governments on where health spending could be best allocated, it could ease tensions between Ottawa and provinces that are averse to Ottawa telling them how to manage their affairs, Mou said.
“This type of governance body probably can provide a better mechanism of managing the fiscal relationship (between Ottawa and the provinces),” she said.
“If we have performance indicators, probably we should leave a third party-type organization to design the indicator and to monitor and provide a kind of neutral judgment on whether a promise meets a condition.”
Colleen Flood, research chair in Health Law and Policy at the University of Ottawa, says Canada has a “fragmented accountability” system that only provides voters with the option of voting out a government if they are unhappy with their health system or how it’s being managed.
She echoed Mou in saying an independent office could provide Canadians with another accountability mechanism, but she suggested a Canadian patient ombudsman could play this role.
“It doesn’t directly fix the problem, but perhaps some constant light on the issues that Canadians are experiencing will help to turn this around, to provide greater accountability on the part of the provinces for their management of the health care system, and also reveal where they definitely need more funding,” Flood said.
Meanwhile, talks between the federal and provincial governments over health funding have been ongoing over the last few months.
In February, Canada’s health ministers met and identified several health workforce priorities, including accelerating pathways for internationally-educated health professionals, improving and leveraging health workforce data, training and workforce support and mental health support, Health Canada said in a statement Tuesday to Global News.
These priorities were reiterated in another meeting that was held in August, with a commitment to take stock of progress at their next in-person meeting with Duclos in two weeks in Vancouver.