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Feds deal a surprise, provinces react

We had been talking about it for a few years now. The end of our current federal-provincial health care accord was to be re-negotiated in 2014. Much speculation occurred; there was great anticipation. Well, the giant balloon was burst with Jim Flaherty’s announcement in December. It was a “take it or leave it offer”. The ten-year deal, calls for maintaining the current 6% growth rate in health transfer payments until 2016-17. After that, transfer payments will be linked to the GDP, ostensibly to our economic growth rate. I think it’s fair to say, that not only was a bubble burst, most of the provinces were taken by surprise. So much for our two levels of government working seamlessly together! And there were, not surprisingly, different opinions from different provinces.

Columnist Jason Fekete from the Vancouver Sun states, “B.C. stands to lose $250 million a year, while Alberta will see a windfall in excess of $1 billion.”1 For better or for worse, the funding flow comes with “no strings attached”. In other words, provinces are left to their own devices to plan what many feel is an enormous challenge of sustaining our current health care system, given the enormous pressures we are facing now and will be facing in the future.

Saskathchewan’s Premier Brad Wall and PEI’s Premier Robert Ghiz3

Last week the provinces decided to plan their agenda. Premier Robert Ghiz of PEI and Saskatchewan’s Premier Brad Wall will be leading a task force. Dirk Meissner from the Canadian Press reports that “The Health Care Innovation Working Group will focus on the provinces and territories finding and sharing new ways to meet health challenges, including the needs of seniors, patients with chronic diseases and northern populations.”2 They plan on focusing on three major issues: 1) Scope of health professional care practice, 2) health human resource issues (HHR) and 3) the institution of system wide practice guidelines.

Honestly, I wish them luck. These are all critical issues and need to be addressed comprehensively. The premiers, who otherwise have full time jobs, plan to have at least two meetings before July, when the first draft of the report is due. These are huge issues that have been looked at for decades.

Let’s take scope of practice. To be sure, our health care system needs to address this issue. We have not yet had a hard look at who is doing what for which condition. There are strong political and financial silos between our current health care providers. In some situations this leads to the system overpaying for a particular health care delivery service. But changing what roles our doctors, nurses, rehabilitation specialists and other health care providers play in our system is no small task. There are a myriad of social, political, regulatory and union issues that could easily paralyze the best-designed plan for decades.

The HHR concerns in Canada have been the topic of commissions, working groups, academic studies and political decisions for as long as I can remember. And we have done a pretty poor job of forecasting Canada’s health care resource needs over the last few decades. For example, in the last 25 years we have expanded medical schools, shrunk medical schools, and expanded them again, all because of tremendous oscillations in our forecasting of doctor shortages or surpluses in our system. Many previous manpower plans have failed to realize that any decision taken today to correct a doctor or nurse shortage, will take almost a decade to take effect. Absolutely, we need great manpower planning. It’s a complex art and difficult science. It will take Ghiz and Wall the entire next six months just to wade through all that has been written on this topic.

Finally, practice guidelines are indeed needed. But in reality, we have been addressing this issue for at least twenty years since Gord Guyatt and David Sackett, from McMaster, popularized the term evidenced-based medicine in the early 1990’s. Indeed, the EBM toolkit has been around since 1999.4

Often, our problem in health care has been not that we don’t have the evidence; it’s that we have not been translating current evidence into action. This issue has birthed an entire field of study and in fact, for the last twelve years our national funding body, CIHR, has had a knowledge translation (KT) section.5

We all wish Premiers Ghiz and Wall the best of luck in their deliberations. For sure, we would offer our services in their quest for solutions to some very difficult problems. Their task, however, is a challenging one; and I am not sure a short political process will have the chance of being transformative. And transformation is what is needed, on the backdrop of 50 years of small incremental changes to our health care system.

Agree or disagree, please respond to this blog… or better yet, please stop by the Macklem House, my door is always open.

Richard

1. http://www.vancouversun.com/health/Provinces+will+burdened+health+care+costs+Kevin+Pa
ge/5985257/story.html
as some, like B.C. stand to loose

2. http://thechronicleherald.ca/canada/53005-premiers-skip-ottawa-form-own-health-working-group

3. http://www.google.ca/imgres?q=ghiz+and+wall&um=1&hl=en&client=firefox-a&rls=org.mozilla:enUS:official&biw=1920&bih=891&tbm=isch&tbnid=kpFpIcXp_QDCWM:&imgrefurl=http://www.theglobeandmail.com/news/politics/in-sask-and-pei-re-election-campaigns-there-are-no guarantees/article2105092/&docid=54hXn1KpGEz78M&imgurl=http://beta.images.theglobeandmail.com/archive/01300/comboshot_copy__1300219cl-8.jpg&w=620&h=348&ei=sWMlT82XLo7xggfostDXCA&zoom=1&iact=hc&vpx=500&vpy=158&dur=6424&hovh=168&hovw=300&tx=171&ty=102&sig=114900228286400560220&page=1&tbnh=90&tbnw=160&start=0&ndsp=51&ved=1t:429,r:2,s:0

4. http://www.ebm.med.ualberta.ca/Bibliography.html

5. https://ktexchange.sph.uth.tmc.edu/knowledge_translation_history.aspx

4 Responses to Feds deal a surprise, provinces react

  1. sarah Jones says:

    I hope that the deliberations will include the pediatric population and their needs. Conversations around pediatric care and the Health Accord have been sparse. Child and adolescent health in a huge problem in Canada and represents one area of chronic disease. The pediatric poulation are the future of Canada and deserve fair representation. Food for thought! Sarah Jones, Co-Chair, Canadian Child and Youth Health Coalition.

    • reznickr says:

      Sarah, well said. Putting dollars into our child health care, wellness promotion and illness prevention has arguably the most profound long term effect in both creating a healthier population and saving valuable health care dollars.

      Richard

  2. Edward J. Wiebe says:

    Sir,
    I am a 74yo almost retired psychiatrist. I have worked in a variety of settings over the years. I have various friends and relatives who have needed major medical care in recent years. My own experience and most of the experiences I hear about have been very favourable regarding the Canadian health care system. Not there aren’t problems but is transformation really called for?
    I sympathize fully with your concerns about the present governments unilateral action and hope this will be an issue in the next election. They seem bent on making the system worse.
    Sincerely,
    Edward Wiebe

    • reznickr says:

      Thanks you Edward. As you are, I am a passionate advocate of our health care system. The universality of our system is a priceless commodity. But, to be sure, we can do better. We spend 11.5% of our GDP on health care which places us in the top tier of expenditures of OECD nations. However our population measures of health are in the lower tier of OECD nations. If Value equals quality divided by cost, we have room to improve.

      Thanks for your comments,

      Richard

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