Although this week’s budget has been called an “election budget” by pundits across the spectrum, it was notably silent on the #1 issue most important to Canadians: our health. The complete absence of any initiative relating to health and health care, and indeed the embracing of policies detrimental to health, speaks to the federal government’s broader abandonment of its critical leadership role in defending and improving Canadian health care.
Canada’s health care systems achieve the extraordinary feat of providing high quality health care services to 33 million people. However, maintaining and improving the accessibility, quality, and sustainability of these services requires active leadership from the federal government. This week’s budget was yet another failed opportunity for the government to demonstrate its commitment to improving our health care systems.
There are 3 missed opportunities in particular where federal leadership, in the context of provincial jurisdiction over the delivery of health care services could really make a difference.
1. National Pharmacare: Perhaps the most glaring omission from this budget was the lack of a national pharmacare strategy. This is a government that prides itself on fiscal responsibility. Yet it chooses to ignore the mounting evidence that a national pharmacare strategy would save Canada billions of dollars while improving health outcomes. Provinces have been calling for a national pharmacare strategy and asking for the federal government to lead a coordinated approach to improving access, quality and reducing costs in the area of prescription drugs. In the absence of that federal leadership, the provinces are working together to do what they can to purchase medicines in bulk. But both they and policy researchers across Canada know that in order to succeed, a national pharmacare strategy requires active federal leadership.
2. National Seniors’ Strategy: What we already know from the Canadian Medical Association’s advocacy for a national seniors’ care strategy is that investing in home and community care for seniors is also critical for the financial sustainability of our health care system. Using hospitals to provide care that could be better delivered by community and home services not only provides ill-fitting service, it does so at an inflated cost. We are unnecessarily draining health care budgets by relying on hospitals to provide health care to our aging population.
3. Scaling Up Innovation: The lack of a National Seniors’ Strategy points to a larger problem with this budget and the current approach to managing Canada’s health care system. The 2015 budget includes funding for the Canadian Foundation for Healthcare Improvement. The CFHI works with health care delivery professionals to test innovations in service and delivery to assess the best practices for improving care in Canada. While the current government funds the CFHI, it does not facilitate the implementation of innovations that CFHI tests. For example, the CFHI advocates for addressing the gaps in seniors’ care that results in frequent readmission of elderly patients to hospital. The CFHI’s research has proven that improving access to home and community based care would result in a decrease in readmission and an improvement of health outcomes for older patients.
Seniors’ care is just one example of improvements that the CFHI advocates for that require active federal leadership to implement across the country. We are now in month 13 without a Health Accord. In the absence of this agreement between Ottawa and the provinces, we have no mechanism for standardizing health care quality across the country. The principle of universality that underpins our health care system ought to apply not only to who is able to access care, but the quality of care that they receive. A patient in Nanaimo should be guaranteed the same quality of care as a patient in Red Deer, Toronto, or Cape Breton. This is a goal that can only be achieved with federal leadership.
Finally, it is hard not to point out that the most important determinant of health is not health care, but income. Any budget measure that reduces poverty and income inequality in Canada will improve the health of the entire population; any measure that worsens inequality or leads to an increase in poverty will worsen the health of Canadians. We should all read the budget through that lens and ask ourselves whether we are doing enough as a country to address the conditions that lead to ill health.
It is our hope that, with an election just months away, the government will reflect on the gaps that its budget left unaddressed and address them. It’s time for Canada to demonstrate the vision and leadership required to improve the accessibility, quality, and sustainability of our universal health care system. More of the same simply will not suffice.