Bilateral deals are no replacement for a real National Helath Accord, and could do more harm than good.
By MONIKA DUTT, Fri., Dec. 30, 2016
In the wake of the breakdown of national Health Accord negotiations, Nova Scotia is the third Atlantic province to sign a bilateral health agreement with the federal government. Although in many ways understandable — older populations and poor-performing economies create pressures to accept the promise of a longer-term infusion of funding — negotiating bilateral health agreements one-by-one, rather than creating a national Health Accord, is a setback to ensuring consistent, quality health care across Canada.
As a doctor working in rural Cape Breton, N.S., with an elderly population and high rates of poverty, I worry that health-care options for patients may diminish due to lack of cohesion between the federal government, provinces and territories. Already many young people leave Cape Breton, and Nova Scotia in general, in search of better employment prospects elsewhere. Several of my patients have changed where they live in the province to access health care — and some have considered moving to other parts of the country where certain treatments can be obtained more quickly or affordably.
Atlantic Canada’s jump into health-care deals, while the rest of the country holds out for a better offer, raises many questions for doctors and patients. Have those who committed quickly received a poorer deal? Will some provinces be rewarded for signing on while others punished for refusing the federal offer? Or will holdouts ultimately negotiate better arrangements? Will these debates eventually hurt patient care with people in some provinces receiving better publicly funded mental health services and home care?
There is a caveat that if other provinces attain a deal that ensures better health outcomes, those with previous agreements will be adjusted; however, a lower ceiling may have been set.
The possibility of up to 13 separate deals could damage the requirement outlined in the Canada Health Act: “substantially similar” care on “uniform terms and conditions.”
The precedent for this difference already exists if one looks at the federally administrated health care for indigenous people, which has always been underfunded when compared to the level of funding offered by the provinces. For procedures that we measure across the country, like surgical wait times, doctors and patients know that how long you wait often depends on where you live. The previous Health Accord helped reduce that difference in the past — and a new national accord could do the same now.
Rather than settling for disconnected side deals, a unified plan should strengthen publicly funded access to medications, primary care, and public health. It would add new public money for mental health care and home-care, which are now funded based on individual provincial decisions. Our health care needs are far more diverse now then when Medicare was established to cover doctors and hospitals, and a Health Accord should recognize this shifting of priorities and the need to invest in innovation and comprehensive care.
The discussions so far have also failed to specifically address federal responsibility for providing services in indigenous communities. The offer of $5 billion for mental health over 10 years may begin to make a dent in mental health needs of youth across the country.
However, the offer does not acknowledge indigenous peoples and the often insufficient and substandard care they receive throughout Canada. If all residents of Canada are to be brought up to a baseline level of care, it is essential the federal government acknowledge they are failing to live up to their own health-care agreements with indigenous communities.
Expectations were, and remain, high for the Health Accord process. The rate of increase of health transfers is an essential part of the debate, but not the only aspect. Extending federal funding to other priority areas is just as important as the base funding level, as this federal government now recognizes.
Focusing on mental heath, seniors care, pharmacare and home care address long-standing problems in health care that have resulted in significant costs elsewhere in the system — especially in the use of pricey hospital beds where better care is preferable. These changes could provide savings that base funding increases by themselves aren’t certain to produce.
Governments at the national and subnational level should not waste this opportunity for meaningful health-care reform and a more equitable distribution of funds across the country. The best route now is back to the bargaining table to continue the hard work of hammering out a deal that works for all people in Canada.
Dr. Monika Dutt is a family physician in Cape Breton, N.S. and chair of Canadian Doctors for Medicare.