Mourning the demise of federal-provincial cooperation in health care
Amid the clamour and confusion around the end of the multi-billion dollar Canada Health Accord and the future of health transfers from federal to provincial governments, there has occurred a quieter, and perhaps more significant, certainty. The Health Council of Canada is officially no more. Now this is not a body that has ever been particularly visible – its former existence is likely news to as many as its passing – but that obscurity should not be mistaken for insignificance.
The Health Council was an independent body with the mission to collect information about the performance of our health care system and to provide provincial and federal governments with guidance on health reform. It was established at the same time as the 2004 Health Accord, and was particularly charged with directing reforms associated with the over $40 billion associated with that agreement. This included efforts to improve surgical wait times, catastrophic drug coverage, home care, primary health care and electronic medical records.
The Health Council was to act as a witness to the successes and failures of those efforts and to aid the provinces in reaching their identified goals.
In its final major report – Better Health, Better Care, Better Value for All, <http://www.healthcouncilcanada.ca/content_bh.php?mnu=2&mnu1=48&mnu2=30&mnu3=53>the Health Council described the years of the Canada Health Accord as a decade of failing Canadians. This is strong language, and perhaps the Council was emboldened by its impending closure. Still, it’s hard to argue with the sentiment in the light of overall health spending in this country.
Private and public health spending in Canada increased from $124 billion in 2003 to $207 billion in 2012 – no small sum. But this new money has bought little in the way of meaningful change in system performance or health outcomes for Canadians.
The blame for that failure doesn’t rest on the Council; they were consistent in their efforts to measure progress and advise new directions. No, the blame rests squarely on the shoulders of the provincial and federal leaders who authored the Health Accord. They failed to tie any of the increase in health funding to the innovations required to meet the stated goals. Rather than working together to scale-up successes and learn from failures, the provinces each took their own direction with wide variation in degree of investment in innovation.
Now we see the federal government making a bad situation worse by walking away from the process of rebuilding a national health system entirely instead of negotiating a more robust agreement with targets and timelines for innovation and cost-savings.
The elimination of the Health Council only further underlines this movement away from national planning for better outcomes. Were this a one-off elimination of a governmental body created for a short-term purpose, this decision would be merely disappointing. That the Council’s disappearance is part and parcel of a larger strategy of the elimination of the dissenting and unbiased voice — something that is so needed in a democracy — is downright disturbing.
By removing or limiting evidence-gathering bodies, be they in health, the environment, or general information such as the long-form census, we decrease the evidence available to us to inform our debate and decisions. By strictly controlling how scientists can share information, cutting public broadcasting and eliminating watchdog organizations like the Health Council, we groom an ill-informed electorate.
These backward steps are the recipe for bad decisions to be called good, the recipe for a poor-performing health care system, a weakened economy, and worse health outcomes and quality-of-life for Canadians.
Canadians want to see the health system they are proud of live up to its promise.
Sooner or later, if governments are serious about delivering quality, accessible care, they’ll have to come together to negotiate and cooperate. And they’ll need an independent body to provide evidence and guidance on the best ways to achieve that change. A great deal of work went into making the Health Council of Canada effective in its role; what a shame to have to start over from scratch.
Ryan Meili is an expert advisor with EvidenceNetwork.ca, assistant professor in the Department of Community Health and Epidemiology at the College of Medicine, University of Saskatchewan, and a family doctor. He is the author of A Healthy Society: how a focus on health can revive Canadian democracy. @ryanmeili