Canada's health-care promises not yet met

Provincial governments are making significant progress on the promises made in 2004 to improve health care, but there's still a lot of work to do, according to the Health Council of Canada.

The national agency released a report Tuesday on how well the provinces, territories and federal government are doing on meeting some of the specific commitments made in the 10-year health accord struck in 2004. Progress Report 2011 focuses on wait times, telephone health advice services, electronic health records, pharmaceuticals and innovation.

"The good news is we are cautiously optimistic about the future of health care in Canada. Our health care system has come a long way since the [accord], however, there is still a lot of work to do to achieve the First Ministers' vision, indeed the vision of all Canadians — a more accessible, higher-quality and sustainable health-care system," said Dr. Jack Kitts, chair of the national agency, at a news conference in Ottawa.

He said the health council believes that with strong direction and continued investment in information systems, the goals set out by the country's health ministers in 2004 can be reached.

Progress made on wait times

In 2004, the provinces and territories agreed to focus on cutting wait times for five clinical areas: cancer, heart, diagnostic imaging, joint replacements and sight restoration. Several jurisdictions have expanded beyond those areas now because of the success reached in the initial areas, the health council reports, and there has also been progress on wait times.

"Today, wait times may very well be a success story of the [accord]. We've made progress on wait times because governments set targets, publicized them and provided the funding to tackle them," Kitts said. "Wait times are good evidence that progress can be made and sustained when health leaders develop an action plan and stick to it."

Measuring progress on wait times is a complex task, the report said. The health council says the provinces have far exceeded what was committed to in the accord.

The one area where jurisdictions are lagging behind in wait times is in diagnostic imaging, the report said. While national benchmarks for wait times have been set in some of the priority areas, none were established for diagnostic imaging and only a few provinces have set their own.

Kitts said the health council would like to see the provinces set targets for other major practice areas such as emergency room wait times and pediatric care.

Little progress on national drug plan

Implementing a national pharmaceuticals strategy was a key pledge made in 2004. The health council reported in 2009 that movement on the strategy had stalled and on Tuesday said, "Two years later, it has not gained momentum." A national plan for catastrophic drug coverage was supposed to be part of that strategy, and little movement has been made on that front either, the report said.

The national agency, created in 2003 specifically to monitor progress on health-care renewal, said there has "been little concerted national action on pharmaceuticals in recent years." Jurisdictions have been making their own changes to drug policies, including steps to bring down the prices of generic drugs, and expanding the scope of practice for pharmacists. The health council said allowing pharmacists to do more helps increase access to health care for patients.

The provinces and territories are making progress on improving drug information systems, the health council reports, but they are slow in fulfilling a health accord promise to increase the practice of e-prescribing.

A significant area of progress on the drug policy front is greater co-operation among the provinces to expand existing joint purchasing programs. Buying in bulk will drive costs down and in 2010 the provinces and territories agreed to develop a pan-Canadian approach to joint procurement for drugs and medical equipment.

"This is a major development for Canada," the health council said in its report.

More than $4 billion has been spent by the federal and provincial governments on implementing electronic health records and by the end of 2010, an e-record was available for about 50 per cent of Canadians.

The health council said governments are making progress on developing the infrastructure for e-health records, but more doctors need to be encouraged to use them.

"Many physicians still rely on paper records and until they go digital, their patients can't fully benefit from the electronic health record," said Kitts.

Sustained federal funding is key to accelerating the use of electronic health records, said Kitts.

Teletriage, providing health advice via telephone, is now widespread across Canada. Prince Edward Island, Nunavut and Northwest Territories are the only jurisdictions that don't have the service. The health council report says there have been few evaluations of the programs, however, and it is planning on doing a separate report in the future on teletriage.

In the area of health innovation, the health council said the federal government has met its financial commitments to support health and science research in Canada. But it warns that Canada's progress as a world leader in innovation "remains to be determined" and it notes that experts say there needs to be more action to bring health innovation to the patient's bedside.

Provinces, territories should work together more: report

The health council concludes that much of the progress on the 2004 health accord promises has come from individual jurisdictions taking action in the interests of their own residents. It concludes that "the next push" lies in getting all governments to work together, across the whole spectrum of health care, in the interests of all Canadians, "which was the real promise of the [accord]."

"We think working together is the best way to go," said Kitts.

The health accord is set to expire in 2014 and discussions have already begun around re-negotiation of a new agreement between the federal and provincial governments.

Until the recent spring election campaign, Prime Minister Stephen Harper's Conservative government had said little about its plans for funding health care post-2014, should it still be in power. 

Funding from Ottawa to the provinces and territories is currently legislated to increase by six per cent a year until 2014. During the election campaign, the Liberals promised to maintain that level of funding. The Conservatives said they would do the same.  

The NDP, now the Official Opposition following the May 2 election, used Tuesday's report as an opportunity to criticize the Harper government, saying that it has failed to show leadership on the health-care file.

"While health-care delivery is under provincial jurisdiction, the federal government still has an important role to play. The federal government must bring together the provinces and territories and set measureable targets and outcomes.  Only by doing this can the government ensure that every Canadian, no matter where he or she lives, can have access to high-quality and timely health-care services," said the NDP's health critic Libby Davies.

Davies said throwing more money into the system won't fix its problems, and that more leadership is needed.

In an interview with Evan Solomon on Power & Politics, Kitts agreed that money alone is not the solution to address the system's ongoing challenges. Money is needed, but so is a focus on making the system more efficient, said Kitts, adding that "transformative change" is also required.

"Most health experts would agree that there's probably enough money in the system, there's enough human resources in the system, [and] there's enough capacity in the system if we were to change transformatively how we deliver the service to maximize the use of those resources," he said in the interview.

Introducing more private delivery of health services should not be part of that change, said Kitts. If the public system is reformed sufficiently, it can do a much better job than it is now, he said, and efforts should be concentrated on that first before considering another system, said Kitts.