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The federal government wants to make sure billions of dollars transferred to the provinces and territories for health care will “deliver real, tangible results for Canadians” with shorter wait times and better services, Prime Minister Justin Trudeau said.
In the past, “huge investments” by the provincial and federal governments have not always delivered the improvements needed, Trudeau said Wednesday.
His remarks came a day after the 13 premiers wrapped up two days of talks in Victoria, united in frustration that Trudeau has not set a date to meet with them to renegotiate funding for what they say is a “collapsing” health care system.
Ottawa needs to stop “picking” on health care and meet with premiers to address their demand for stable, long-term health care funding, British Columbia Premier John Horgan told a press conference during the Council of the Federation meeting.
Andrew Longhurst, a health policy researcher at Simon Fraser University in Burnaby, British Columbia, said Ottawa has a right to be concerned about how the provinces and territories spend money on health transfers because they have historically flowed into their general accounts. and in some cases they have continued to cut taxes and run budget surpluses.
Provinces are also engaged in “blame-shifting” about how the system has reached a crisis point, ignoring their own roles in failing to take on the difficult, years-long job of modernizing health care, he said in an interview.
There are some promising evidence-based initiatives, “but what we’re not seeing in most provinces is a systematic expansion” of these practices, said Longhurst, who is also a research fellow at the Canadian Center for Policy Alternatives.
Coping with the COVID-19 pandemic in the provinces has compounded the crisis, he said, noting that indoor carry mandates have been lifted as another highly contagious strain spreads and hospitalizations rise.
“The reality we’re seeing among our health workforce across the country and our health services is severely strained to the point of collapse … because we’re not managing the ongoing pandemic in a smart way,” Longhurst said.
Horgan on Tuesday said health care is the main spending driver for provincial and territorial budgets, so there is no debate about what they would do with the extra funds.
However, each jurisdiction has different priorities, and a province with an aging population may focus more on long-term care than another, he said.
He also said the premiers were happy to talk about potential terms related to the federal money, but first they needed to meet the prime minister in person.
Horgan, who chairs the council of prime ministers, said he wrote to Trudeau in December and April suggesting how to begin the work, but has not received a response.
Trudeau told media he didn’t think any of his predecessors had met with prime ministers as much about health care as he had in the past two years, and leaders would continue to work together to address the “strain” on the system.
“The federal government is going to be there to invest in health care, but we’re going to make sure that those investments are enough for Canadians,” he said.
Health Minister Jean-Yves Duclos outlined the federal government’s five priority areas during a speech in March: addressing staff shortages and delays in diagnosis, treatment and surgery; access to family health services; long-term and home care; mental health and substance use; and health data and virtual care.
Horgan, along with Alberta Premier Jason Kenney and others, said they had not seen the potential conditions Ottawa might want to attach to the funds.
Nova Scotia Premier Tim Houston said none of the provinces and territories are trying to “save the health budget and divert the money somewhere else,” and the only thing holding back progress is a lack of discussions with Ottawa.
Premiers want the federal government to increase its share of long-term health funding to 35 per cent, up from what they said was 22 per cent.
Trudeau said Ottawa has added $72 billion in health care funding over the past two years, on top of the tens of billions provided through the Canada Health Transfer.
Longhurst said declines in federal health transfers predate the Trudeau government and it’s reasonable for prime ministers to want more.
But significant opportunities for improvement lie in reshaping the outdated models and structures that underpin health care delivery, and that goes beyond spending more money, he said.
The fee-for-service system of the 1960s, in which doctors and surgeons essentially run their own businesses while being paid with public dollars, is one example of an old model that is holding back improvements in patient care, Longhurst said .
“We have other models that are much more aligned with these systemic goals of improving access and improving the ability for teams to work together (and) have better support, which are not just about medical intervention, but about prevention and management of chronic diseases, etc. ,” he said.
The effects of growing inequality and the social determinants of health, such as housing insecurity and poverty, should not be left out of the conversation, he added.
Canada does not spend at the same level as many of its comparable countries on welfare benefits that have been shown to improve health outcomes, he said.
“We know that over generations, these investments actually pay dividends.”
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