By Renato Discenza, President and CEO, HealthPRO and Paul-Émile Cloutier, President and CEO, HealthCareCAN
With the federal government having unveiled its spending plan for the coming year, the conversation between the federal government and the provincial and territorial governments over Canada Health Transfers (CHT) will be taking on a new urgency.
The past two years of fighting a relentless COVID-19 pandemic has revealed real cracks in our health care system and changed the way many Canadians view decisions on health care. It’s easier for any of us who have been paying attention to see the direct correlation between the level of funding our provinces receive from the federal government and our access to treatments and care that impact our health and well-being.
Just consider how dealing with the pandemic has derailed routine surgical procedures and created lengthy waitlist for thousands of Canadians – in Ontario alone, there is a backlog of more than one million people waiting for surgeries.
The federal government’s pre-budget announcement that it will provide provinces and territories an additional $2 billion as a one-time top-up to reduce surgical backlogs and improve access to care is welcome news. It’s a promising signal that Ottawa is keen on working with provinces and territories to ease some of the pandemic pressures impacting them.
All levels of government demonstrated over the past two years that, when push comes to shove in a crisis, they are willing to step in with extraordinary measures and increased spending to protect the health of Canadians.
But what about as we try to return to more normal circumstances and emerge from the still-lingering pandemic? But every year we have a political shell game about whether the federal government should increase the provincial spend on health care.
Now is the time to look at how we change the CHT framework for the better.
If Ottawa wants to support the provinces in providing public, universal health care services we are all proud of, it should consider an approach aligned to what they are looking to achieve and what we want – better health for Canadians.
The federal government should consider an outcome-based approach of funding. In this model, provinces would receive an increase to health care transfers to enhance performance indicators to measure the impact on Canadians’ health, and publicly report their progress on those indicators.
This could include wait times for a broad array of diagnostics or surgery, access to specialized services, home care, reduction in hospital visits for specific chronic diseases – but the key aspect is that each individual province chooses the indicators.
Provinces could choose to spend on technology, research, innovation, education, staffing – whatever is needed to achieve the outcomes they are being measured on. The federal government has the health data infrastructure to measure these indicators and help provinces set some of these indicators.
This approach creates accountability between governments, but more importantly also creates an accountability to the public and patients. Creating a system where the CHT dollars are focused on improving specific health indicators also creates accountability – something every taxpayer in Canada deserves.
It also enables provinces to set their own priorities. Canada is a diverse country with varying health care needs across each province. The 2022 priorities of the Alberta health care system could look very different from the priorities of the Nova Scotia health system.
As members of the broader health system, our national organizations – HealthCareCAN and HealthPRO – share a unique perspective on the relationship between the federal and provincial governments and the ongoing debate over health funding. Sometimes insight comes just from being in a place to observe the picture differently. This is the case as we watch our members, across Canada reconcile the policy and funding from the federal government, against the operational realities of provincially delivered health care. It is sometimes frustrating to see governments and healthcare providers, all ultimately wanting a better and healthier life for the people of Canada, struggle to align the federal health care funding transfer to improved outcomes that everyday Canadians can see.
It appears that the federal government may be considering an outcome-based funding model—noting in its 2022 Budget that any conversation with the provinces and territories on the Canada Health Transfer must focus on “better care outcomes for Canadians.” What we don’t know is when and how these conversations will take place.
What we do know is that the current political conversation is not working, and as we work to come out of the pandemic, our federal, provincial, and territorial partners need to work together to repair our health system with the same united approach they embraced to fight COVID-19.
(Renato Discenza is President and CEO of HealthPRO, which manages procurement contracts for supplies and medicines on behalf of more than 1,300 member hospital and health care organizations across Canada. Paul-Emile Cloutier is President and CEO, HealthCareCAN, the national voice of health organizations and hospitals across Canada.)