Federal Politics

CMA presses government on budget

Ottawa should put its money where its mouth is, said CMA Hugh Scully during prebudget hearings before the House of Commons Standing Committee on Finance. "The Canada Health Act assures Canadians they will have access to medically necessary services but federal transfers are not high enough to cover that commitment," warned Scully. He added that federal money for health and social programs announced in the 1999 budget only brought federal cash contributions back to 1995 levels.

Factors such as the growing and aging population and new technologies are causing federal health spending to lag behind the public's demand for care, contends the CMA. "While last year’s reinvestment focused on the immediate crisis in the health care system, it failed to address some other key concerns such as the indexing of cash entitlements, the critical shortage of health care providers and the need to expand the continuum of care from hospital to community," said Scully.

The Health Action Lobby, a coalition of 29 health and consumer organizations that includes the CMA, the Canadian Nurses Association and the Canadian Healthcare Association, echoed the CMA approach with its call for an increase in federal funding. The sustainability message was further bolstered by the release of Auditor General Denis Desautels annual report, which took the federal government to task for "passively" enforcing the Canada Health Act. CMA News 2000;10(1):1.

Health Canada undergoes a shakeup

Health Canada, the third largest federal government department with 6,000 employees, is undergoing a major realignment. The department said: "This is about a change in mindset. We want to make our regulatory processes more transparent and we want to build a new relationship between Ottawa and the regions. It is not going to be ‘business as usual’ for anybody in the department." The most important aspect of the shakeup that the two largest branches in the department, Health Protection and Health Promotion and Programs, are being reorganized into three branches: Population and Public Health, Health Products and Food, and Environmental and Product Safety. CMAJ 2000;163(1):80-1.

Health care and the federal election

Health care played a large role in the fall federal election campaign but the CMA stressed the importance of the future, regardless of how the Nov. 27 vote turned out. In a special voter’s guide sent to all CMA members, the association said that as the ones who know the system intimately and often have to struggle mightily to make it work for their patients, physicians are keenly aware of the system’s shortcomings.

The CMA hopes those shortcomings can be addressed through collaboration and the development of a real plan of action that builds on the consensus reached at the September meeting of Canada’s first ministers concerning federal funding for health care.

Following the announcement of the first ministers’ agreement, new CMA President Peter Barrett expressed cautious optimism about the deal, noting: "We’re better off today than we were yesterday, but we are also aware of the shortcomings of the deal." He went on to note that "the infusion of money will stabilize the health care system over the short term, but not sustain it for the long term." He also warned that the funding will not be restored until the next fiscal year. The CMA called for a long-term strategy and said the elements are in place to produce one. This strategy will have to cover the areas detailed in the CMA’s plan for revitalizing health care, notably renewing the health care system, addressing the shortage of health care professionals (especially physicians) and building connectivity within the health care system to better manage and coordinate resources. CMA Interface 2000;1(3)

Health minister meets with CMA

Federal Health Minister Allan Rock told the CMA Board of Directors in May that he hoped to meet with his provincial and territorial counterparts soon, but he added, that he did not ant a repeat of an earlier get-together in Markham, Ont. "Markham wasn’t much of a meeting," said Rock. "It was more an opportunity for representatives from the provinces to emphasize that more money is needed for health."

Rock told board members that he continued to believe that a firm plan must be established on the specific areas where more money is needed as well as determining how much public money should go to what services. "It's easy to say that the federal government should transfer more money," said Rock. "But it’s also necessary for governments to work toward some kind of common approach on health priorities." He added that he hopes the CMA might be able to act as an intermediary to advance this cause. "We need a meeting of the minds about where the system is going, what the issues are and what we need to look at changing." CMA News 2000;10(6):1

Renewal of health care promised again

For the fourth time since becoming health minister, Allan Rock stood in front of the CMA in August to defend his government’s record on health care and to promise that better days lie ahead. Given the meeting of provincial premiers the week before, Rock said he was optimistic. For the first time "all the governments are talking about the same elements, we have a specific time frame of 30 days to talk, federal money is committed and we have broad professional support and accumulated evidence." CMAJ 2000;163(5):594-5.

Senate study of health care

Almost three years to the day after the National Forum on Health released its final report examining the state of Canada’s health care system, a Senate committee decided to do it again. Senator Michael Kirby and the Standing Senate Committee on Social Affairs, Science and Technology started its three-year study on the role of the federal government in the delivery of health care in Canada in March.

"We will begin by examining the fundamental principles upon which Canada’s publicly funded health care system is based and then move systematically through five other stages to conclude with a firm set of policy recommendations," said Kirby who is chair of the committee. "As a result of this process the committee hopes to become the forum for an open and wide-ranging public debate on federal health care policy."

Some critics questioned the need for yet another study examining health care in Canada, particularly one that includes six phases and will take three years. However, committee members maintained that another look at the system is needed, particularly considering the pressure on the federal government to strengthen it role in the system by transferring more tax money to the provinces to pay for health services. CMA News 2000;10(3):6

Who spends what on health care

The question of just what share of Canadian health care expenditures the federal government actually pays is a tricky one, notwithstanding attempts by the Ontario government to do so in advertising campaigns. A CMAJ article traces the recent history of the federal financing of health care, going back to 1977 with the Established Programs Financing program. This program provided unencumbered direct per capita funding to the provinces that was indexed to growth in the gross domestic product and also allowed the provinces to collect more taxes by taking over "tax room" vacated by the federal government. In 1984 the Mulroney government unilaterally reduced the index, shrinking federal transfers, but allowed the tax room allotted to the provinces to increase with inflation. As the tax room grew the cash transfers kept shrinking, taking the federal ability to enforce the Canada Health Act with them. The Chrétien government moved to correct this in 1996 by combining the EPF with the Canada Assistance Plan. The new arrangement — the Canada Health and Social Transfer — cut federal funding for both programs but also had the novel innovation of a "cash floor" through which federal spending could not fall.

Within this historical context, the author questions provincial demands that the federal government restore funds cut from health care, particularly considering provinces used their power over where funds would be spent to cut vast sums from health spending in favour of tax cuts. She wonders if the current calls from these tax-cutting provinces for increased federal spending on health signal a desire to a return to system where the federal government targets funding and devises methods to ensure the money is spent appropriately. CMAJ 2000;163(1):43-4.

Who won in the health care deal?

On Sept. 12, The prime minister and provincial and territorial leaders all agreed to increase federal transfers in a deal worth $23.4 billion over five years. Each side immediately proclaimed victory at the expense of the other, but with elections looming both provincially and federally, everyone wanted to wear the cloak of "protector of medicare." But what does the deal really mean and who really wins? CMAJ 2000;163(8):1029-30.

Copyright 2000 Canadian Medical Association or its licensors