This week the country’s fourteen health ministers have been gathering in Vancouver for a pan-Canadian summit to begin negotiating a new Health Accord. The previous accord saw $41 billion transferred to the provinces over the last decade. This next one may be even bigger.
The challenge facing our health ministers is to set clear priorities for how federal health dollars should be used. If we learned anything from the previous Health Accord, it is that wide-ranging agreements get diluted and that diluted agreements do not achieve their intended results – even when they boost provincial coffers.
The rationale for a Health Accord lies in the lackluster performance of our health systems when compared to other industrialized countries and the catalytic role that federal government leadership can play. Canadians currently pay more, receive less, wait longer and live shorter than citizens of most other industrialized countries. We only look good in international rankings when compared to the United States.
We can do better, and this Health Accord is our best opportunity for doing so. But health ministers will only succeed if they commit to spending smarter and negotiating wiser.
To start, spending smarter means channeling any new health dollars strategically towards those services that will achieve the greatest health impact. We do not need to invest in more of the same. This means ending what amounts to unlimited budgets for costly curative health care at the expense of other health-promoting initiatives like home care, public health, rehabilitation and social services.
In particular, the vast majority of government health dollars currently go towards hospitals and physicians, both always shamelessly crying poverty no matter how comparatively well-funded they may be. This leaves fewer dollars for new ways of delivering care and for population health strategies that keep us well in the first place.
The best principle for channeling new health dollars is value-for-money. This means gathering all available evidence on the benefits and costs of each service and prioritizing accordingly. Measuring cost-effectiveness can be difficult. We do not always have complete information and it takes expertise to pool results from different studies. This can be overcome by centralizing these assessments nationally and linking federal funding recommendations to which provinces can respond.
More difficult are the politics of implementing value-for-money policies. No politician will win votes by funding even the most cost-effective services like public health if the people who benefit don’t know it. They are also not helped by the Canada Health Act which petrified priority for hospital and physician services instead of creating an automatic process for updating priorities as needs change, values evolve, evidence develops and cost-effectiveness becomes clear. As a result, the hospital and physician winners of today’s underperforming system have also understandably created the most powerful lobbies.
All health ministers and Canadians would benefit from institutionalizing in the Health Accord a binding commitment to spending smarter. Status-quo champions would find their influence diminished when health ministers can argue that unpopular value-for-money decisions are about spending tax dollars wisely.
To get there, health ministers also need to negotiate wiser. Next week’s meeting need only have three results. First, a commitment to spending new federal health dollars on the most cost-effective initiatives. Second, a mandate for officials to begin work on a mechanism for identifying, constantly updating and adapting those initiatives for the unique context faced by each government. And third, a detailed plan for delivering a final Health Accord including a target date for a First Ministers conference.
In this way, the new Health Accord will not only commit governments to principles and processes worthy of celebration, but also to a plan for kick-starting a more sophisticated partnership that reflects our federation in which all fourteen governments share constitutional jurisdiction over health.
The political conditions are right for getting such an ambitious agreement and setting this new collaborative tone. Canadians overwhelmingly support health reform, provinces have an appetite for change, federal politicians are willing leaders and the risk of silly partisan disagreements is low. There is also growing understanding that the status quo is unacceptable and that we can do better.
Negotiating this new Health Accord could end up being the most significant achievement of the recently elected federal government. It could be Trudeau’s Obamacare. But all governments will collectively be judged for the Accord’s success or failure.
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