A national vision of health care needs leadership

Dear colleagues,

Has the federal government “washed its hands” of health care reform? Is it providing the leadership to ensure a pan-Canadian vision and national standards of care? Ottawa is sending mixed signals. Prime Minister Stephen Harper says that the provincial and territorial governments must create the vision to improve the quality of health care on their own; it is their responsibility to innovate and reform the system and they are solely accountable for results. Fair enough, but Health Minister Leona Aglukkaq says that she would be pleased to continue intergovernmental discussions with respect to innovation, improved accountability and other areas to enable sustainable health care.

The federal government has unilaterally proclaimed a funding formula without consulting provincial and territorial governments. Health transfers will amount to six per cent a year in a new funding agreement starting in 2014. After 2017, increases will be limited to the growth of the economy — measured by the gross domestic product or three per cent, whichever is greater.

How have provincial and territorial leaders reacted to all of this? Some premiers have voiced concerns that the federal stance will lead ultimately to the balkanization of medicare into a patchwork system with varying standards. They argue that a pan-Canadian system "needs to be meaningful, timely and relevant" and should be based on common data so provinces can learn from one another. It seems that provincial and territorial leaders are willing to work together.

In last week’s Council of the Federation meeting in Victoria, B.C., they announced the establishment of a Health Care Innovation Working Group to find common ground in the renewal of the health system — by July. Six months is an ambitious time frame. They plan to concentrate on scopes of practice, human resources for health management and clinical practice guidelines. Their intent is to share their “best clinical and surgical practice guidelines,” study how much to pay health-care professionals, look at who should care for patients and what kinds of treatments should be offered.

This master plan should sound an alarm; physicians must get actively involved or face a loss of professional autonomy and decision-making authority. We have a pivotal role in the reform process and our voices must be heard. Canadians expect us to be part of the reform process.

Canadians expect all levels of government to work together
A recent national survey by Ipsos Reid commissioned by the Canadian Medical Association found that 97 per cent of Canadians want the federal government to ensure that the Canada Health Act remains strong. They see the federal government’s role as providing leadership and safeguarding pan-Canadian standards. Seventy-four per cent of respondents believe that health care is a “shared” responsibility. If the federal government doesn’t come to the table or if the provinces and territories exclude them, then they are all letting Canadians down. Collaboration is a tough pill to swallow if you practice partisan politics; it takes leadership to work together.

People in Canada cherish medicare but they also recognize that the current model of health care delivery faces fiscal and operational challenges. Rapidly rising costs, long wait times and access to physicians are a few of the high-profile problems. Solutions may require a paradigm shift that embraces new ideas, facilitates collaboration on an unprecedented scale and tempers the growing appetite for money. Sharing leading practices and utilizing resources more efficiently and effectively will be the norm.

Enter the debate on health care reform
As physicians and health care leaders, I urge you to lobby your local MP; the federal government must take a more active role in health and health care renewal. We have a lot to offer. The Royal College’s 2012–2014 strategic plan, The goal that matters most, CanMEDS, MAINPORT and Maintenance of Certification program can be held up as examples of leading practices that facilitate health care improvement and reform.

Our vision calls for, “the best health for all, the best care for all.” This statement implies a broader perspective that goes beyond health care. The challenge is to find a balanced approach to concentrate on areas that where Fellows can make a difference. I would be happy to hear your views on what we can do to contribute to positive change.

Yours sincerely,

Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer