Since October 1994 members of the National Forum on Health have been holding consultations and deliberating on ways to improve Canada’s health system. Members of the Canadian Union of Public Employees and the Canadian Health Coalition have been active in the Forums’ consultations and it seems we have had some success in influencing the Forum’s recommendations. The report has now been issued with some very progressive recommendations.
Recommendations on Preserving and Protecting Medicare
The Forum recommends the following key features be preserved and protected:
· Public funding for medically necessary services;
· The single payer model;
· The five principles of the Canada Health Act;
· A strong federal/provincial/territorial partnership;
· Expanding publicly funded services to include all medically necessary services including home care and drugs;
· Reforming primary care funding, organization and delivery;
· Establishing a multi-year transition fund.
Home Care
The recommendation to consider home care as an integral part of publicly funded health services is a very positive development. Included in home care are professional services, medical supplies, homemaking and attendant care, and maintenance and preventative care.
However, the Forum suggests that home care should be funded by re-allocating savings from reductions in the institutional sector. We are of the opinion that gutting the hospital sector will not benefit the health of Canadians and the attack on hospitals must end. It is our view that the cost of public funding for home care can be achieved by shifting the spending from private to public budgets. We are already paying millions of dollar per year for home care. It is now time to fund it from the general tax base.
Pharmacare
The Forum’s proposal to establish a universal drug program is consistent with the Alternative Federal Budget proposals and with the Canadian Health Coalition action plan. The Forum proposes to finance pharmacare by shifting, over time, spending from private budgets to public budgets either through tax increases or premiums or both.
This is a proposal which we should be supporting in principle at every opportunity. We should be using this report to strengthen our position around the review of Bill C-91.
Primary Care
The Forum is proposing substantial reforms to primary care delivery and funding. They do not propose one single model but are proposing some key elements which must be common in any model. The two key elements are:
· Realignment of funding to patients, not services; and
· A remuneration method that is not based on the volume of services provided by physicians but promotes a continuum of preventative and treatment services and the use of multi-disciplinary teams of providers.
The Forum’s proposal on the realignment of funding really amounts to a capitated system. Without knowing the details of how this would be implemented, it is not clear that this is a desirable development. Capitated funding systems may open a door to private-for-profit health maintenance organizations.
We can support the proposal that remuneration for physicians be based on something other than fee-for-service. However, the Forum has not stated specifically that physicians should be paid on salary. We do concur with the Forum’s proposal to have multi-disciplinary teams of providers.
Reform to primary care obviously requires considerable cooperation among the provinces and territories. Throughout the report, the Forum makes numerous reference to the need for a more collaborative approach among the federal, provincial, and territorial players in health care. This cooperation is unlikely to occur at this point, given the provinces recent vision statement on health care. This vision statement provides ample opportunity for private-for-profit provision of health care. If there is going to be greater cooperation, it will take a stronger, more directive federal government role in the whole process. This means that cash transfers under the CHST would be necessary to enforce any new expanded medicare.
Transition Fund
The Forum proposes that the federal government establish a multi-year transition fund with $50 million in annual funding. This fund would be available for pilot projects, to disseminate results of the pilot projects, and to promote the implementation of best practices.
Nation-wide Health Information System
The Forum has recommended that a nation-wide population health information system be established to support clinical, policy and health services decision-making, as well as decision-making by patients and the public. This nation-wide network would require the provinces and territories to develop and maintain a standardized set of data on health status and health system performance. The Forum recommends the creation of a national population health institute as soon as possible. Current agencies such as the Canadian Institute for Health Information (CIHI) should be reviewed to determine if they can meet the mandate. The Forum recommends additional funding to create the population health data network and to create the national population health institute.
There are several issues relating to the information systems network which require further elaboration. Issues such as privacy, security, confidentiality, standards and funding for research and development will be at the top of this list. Such a network will require considerable cooperation among the provinces and territories.
An additional issue is the question of whether this information system is publicly administered and delivered. The Forum gives no indication as to whether this information system should be privatized or be part of the public sector. The Canadian Institute for Health Information is currently a privatized operation and charges user fees for the information. It should be a major concern for us that health information not be in the control of the private sector who may use information to influence decision-makers on health policy. Moreover, it is essential that there be public accountability as to which information is collected and disseminated. A privatized system would undoubtedly put the cost of information out of the reach of the public and community groups.
ChildrenThe Forum spent considerable time considering the social determinants of health and they have developed some recommendations relating to actions to improve the health of Canadians especially children and families. The Forum recommends that the federal government, in cooperation with other levels of government, develop and implement a broad and integrated child and family strategy of programs and income support. Specifically, an integrated child benefit program; better access to high quality child care and early childhood education services; workplace policies more favourable to families; more equitable taxation of families with children; and community-based programs with a home visiting component.
These are all objectives which we could clearly support. The major problem will be to convince the government to implement these recommendations in a progressive way.
How to Use the National Forum on Health Report
This report contains many progressive recommendations for change in Canada’s health care system. Many of these recommendations are consistent with positions we have taken over the past decade. This report should be used at every opportunity during this pre-election period to press members of all parties and in particular members of the federal Liberals, to implement the recommendations as soon as possible. We should be letting the federal Liberals know that Prime Minister Chretien is the Chair of this National Forum and its recommendations should be taken seriously. The Forum has now made it’s recommendations and the report should not languish on the shelves. It is a blueprint for action.
Having said that, we need to be ever diligent to ensure that the recommendations we are making follow the progressive principles we have outlined in other places including the Alternative Federal Budget.
The section on Pharmacare is particularly important and should be used extensively in our campaign on the review of Bill C-91. In order to implement the Forum’s recommendation on pharmacare, it is essential that the patent protection under Bill C-19 be changed in the interest of providing a cost efficient pharmacare program.
The Forum has made it clear that enough money has been taken from the health care system under the cuts to the CHST and no further cuts should be made. The Forum is recommending that the CHST cuts be stopped, i.e., be frozen at 1997/98 levels. We should use this position to our advantage in the pre-election and in the election campaign.
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