Where is health reform going?

Since the mid 1960s, Canadians have grown accustomed to a health system that offers a decent standard of care to everyone, regardless of their social or economic status.Some see it as Canada’s most important social institution. It’s often called the glue that holds the country together.But it’s expensive glue. The federal government pumps $95 billion annually (Statistics Canada 2000 figure) to support health care.

Plus, Canadians spend an additional $30 billion a year through private plans or out-of-pocket expenses to cover prescription drugs, dental and vision care, long-term care and home care.

And in spite of all this money, the system is still struggling to deliver the kind of health services Canadians expect and demand. So calls for reform are coming fast and furious. The first past the post is Alberta, where an Advisory Council on Health released a review in early January.

More studies underway
CARP, Canada’s Association for the 50 plus, is closely monitoring the reform debate, especially the effect two other important studies will have on the health care decision makers in this country.

• Heal of Canadians: The Federal Role, is headed by Senator Michael Kirby and will be released in June 2002.
• Commission on the Future of Health Care in Canada, led by former Saskatchewan premier Roy Romanow, should be out by November 2002.

Both studies were undertaken to determine what Canadians expect from their health care system and what changes they’ll endure to make it work.

In addition, the Alberta government has released its provincial study led by Don Mazankowski, a former deputy Prime Minister. It recommends a more private health care services and a review of services presently covered by health care. Alberta Premier Ralph Klein says the report “will not be left to gather dust on the shelf”.

CARP says it want to ensure the interests of 50-plus Canadians are not lost in the debate.

Debate, planning needed
“Our members tell us they worry about how changes to our system will affect them, and they look to us to protect their interests,” says Lillian Morgenthau, CARP’s president and founder.

“So, any tampering with the system — by introducing a two-tiered system, privatization or user fees — must not be done without extensive public debate and long-term planning.”

CARP’s policy experts feel that language used in the Kirby interim report leaves room for the possibility of applying user fees and expanding privatization within our health system.

Next page: Romanow’s comments

Romanow’s comments
And while it’s too early to know what the Future of Health Care report will say on the subject, observers note that Romanow has said that he’ll “consider the implications, the changes and the difficult choices that may be necessary to achieve the desired future for our health care system.”

“Canadians are going to have to decide how they will bring new meaning to the five principles that have underpinned our health care system since the 1960s,” Romanow said in a speech earlier this year.

“And the kinds of choices they make will have much to do with defining our health care system for the next 35 years.” 

Health Act principles
Any talk of health care reform discussion will gravitate around the five principles Romanow’s referring to, those enshrined in the Canada Health Act:

• Public administration
• Comprehensiveness
• Universality
• Portability
• Accessibility. 

Few know basics
Few Canadians are even aware of these five principles. Nor do they know that some of the health care services we take for granted aren’t covered by these

CARP’s positions is that any radical change to these principles could jeopardize health care for 50-plus Canadians.

“The principles of the Canada Health Act have to be protected to ensure that all Canadians have assess to effective health care,” says Morgenthau.

No erosion of basics
CARP representatives say they will appear before the Future of Health Care commission to present the views of older Canadians. They say they understand that changes are needed, but that any changes eroding the five basic principles are not acceptable.

Nor does the organization accept reform driven solely by ideological or economic agendas. 

Next page: Background on principles

Five Health Act principles: 

Canada’s Health Act contains five basic principles, which provincial and territorial governments must heed in setting health care policies and planning:

Public Administration:
The provincial/territorial health plans must be administered and operated on a non-profit basis, run by provincial/territorial governments and subject to audits of accounts and financial transactions.

Comprehensiveness:
Provincial/territorial health plans must pay for all medically necessary health services provided by hospitals and medical practitioners according to provincial law.

Medically necessary services do not always include payment for prescription drugs, optometry services, physiotherapy, and home care, as well as private ward accommodation in hospitals, to name just a few.

Universality:
All insured persons of the provinces and territories are entitled to all the health services provided for by each provincial or territorial plan.

Portability:
Coverage under public health insurance must be maintained when a resident moves or travels within Canada or travels outside the country.

Accessibility:
Everyone must have “reasonable access” to all medically necessary hospital and physician services.