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Posted by on Oct 25, 2008 in Bioethics | 0 comments

Healthcare reform confusion (25.10.2008)

Healthcare reform confusion (25.10.2008)

We often hear about healthcare reform in Canada, yet it means different things to different people and to different groups. This, predictably, leads to quite a bit of confusion. Why all this confusion about what healthcare reform means – to government agencies, healthcare institutions, healthcare workers, taxpayers, patients, caregivers, and others?

One of the major reasons for all the discussion – and confusion – is the fact that we’ve had so many government studies and commissions on healthcare reform, within the past few years alone. At the federal level, both a Committee and a Commission released their reports on the future of Canadian health care in Canada in 2002; usually referred to as the Kirby Report (1) and the Romanow Report (2).

That’s in addition to all of the governmental commissions that studied – and are still studying – healthcare reform at the provincial level. For example; a year or so before the Kirby and Romanow Reports were released, the provincial governments of Alberta (3), Québec (4), and Saskatchewan (5) issued their own reports. And there were some additional government reports on specific, targeted healthcare issues.

As in most democratic governmental systems, though, no changes are implemented once a report is released. The reports must be analysed by the relevant governmental bodies, and budgets must be considered. In some cases additional committees are required to consider impacts on other programs, other governmental priorities.

I’m going to focus here on the results of the Kirby and Romanow Reports, rather than on the separate provincial reports. Both of these federal Reports called for increased annual spending in healthcare; the Kirby Report recommended an additional $5 billion via a dedicated tax, while the Romanow Report proposed an additional $6.5 billion.

As a result of these two Reports, the federal government announced a new “10-Year Plan to Strengthen Health Care”(6) in 2004. This Plan included an additional $41 billion of federal funding, but spread this influx of new funds over a 10-year period.

But it’s never so easy in Canada, where healthcare’s concerned… Before any new funding could be planned, let alone distributed, the Canadian government and the provincial and territorial First Ministers had to agree on the aims or principles of these additional funds. The difficulty and complexity in reaching these kinds of healthcare funding agreements, when healthcare is managed by the provinces and territories, is apparent in the following federal statement:

“Recognizing that an asymmetrical federalism allows for the existence of specific agreements for any province, First Ministers also agreed that a separate communiqué be released to reflect the arrangements between the Government of Canada and the Government of Québec regarding the interpretation and the implementation of the present communiqué. The funding provided by the federal government will be used by the government of Québec to implement its own plan aiming, notably, at ensuring access to quality care in a timely manner and at reducing waiting times”.(7)

Québec aside, the remaining provinces and territories were at least able to agree with the federal government to – at a minimum – “an action plan based on the following principles:
. Universality, accessibility, portability, comprehensiveness, and public administration;
. Access to medically necessary health services based on need, not ability to pay;
. Reforms focused on the needs of patients to ensure that all Canadians have access to the health care services they need, when they need them;
. Collaboration between all governments, working together in common purpose to meet the evolving health care needs of Canadians;
. Advancement through the sharing of best practices;
. Continued accountability and provision of information to make progress transparent to citizens; and
. Jurisdictional flexibility.”(6)

Aboriginal peoples’ health was also to be addressed, but as this is a federal responsibility it wasn’t detailed in the document regarding the provinces and territories.

The specific areas in which the new federal funding was agreed to be spent were:
. Reducing Wait Times and Improving Access
. Strategic Health Human Resource (HHR) Action Plans
. Home Care
. Primary Care Reform
. Access to Care in the North
. National Pharmaceuticals Strategy
. Prevention, Promotion and Public Health
. Health Innovation
. Accountability and Reporting to Citizens

It remains to be seen whether there will be any sustainable impact on health outcomes and metrics for Canadian patients…

(1) The Health of Canadians – the Federal Role, Final Report (Kirby Report). The Standing Senate Commission on Social Affairs, Science and Technology. Oct 2002. Web:


(2) Building on Values: The Future of Health Care in Canada, Final Report (Romanow Report). Commission on the Future of Health Care in Canada. Nov 2002. Web:


(3) A Framework for Reform (Mazankowski Commission Report). Premier’s Advisory Council on Health for Alberta, Government of Alberta. 12 Jan 2001. Web:


(4) Emerging Solutions – Report and Recommendations (The Clair Commission). Commission d’étude sur les services de santé et les services sociaux (Commission of study on health and social services), Government of Québec. 17 Jan 2001. Web:


(5) Sustaining a Quality System (Fyke Commission Report). Commission on Medicare, Government of Saskatchewan. 06 Apr 2001. Web (PDF):


(6) A 10-year Plan To Strengthen Health Care. Health Canada; Government of Canada. 16 Sep 2004. Web:


(7) New Federal Investments on Health Commitments on 10-Year Action Plan on Health. Health Canada; Government of Canada. 16 Sep 2004. Web:




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