The federal government wants to ensure billions of dollars transferred to the provinces and territories for health care “deliver real, tangible results for Canadians” with shorter wait times and better services, Prime Minister Justin Trudeau says. In the past, “huge investments” from provincial and federal governments have not always yielded the improvements needed, Trudeau said Wednesday. His comments came a day after the 13 premiers wrapped up two days of talks in Victoria, united in frustration that Trudeau had not set a date to meet with them to renegotiate funding for what they say is a “collapsed” health system care. Ottawa needs to stop “arguing” over health care and meet with premiers to address their demand for stable, long-term health funding, BC Premier John Horgan told a news conference during his rally Council of the Federation. Andrew Longhurst, a health policy researcher at Simon Fraser University in Burnaby, B.C., said Ottawa is right to be concerned about how provinces and territories spend health transfer money because it has historically flowed into their general accounts and in some cases, they have continued to cut taxes and run budget surpluses. Provinces are also engaging in “blame shifting” about how the system has reached crisis point by ignoring their own roles in failing to take on the difficult, long-term task of modernizing health care, he said in an interview. There are some promising evidence-based initiatives, “but what we’re not seeing in most provinces is a systematic scale-up” of these practices, said Longhurst, who is also a research associate with the Canadian Center for Policy Alternatives. The provinces’ handling of the COVID-19 pandemic has exacerbated the crisis, he said, noting that indoor mask orders have mostly been lifted while another highly contagious strain spreads and hospitalizations rise. “The reality we’re seeing in our healthcare workforce across the country and our health services is severely strained to the point of collapse … because we’re not managing the ongoing pandemic in a smart way,” Longhurst said. Horgan said Tuesday that health care is the main cost driver for provincial and territorial budgets, so there is no debate about what they would do with additional resources. But there are different priorities in each jurisdiction, and one province with an aging population may focus more on long-term care than another, he said. He also said premiers are happy to talk about possible conditions attached to federal money, but they must first meet the prime minister in person. Horgan, who chairs the council of premiers, said he wrote to Trudeau in December and April with a proposal on how to start the project, but had not heard back. Trudeau told media he doesn’t think any of his predecessors have met with prime ministers about health care as much as in the past two years, and leaders will continue to work together to address “strains” on the system. “The federal government will be there to invest in health care, but we’re going to make sure those investments pay off for Canadians,” he said. Health Minister Jean-Yves Duclos outlined the federal government’s five priority areas during a speech in March: tackling staff shortages and delays in diagnosis, treatments and surgeries; access to family health services; long-term care and home care; mental health and substance use; and health data and virtual care. Horgan, along with Alberta Premier Jason Kenney and others, said they have not seen the possible conditions Ottawa might want to attach to the funds. Nova Scotia Premier Tim Houston said none of the provinces and territories are trying to “smoke a health care budget and divert money somewhere else” and the only thing holding back progress is a lack of discussions with Ottawa. Premiers want the federal government to increase its share of long-term health funding to 35%, from what they said was 22%. Trudeau said Ottawa has added $72 billion in health care funding over the past two years, on top of the tens of billions provided through the Canada Health Transfer. Longhurst said cuts to federal health transfers predate the Trudeau government and it’s reasonable for prime ministers to ask for more. But significant opportunities for improvement lie in overhauling outdated models and structures that underpin the way health care services are delivered, and that goes beyond spending more money, he said. The fee-for-service system of the 1960s in which doctors and surgeons essentially run their own business while being paid with public dollars is an example of an outdated model that hinders improvements in patient care, Longhurst said. “We have other models that are much more aligned with those system goals of improving access and improving the ability for teams to work together (and) have better support that’s not just about medical intervention, but prevention and management of chronic diseases etc.,” he said. The effects of growing inequality and social determinants of health, such as housing insecurity and poverty, should not be left out of the discussion, he added. Canada is not spending at the same level as many of its peer countries on social supports that are proven to contribute to improved health outcomes, he said. “We know that over generations, these investments pay real dividends.”
