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Missed Opportunities to Encourage National Collaboration in Health Care

By Keltie Gale, Consultant at Santis Health

Despite Canada’s “universal” health care system, the care a patient receives can vary drastically between provinces. In order to achieve the equality of care that Canadians expect and deserve, provincial health systems need greater cooperation and collaboration and the federal government needs to incentivize these behaviours.

One prime opportunity for collaboration and cooperation is laid out in Dr. Danielle Martin’s recent book Better Now, Six Big Ideas To Improve Health Care for All Canadians. Big Idea Number Six speaks to the need to build systems that support the implementation of large-scale change. She points to the need for systems that will allow successful innovations to spread and scale in order to achieve better consistency across individual healthcare systems and between systems.

Acknowledging the challenges of implementation of new ideas, Dr. Martin points to three key success factors: (1) The system responsible for implementation must have the ability to track their implementation and to respond to the data; (2) they need to be bold enough to overcome entrenched interest; and (3) they need healthcare providers who are engaged in the process and who want to participate.

The Canadian Institute for Health Information (CIHI) annual report on wait times, released in March, is an example of the type of collaboration needed. CIHI can effectively collect and report this nationally standardized data because of provisions in the 2004 health accord that committed the provinces to working towards meeting wait times benchmarks for five priority procedures. In this case, CIHI is the mechanism that allows systems to track progress towards this goal.

Beyond these first five procedures, CIHI anticipates that it will have consistent reporting across the country on chemotherapy wait times for breast, colorectal and lung cancer by 2018, and six provinces have already standardized their reporting for wait times for diagnostic imaging. While these advances may seem minor, they represent growing alignment and any movement towards consistency across provinces should be seen as a success. Standardization of definitions, benchmarks and reporting can serve as the base for greater consistency of care.

Despite these modest signs of progress, the federal government has missed two major opportunities to take the bold steps needed to overcome entrenched interests and encourage greater national collaboration.

First, the recent health accord negotiations. When the negotiations among the health ministers broke down in December, the federal government pursued a different strategy. One by one, federal Minister of Health Jane Philpott and her team negotiated bilateral agreements with each province, save Manitoba with whom discussions are continuing as the province holds out for more money in key areas including healthcare in indigenous communities.

By negotiating and signing bilateral agreements with provinces individually, the Federal government missed an opportunity to rally the provinces around a common goal. Funding was directed to home care and mental health but the stipulations for this funding were negotiated province by province. While it is important to invest in these areas, the federal government could have created systems for better coordination and consistency across the country if these commitments had been made by the provinces collectively.

Second, Budget 2017. There is continued funding for CIHI and the Canadian Foundation for Healthcare Improvement along with investment in Health Canada, the Patented Medicine Prices Review Board (PMPRB), and the Canadian Agency for Drugs and Technologies in Health (CADTH). The government re-announced the specific funding agreed upon in the health accord negotiations for home care and mental health. Increased funding was directed to addressing the opioid crisis through the Canadian Drugs and Substances Strategy and its Opioid Action Plan.

While all of these federal initiatives are worthwhile, perhaps the budget is more notable for what is not there. More investments like that for the opioid crisis could have targeted other government health care priorities and helped build the necessary foundations for greater provincial collaboration.

Whether they live in the east or the west and a rural or urban area, Canadians should expect consistency in the care they receive. Agreements on wait times in 2004 were a start but Canada needs new, collective, broad, bold goals for better patient care and needs the provinces working together to achieve these goals. The federal government should have stepped up and used the health accord negotiations and the budget as platforms for working towards the equality we all expect and deserve in our healthcare systems.