Canada's federal and provincial governments reach agreement over healthcare spending
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《英国医生杂志》
Canada’s Prime Minister Paul Martin, provincial prime ministers, and territorial leaders have reached a new, 10 year agreement on reforming the country’s health system that will cost the federal government $C41.2bn (￡17.7bn; $31.8bn; �26bn).
The deal promises reductions in patients’ waiting times for access to the system; an increase in the number of health professionals; some short term home care and end of life services; increased funding and reforms for northern communities; a national pharmaceuticals strategy whereby patients would be covered for illnesses that had exceptionally high treatment costs; and a new immunisation programme for children.
The initial response from the Canadian Medical Association, nurses, pharmacists, and healthcare associations was positive. The president of the Canadian Medical Association, Albert Schumacher, called it a "step in the right direction." Although his association’s proposal for a fund to reduce waiting lists was not accepted, Dr Schumacher said: "They have agreed to set national benchmarks for medically accepted waiting times in five areas and that’s a big win."
The agreement was crucial for the prime minister and his newly elected government, who had campaigned on reforming the health system "for a generation." It also produced an unexpected political bonus for Quebec’s premier, Jean Charest, whose approval ratings have been dismal recently. His winning of special status for his province in the healthcare system drew praise not just from fellow federalists but from former separatist premier Jacques Parizeau. Mr Charest called the deal a strong symbol of what it means for the people of Quebec to be part of Canada, and Mr Parizeau suggested—without perhaps intending to—that Mr Charest advanced the cause of Quebec’s separation from Canada.
Even federal Opposition Leader Stephen Harper applauded the Quebec arrangement. "All of the provinces actually have a lot of flexibility in how they implement this. Quebec has just had its flexibility enshrined in a separate agreement," he said.
During the first six years the provinces will receive $C18bn—twice what Prime Minister Martin initially offered them. In return, the federal government received agreements on accountability, including national waiting list standards. Federal health minister Ujjal Dosanjh said the benchmarks will help Canadians to see how well their system is performing.
Quebec will form its own plan on how to reduce waiting times and its own drug formulary but will still have to report on such things as benchmarks to improve waiting times, provision of home care, access to drugs, and prevention of chronic illness.
Canada’s publicly funded healthcare system was first introduced into one of Canada’s provinces when it was introduced in Saskatchewan in 1962, and most of the province’s doctors responded by going on strike to protest against "creeping socialism." Within five years, government funded health care spread across the country.
At one time, the federal government provided about a third of the money that provinces spent on health care, but record federal budget deficits in the early 1990s led to drastic cuts in transfers to provinces. By the time another former Saskatchewan premier, Roy Romanow, released his landmark report on sorting out the problems of the system in 2002 (BMJ 2002;325:1320), the federal government was providing only 16% of the total spending by the provinces on the system. Mr Romanow recommended an immediate infusion to bring the federal government’s share to 25%.
In February 2003 a new agreement promised $C13.5bn over three years, which the premiers complained was only about half what Mr Romanow had recommended.(Quebec David Spurgeon)
The deal promises reductions in patients’ waiting times for access to the system; an increase in the number of health professionals; some short term home care and end of life services; increased funding and reforms for northern communities; a national pharmaceuticals strategy whereby patients would be covered for illnesses that had exceptionally high treatment costs; and a new immunisation programme for children.
The initial response from the Canadian Medical Association, nurses, pharmacists, and healthcare associations was positive. The president of the Canadian Medical Association, Albert Schumacher, called it a "step in the right direction." Although his association’s proposal for a fund to reduce waiting lists was not accepted, Dr Schumacher said: "They have agreed to set national benchmarks for medically accepted waiting times in five areas and that’s a big win."
The agreement was crucial for the prime minister and his newly elected government, who had campaigned on reforming the health system "for a generation." It also produced an unexpected political bonus for Quebec’s premier, Jean Charest, whose approval ratings have been dismal recently. His winning of special status for his province in the healthcare system drew praise not just from fellow federalists but from former separatist premier Jacques Parizeau. Mr Charest called the deal a strong symbol of what it means for the people of Quebec to be part of Canada, and Mr Parizeau suggested—without perhaps intending to—that Mr Charest advanced the cause of Quebec’s separation from Canada.
Even federal Opposition Leader Stephen Harper applauded the Quebec arrangement. "All of the provinces actually have a lot of flexibility in how they implement this. Quebec has just had its flexibility enshrined in a separate agreement," he said.
During the first six years the provinces will receive $C18bn—twice what Prime Minister Martin initially offered them. In return, the federal government received agreements on accountability, including national waiting list standards. Federal health minister Ujjal Dosanjh said the benchmarks will help Canadians to see how well their system is performing.
Quebec will form its own plan on how to reduce waiting times and its own drug formulary but will still have to report on such things as benchmarks to improve waiting times, provision of home care, access to drugs, and prevention of chronic illness.
Canada’s publicly funded healthcare system was first introduced into one of Canada’s provinces when it was introduced in Saskatchewan in 1962, and most of the province’s doctors responded by going on strike to protest against "creeping socialism." Within five years, government funded health care spread across the country.
At one time, the federal government provided about a third of the money that provinces spent on health care, but record federal budget deficits in the early 1990s led to drastic cuts in transfers to provinces. By the time another former Saskatchewan premier, Roy Romanow, released his landmark report on sorting out the problems of the system in 2002 (BMJ 2002;325:1320), the federal government was providing only 16% of the total spending by the provinces on the system. Mr Romanow recommended an immediate infusion to bring the federal government’s share to 25%.
In February 2003 a new agreement promised $C13.5bn over three years, which the premiers complained was only about half what Mr Romanow had recommended.(Quebec David Spurgeon)