Antonia Maioni highlights significant changes in Canadian health care that resulted from Commissions and reports between 1997 and 2008. —Produced as part of the MUHC-ISAI's 2008 program

Recommendations from key healthcare commissions

1997 National Forum on Health

• preserve public funding and single payer model

• expand public funding to include home care and drugs

• reform primary care

• establish transition fund to support pilot projects

• increase information and research to enable evidence-based decision-making

1998 Barer-Stoddart projections reassessed

Reassessment of Barer-Stoddart physician supply projections of 1991 which had prompted a 10% decrease in medical school enrollment) raises concerns about physician shortages

2000 Ontario Health Services Restructuring Commission (Duncan Sinclair, Chair)

• restructure Ontario’s hospitals, close many

• make other parts of health care work like a system

• develop health information management system

• implement a new model of primary health care

2001 Clair Commission in Québec (Michel Clair, Chair)

• family practice groups to provide 24/7 service

• loss of autonomy insurance fund

• allow private clinics to provide services to hospitals

• emphasize merit as well as seniority in health sector contracts

• establish body to define basket of insured services

2001 Commission on Medicare in Saskatchewan (Kenneth Fyke, Chair)

• 24/7 access to primary care

• district contracting with specialists

• establish quality council

• reduce number of regional health authorities

2002 Premier’s Advisory Council on Health for Alberta (Donald Mazankowski, Chair)

• provide time guarantees for health services

• redefine comprehensiveness for publicly insured services

• establish multi-year contracts between government and regions

• blend of public, private and not-for-profit service delivery

• allow regional health authorities to raise additional revenue

2002 Committee of the Senate of Canada (Senator Michael Kirby, Chair)

• enact a health care guarantee to ensure patients receive treatment within a specified maximum time

• expand public health care insurance to include coverage for catastrophic prescription drug costs, post-hosp?ital and palliative home care

• strengthen federal contribution to health care technology, health system evaluation, human resources and academic health science centres

• federal use of incentives and/or penalties to encourage country-wide standards

• continued adherence to efficient and effective universal health care insurance

2002 Royal Commission (Roy Romanow, Chair)

• common declaration of commitment to universally accessible, publicly funded health care system

• establish Health Council of Canada to provide national leadership

• modernize CHA to expand insured services to include home care, drugs, diagnostic services

• include dispute resolution mechanism in CHA

• make dedicated funding contingent on respect for CHA principles

• include a built-in escalator and immediate booster funding in the CHST

• implement catastrophic drug coverage

• form a national drug agency to evaluate and approve new drugs

• form an Aboriginal Health partnership

• protect public health services in trade agreements

2006 Alberta Health Policy Framework released (Premier Ralph Klein)

• expand choice in both public and private delivery systems

• use private facilities in training

• replace prohibitions on doctors opting out

• promote flexibility in scope of practice

• base compensation models on health outcomes and quality indicators

• revise services that are publicly funded

2008 British Columbia’s Conversation on Health (Premier Gordon Campbell)*

*as reported in Throne Speech health reform vision

• commitment to single public payer

• private and public service delivery

• tie funding to performance and encourage competition between service providers

• create tax sheltered Independent Living Savings Account for future home care and supportive housing needs

• expand scope of practice for nurses and pharmacists

• clarify certification of health professionals and create restricted license category

• establish Safety Councils and Quality Review boards in each region

2008 Québec working group on health care financing (Claude Castonguay, Chair)*

*with Joanne Marcotte (ADQ) and Michel Venne (PQ)

• systematically review what is publicly covered

• accelerate 24/7 access to primary care

• allow physicians to work in public and private care, within certain limitations

• provide home care for frail elderly on means-tested basis

• disengage government from health care provision and empower regions to become purchasers of services

• replace global budgets by service-based formula for hospitals

• increase workplace dynamism

• impose a means-tested annual fee based on health care utilization

• use 1% of Québec sales tax for health care

• creation of National Institute for Excellence in Health to assess new drugs and technologies

Actions resulting from key healthcare commissions

1994 Canadian Institute for Health Information

An independent not-for-profit organization that collects data from hospitals, regional authorities, medical practitioners and government, and reports on health care services, health spending, health human resources and population health. Its Board of Directors represents federal and provincial health ministries, Statistics Canada, health regions and institutions, and academe.

2000 Federal/Provincial/Territorial (FTP) Health Accord

• increases Canadian Health and Social Transfer (CHST) after 5 years of cuts

• dedicates new funding to medical equipment, health IT, the Health Transition Fund and pilot projects in primary care reform

2000 Alberta Health Care Protection Act (Bill 11)

• defines how insured services can be provided by hospitals or designated surgical facilities

• opens door to regions contracting (with Minister’s approval) from private sector

2003 Creation of Patient Safety Institute

The Institute is founded after the Baker-Norton report on patient safety, “Patient Safety and Healthcare Error in the Canadian Healthcare System,” revealed the extent of adverse events and related deaths. Dr. John Wade becomes Founding Chair. Funded by Health Canada, it has the mandate to build and advance a safer healthcare system in Canada. The goal is to achieve a measurable reduction in the rate of adverse events patients experience under the care of the Canadian healthcare system.

2003 First Ministers’ Accord on Health Care Renewal

• establishes a Health Reform Fund to support primary health care, home care and catastrophic drug coverage

• increases general funding and directed funding for diagnostic and medical equipment, EHRs and telehealth equipment

• performance indicator working group established by provinces, territories, Statistics Canada, CIHI and Health Canada

2003 Health Council of Canada

Created as a non-profit agency funded by Health Canada to monitor provisions of the 2003 Accord on Health Care Renewal. Michael Decter becomes Founding Chair. Members of the Council are the ministers of health of the participating jurisdictions. The Governments of Alberta and Québec are not members of the Health Council of Canada. The Health Council of Canada monitors the provisions of the 2003 Accord on Health Care Renewal and the 2004 10-Year Plan to Strengthen Health Care and provides constructive advice on how to improve health care access, quality, effectiveness and population health.

2004 First Ministers’ Accord “10-year Plan to Strengthen Health Care”

• provides new federal money for wait time reduction, indicator development, benchmark wait time development, medical equipment, aboriginal health and to speed progress on home care and catastrophic drug coverage

• demands from provinces meaningful reductions in wait times for specific areas

• demands plans for provincial coverage of short-term acute home care, as well as affirmation of provincial support for the principles of the CHA and the single-payer system

• the CHST becomes the Canada Health Transfer (CHT), with base funding set above amounts recommended by Romanow and an annual escalator of 6%

2004 Wait Times Alliance

Established to track progress on wait time reductions. Several national medical specialty societies committed to issuing an annual report card and provide governments with advice, from the physicians’ perspective, on medically acceptable wait-time benchmarks in the 5 priority areas.

2004 Ontario Commitment to the Future of Medicare Act

Its most important effect is to prohibits physicians from opting out of the public system, with a few exceptions.

2005 Chaoulli Decision

The Supreme Court of Canada rules than Québec’s ban on private health insurance for medic?ally necessary services violates provincial human right law: “Access to waiting lines is not access to care.”

2006 Alberta Health Policy Framework

• rejected by Albertans

• attracts warnings from Federal Health Minister Tony Clement that allowing dual practice jeopardizes the accessibility requirement of the CHA

2006 Québec passes Bill 33

• allows the private sector to supplement public services without additional costs to patients

• allows limited involvement of private insurance for specified services

• allows private medical centres to act as providers of service for hospitals

• describes a framework for specialized private medical centres under which services can be provided by opted-in or opted-out physicians