On March 4, 2014, the Ministry of Health and Social Services of Québec released the report it commissioned from an expert committee in June 2013 to look at federal involvement in health and social services in Quebec. The committee was led by two former Deputy Ministers of Health, Mr. Denis Lalumière and Mr. Pierre Malouin.
The report provides a brief history of federal-provincial relations since confederation with regard to budget transfers in health and social services. It then focuses on 37 specific federally-funded initiatives since 2002 that, in the expert committee’s opinion, have an impact on Quebec’s ability to plan, organize, manage and evaluate the health and social services provided on its territory.
The authors provide the total budget for these initiatives and the proportion received by Quebec. Monies flow to the Ministry, to health establishments, community organizations, etc., as well as to third parties such as Canada Health Infoway, the Canadian Institute for Health Information (CIHI) or the Health Council of Canada. All told, the authors conclude that Quebec receives 16.3% of the average 1.39 billion/year in federal budget transfers related to health and social services. That is less than the 23,2% proportion it should receive according to its share of the Canadian population.
For each of the 37 budget transfer items, the authors present objectives, conditions attached to federal monies, and the impact on Quebec health and social services. The authors find that when priorities match those of the Quebec Ministry, federal monies benefit the Quebec population. Examples include federal transfers to contribute to wait-times reduction, the purchase of medical equipment, the provision of minority language health services and the purchase of new vaccines. The authors clearly state that these transfers have improved the health and social services network’s ability to meet the needs of Quebeckers.
However, even when they do match Quebec priorities, problems arise when federal disbursements are conditional on achieving milestones or performance measures, as in transfers to support the creation of family medicine groups or the integration of people with disabilities into the workforce. The authors state that heavy reporting and accountability burdens impede Quebec’s ability to claim this funding.
Initiatives that present the greatest problem for the expert committee are the federally-funded pan-Canadian third-party organizations. The authors describe these as attempts to play a guardianship role over health care and takes issue with the notion of a single Canadian healthcare system that these organizations represent. Four are mentioned in particular:
- The Canadian Institute for Health Information (CIHI): Quebec has had an agreement with CIHI since 2004 and benefits from some of its products and services. However the expert committee strongly objects to CIHI reporting on health system performance and making inter-provincial comparisons. The authors believe that CIHI reporting on Quebec undermines the Commissaire à la Santé et au Bien-être du Québec, which is the body mandated by the province to report to the population on the state of health and social services. The Commissaire undertakes comparative analysis of particular aspects of health system performance in collaboration with the Commonwealth Fund.
- The Health Council of Canada receives similar criticism. Created in 2004 to monitor the Health Accord governing special transfers from Ottawa, the Health Council was shut down in March 2014 after Prime Minister Harper decided not to renew the Accord.
- Infoway: While the authors state that Infoway has enabled Quebec to make progress on information and communication technology (ICT), they attribute some of the province’s inability to collect Infoway monies to the imposition of conditions that do not meet Quebec priorities, including the requirement for interoperability of ICT architecture across Canada.
- The Canadian Agency for Drugs and Technology in Health (CADTH) dates back to 2006, when it took over the responsibilities of the Canadian Coordinating Office for Health Technology Assessment (CCOHTA). While CCOHTA coordinated the assessment efforts of different provincial bodies, CADTH has further centralized operations, leaving little room for input from provincial bodies, such as Quebec’s Institut national d’excellence en santé et en services sociaux (INESSS). CADTH and INESSS maintain communication to keep each other abreast of their respective initiatives, but there is duplication and Quebec does not receive federal monies for INESSS.
These bodies receive significant funding from the federal government and the expert committee considers that Quebec, as a non- or partial participant does not receive the share it should of these expenditures. Funding to Infoway and CIHI alone accounts for over $300 million of the $830 million in federal transfers the authors consider Québec has missed out on between 2002 and 2013.
In their conclusion, the authors state they are convinced that the cohesiveness and efficiency of Quebec’s health system would be improved if the federal government simply handed over the province’s share of budget transfers and stayed out of health care. However, the details presented in their report call for a more nuanced conclusion that would preserve those programs the authors themselves say benefit Quebec’s population, and examine why problems with conditional disbursements arise and potentially even what the province might gain from inter-provincial comparisons on important quality measures.
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