How health wait times fell off the Harper government’s radar

The Conservatives’ response is dead on arrival

Lucas Oleniuk/Toronto Star/Getty Images

Lucas Oleniuk/Toronto Star/Getty Images

Last week, as Stephen Harper’s Conservatives marked eight years since their rise to power, the Health Council of Canada delivered what seemed to be a rather inconsiderate anniversary gift. The council released a report that placed Canada dead last, among 11 prosperous countries surveyed, when it comes to how quickly patients can get an appointment with a regular family doctor. Faced with that news, Rona Ambrose, the federal health minister, issued a statement pledging to “continue to work with the provinces and territories on reducing health wait times.” But John Abbott, the council’s chief executive officer, described the Harper government’s level of engagement on the problem as “close to zero.”

It wasn’t always that way. Back in the early months of the Harper government in 2006, reducing wait times featured prominently among the new Prime Minister’s five top priorities. The others—lower taxes, safer streets, better accountability, stronger families—all, arguably, still rank today as major Tory themes. But wait times? After an initial injection of $1 billion—largely to encourage provinces to set “wait-times guarantees” for selected surgeries and health services—the federal government hasn’t followed up with anything significant. “They don’t want to take the political heat for areas that are failing to perform,” says Dr. Howard Ovens, a member of the Canadian Association of Emergency Physicians’ public affairs committee.

His suspicion that Ottawa has retreated because quick access to health services is notoriously hard to guarantee—and voters tend to feel deep frustration over long waits—fits with a certain view of Conservative strategy. Decisive moves were possible on all the other top priorities Harper flagged back in his early days in office. Cut the GST, outlaw corporate and union donations to political parties, impose longer jail time for certain crimes, pay parents $100 a month per kid—easy-to-understand measures such as these were implemented swiftly. Changing the way doctors and hospitals deliver services is far messier, and it’s mainly a provincial responsibility, anyway. Harper, who declines to even meet the premiers as a group, has shown no appetite for tackling problems that would force him to try coaxing them into agreement.

Still, his early work on wait times looked like the beginning of something. Starting in 2007, Harper paid the provinces $612 million over three years to try guaranteeing a reasonable wait for a sample procedure. For instance, British Columbia promised radiation therapy within eight weeks; Newfoundland, bypass surgery within 26 weeks. The money ran out in 2010. Today, the Conservative party’s website doesn’t even mention that short-lived project in a list of 11 actions the government has taken on health, from promoting healthy eating to encouraging doctors to practise in remote areas. There are other signs the Tories aren’t eager to draw attention to any federal role in the most intractable health care problems. The Health Council of Canada, which was set up in 2003 by the then-Liberal government, as part of the follow-up to the Romanow commission on the future of health care in Canada, is shutting down after the Harper government cut off its $6 million a year in funding.

As the council’s head, Abbott is predictably unhappy about winding it up. He argues that the council played a unique role in pressing not only the federal and provincial governments, but also the powerful doctors’ associations and hospital lobby, to take action on sometimes controversial files. For instance, the council urged politicians to pursue a national pharmaceuticals strategy that would give Canadians catastrophic drug coverage—a push the Harper government certainly didn’t welcome. This month, the council is selling off the furniture from its Toronto headquarters. It formally ceases operations at the end of March. Key statistics will continue to be gathered and reported on by the Canadian Institute for Health Information, but the institute doesn’t have the council’s mandate to propose reforms based on those data.

Even though doctors tend to forge closer links to provincial health ministries, their lobby groups often favour the federal government taking on a bigger role. Ovens says there has been some progress in shortening waits over the past decade or so, but success tends to be uneven across the country, sometimes following what he calls a “whack-a-mole” pattern that sees provinces addressing whatever type of surgery or service has most recently drawn negative media attention. When it comes to emergency services, Ovens’s specialty, he argues that the feds are best positioned to set national goals. “There is a coordinating role they could play,” he says, “just bringing everyone together and chairing a forum on how we are going to report this stuff, what we are going to set as the targets.”

Ovens says the federal government could go further than just serving as a coordinator, by requiring provinces to meet targets to qualify for some funding for access to care through emergency departments. The concept of transfer payments tied to performance is contentious. Still, the College of Family Physicians of Canada urged just that in a sweeping 2011 policy paper, calling for new strings to be attached to federal health transfers to the provinces. “Unlike past agreements,” the family physicians’ group said, “these health care funding agreements must include clear accountability provisions, with the requirement that each jurisdiction eligible to receive funds must meet explicitly defined targets.”

Dr. Francine Lemire, chief executive of the College of Family Physicians, says Canadians view health care as part of their shared identity, so they aren’t satisfied with provinces being left alone to set standards. “We believe there’s a need for a federal leadership role,” Lemire says. Ovens argues that, without Ottawa playing an active part, provinces tend to lose sight of each other. “A lot of provinces are making the same mistakes and not learning from each other,” he says. “We’re not asking the feds to start delivering health programs; we’re asking that there be some leadership shown in trying to learn the right lessons from what’s happening provincially and to get us rolling in the right direction.”

But Health Minister Ambrose’s officials defend Health Canada’s record in providing practical help that filters down to the provincial level. They point out that the federal government has provided $900 million since 2006 to what’s called the Canada Health Infoway, to allow provinces and territories to invest in electronic health information and communication technologies, including health records, which are often cited as vital to improving efficiency and cutting wait times. As well, the Canadian Institute for Health Information is getting $239 million in federal funding over three years to keep building up reliable, comparable data about the health care system across the country, including wait times, which also helps health managers pinpoint successes and failures.

Worthy as those initiatives might be, though, they hardly rise to the lofty level that Harper set back in 2006. “In this country, there is a deal between the state and its citizens,” he said in the House that spring, after delivering his ?rst agenda-setting Speech from the Throne. “If they pay their taxes into a public insurance system, they are supposed to get necessary medical treatment when they need it.” He promised “to act right away to make things better and faster.” That $1-billion, three-year payment to provinces for experiments with wait-times guarantees was packaged as fulfilling his commitment. Canadians who caught the news last week that they wait longer than patients in 10 other comparable countries just to see a family doctor might wonder why this particular policy challenge has fallen off the federal radar.


How health wait times fell off the Harper government’s radar

  1. I dont even need to read most of this article, I am this article. We are slowly and painfully dismantling one of the most important treasures that our Canadian society that has endured until we elected a reform party(harper)to government. When is Canada going to elect a leader who will represent all segments of our country, not just one part of it. This is a big nation and everyone should be included.

  2. I thought healthcare was a provincial responsibly………..

    • That’s if your a conservative.

      • That’s if you read The Constitution Act, 1982, an act of Parliament.

        • The delivery of healthcare falls to the provinces; however the provinces are expected to deliver the services within the provisions of the Canada Health Act, including all of its five basic principles of universality, accessibility, portability, administration and comprehensiveness. Failing to provide timely surgeries would fall into accessibility.

    • Your right, so why do we have to pay salaries, bonus, pensions, health insurance, vacations, etc. etc. etc. to a minister, a ton of executives and public servants at Health Canada if they are worthless.

  3. Mostly because this is a provincial responsibility not the Federal government’s job. I’m sure the provinces want the feds involved so that they can squeeze money out of the feds for ‘projects to improve wait times” (we have heard that for the last 25 years), but at the end of the day, health care is delivered by the provinces and the provinces need to address wait times.

    And voters need to focus their anger at provincial politicians!

    • So then why was Mr. Harper promising to butt into provincial business? Did you support that at the time?

      • Easy and popular promise to make. Easy to ignore once in power. All federal governments do it. Just like Paul Martin giving big Health Transfers to the provinces absolving his government of any blame, and Harper continuing to do the same (“hey, we gave the provinces the cash, blame them.”)

        • I’m actually looking more for an answer from the account Maureen55, as her defence of the federal government comes either with a helping of hypocrisy for herself or an acknowledgement that the Harper Conservatives are hypocrites.

          • I believe it is also based on a lack of knowledge about the Canada Health Act, and how healthcare services are provided in our country. That, and a bald kneejerk defense of anything critical of the harper regime. Because timely health care for the plebes doesn’t matter as much as defending Our Glorious Leader.

            You know, some high school courses in our how our nation and provinces work together, our governance, might be a good idea.

  4. I know how to decrease wait times, easy!
    All those who voted conservative automatically wait until all others are seen first. After all, since the conservative platform is easy to see, all conservatives must agree with it and therefore should be happy to support their party… right?

  5. I have been a family doctor for over 30 years. Every day I see same day appointments. There are empty slots in my schedule for that, and even if I am fully booked, those who need to be seen (like sick kids) get seen. I take 2 one week vacations each year. Sometimes I see patients in the evening. In my experience, if one of my patients really needs to see a specialist, I merely have to speak to the specialist personally. I have only been refused a handful of times in 30 years. If a patient is sick, they will get seen promptly.

  6. Why not just pass a piece of legislation entitled the “wait times have decreased dramatically act?” Doesn’t matter the actual content.

    That should fix the problem, much as the “accountability act” did and the “fair elections act” might very well.

  7. They fell off of Martin’s radar too.

  8. Involvement in the health portfolio by this government does not serve their aim to privatize health care.

    • Exactly. Dear Leader wants to suffocate the system before he brings in privatization legislation.

  9. “Changing the way doctors and hospitals deliver services is far messier, and it’s mainly a provincial responsibility, anyway.”

    Here in Ontario the McGuinty/Wynne government have increased our OHIP (medical payments) by the largest tax increase Ontarion has ever had.
    The result has been like the rest of their numerous boondoggles longer wait times and poorer service at the Family Doctor level and most surgeries.
    Transfer payments to any ‘have not’ provinces which now include Ontario should include Health Care Availability.
    Why do the likes of France, England, Germany who have had challenges in their Health care Systems continue to improve over the past 20 years while Canadian Provinces services decline?
    This article likes to blame the Feds but it is the provinces that have really dropped the ball-rather sickening; actually.

    • It takes 6-12 years of education after a Bachelor degree to train a doctor. Governments of all stripes have for years systematically controlled the number of places in our medical schools in the delusional belief that will manage costs. There is no shortage of dentists or pharmacists or other health professionals because there is no government meddling. There is only the law of supply and demand, which works perfectly. European countries have a parallel private system to compete with the public system, so it`s not a fair comparison. My proposed solution: 1- double the number or places in medical schools across Canada immediately – there are plenty of qualified candidates. 2- For the public system, offer doctors a salary and benefits and performance bonuses commensurate with their expertise and training instead of a complicated fee for service structure as exists now, 3- Cover and manage their practices environment, staff and expenses. 4- Let a parallel private sytems develop and compete with the public sector and let the best man win. Competition is good, not to be feared. 5- Break down hospital budgets to determine what portion is actual direct medical costs and what are indirect administrative costs. Presently you cannot ascertain this. Let me assure you that we would find that administrative costs have gone completely out of control (close to 40% of the total budget I`ll bet, but no one really knows). 6- Have a co-pay for all services except in hospital treatment which should be free. Free access leads to abuse. Of course none of this or other solutions will happen. There is too much vested interest in the status quo.

  10. I don’t understand why wait times are Harper’s responsibility. Of course this might have something to do with their ire. “On April 8, 2013, the federal Minister of Health wrote a letter to the Health Council of Canada’s Corporate Members to inform them that, as
    part of the deliberations on the 2013 federal budget, the government decided to wind down funding for the Council. In light of this announcement, the Health Council will operate as usual for the 2013-14 fiscal year and will wrap-up its operations early in 2014-15.”

    There is no point in a Health Council of Canada if non of the provinces care what they have to say. The Feds gave the provinces money to improve wait times. Obviously this has gone into the black hole of healthcare spending. Any interference by the Feds in provincial affairs is seen to be meddling.

  11. …and what happened to the health wait times under Paul Martin’s radar, it suddenly vanished on his Mad As Hell Cross Country Tour.

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