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.