2003 First Ministers' Accord on Health Care Renewal1
Factsheets
News Release
Other Related Information
In September 2000, First Ministers agreed on a vision,
principles and action plan for health system renewal. Building from
this agreement, all governments have taken measures to improve the
quality, accessibility and sustainability of our public health care
system and all have implemented important reforms. Federal and
provincial/territorial governments have also commissioned a number
of task forces and studies that reflect the views of Canadians.
These studies reflect a great convergence on the value of our
publicly funded health system, the need for reform, and on the
priorities for reform: particularly primary health care, home care,
catastrophic drug coverage, access to diagnostic/medical equipment
and information technology and an electronic health record.
Canadians want a sustainable health care system that provides
timely access to quality health services. They recognize that
reform is essential, and they support new public investments
targeted to achieve this goal.
This Accord sets out an action plan for reform that reflects a
renewed commitment by governments to work in partnership with each
other, with providers, and with Canadians in shaping the future of
our public health care system.
A Commitment to Canadians
Canadian values are reflected in the five principles of public
health insurance: Universality, Accessibility, Portability,
Comprehensiveness and Public Administration. First Ministers
reaffirm their commitment to these principles. They also commit to
enhancing the transparency and accountability of our health care
system while ensuring that health care remains affordable.
Drawing from this foundation, First Ministers view this Accord
as a covenant which will help to ensure that:
- all Canadians have timely access to health services on the
basis of need, not ability to pay, regardless of where they live or
move in Canada;
- the health care services available to Canadians are of high
quality, effective, patient-centred and safe; and
- our health care system is sustainable and affordable and will
be here for Canadians and their children in the future.
First Ministers believe that the initiatives set out in this
Accord will result in real and lasting change. The ultimate purpose
of this Accord is to ensure that Canadians:
- have access to a health care provider 24 hours a day, 7 days a
week;
- have timely access to diagnostic procedures and
treatments;
- do not have to repeat their health histories or undergo the
same tests for every provider they see;
- have access to quality home and community care services;
- have access to the drugs they need without undue financial
hardship;
- are able to access quality care no matter where they live;
and
- see their health care system as efficient, responsive and
adapting to their changing needs, and those of their families and
communities now, and in the future.
All governments have made significant investments in health care
since the First Ministers' agreement of September 2000. First
Ministers agree that public health care in Canada requires more
money, but that money alone will not fix the system. While all
jurisdictions are making progress on health reform, First Ministers
agree that significant new investments must address immediate cost
pressures and the reforms necessary to achieve timely access to
quality care in a sustainable manner. The federal government will
continue to work with territorial governments to address their
unique challenges.
A Plan for Change: A new Health Reform Fund for Primary Health
Care, Home Care and Catastrophic Drug Coverage
First Ministers agree that additional investments in primary
health care, home care and catastrophic drug coverage are needed
for a long-term sustainable public health care system in Canada.
The federal government will create a 5 year Health Reform Fund
which will transfer resources to the provinces and territories to
address these three priorities. Recognizing that provinces and
territories are at differing stages of reforms in these areas, the
Fund will provide the provinces and territories the necessary
flexibility to achieve the objectives set out below. Premiers and
Territorial Leaders agree to use the Health Reform Fund to achieve
these objectives. Therefore, these funds to be transferred to the
provinces and territories will be available for any of the programs
described within the Health Reform Fund, at their discretion.
Achievement of the objectives of the Health Reform Fund by a
province or territory will allow use of any residual fiscal
resources in the Fund for other priority areas of their own health
system.
The Government of Canada will establish a new long-term Canada
Health Transfer (CHT) by March 31, 2004. It will include the
portion of the current CHST (both cash and tax points)
corresponding to the current proportion of health expenditures in
provincial
social spending supported by this federal transfer. In
establishing the CHT, the federal government will ensure
predictable annual increases in health transfers.
Subject to a review of progress toward achieving the agreed-upon
reforms and following a First Ministers' Meeting, by March 31,
2008, the federal government will ensure that the level of funding
provided through the Health Reform Fund is also integrated into the
CHT.
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Primary Health Care: Ensuring Access to the Appropriate
Health Provider When Needed
The key to efficient, timely, quality care is primary health
care reform. First Ministers agree that the core building blocks of
an effective primary health care system are improved continuity and
coordination of care, early detection and action, better
information on needs and outcomes, and new and stronger incentives
to ensure that new approaches to care are swiftly adopted and here
to stay.
First Ministers agree that the ultimate goal of primary health
care reform is to provide all Canadians, wherever they live, with
access to an appropriate health care provider, 24 hours a day, 7
days a week. Towards this goal, First Ministers agree to
immediately accelerate primary health care initiatives and to make
significant annual progress so that citizens routinely receive
needed care from multi-disciplinary primary health care
organizations or teams. First Ministers agree to the goal of
ensuring that at least 50% of their residents have access to an
appropriate health care provider, 24 hours a day, 7 days a week, as
soon as possible and that this target be fully met within 8 years.
First Ministers agree that each jurisdiction will publicly set out
its own multi-year targets for verifiable progress towards
achieving this objective.
Home Care for Canadians
Improving access to a basket of services in the home and
community will improve the quality of life of many Canadians by
allowing them to stay in their home or recover at home. First
Ministers direct Health Ministers to determine by September 30,
2003, the minimum services to be provided. Such services provided
in the home can be more appropriate and less expensive than acute
hospital care. To this end, First Ministers agree to provide first
dollar coverage for this basket of services for short-term acute
home care, including acute community mental health, and end-of-life
care. First Ministers agree that access to these services will be
based on assessed need and that, by 2006, available services could
include nursing/professional services, pharmaceuticals and medical
equipment/supplies, support for essential personal care needs, and
assessment of client needs and case management. The Government of
Canada will complement these efforts with a compassionate care
benefit through the Employment Insurance Program and job protection
through the Canada Labour Code, for those who need to temporarily
leave their job to care for a gravely ill or dying child, parent or
spouse.
Catastrophic Drug Coverage and Pharmaceuticals Management
First Ministers agree that no Canadian should suffer undue
financial hardship for needed drug therapy. Accordingly, as an
integral component of these reforms, First Ministers will take
measures, by the end of 2005/06, to ensure that Canadians, wherever
they live, have reasonable access to catastrophic drug
coverage.
As a priority, First Ministers agree to further collaborate to
promote optimal drug use, best practices in drug prescription and
better manage the costs of all drugs including generic drugs, to
ensure that drugs are safe, effective and accessible in a timely
and cost-effective fashion.
Reporting
First Ministers agree to prepare an annual public report to
their citizens on each of the above three areas commencing in 2004.
They further agree to use comparable indicators and to develop the
necessary data infrastructure for these reports. This reporting
will inform Canadians on progress achieved and key outcomes. It
will also inform Canadians on current programs and expenditures,
providing a baseline against which new investments can be tracked,
as well as on service levels and outcomes.
A Plan for Change: Diagnostic/Medical Equipment Fund
Enhancing the availability of publicly-funded diagnostic care
and treatment services is critical to reducing waiting times and
ensuring the quality of our health care system. To this end, First
Ministers agree to make significant new investments, including
support for specialized staff training and equipment, which improve
access to publicly funded diagnostic services. The Government of
Canada will establish a Diagnostic/Medical Equipment Fund for that
purpose.
Commencing in 2004, First Ministers agree to report to their
citizens on an annual basis on enhancements to diagnostic and
medical equipment and services, using comparable indicators, and to
develop the necessary data infrastructure for these reports. This
reporting will inform Canadians on progress achieved and key
outcomes. It will also inform Canadians on current programs and
expenditures, providing a baseline against which new investments
can be tracked, as well as on service levels and outcomes.
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A Plan for Change: Information Technology and an Electronic
Health Record
Improving the accessibility and quality of information is
critical to quality care, patient safety and sustainability,
particularly for Canadians who live in rural and remote areas.
Better use of information technology can also result in better
utilization of resources. First Ministers agree to place priority
on the implementation of electronic health records and the further
development of telehealth applications which are critical to care
in rural and remote areas. The Government of Canada will provide
additional support for Canada Health Infoway to achieve this
objective. First Ministers are also committed to the appropriate
protection of personal information in building a national system of
electronic health records.
Canada Health Infoway will report to the Canadian public and to
the members of Infoway, who are Deputy Ministers of Health of
federal/provincial/territorial governments, on an annual basis on
its progress in implementing these initiatives. This reporting will
inform Canadians on current programs, investment expenditures and
milestones.
Additional Reform Initiatives
The adoption of innovations and the sharing of best practices by
health care providers and managers is critical to making health
care more efficient and improving its quality. First Ministers
commit to accelerate collaborative work on priority issues with
respect to patient safety, health human resources, technology
assessment, innovation and research, and healthy living. The
federal government is committed to providing funding in support of
this work.
Building from this, First Ministers direct Health Ministers to
work on the following:
Patient Safety
The implementation of a national strategy for improving patient
safety is critical. Health Ministers will take leadership in
implementing the recommendations of the National Steering Committee
on Patient Safety.
Health Human Resources
Appropriate planning and management of health human resources is
key to ensuring that Canadians have access to the health providers
they need, now and in the future. Collaborative strategies are to
be undertaken to strengthen the evidence base for national
planning, promote inter-disciplinary provider education, improve
recruitment and retention, and ensure the supply of needed health
providers (including nurse practitioners, pharmacists and
diagnostic technologists).
Technology Assessment
Managing new technologies and treatments is critical to ensuring
that our health system remains relevant to the evolving needs of
Canadians. Health Ministers are directed to develop, by September
2004, a comprehensive strategy for technology assessment which
assesses the impact of new technology and provides advice on how to
maximize its effective utilization in the future.
Innovation and Research
Applied research and knowledge transfer are essential to
improving access and the quality of care. The work of academic
health centres is vital in developing new approaches for the
collection of information and evidence needed to improve care.
Healthy Canadians
An effective health system requires a balance between individual
responsibility for personal health and our collective
responsibility for the health system. Coordinated approaches are
necessary to deal with the issue of obesity, promote physical
fitness and improve public and environmental health. First
Ministers direct Health Ministers to continue their work on healthy
living strategies and other initiatives to reduce disparities in
health status. First Ministers further recognize that immunization
is a key intervention for disease prevention. They direct Health
Ministers to pursue a National Immunization Strategy.
Aboriginal Health
First Ministers recognize that addressing the serious challenges
that face the health of Aboriginal Canadians will require dedicated
effort. To this end, the federal government is committed to
enhancing its funding and working collaboratively with other
governments and Aboriginal peoples to meet the objectives set out
in this Accord including the priorities established in the Health
Reform Fund. Governments will work together to address the gap in
health status between Aboriginal and non-Aboriginal Canadians
through better integration of health services.
First Ministers direct Health Ministers to consult with
Aboriginal peoples on the development of a comparable Aboriginal
Health Reporting Framework. They further agree to consult with
Aboriginal peoples in this effort, to use comparable indicators,
and to develop the necessary data infrastructure. This reporting
will inform Canadians on progress achieved and key outcomes. It
will also inform Canadians on current programs and expenditures,
providing a baseline against which new investments can be tracked,
as well as on service levels and outcomes.
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Reporting to Canadians on Change
First Ministers agree that Canadians are entitled to better and
more fully comparable information on the timeliness and quality of
health care services. Enhanced accountability to Canadians and
improved performance reporting are essential to reassuring
Canadians that reforms are occurring. To this end, First Ministers
agree that:
- each jurisdiction will report to its constituents on its use of
all health care dollars spent on an annual basis;
- each jurisdiction will continue to provide comprehensive and
regular public reporting on the health programs and services it
delivers as well as on health system performance, health outcomes
and health status;
- these reports will include the indicators set out in the
September 2000 communique as well as additional comparable
indicators, to be developed by Health Ministers, on the themes of
quality, access, system efficiency and effectiveness based on Annex
A of this Accord; and
- jurisdictions will develop the necessary data infrastructure
and collect the data needed for quality reporting.
This will enable the development of nationally comparable
information for Canadians on the themes of access, quality, system
efficiency and effectiveness and on reform priorities and
objectives set out in this Accord.
First Ministers recognize that Canadians want to be part of the
implementation of this Accord. Accordingly, they agree to establish
a Health Council to monitor and make annual public reports on the
implementation of the Accord, particularly its accountability and
transparency provisions. The Health Council will publicly report
through federal/provincial/territorial Ministers of Health and will
include representatives of both orders of government, experts and
the public. To fulfill its mandate, the Council will draw upon
consultations and relevant reports, including governments' reports,
the work of the Federal/Provincial/Territorial Advisory Committee
on Governance and Accountability and the Canadian Institute for
Health Information (CIHI). Health Ministers will establish the
Council within three months. Quebec's Council on Health and
Welfare, with a new mandate, will collaborate with the Health
Council.
Annex A to Accord
Performance Indicators
First Ministers direct Health Ministers to develop further
indicators to supplement the work undertaken in follow-up to the
September 2000 Communique. This work is to be completed by
September 2003, following review by experts and stakeholders, to
ensure these new indicators measure progress on achieving the
reforms set out in this Accord and meet the following
objectives:
- Timely Access: the measurement of access to essential services
across the country as well as waiting times;
- Quality: the measurement of quality of health care services
across the country, including patient safety, patient satisfaction
and health outcomes;
- Sustainability: including measurements of the state of health
human resources, equipment, information systems and value for money
from the system; and
- Health Status and Wellness.
Ministers are to consider the following:
Timely Access Indicators
Access to health care providers/services
- % of population having a regular family doctor (FMM 2000)
- % of doctors accepting new patients
- number of multi-disciplinary primary health care organizations
or teams by region (rural/urban)
- % of population having access to 24/7 primary care provider
(e.g, nurse practitioner, doctor)/telehealth/online health
information
- % of population routinely receiving needed care from a
multi-disciplinary primary health care organization or team
- % of population with public coverage of core set of home care
services
Wait Times/Volume measures for
- radiation therapy for breast and prostate cancer, cardiac
bypass surgery, hip and knee replacement surgery (FMM 2000)
- referral to specialists for cancers (lung, prostate, breast,
colo-rectal), heart and stroke
- emergency rooms from entry to discharge (seasonally
adjusted)
- diagnostic tests (MRI, CT)
- from referral to provision of first home care service
- waiting period before being eligible for public coverage of
home care services in another jurisdiction
- proportion of services/facilities linked to a centralized
(provincial/regional) wait list management system for selected
cancers and surgeries, referral to specialists, emergency rooms and
diagnostic tests (all of the above wait time indicators)
Catastrophic Drug Coverage
Quality Indicators
Patient Safety
- reported medical error/events (e.g., disease surveillance,
adverse drug reactions) - to be determined by proposed Institute on
Patient Safety
Patient Satisfaction (FMM 2000)
- overall health care services
- hospital care
- physician care
- community-based health care
- telehealth/online information
Health Outcomes
- readmissions for selected conditions
- AMI, pneumonia (FMM 2000)
- congestive heart failure, GI haemorrhage
- mortality rate for cancers (FMM 2000)
- survival rate for cancers (FMM 2000)
Sustainability (Efficiency and effectiveness) Indicators
Health Human Resources
- age distribution of practicing providers by area of
specialty
- number of providers (by specialty) leaving/entering the system
each year
- a 10-year rolling forecast of providers expected to enter
system (trained in Canada, incoming from other countries)
Equipment
- number and types of equipment installed
- number of diagnostic professionals to operate equipment
- volume flow/wait times for MRI, CT (covered under access
indicators)
Information Systems
- progress on building information systems
- degree of standardization of information collected and shared
for evidence-based decision-making
- degree of technology utilization based on evidence
Value for Money - qualitative indicators primarily
- annual health reports on plans and priorities reported by every
jurisdiction
- expenditures linked to reform areas (link inputs to
outputs)
- lessons learned and best practices shared within and between
provinces/territories
- comparisons of productivity measures
Health Status and Wellness
- % of Canadians engaged in physical activities
- % of Canadians with recommended Body Mass Index (BMI)
- Potential years of life lost (PYLL)
- Disability-Free Life Expectancy (DFLE)
- Cost of Illness
1Nothing in this document shall be construed to derogate from the respective governments' jurisdictions. This Accord shall be interpreted in full respect of each government's jurisdiction.
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