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November 3rd, 2005
Ms. Jean Crowder, MP
Nanaimo-Cowichan, BC
House of Commons
Room 446, West Block
Ottawa, Ontario, K1A 0A6
Dear Colleague,
Further to our meeting on Monday, I am forwarding to you our response to the document
you provided.
We
are pleased to be working on the issue of strengthening public health care with the NDP as it has
allowed us to accelerate work that we had already underway. For example, we insisted in the 2004
Health Accord that all provinces affirm support for the principles of the CHA and the single-payer
system. We also strengthened CHA enforcement with the establishment of the DAR. Finally, since the
Chaouilli decision by the Supreme Court of Canada we’ve been examining ways to further strengthen
our capacity to ensure the integrity of the public health care system and incent positive change
rather than the development of parallel models. The attached proposals in fact, reflect the benefit
of that work.
It should be noted that in order to address your concerns about multi-payer systems, it will be
important that rules be designed to ensure that community based clinics, such as the Group Health
Centre in Sault Ste. Marie sponsored by the United Steelworkers, or any provincial effort at ensuring
that physicians can work together to enhance their effectiveness and efficiency within the single
payer health care system, are not penalized.
I look forward to further discussion with you over the
coming days. I would also suggest that we include Health Canada officials at our next meeting.
Sincerely,
Ujjal Dosanjh
Canadian Public Health Care Protection Initiative
Preamble
Canadians cherish medicare and look to the federal government to preserve and enhance timely access
to health care on the basis of need and not ability to pay. To that end, the Canada Health Act (CHA)
was introduced in 1984 in response to the threat created by user charges and extra-billing by physicians.
CHA deductions and penalties have been taken every single year in the past ten as required, most
recently in March 2005. To address multi-payer challenges to the integrity of medicare as they have
arisen, the federal government introduced the federal policy on private clinics in 1995, is addressing
queue-jumping at private diagnostic clinics, and has formally initiated the CHA Dispute Avoidance
and Resolution process for the first time over user charges at a private surgical clinic in New Brunswick.
Noting the new challenges posed by the Chaoulli decision, the Government of Canada has chosen to
further strengthen the single payer system to meet the health care needs of Canadians, now and in
the future. This includes the work of Dr. Brian Postl in facilitating the management and reduction
of wait times - the number one health care concern of Canadians.
In addition, the Government of Canada is proposing the following actions to address the multi-payer
system, conflict of interest, reporting and enforcement.
Multi-Payer System and Conflict of Interest
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In 2004, the Government of Canada committed $41 billion for the purpose of strengthening the
public health care system by way of the 10 Year Plan to Strengthen Health Care. In that Accord,
all governments formally committed to the principles of a single payer system and access to high
quality, publicly insured, health care services based on need. The 2004 Accord embodies the principles
enshrined in the CHA.
To build on prior efforts to support the single payer public health care system, the federal
government will act as follows: where private involvement threatens the integrity of the single
payer system, the federal government will act to ensure that the terms and conditions for any
new federal dedicated funding require that these funds be spent within the public health care
system. The Government of Canada will continue to respect the terms of current transfer arrangements
including ensuring their compliance with the CHA.
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The accessibility criterion of the CHA requires that all insured physician and hospital services
be provided on an equitable basis - which the federal government defines to mean timely access
to health care for all Canadians on uniform terms and conditions. This means that timely access
to care should be based on medical need, not ability to pay. This principle was accepted by all
First Ministers in the 2004 Accord.
However, where physicians are permitted to provide the same services - in one case under the
provincial health plan and in another on a patient pay basis - a potential for conflict of interest
is created as physicians have an incentive to stream patients to their private pay practice.
The practice of physicians providing the same services on both a publicly insured and privately
paid basis (i.e., a multi-payer system) therefore could undermine access to publicly insured
services. As a result, the federal government will take action under the CHA.
The federal government will therefore interpret the CHA so as to take action against the practice
of physicians providing the same services on both a publicly insured and privately paid basis
when such practice undermines access to publicly insured services. A similar step was taken in
1995 to address the issue of facility fees at private surgical clinics, resulting in significant
deductions from federal transfers and the elimination of facility fees.
Another option for possible consideration in acting on this issue is the development of CHA information
regulations. As required under s.22(4) of the CHA, the federal Minister of Health would be required
to consult with his provincial and territorial colleagues prior to making any such regulations.
Reporting and Enforcement
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Better information is essential to reporting to Canadians on the management and performance
of their health care system. To that end, the Canadian Institute for Health Information (CIHI)
was created in 1994 and the Health Council of Canada in 2003. Through the 2004 Accord, all governments
committed to comparable performance indicators, evidence-based wait time benchmarks, and other
measures necessary to report and be accountable to their residents.
However, there is a lack of information and understanding of the role of the private sector in
Canada's health care system. In order to ensure the viability and integrity of the publicly funded
health system, and to continue to develop sound public policy, it is necessary for Canadians
and their elected representatives in the House of Commons to have a sound understanding of the
evolution of the system including the nature and role of the private sector.
Therefore, the federal Minister of Health will ask the House of Commons to consider a motion
requesting the Health Council of Canada, working with the Canadian Institute for Health Information
and Statistics Canada, to undertake analytical work on this subject and report to Canadians.
Pursuant to this resolution, the Minister of Health will write to the Health Council of Canada
requesting that they investigate and report on the interface between public and private delivery
of health care in Canada. The Minister will also write to CIHI asking that they gather, analyse
and provide to the Health Council all relevant information, using federal and provincial reports,
on the allocation of health transfers. In both instances, the Minister will ask the Boards to
identify the powers and tools they would require to complete this work.
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The above commitments will be backed up with compliance and enforcement provisions as follows.
Under section A), eligibility provisions will be part of the terms and conditions for any new
dedicated federal funding. Under section B), existing compliance provisions of the CHA will be
used, which includes the CHA Dispute Avoidance and Resolution process formalized by First Ministers
in 2004. Under section C), compliance issues are not relevant.
The Minister of Health will, in advance, advise and engage his provincial and territorial colleagues
with respect to these initiatives. These initiatives will be carried out in a manner that is respectful
of provincial and territorial jurisdiction.
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