Panel urges doctors to discuss user fees

A contentious report from an advisory panel to the Canadian Medical Association says it should consider everything from user fees to franchises and “various insurance schemes” to bolster Canada’s flagging health-care system.

ST. JOHN’S, N.L. — A contentious report from an advisory panel to the Canadian Medical Association says it should consider everything from user fees to franchises and “various insurance schemes” to bolster Canada’s flagging health-care system.

“Be open to discussing a range of ways of funding services along the entire continuum of care with the goal of improving access,” says the report released Monday as about 300 association delegates met in St. John’s.

“While there is no unanimity on the best ways to fund a national health care system, such mechanisms as user fees, franchises and various insurance schemes are widely used elsewhere by governments across the political spectrum.”

Health Minister Leona Aglukkaq, who spoke to the meeting Monday, stressed that the federal government supports the Canada Health Act which prohibits user fees.

Still, she said she would consider the 10 recommendations made by the six-member panel which includes former Quebec health minister Philippe Couillard and economist Don Drummond, a Matthews Fellow on Global Public Policy at Queen’s University.

“Of course I’m open to any suggestions … to look at how we deliver health care in Canada,” Aglukkaq told reporters.

She said Ottawa will work with the provinces and territories to renew the 10-year, $41-billion health accord which expires in 2014. She offered no timelines for the start of those talks, however.

A patient-centred approach with improved fiscal and outcome reporting will help transform the health-care system as the population ages, Aglukkaq said.

She also said governments and doctors have a leading role to play.

“Although we are still in our planning stages, I can tell you that we will be working collaboratively with the provinces and the territories to renew the accord,” Aglukkaq said. “And there will be a clear emphasis on accountability.

“This way, Canadians will be able to know that we are achieving real results in improving the system.”

The 10-year, federal-provincial funding accord reached under former prime minister Paul Martin was touted as a deal to transform health care.

But problems persist in a fractured, unwieldy system that has been criticized for a shortage of countrywide reporting and performance benchmarks amid long wait times and rising drug costs.

Critics point out that lofty talk of national home care and pharmaceutical programs that could ease pressure on hospitals and cut redundant spending has amounted to little more than that — talk.

Prime Minister Stephen Harper promised during the spring election campaign to maintain yearly federal escalator funding of six per cent a year until at least 2016, but has said little beyond that. His Conservative government has also tended to stress that health care is primarily a provincial responsibility.

Outgoing association president Dr. Jeff Turnbull said the advisory panel was asked for its input as the association crafts an action plan as part of accord renewal talks.

The professional organization, which represents about 74,000 physicians, is just beginning to discuss the report, Turnbull said.

“So there will be no resolutions,” at this week’s meeting, he said. “This is an opportunity for us to look at all options. However, we believe firmly in a publicly funded health care system that supports the principles of the Canada Health Act.”

Medicare advocate Mike McBane, national co-ordinator of the Canadian Health Coalition, said policies that could lead to increased privatization are not in the public interest.

“I think the report is very dangerous,” he said in an interview. “We’re not open to policies that would actually break the system and introduce inequalities so that those who have money jump to the front.

“They should at least have the honesty to say, ’Whose interest is this, who would it benefit, and who would lose?’ These are the questions that should be asked before we ever decided something like this.”

McBane said the key problem with health care isn’t a lack of money — it’s a lack of efficient, cross-country spending practices and treatment standards.

“The system is in bad shape primarily because of lack of co-ordination. And provinces can’t offer national co-ordination. So it’s a total abdication of essential responsibility for Ottawa to not be taking leadership, and to not have a plan … to co-ordinate the system better.”

Aglukkaq also announced a new national research strategy to improve funding for clinical trials and countrywide sharing of results. But there was little detail on funding amounts or how the effort will play out.

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