New deal for health needs bite

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(DALE CUMMINGS)

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(DALE CUMMINGS)

Canada's nurses are crossing the country campaigning for a better deal for health care. The Canadian Nurses Association says it is disenchanted with the deal the federal government signed in 2004 that raised health transfers to provinces by another $41 billion on a promise it would buy change. Canadians saw some services improve, a little, but the hope for reform was naive.

Canada's nurses say they are not interested in pouring scads more cash into the system -- which may come as a surprise to Manitobans who now see salary increases to nurses tied automatically to those in richer provinces (doctors won the same benefit this year). Yet, the CNA's Judith Shamian says repeating the six per cent annual increases that flowed from 2004's deal-for-a-decade is "crazy and not necessary."

Crazy is a good description of the 2004 deal, which spurred health spending across the country. The health budget in Manitoba has risen by an average eight per cent annually under the NDP. Health now eats up about 44 per cent of total provincial spending here. As with other provinces, the additional federal money to this province for wait-time cuts was spent in areas in which Manitoba was at, or near, the maximum wait-time goals.

The fatal flaw in the deal was that the federal government, which demanded the provinces track progress, got pretty much nothing in return. Some incremental improvements to wait times were seen but when provincial auditors tried to measure outcomes, they found the provinces collected data in a way that thwarted comparison.

Then-prime minister Paul Martin's pledge to improve home care and coverage for catastrophic drug costs (not all provinces have a pharmacare program, for example) hit the ditch early.

Home care and drug insurance still top everyone's list. Provincial premiers are beginning consultations to prepare for negotiations with Prime Minister Stephen Harper, who has already promised to continue the six per cent health transfer increases for two years beyond 2014. The premiers want the increases to go on, but beyond that, Canadians have little idea of what a new deal would look like.

Canada's finances -- like those the world over -- look a lot different today compared to 2004. The days of multimillion-dollar surpluses are gone. Ontario and the federal government both say costs must be cut and are revising target dates for eliminating deficits. Health spending has fuelled public deficits across the country: Public spending on health is expected to hit $141 billion this year. In 2000, Manitoba spent $2.6 billion on health; this year it will spend $5 billion.

The CNA wants to see a new transfer agreement with bite. Rather than pouring cash into acute care, spending must be redirected to prevention. Primary care has to take service to people -- doctors, nurses, nurse practitioners and physiotherapists in teams regularly to rural communities, for example. Allowing nurses to order tests and write prescriptions would save the system and patients money, Ms. Shamian said. The CNA wants federal cash tied to results.

Ms. Shamian said premiers have told the CNA they fear continued increases to health transfers will again flow to wage increases -- some feel new money should go to a holding fund and released to provinces that produce results. That's a worthy idea the Harper government must explore.

Most health money goes to hospitals (salaries, primarily nurses), drugs and doctors (fee for service), in that order. Ms. Shamian offered that nurses would be willing to trade salary hikes for the greater rewards that come with change in the system that would use their skills more robustly.

Stemming the rise in health salaries can help Canada tame a voracious health-spending monster. Winning political peace with powerful health unions has proven irresistible to politicians. The Harper government has its opportunity to change that in its negotiations. The idea of releasing federal cash after results are shown has real currency in times of restraint.

Republished from the Winnipeg Free Press print edition November 9, 2011 A10