Accountability and health care

Opinion

Hey there, time traveller!
This article was published 24/08/2023 (744 days ago), so information in it may no longer be current.

WHO should be accountable for our health care?

This seemingly simple question is actually complex.

There are multiple levels of people who could be held responsible for the care we receive (or don’t receive).

The front-line providers such as the nurses, doctors and other professionals are responsible for the care they provide to us.

Health delivery organizations such as hospitals and community agencies are responsible for the organization of the delivery of care by front-line providers. The provincial government is responsible for policy development, and the planning, organization and funding of care.

In Canada the federal government is responsible for public health and the implementation of the Canada Health Act, which governs the funds that the federal government provides to the provinces to support the provincial health-care systems.

Most health care in Canada (about 70 per cent) is funded by a combination of provincial and federal government dollars. The federal and provincial governments have for many years feuded on how much of the funding each level of government contributes.

The federal government uses their contribution to ensure the provinces adhere to the provisions of the Act. Where provinces have allowed private billing for medically necessary services which is not permitted under the act, funds have been withheld by Ottawa. This is an example of the provinces being held accountable to the federal government for transfer funds.

Manitoba recently had federal funds withheld in response to the sanctioning of private clinics offering services that are covered by the act. That practice was immediately stopped by the province when the funds were withheld.

Over the last decade, the federal government has responded to public and provincial pressure by supplementing health-care transfer payments with funding targeting to specific goals.

So how else does accountability in health care play out in reality?

Nurses are technically accountable to their employers but in practice, this means being responsible for the hours worked and little else. This applies to most provider groups. Most physicians are independent contractors with no accountability to the system. Both nurses and physicians are accountable at the individual level to their patients. During COVID, this was demonstrated (particularly by nurses) by the long hours they worked under extremely challenging conditions.

Federal Health Minister Mark Holland was quoted this week as saying that “…you shouldn’t walk around with a stick” when talking about how he intends keeping the provinces accountable for the $198-billion deal currently being finalized.

Unfortunately, his assertion that “the demands coming from Canadians will ensure accountability” denies past experience. The media has reported that Manitoba failed to spend the money intended for health care during the pandemic.

We saw the consequences of that when our province had to sending seriously ill patients out of province for care, something almost no other province resorted to.

Accountability to the public is not a feasible mechanism to ensure the necessary health-care reforms are indeed funded through this new infusion of funds. Accountability in the context of change requires measurement to demonstrate the change occurred.

The Manitoba government has demonstrated repeatedly it is unable or unwilling to report on our health-care system. For eight years, it starved the system of desperately needed money, resulting in untold suffering and death of the citizens it is supposedly accountable to.

Then, on the verge of an election the party in power has promised “historic spending.”

Had this spending occurred as it was needed over the last eight years, we would not be in crisis situation we are faced with today.

Health care in Canada is political. It is the most important election issue time and time again, both provincially and federally.

We cannot afford to waste this $198-billion opportunity by relying on the goodwill of provincial governments.

Our health-care system desperately needs reform and every new dollar of investment should be accounted for by the recipients of that investment.

Dr. Alan Katz is a family doctor and health services researcher in Winnipeg.