On January 20th, the provincial and territorial health ministers gathered in Vancouver to discuss a variety of topics concerning the health of Canadians. The federal Minister of Health Jane Philpott joined the provincial ministers the next day. This type of meeting is not entirely unusual; former Minister of Health Rona Ambrose met with her provincial counterpoints on several occasions throughout her term. One such event was in the fall of 2014 when Ambrose met with the provincial and territorial Ministers to discuss the possibility of a national dementia strategy.
What does make this meeting unique is the broad spectrum of topics that attendees were slated to discuss. Despite occasional meetings with pointed objectives, Ambrose and the former government took a hands-off approach to health policy that has bred some tension with the provinces. The primary source of this tension comes from the former government’s decision to allow the Health Accord to expire in March 2014. The Health Accord was originally negotiated in 2004 and set out a stable funding formula for federal-provincial transfer payments. When it expired, the federal government unilaterally imposed a formula that fixed transfer payments at a six per cent increase each year until 2017, when they would become tied to the economic growth rate.
Critics have argued that this move put an excessive fiscal burden on the provinces, which face rising health care costs, ageing populations, and already massive fiscal deficits. The federal government’s refusal to negotiate only served to further incense the cash-strapped provinces.
Enter Jane Philpott, illuminated by Justin Trudeau’s sunny ways.
Philpott, a rookie MP and a family physician, was elected following a campaign which made a lot of big promises for health care, including the negotiation of a new Health Accord. In line with these promises, the Health Accord is front and centre in the Minister’s mandate letter, which states that the Minister’s first priority is to “engage provinces and territories in the development of a new multi-year Health Accord. This accord should include a long term funding agreement.” Philpott moved on the issue quickly, announcing her intention to attend the Provincial-Territorial health ministers’ meeting in January shortly after she was sworn in back in November.
So, how did Philpott fare? And when will we see the promised new Health Accord?
Unsurprisingly, a new Health Accord was not negotiated in a day on January 21st, nor is there even a speculative date for one. Further, many of the old tensions of federalism, which have been the defining feature of health policy in Canada for decades, did not disappear either. In the days leading up to the summit, Philpott, perhaps bracing herself for some friction, discussed how she expected the provinces to want to focus almost exclusively on financial matters while she was more interested in using the meeting to build working relationships and define Canada’s healthcare priorities. Philpott would like to be more involved with the on the ground policy decisions regarding health care while the provinces would like to simply take the federal money and scurry back to their provincial ministries to hammer out the details.
Her assumptions were correct. Ontario Minister of Health and Long-Term Care Eric Hoskins and British Columbia Minister of Health Terry Lake also spent considerable time with the media in the lead up to the meeting voicing their goals for the meeting. Lake went on record several times, making loud calls for a funding formula that would take ageing populations into account. Hoskin agreed on the point that the funding formula was a priority but heartily disagreed to the idea of tying funding to demographics.
The actual meeting was characterized by a similar disagreeable tone as fourteen different voices with diverse goals and fiscal constraints weighed in. Lake politely referred to the discussions as “frank and open” as well as “spirited.” But despite the friction, the Statement of the Federal-Provincial-Territorial Ministers of Health released at the conclusion of the meeting does show some progress that addresses concerns expressed at both levels of government.
The statement defines Canada’s most pressing health care priorities, as Philpott set out to do. The checklist includes affordable access to pharmaceuticals, improving mental health services, and promoting cost-saving health innovations. In particular, the Ministers made significant headway on pharmaceutical policy as they agreed to form a working group to focus on developing a national strategy. This comes immediately following Philpott’s announcement that the Federal government would cooperate with the provinces on national bulk purchasing of pharmaceuticals. The Pan-Canadian Pharmaceutical Alliance was formed in 2010 to establish an arena where the provinces could negotiate which drugs they would like to bulk purchase – the most efficient method of pharmaceutical procurement. Ambrose refused the provinces’ invitation to participate in the working group which makes Philpott’s announcement all the more significant.
For the provinces, the document also emphasizes the importance of funding reform. It states that the “Ministers agreed that new resources are needed to stimulate and support needed changes in health care systems across the country.” Emphasizing the importance is still a long way from seeing actual reform but allowing the provinces participate in the discussion is a necessary first step. Finally, and possibly most critically, the statement declares that the Ministers of Health will be meeting again in mid-2016 to follow up on the issues discussed.
So yes, this meeting was a lot of talk and little action. It did not magically produce a new Health Accord. Mr. Trudeau didn’t even ride up and save the day on horse back as the now infamous dreamy Trudeau sweatshirt suggests.
But the meeting also didn’t fail.
The meeting provided each Minister with a set of priorities to take back to their respective governments for whom they now have to design policy proposals for that mid-2016 meeting. It is that mid-2016 meeting that will determine the success of this one. If Philpott and the Provincial-Territorial Ministers come to the table ready to sit through some hard policy discussions and tense negotiations, then January will have been a success. The Ministers have their priorities; now we just have to wait and see if Philpott can wrangle the provinces well enough to turn those priorities into action.
Katie Bowers is a 2017 MPP candidate at the University of Toronto. Previously, she completed an undergrad in Political Science at UBC and worked as an intern the BC Legislature. She is interested in health policy, foreign policy, international development, and travelling around the world.
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