More than money: Canada’s health minister wants ‘system transformation’

“It might seem dishonourable for a Minister of the Crown to even say this,” Jane Philpott told a room full of doctors in August. “It’s a myth that Canada has the best health care system in the world.” 

Long before Donald Trump called out the Canadian health care system as “slow” and “catastrophic in certain ways”, this country’s health minister offered a more modest criticism: Canada could be doing much better. In fact, during the same speech, Philpott told the Canadian Medical Association that Canada’s health care system ought to be transformed.

• The death of Patient X and the failure of the system
• Innovation, not just cash, will cure healthcare woes, Philpott tells doctors

“This is an opportunity that we must not miss. How can we leverage those Health Accord discussions to trigger the system transformation that we all recognize to be necessary?”

On the health file, the stand-off with the provinces over funding has dominated the discourse and that likely will continue this week when the provinces and territories sit down with Philpott. But Philpott insists her goal is to talk about how to run the Canadian health care system.

‘We’re all talking about conditions — strings attached, no strings, loosely attached, tightly attached, whatever — but we’re not talking about the real thing that comes first: Funding’ 
– Gaétan Barrette, Quebec health minister

Canadians could be forgiven for missing the Health Minister’s calls for revolutionizing the system. Liberal projects like bringing in 25,000 Syrian refugees and trying implementing carbon pricing have attracted a lot more attention.

Health care is a provincial and territorial responsibility and the members of Canada’s federation want to talk dollars, but Philpott insists she doesn’t control the purse strings. So talking about changing the system may be a tough sell.

Minister of Health Jane Philpott, shown in the House of Commons on Sept. 29, meets next week with provincial and territorial health ministers. (Sean Kilpatrick/Canadian Press)

A former family doctor herself, Philpott’s remarks over the past several months paint a picture of what she’d like Canada’s health care system to look like, even as she acknowledges that some of the changes go beyond what the federal government can do.

Less fragmentation, more primary care

Philpott admits a bias. She’d like a system that’s rooted in primary care. That means Canadians dealing with their family physician, G.P. or a nurse practitioner. Rather than being sent across the city for tests and to meet with specialists, she argues for better co-ordination.

Philpott says rejigging the system to focus it around the primary care provider would save money and lead to healthier patients.

“Fragmentation leads to waste, it leads to frustration, and to dangerous delays in care.” 

There’s an app for that

Philpott argues that if Canadians can do their banking on their phone, accessing health care should be easier.

“It’s shocking that in the age of Facebook and e-commerce, we’re still using fax machines in doctors’ offices and most Canadians still can’t go online for their health records.”

She’s also enthusiastic about other forms of innovation to help make health care more efficient. It’s something she and the provincial health ministers have agreed is a priority, though Quebec’s Health Minister Gaétan Barrette said he’s skeptical about whether most proposed innovations in health care actually save money.

Home care

Home care has been the Liberals’ biggest health care pitch. They’ve pledged $3 billion over four years to the cause, though other, related services like palliative care could also be funded by that money.

In her speech to the CMA, Philpott pointed to statistics about the cost of health care in Ontario. She said it costs $840 a day to keep a patient in hospital, while home care costs just $55 a day. Along with the savings, she says most patients would prefer to be at home.

Social inequity

As if the health care file wasn’t big enough, Philpott says better health care means tackling the even larger issue of social inequity, an issue she says that all of government and even society needs to address.

She points particularly to the Indigenous population, saying lack of education, crowded housing, high unemployment and incarceration rates all have health repercussions. In a speech to health care professionals in Ottawa in September, she cited the stunning statistic that amongst Inuit, the rates of tuberculosis are 375 times higher than those for non-Indigenous Canadians.

Pushback?

It’s hard to imagine provincial or territorial ministers arguing against better co-ordination or opposing more home care. Some probably share the same goals. But to see where opposition might arise, you only need to take a closer look at what Philpott is saying.

Quebec Health Minister Gaetan Barrette has said funding is a major issue for the provinces and no system change can come without a federal commitment to more cash. (Jacques Boissinot/Canadian Press)

“It’s time to reclaim the political will, time and resources to develop and implement bold reforms in the funding and organization of front-line delivery,” she said back in August.

Some provinces have no interest in getting direction from the federal government on “bold reforms.” Others who might be on side are more likely to resist when they can’t agree with the federal government on funding.

Take the question of innovation in health care. In September ,while attending the same conference as Philpott, Quebec’s Barrette offered a warning about innovation. He said that, while it does sometimes improve the system, it almost never delivers the kind of cost saving it’s expected to. The underlying message for Philpott: If you want me to innovate, you’ll need to find more money to pay for it.

That’s presuming such a thing would even be up for discussion. Barrette told reporters that any focus on how health care dollars are spent is a kind of trap to distract from the question of how much money is available.

“We’re all talking about conditions — strings attached, no strings, loosely attached, tightly attached, whatever — but we’re not talking about the real thing that comes first: Funding. It’s a trap!”

If talking about how how health care is delivered is essentially off the table, agreeing on “bold reforms” and “system transformation” becomes virtually impossible.