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An overhaul of the Canada Health Act, detailed financial information about the long-term costs of health care and re-examination of the role and responsibilities of physicians in managing health care are among elements identified as integral to transformation of the health care system during the 143rd annual general meeting of the Canadian Medical Association.
The list included a call for the inclusion of “sustainability” as a new core and protected principle of medicare, as well as a “re-interpretation” of the Canada Health Act’s five principles: universality, accessibility, portability, comprehensiveness and public administration.
The call for concrete information about the costs of health care came from Auditor General of Canada Sheila Fraser, who contended Canada should not make decisions about health care reform without long-term cost projections on the order of 25 or more years.
The role of doctors in the system, meanwhile, prompted the gathering’s most heated debate, with some physicians decrying the marginalization of physicians in the management of the system and others arguing that doctors should eschew greater involvement in medicare on the grounds that the system’s collapse is inevitable. CMA was charged with establishing a working group to investigate the issue.
Delegates adopted a pair of motions aimed at overhauling the Canada Health Act (CHA). One supported recognition of a sixth principle, “sustainability,” that would define “standards of health human resources, infrastructure, clinical outcomes and fiscal capacity.” The other called on the federal government “to re-interpret the principles of the Canada Health Act in light of the evolution in the delivery of health care services.”
Several delegates noted that including sustainability as a CHA principle would be fraught with difficulties, as it may be defined differently by different groups and could undermine federal government enforcement of the act’s other principles. But as other delegates noted, the federal government is not enforcing those principles, so the risk may be moot.
New CMA President Dr. Jeff Turnbull sponsored the motion and says that “the establishment and the implementation” of the principles should be scrutinized to see if they are applicable to health care as it’s now delivered. “In addition to that, we should see if there’s any new principle that we have to consider, such as patient-centredness,” he adds. “Quite frankly, I would also consider whether equity should be a principle onto its own right.”
Motion co-sponsor Dr. John Tracey, a Brampton, Ontario, family physician and a member of the CMA board of directors, said re-examination of the act’s principles should also include an assessment of the “concept of medical necessity.”
Several provinces have been forced by rising health care costs to assess what medical services are medically necessary and covered by medicare.
But Fraser argued that such decision-making shouldn’t be made in an information vacuum. She said that governments cannot ascertain if they have resources to meet public health needs without making sound, long-term financial projections. “Canadians and the government need to know the challenges ahead and how policy choices will affect the financial burden on present and future generations. And fiscal projections that look only a few years down the road won’t give them what they need,” Fraser said.
She also argued that future federal cash transfers to the provinces for health care should include concrete reporting requirements as current “unconditional” transfers offer no guarantee of accountability.
Previously published at www.cmaj.ca