– The C.D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies.
CANADA – The federal government should recognize the limited success of past attempts to achieve healthcare reform with conditional transfers to the provinces and instead focus more on independent initiatives, according to a new C.D. Howe Institute report. In “The Naylor Report and Health Policy: Canada Needs a New Model,” authors Åke Blomqvist and Colin Busby suggest a variety of initiatives including the promotion of better information technology dissemination to providers and patients, and more systematic cost-effectiveness evaluations of new drugs and devices.
“Conditional cost sharing is more of a barrier to improvement than it is a solution: conditional transfer discussions are fraught with opportunities to distract from priorities, duck responsibility and delay change,” state the authors.
The federal government is engaged in discussions with the provinces about a new Health Accord. The outcome of these discussions could put the provinces on a road to healthcare reform or delay change.
There are many ways the federal government can contribute to improved health system performance through innovative measures in areas that it already oversees such as health services for First Nations. It should support provincial initiatives mainly by reporting on and evaluating their outcomes, and perhaps also via an innovation fund of the type recommended by the Naylor report.
Attempts by the federal government to negotiate a new set of transfers for a single nationwide pharmacare plan, akin to the way we pay hospitals and doctors, could prove to be counterproductive and delay needed reforms – provinces seeking improved drug coverage for their citizens could take the initiative and lead the way.
The authors conclude that from the public’s viewpoint, the question of which level of government pays for healthcare is largely irrelevant: Most people do not care whether it is the federal or provincial part of their tax bill that pays for healthcare. What the public does care about is a system in which everyone has ready access to high-quality care when they need it, and that its cost is kept within reasonable limits.
