Impatience and Intergovernmental Relationships in Healthcare.

William Gardner, Katherine Fierlbeck and Adrian Levy have laid out a bold plan in this issue of Healthcare Papers for breaking through the impasse in federal–provincial relations around healthcare. As one of the commentators notes, their plan is elegant. It includes goals, measurement and alignment of incentives for improvement; three common sense elements of management with which it is hard to argue. This plan could revitalize the federal role, stimulate stronger provincial and regional management of healthcare systems and fit well within the current accountability paradigm in Canada that stresses measurement and reporting. An excellent series of commentaries on the lead paper further flesh out and challenge this plan. Although each of the authors takes a different approach to the arguments made by Gardner, Fierlbeck and Levy, there are some important consistencies across the commentaries. First, all of them agree that we have reached an impasse in federal–provincial relations when it comes to healthcare. The reasons behind this impasse – and even the perceived importance of the impasse – vary across the commentaries but everyone agrees that it is real. Second, everyone agrees that the Canadian healthcare system could do better. This should not come as a surprise to readers of Healthcare Papers, but it is valuable that we have consensus in this area. Perhaps as importantly, there is general agreement across the authors in this issue that some form of stimulus is necessary, whether it be financial incentives or not. Finally, there is a general theme across the papers that much of what we need to do to improve performance is within our grasp. Zelmer makes the well-supported case that we have pan-Canadian institutions that could fulfill many of the functions laid out by Gardner and colleagues. Forest makes the case Impatience and Intergovernmental Relationships in Healthcare