Post Romanow, post Kirby. What's next?

On November 28, the Honourable Roy Romanow tabled his long-awaited report, “The Future of Health Care in Canada,” in the House of Commons. Written following 18 months of serious deliberation, the report includes a range of recommendations aimed at sustaining Canada’s health care system under the principles of the Canada Health Act. While many of the recommendations are consistent with submissions made by our College and its Chapters to the Romanow Commission, some fall short. Some of our concerns are not addressed at all. Many of the shortcomings in the Romanow Report were, in fact, addressed in the recent submission of the Kirby Committee, “Canada’s Health Care Future.” The Kirby Report, however, also leaves many questions unanswered. The full text of these two reports can be found on their websites at http://finalreport.he althcarecommission.ca/ and http://www.parl.gc.ca/37/2/ parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6e.htm#INTRODUCTION. The following recommendations from the Romanow Report are consistent with recommendations made by our College and, although many of them still require further analysis, they generally have our support at this time: • establishment of a Health Council for Canada to monitor and report to Canadians on the performance of our health care system, including funding and human resource issues; • changes to the Canada Health Act to add medically necessary home care and prescription drugs as insured services, guaranteeing predictable funding transfers over time from federal to provincial or territorial jurisdictions, and providing a process to resolve federal-provincial-territorial disputes; • guaranteed, targeted funding for primary care ($2.5 billion); rural and remote health care ($1.5 billion); home care for palliative, postacute, and mental health services ($2 billion); catastrophic drug coverage ($1 billion); and diagnostic services ($1.5 billion); • management of waiting lists; • support for information technology and electronic health records; • measurement and assessment of the quality and safety of medical care (although this recommendation falls short of recommending a patient safety infrastructure); • aboriginal health programs; • tobacco, obesity, physical activity, and immunization programs; and • a national approach to assessment and training of international medical graduates. The Romanow Report falls short in the following areas: • health human resources, in particular, the severe shortages of physicians and nurses: without addressing this issue, our main concern—access to high-quality health care for all Canadians—will not be achievable; • specialty care: access to specialists and specialized services is critical to meeting the needs of family doctors and their patients; • hospitals and acute care: the infrastructure needs of this sector are immense and must be included in any vision of the future; • academic health science centres and community teaching programs: these are key to meeting future health human resource needs, and targeted planning and funding are required; and • care guarantees, as part of the waiting list strategy. Each of these issues received more focused attention accompanied by specific recommendations in the Kirby Report. The price tag for the recommendations in the Romanow Report is high and could get even higher once other essential components, such as those recommended in the Kirby Report, are considered. How we will pay the bills remains a challenge. Many believe that relying solely upon projected surpluses or reallocating funds targeted for programs essential to other aspects of Canadian life is not the plan we should be following. Finding a fair tax strategy and avoiding private payment for health care will likely remain a hot issue for our nation. The next few weeks will provide important signals about what will happen with the Romanow and Kirby reports. Meetings of the federal-provincial-territorial Ministers of Health and First Ministers followed by a federal budget will tell us clearly whether our governments are ready to act or whether we are simply beginning another lengthy series of studies and negotiations. Although these two exhaustive reports have now been completed, perhaps we have only reached the point where, in Mr Kirby’s words, “the real debate can now begin.” If so, we hope it is a short debate. Canadians have waited long enough. To ensure the future of health care in Canada, we need action now! Post Romanow, post Kirby What’s next?