Dave

Do we want a case study from Canada??

See below.
P


----- Original Message -----
From: "Dennis Raphael" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, September 16, 2004 11:38 PM
Subject: [SDOH] Health Care -- Canada 1st Ministers Meeting


This is from the Ontrario health Coalition and sums it all up!
-----------------------------
Memo
Re. First Ministers’ Agreement Implications for Ontario
Date: September 16, 2004

First Ministers’ Agreement:
Implications for Ontario

The worst things in this agreement are the things our Premier and the other
First Ministers didn’t do.

I. PRIVATIZATION
The fact that the First Ministers dodged the question of privatization was
likely the worst feature of the negotiations. It means that they did
nothing to stop it. Over the two days of public negotiations Mr. McGuinty
did not once mention stopping privatization or support for public delivery.
There is nothing in the final agreement that will protect Ontarians from
privatized P3 hospitals, private for-profit diagnostic clinics, privatized
homecare and competitive bidding, or any other form of privatization.  In
Brampton we are already seeing that the private hospital will cost hundreds
of millions more than a non-profit hospital would. The sustainability of
the health system depends on definitive action to restore public non-profit
hospital infrastructure and public non-profit delivery of health services.

We need to remind our Liberal MPPs that in their election campaign Mr.
McGuinty clearly campaigned for a change. In fact, it was the central
slogan of his campaign.  He regularly rejected the privatization agenda of
the Conservatives and pledged to support restored standards and public
funding and delivery of healthcare. We expect improved leadership from him
on this.

II. CANADA HEALTH ACT, TWO TIER SERVICES AND DELISTING
The lack of discussion about the enforcement of the Canada Health Act
reinforces the federal government’s current lack of protection for the
universality, comprehensiveness, portability, and accessibility of the
health system.  There was no progress on prohibiting the two-tier access
promoted by the for-profit clinics in Ontario & other provinces – notably
B.C. This deal will not restore the services that have been taken off the
OHIP list, including the audiology, physiotherapy, optometry and
chiropractic services. There is a one-sentence note at the end of the deal
reached by the First Ministers that formalizes a “disputes resolution”
process as per letters exchanged by the provincial and federal governments.
We are waiting for details, but our initial reaction is that we are very
concerned about replacing enforcement of these principles with negotiation.

III. MONEY & DEMANDS ON IT
There is very little targeted money in this deal, and no enforcement
mechanisms for the money that is targeted.  In addition, the amount
targeted to homecare and drug coverage was so little ($500 million across
the country) as to be more of a public relations exercise than a real
establishment of new programs.

However, there is a significant increase in the health transfer.  This will
increase the amount of funding available in Ontario. Note: the hospitals
claim they have a $600 million shortfall and the government is currently in
negotiations with the Ontario Medical Association on fees for physicians.
These are two powerful demands on the increased money.

IV. HOMECARE & SHRINKING OF MEDICARE
With the closure of tens of thousands of hospital beds in Ontario over the
past two decades, and the shift of care into the community, many patients
have been moved out from under the umbrella of the Canada Health Act which
covers hospital and physician services.  (Note: many argue that the Act
should be interpreted to cover the homecare services which are really
“hospitals without walls”).  It is important that homecare must be covered
by the CHA.

In addition, seniors and others require that supportive care at home be
provided publicly.  Many Ontarians have lost their home support services as
acute homecare patients take up the available homecare funding and
Community Care Access Centres have reduced the scope of the services
offered publicly. The new federal funding may help to open an opportunity
to push for the restoration and extension of these services.

V. PHARMACARE
The small amount of money targeted to pharmacare across the country will
make no noticeable impact in Ontario.  Like other provinces, we already
have a drug program – the Trillium Drug Plan – that provides coverage for
listed drugs on a means-tested basis.  This agreement will not improve this
plan and does not cover it with the principles of the Canada Health Act
that would have ensured it was universal (not means-tested) and would have
stopped requirements for up-front or co-payments.

VI. WAITING TIMES
We are concerned because this issue can be used to destroy public
healthcare by right-wing advocates of a two-tier health system.  The crisis
rhetoric regarding wait times is used by those with vested interests in
privatization to push for clear “benchmarks” for waiting times, and to pay
out of pocket to jump the queue if these are not met. Their proposals, if
implemented, would make the system more costly and less equitable, wait
times for most people who cannot afford to jump the queue would worsen, we
would lose public control and the trade agreement threats posed by
privatization would worsen.  A great deal can be done within the public
system  to improve wait times, by rationalizing and improving management of
wait lists as they did with cardiac care in Ontario.

CONCLUSION
We need to ensure that the improved funding does not simply create a more
expensive health system, but creates a better health system.  We will need
to redouble our efforts at the provincial level to stop for-profit
healthcare and P3s, ensure comprehensive publicly-funded services including
home support services, stop the delisting, and protect and extend the
principles of the Canada Health Act. Similarly, progress on primary care
reform, human resources recruitment and retention, public health, promotion
& prevention, and determinants of health all remain at the provincial
level.

For more information contact Ethel Meade, co chair or Natalie Mehra,
coordinator at 416-441-2502.

--

Ontario Health Coalition
15 Gervais Drive, Ste. 305
Toronto, ON M3C 1Y8
Tel: 416.441.2502 Fax: 416.441.4073
www.ontariohealthcoalition.ca

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