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Wednesday, 26 March 2014

Obituary for the Canada Health Accord. The death of an ambitious public health care agenda

On March 2014, a decade old pan-Canadian accord on health will expire and quietly turn to dust.  There will likely be no funeral, no testimonials, no accolades, merely the turning of the clock to a new relationship.

The 2003 accord on health care reform  laid out an ambitious agenda for health care reform, with some benchmarks to demonstrate value, and a price tag well in excess of $100 Billion.  The agreement was signed by then Prime Minister Chr├ętien leading the liberals who three years later lost to the Harper-led conservatives and the start of a slow waning death of collaboration between the provinces and federal government on health.  The demise of the Health Canada of Council is another victim of the lack of sustained federal commitment Obituary for the health Council of Canada

In its defense the accord has achieved certain changes.  Primary health care has once again being re-positioned as a driving force in the health care system, although another decade or two would be required to achieve the sorts of reforms needed to support a sustainable health system.  Improved accessibility to general practitioners has been measured over the last few years. The Canada Health Infoway has made significant strides in modernizing the electronic health record structures but falls short of comparable systems in other countries.  Patient safety has perhaps benefited the most over the last decade from the added attention through initiatives such as Safer Healthcare Now.  Aboriginal Health has come closer to receiving the attention that eliminating the disparity deserves. 

Accountability was a major theme in the 2003 accord.  The Health Council reports HCC reports , combined with a focused approach by CIHI CIHI indicator series  , and annual reporting by the Chief Public Health Officer CPHO reports  of Canada amongst others has contributed to a better understanding of what is and what is not working.  If only more would listen. 

Unfortunately many initiatives are only partially implemented, half complete, and areas like public health that were predominately ignored have fallen to the reform wayside.  For the provinces, there is a significant health transfer component that was linked to the agreement that also expires. With no renewed agreement in the works, provinces and health care workers may only begin to appreciate what the 2003 accord achieved.   At what cost both financially and in terms of lives remains to be seen, and likely will not be adequately documented.

If there is an opportunity for a newly defined relationship, there is currently no open dialogue occurring, and the signals from parliament hill have repeatedly alluded to a federal government slinking away from a cornerstone of Canadian society - universal health care.

We can only hope that the 2003 accord does not rest in peace, that the ghosts of the past arise to haunt and provoke the leaders of this decade into some form of resurrection. 

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