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Extra Money Isn’t Enough to Fix Health Care, Premiers Agree

New federal funding welcomed, but most agree innovation also required.

Andrew MacLeod 8 Feb 2023TheTyee.ca

Andrew MacLeod is The Tyee's Legislative Bureau Chief in Victoria and the author of All Together Healthy (Douglas & McIntyre, 2018). Find him on Twitter or reach him at .

The federal government’s proposal for increased health-care funding fell far short of what the country’s premiers have been demanding.

But even among the premiers, there’s recognition that money alone won’t fix the crisis.

“It is more money than it was yesterday, but again I think a little disappointing,” said Manitoba Premier Heather Stefanson at a news conference after premiers met Tuesday with Prime Minister Justin Trudeau.

“It’s significantly less than we were looking for,” added Stefanson, who is also chair of the Council of the Federation in which Canada’s premiers work on common goals.

The premiers had wanted $28 billion a year in new funding, which would bring the federal government’s share of health-care funding up to 35 per cent, a contribution they’ve pressed for over the past two and a half years.

Instead the federal government offered to up the Canada Health Transfer by $46.2 billion over the next 10 years, which works out to $4.62 billion a year, or about one-sixth of what the premiers wanted.

About half of the money would be for bilateral agreements with the provinces and territories, and there is money to cover five-per-cent annual increases over the next five years.

B.C. Premier David Eby said that while it was important to have the discussion with the federal government, the health system is in crisis and the public wants to see the different levels of government working together.

“This proposal is fiscally limited,” he said, “but I think it provides a foundation and some reassurance to British Columbians that we’re having those conversations and moving forward.”

Quebec Premier François Legault said the new money will bring the federal contribution up to 24 per cent from the current 22 per cent. “It’s not tenable in the long term.”

Others, like Ontario’s Doug Ford, said they were always grateful for new funding, regardless of the amount.

The progressive conservative premier of Prince Edward Island, Dennis King, took a similar line, but also acknowledged that money alone won’t fix Canadian health care.

“I think what’s lost in the conversations that we needed to continue to focus upon is it isn’t just money that we need,” he said. “We need innovations, a change how we deliver health care.”

The public discussion between the premiers and federal officials had instead “led, maybe, Canadians to believe that money simply is going to fix this, and that is not totally accurate,” he observed. “We do need money to help with the innovations and to get people within the system to change what they do and maybe broaden what they do, but it isn’t just about money.”

In Canada, delivery of health care is the responsibility of provincial and territorial governments, and there are long-standing debates about how much the federal government should contribute.

There’s no question the country’s health-care systems have been more strained than normal during the COVID-19 pandemic, with some premiers arguing we are at a “breaking point.” Stories of staff shortages, crowded hospitals, difficulties getting access to primary care and long wait times have become common.

That strain has come, however, despite a steady rise in spending on health care.

In 2022 Canadian health spending was on track to reach $331 billion, or about $8,563 per person, according to the most recent analysis from the Canadian Institute for Health Information.

While there was a bump in health-care spending during the first two years of the pandemic, even before 2020 it had been increasing by four per cent a year, roughly double the rate of inflation.

The CIHI said Canada was expected to spend about 12.2 per cent of its gross domestic product in 2022 on health care. Forty years ago health spending was a relative bargain at 7.9 per cent of GDP.

In 2021, according to the Organisation for Economic Co-operation and Development, Canada was among the top spenders on health care, spending a portion of GDP similar to the United Kingdom, Sweden, the Netherlands and Japan.

The story in B.C. is similar, showing steadily rising spending.

In the current fiscal year health spending is forecast at $27.7 billion, about 40 per cent of the province’s operating budget.

The next provincial budget isn’t planned for release until Feb. 28, but last year’s documents show that from 2015 to 2025 the average annual increase in health spending would be 4.8 per cent.

In 2015 the province spent about 7.7 per cent of its GDP on health. That bumped up to 8.3 per cent in 2020-21, a year when GDP declined, but is forecast to drop back down to 7.3 per cent by 2025.

BC Liberal party opposition Leader Kevin Falcon is a former finance and health minister.

“I’ve always been very, very clear that if the solution to our health-care problem was just more money, we would have solved it a long time ago,” Falcon said Monday. “It is much deeper than that.”

The BC NDP government is guilty of “status quo thinking,” he said, resulting in many people unable to find a family doctor, a million British Columbians on wait lists, and long wait times at walk-in clinics.

“So the results we are getting are terrible, and the problem is they are going to continue with the status quo thinking, the status quo approach,” he said. “David Eby made that very clear by keeping on Adrian Dix as the health minister.... More of the same is going to get more of the same results."

It’s not just about how much money the province spends on health care, Falcon added, but how it spends it. The focus should be on putting patients at the centre of health care and more needs to be done to limit the amount that goes to salaries for senior executives and administrators.

Still, he said later during media availability, as premier he too would be pressing the federal government to increase the health transfer. “We can always use more money in the health-care system,” he said, “but we should be tying it to innovation and outcomes, and we should be making sure that you’re holding provinces to account for driving better outcomes for the public.”

The current B.C. government can’t be trusted with more money, Falcon said. “Right now, giving this NDP government more money when we’ve seen over six years worsening outcomes in every single measurement of the health-care system, it’s not going to be a good thing.”

BC Green Party Leader and Cowichan Valley MLA Sonia Furstenau said that any money added to the health budget needs to be spent well.

“We know we have a health-care system that is very heavy on administrative costs,” she said. “We have far too many senior executives in our health-care system while we don’t have enough nurses, we don’t have enough family doctors working in B.C. We need more nurse practitioners. We need the people who are delivering health care and the investments need to go there.”

The federal government’s reluctance to hand over more money is understandable in the absence of a “clear and explicit plan” for how it will improve health-care delivery to people and how the province will measure success, Furstenau said.

“We have a real need from government, from all governments right now, to be transparent about what they’re intending as outcomes when they spend money and how they are measuring success.”

B.C. Health Minister Adrian Dix said that the province is spending to meet the increasing demand for health care, which is largely driven by the population getting larger and on average older. "It requires [both] innovation and investment to meet that demand," he said.

Ahead of the meeting with Trudeau, Eby said the B.C. government had made significant increases to health spending, including taking steps to improve access to urgent care and to family doctors.

While the premiers were looking for a federal partner to better share the cost of providing care, he said, the province would continue to ensure people can get the care they need and deserve.

“We are going to make sure British Columbians are looked after, independent of whatever happens around this table,” he said.  [Tyee]

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