Canada should spend billions more on health

An official report into Canada's creaking state-funded health care system recommended major changes last week and said Ottawa would have to pump C$6.5 billion a year more into health by 2005.

The government-appointed Royal Commission on the Future of Health Care in Canada also set the scene for a political battle by rejecting the idea of user fees or a parallel private system, two ideas favoured by some conservatives.

"Canadians view medicare as a moral enterprise, not a business venture... Canadians want their health care system renovated; they do not want it demolished," said commission head Roy Romanow, the former premier of Saskatchewan.

Canada does not allow private healthcare for basic services such as hospital care, unlike European countries where a private system runs alongside a state-funded network, allowing those with private health insurance to jump lines.

The commission spent 18 months looking into Canada's 40-year-old "medicare" system, which is beset by shortages of cash and doctors and ever longer lines for treatment.

The report said Ottawa - which shares the cost of paying for health care with Canada's provinces - should guarantee to pay at least 25 per cent of primary health costs by the 2005-06 financial year. It said Ottawa currently estimated it would be paying around 15 per cent of primary health costs in 2005-06.

"Under this scenario federal funding for health care would be C$6.5 billion above currently forecast levels," it said. In the 2003-04 financial year Ottawa should spend C$3.5 billion extra and this should rise to C$5 billion by 2004-05.

Prime Minister Jean Chretien welcomed the report, which will be discussed by federal and provincial health ministers on Friday.

Canada already spends a total of around C$100 billion a year on health care. Finance Minister John Manley, who has said there will not be unlimited health funding in his budget next February, declined to comment on the Romanow report.

The Liberal government takes enormous pride in medicare and often compares Canada favourably to the United States, where more than 40 million Americans have no health insurance.

But medicare has been in trouble for some time and Romanow, declaring "the status quo is not an option," said changes were needed to take into account the fact that more people could be treated at home and to deal with the soaring cost of drugs.

The report recommended setting up:

¤ a fund to improve timely access to care in rural and remote areas (C$1.5 billion over two years)

¤ a fund to improve waiting times for diagnostic services ($1.5 billion over two years)

¤ a fund to remove obstacles to timely primary care ($2.5 billion over two years)

¤ a fund to help establish a national home care strategy ($2 billion over two years)

¤ a "Catastrophic Drug Transfer" fund to protect against the cost of expensive drugs (C$1 billion a year from 2004/5).

Stephen Harper, leader of the right-wing opposition Canadian Alliance party, dismissed the report as a throw-back to the days when medicare was born.

"Rather than looking forward, Mr Romanow and the Liberals have simply shown they're stuck in a time warp listening to the Greatest Hits of the '60s," he told reporters.

The medicare system is a major irritant in ties between Ottawa and the provinces, which want more money for health, while insisting that they alone should decide how to spend it.

Romanow is unlikely to win new friends in the provinces by insisting Ottawa should set up a monitoring system to ensure that any new money is spent on the proposed funds he outlined.

"We are going to be absolutely adamant that the provinces have the flexibility to provide the programs and priorities we know our patients need in our province," said Sindi Hawkins, minister of health planning in British Columbia.

Another potential flash point between Ottawa and the provinces is the push by Alberta and British Columbia to partially privatize their systems.

Romanow said private firms could provide some ancillary services, but he rejected the idea of user fees for medical services or a parallel private system with its own hospitals.

"There is no evidence these solutions will deliver better or cheaper care, or improve access," he said, dismissing the idea of a system "where money, rather than need, determines who gets access to care".

A major complaint about medicare is the long waits for specialist treatment and examinations using equipment such as Magnetic Resonance Imaging (MRI). Critics say Canada has fewer MRI machines per capita than Hungary.

Some Canadian provinces now allow private MRI clinics, something Romanow said should be banned.