Canada’s health minister says the federal government has put enough money on the table to ensure every Canadian has access to family medicine, throwing the ball in the provinces’ court to deliver.
“The $2.5 billion on average over the next 10 years, that’s more than what is needed for provinces and territories to give access to family medicine to all Canadians in this country,” said Jean-Yves Duclos, in an interview with the Star’s “It’s Political” podcast.
An estimated 6.5 million Canadians don’t have access to a family doctor.
He noted the provinces aren’t starting from the same point and acknowledged it will be “obviously more challenging” for those who are a bit behind. “But even they, these provinces, have enough dollars with the funding we announced … to give every Canadian in their province access to family medicine,” he said, expanding that definition to include doctors, nurse practitioners and pharmacists.
(Data from the Canadian Institute for Health Information from 2019-2020 suggests Quebec and British Columbia are nation-wide laggers, with only 79.5 per cent of Quebecers and 81.7 per cent of British Columbians having regular access to a health provider, whereas Ontario leads with 90.6 per cent.)
How the provinces ensure access is up to them to decide, said Duclos. “I’m not going to, obviously, do their job because I’m unable to do that job. But they have the tools and the resources to do that.”
Dr. Jane Philpott, the former federal Liberal health minister who negotiated the previous health-care deal, said that in hindsight she believes the federal government should have picked “one big thing” that they could “actually measure.” She suggested a new primary care act, where Ottawa ponies up money to guarantee everyone access to primary care.
“If someone puts up their hand five years from now and says, I don’t have a family doctor, then there should be mechanisms where you could then claw back the funds for the people that don’t have family doctors,” she said.
Duclos won’t go down that route — there are no specific strings to this federal money. But the minister believes the focus on data collection and transparency will be “helpful in driving provinces and territories” towards that goal.
Duclos might be right, said Dr. Alika Lafontaine, the president of the Canadian Medical Association and an anesthesiologist from Grande Prairie, Alta., but it’s too early to tell. “The investments may actually be enough, but we don’t actually know because we haven’t mapped out where the problems specifically are.”
In most areas of the country, he said, the provinces don’t know where family doctors work, what services they provide, and where the needs are. But data collection will help decision makers see and address primary care gaps, he said.
If the Ontario government is worried the province won’t be able to deliver on Duclos’ expectations, it isn’t showing it.
In a statement, Health Minister Sylvia Jones’ spokeswoman Hannah Jensen said the government knows “more needs to be done” and that’s why it recently launched a series of health-care changes that include the expansion of private health delivery of publicly insured services. Jensen noted Ontario has launched the largest medical school expansion in a decade, is seeking to break down barriers for internationally educated health-care workers, and plans to allow health-care workers registered in other provinces and territories to work immediately in Ontario.
“We look forward to coming to an agreement with the federal government to build on the work our government is already doing to connect more people to family doctors,” she said.
Duclos and Intergovernmental Affairs Minister Dominic LeBlanc have met with nearly all provinces and territories except for Quebec, New Brunswick and Prince Edward Island to hash out bilateral deals. In total, Ottawa has agreed to send the provinces $46.2 billion over 10 years.
After that’s done, the minister said he plans to tackle another problem of “great concern” to him — the increasing creep of for-profit care. Calling them “loopholes,” he pointed to Canadians having to pay for virtual health-care services that are covered if seen in person, patients charged for medically necessary services provided by health professionals through expanded scopes of practice, and people charged for medically necessary surgeries performed in another province.
“Now, that’s not all right, this is something which we are very mindful of and will be acting on in the near future.”
Duclos wouldn’t say what he plans to do about these breaches of the Canada Health Act, aside from meeting with his provincial counterparts. “We are in a federation, and the best way to proceed is to solve these challenges collaboratively.”
Since the Liberals came to office in 2015, $105 million has been deducted from the provinces and territories for non-compliance.
But according to the federal NDP health critic, the provinces too often get a slap on the wrist. “Ensuring compliance requires effective enforcement,” said Don Davies.
“I strongly believe all additional federal transfers should be conditioned on their application to public delivery of care. (Prime Minister Justin Trudeau) said he believes in conditions and public health care — that would be an excellent way to show it,” said Davies.
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