Dr. Joss Reimer during a COVID-19 livestreamed news conference at the Manitoba legislature in Winnipeg on March 17, 2020.JOHN WOODS/The Canadian Press
The organization that represents Canadian doctors is calling for the appointment of a chief health accountability officer to gauge whether tens of billions of dollars in new federal spending is leading to tangible improvements in the health care system.
The Canadian Medical Association plans to propose the new role on Monday as it releases a report from the consulting firm Deloitte analyzing a laundry list of bilateral health deals signed by Ottawa and the provinces and territories since 2017.
The CMA concluded that the deals are so complicated, and their accountability mechanisms so opaque that an independent office should be created to publicly report on the shortcomings and successes of the agreements as they’re implemented.
“The complexity is one of the things that I certainly was struck by, just trying to go through the Deloitte report,” said CMA president Joss Reimer. “If I, as the president of the CMA, am finding this a very complex report, what can we possibly be expecting of the average Canadian?”
In early 2023, Prime Minister Justin Trudeau announced nearly $200-billion in federal funding for health care over the next decade, $46.2-billion of which was new money. Just more than half of the new funding – $25-billion – was earmarked for bilateral deals that were to be negotiated under the banner of the Working Together agreement.
Every province and territory has since inked a deal with Ottawa. Quebec, the final holdout, signed on in March.
The Working Together agreements were not the only federal funding announcements that Deloitte analyzed in the new report. Unveiled at the same time in early 2023 were $19.3-billion for one-off additions to the Canada Health Transfer (federal money given to provinces and territories annually for health care); plus $1.7-billion for personal support workers; and $175-million for a Territorial Health Investment Fund.
Before the 2023 announcements, there were bilateral deals cut in 2017 aimed at improving mental-health care and home and community care, as well as billions more in federal funding promised for long-term care and Indigenous health.
The bilateral approach to federal funding for health care was supposed to allow the provinces and territories, which are responsible for delivering medical services, to direct fresh money to their most pressing needs. Most of the bespoke agreements also required that provincial governments report to Ottawa and to the public on whether they are meeting their targets, which differ from deal to deal, although the federal government also established some shared priorities.
Dr. Reimer said the CMA was encouraged that many of the bilateral deals feature concrete goals that, if met, would improve access to care. She cited targets for the share of Canadians that have a regular primary-care provider and targets for reducing surgical and diagnostic services backlogs as good examples.
But there are notable gaps in the agreements, Dr. Reimer added. No jurisdiction set targets to reduce or eliminate temporary closings of emergency departments, a problem that appears to have grown worse since the pandemic contributed to staffing shortages across the country. Deloitte found no public tracking of ER closings, save for sporadic media reports.
“I’m from a rural area and I don’t recall our emergency room ever closing when I was growing up,” said Dr. Reimer, a former chief medical officer for the Winnipeg Regional Health Authority who is originally from Winkler, a Manitoba city of about 15,000.
“So now to see this happening every week in the news, it’s heartbreaking to see these communities without access to care that they need. It’s something that’s measurable that we can all see. It seems like a good indicator for us to include.”