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Canada's government tries to save healthcare system

David Spurgeon Quebec

The proposal by Canada's federal health minister, Allan Rock, to save the country's healthcare system by paying half the cost of a national home care programme has been greeted contemptuously by provincial premiers. They say that he should restore billions of dollars of funding he has cut in past years before introducing such "boutique" programmes.

In a letter to the prime minister, Jean Chrétien, Ontario's premier, Mike Harris, said that Mr Rock's attempt to position himself as the saviour of Medicare (Canada's health insurance system) was "blatant hypocrisy." "After all, the federal government is responsible for the largest funding cut in Canadian history," they added.

Meeting later in Quebec city, the premiers agreed that the system needed fundamental reform but that without more money it would collapse. They want restoration of the Canada Health and Social Transfer Payments to 1994-5 levels, when Ottawa assumed 17% of total healthcare costs. This would add $C6.3bn (£2.7bn; $4.38bn) to the present spending level, they said. Prime Minister Chrétien said that the transfers have already been restored to the 1993-4 level.

The prime minister and the premiers agree that the healthcare system is in crisis, a fact of which the public and health workers are acutely aware as a result of emergency room overcrowding, shortages of nurses and doctors, and complaints by doctors of overwork. According to the latest poll, eight in 10 Canadians believe the system is in crisis, and only one in four rates it highly.

Alberta's premier, Ralph Klein, increased the controversy about solutions by proposing to use private hospitals for major surgery (BMJ to come...), thus taking the load off the public system. This was criticised by federal officials, who feared the plan would lead to a two tier system and who implied that Alberta's funding might be cut if Premier Klein made more use of the private system.

Mr Rock did not give details of his home care plan, but from what he has said in the past, he clearly sees it as an integral and vital part of the national healthcare system.

He told a 1998 national conference on home care that 80% of home care in Canada is delivered by an informal caregiver: one in five Canadian women aged 30-55 looks after someone in the home who is chronically ill or disabled. They spend an average of 28 hours a week in this way; about half of them also work outside the home, and many have children. Increasingly, he said, this takes a toll on their health.

"Home care is fundamental to saving Medicare," he said. Home care budgets amount to only 4% of public spending on health in Canada, with percentages and services varying greatly among the provinces. Mr Rock has called for a definition of what constitutes home care and the establishment of national standards.

The Health Education Action Lobby estimates a national system would cost $C1.5bn a year. A recent study found that about $C8000 a year per person could be saved if frail elderly people could be cared for at home instead of in nursing homes.