November 28, 2002
For-Profit Health Care
Ontario Health Coalition
Toronto – In light of the Romanow Commission report released this morning, the Ontario Health Coalition demands that the Ernie Eves government abandon its race to create for-profit MRI & CT clinics and P3 hospitals.
“The evidence, the ethics, the values of people, and now the Romanow Commission are against for-profit healthcare. Now it is time for the Eves government to abandon its reckless endangerment of Medicare and learn to listen to reason”, said Irene Harris, coalition co chair. “It’s clear that federal funding is coming. Eves has no justification for handing those MRIs and CTs to for-profit companies instead of putting them into hospitals.”
The coalition is pleased with some of the key recommendations of the Romanow Report noting specifically the opposition to privatization and for profit health care, primary care reform, extension of the Canada Health Act to cover homecare & the establishment of a national homecare program, the beginnings of national pharmacare including a new regulatory regime and price controls for drugs, the increase in federal funding, the increase in accountability for health spending, and a national human resources strategy.
“We’re pleased that Romanow has listened to the need to extend the Canada Health Act and kick-start national homecare and pharmacare”, noted Irene Harris. She added that the coalition has received “a great boost” from the Commission’s rejection of profit and privatization in healthcare. The coalition is now looking for a strong federal enforcement mechanism and the prohibition of private clinics.
“However, some of the most marginalized voices in our society have yet to be heard”, concluded Ms. Harris. “Now we need to ask our federal and provincial politicians to hear specifically the needs of the frail elderly and those with disabilities who require home support services to live independently. We need to protect support service workers in hospitals at risk of privatization. Ultimately, we need to build some real enforcement and a renewed commitment to the values of Medicare as a human right and a public service.”
Ontario Health Coalition
15 Gervais Drive, Suite 305
Toronto, Ontario M3C 1Y8
phone: 416-441-2502 fax: 416-441-4073 email: email@example.com
To download the Romanow Commission report click here ...
Preliminary Analysis of the Romanow Report from the Canadian Health Coalition and the Canadian Labour Congress:
Overview and Broad Principles
The Romanow Report on the Future of Health Care
concluded that there is a consensus among Canadians that Medicare is a
moral enterprise, not a commercial venture. Canadians believe that equal and timely access to medically necessary health
services on the basis of need alone is a right of citizenship. The core values which underpin Medicare remain the same - equity,
fairness and solidarity. As a result, Canadians reject diluting the principles of Medicare, scrapping national standards, paying
privately to get faster care, and treating health care as a business.
In his message to Canadians, Commissioner Romanow said,
"I believe it is a far greater perversion of Canadian values to accept a
system where money, rather than need, determines who gets access to care." The Report clearly states that Romanow
challenged those advocating user fees, medical savings accounts, de-listing public services, greater privatization, and a parallel
private system to provide him with evidence that these choices would improve or strengthen the health care system. He clearly
said that "The evidence has not been forthcoming." There is no evidence that these solutions will deliver cheaper care or improve
access to care. Further, the principles underlying these solutions are directly contradictory to the values of Canadians and the
values of Medicare.
For those reasons, the Romanow Report rejects a parallel
tier of private, for-profit care for the delivery of what he calls direct
health care services such as medical, diagnostic and surgical care. This conclusion is to be applauded. It is based on evidence
that for-profit care will harm, not improve, Medicare.
However, the Report mistakenly says that a line can be
drawn between health services and ancillary services such as laundry,
food preparation, cleaning, and maintenance services. These services are said to be appropriate for delivery in the private sector.
The labour movement disagrees with this approach. These services are health services and those who provide them are health
care workers, and they see themselves as health care workers. These services are pertinent to the health of patients. Good
nutrition is critical to people who are sick, and the cleanliness of hospitals is essential to patients, staff and the public.
While the Report has rejected a parallel tier of
for-profit care, there does not appear to be a mechanism for ensuring that this
not happen. It does recommend that the Canada Health Act must be clarified to include these services under the Act. The
Report needs to be looked at more closely.
Overall, the Romanow Report offers some important steps
forward to preserving and expanding Medicare for today's and future
generations, but it is just a starting point. It has established some fundamental principles which need to be built and expanded
The Report rejects the argument that Public-Private
Partnerships to design, build and operate health facilities, such as hospitals,
will save the public money. Romanow notes that these agreements have been shown to cost more over the longer term, and can
have the effect of hospital bed closures and a reduction in nurses and other health staff. Romanow stops short of recommending
no Public-Private Partnerships.
Medical Savings Accounts, User Fees and Co-payments, Tax Credits, and Deductibles
Romanow rejects these alternative measures to raise more
funding for Medicare. In the end, all of these measures violate the
core principle of equity and equal access to care based on need for care. These measures promote access based on ability to
MRIs and CT Scans
The Report calls all diagnostic services required to
assess a patient's need for health services to come under the conditions of the
Canada Health Act, including the prohibitions of user fees, facility fees and extra-billing. The CHA should be amended to clarify
The Report calls for federal health funding to be taken
out of the CHST and put into a new transfer - The Canada Health
Transfer. This transfer would be a cash-only transfer and have an escalator clause so that federal funding would keep pace with
economic growth and our ability to pay. The CLC has called for this since the CHST was put in place in 1995.
Expansion of the Public System
The Report recommends that the Canada Health Act should
be revised to include home care services in priority areas. This
would include post-acute home care, including drugs and rehab services, as well as coverage of palliative care in the home during
the last six months of life. Also, it would include a program of support for informal care givers. Home mental health services
should immediately come under the CHA.
It calls for a Catastrophic Drug Transfer to help
provinces with their drug plans. Eventually, the CHA would cover the cost of
It calls for a creation of a National Drug Agency to
control costs and insure the safety of drugs and it also calls for the
establishment of a National Drug Formulary to help control costs. Finally, it calls for a review of aspects of the Patent Act.
There must be an effective dispute mechanism maintained
in the CHA. The dedicated Health Transfer would be directly
connected to the principle and conditions in the Act.
The Report calls for the development of a Rural and
Remote Access Fund to attract and retain health care providers, including
opportunities for health professionals in training to gain experience for doctors, nurses and other health providers.
The Report states that the current status of injured
workers getting preferred access to care violates the principle of equal access
to care for all Canadians. The Canada Health Act allows this to take place. This exception needs to be reconsidered.
The Report calls for the establishment of a new Canadian
Health Covenant which would state Canadian values and would be a
guiding force for Medicare.
A Health Council of Canada would be established to
analyze and assess the national health system as a whole. Membership in
the Council would include the public, providers and governments.
The Canada Health Act should be revised to include a Sixth Principle of Accountability.
Trade and Health Care
In recognition of the threat to health care from
globalization, Romanow sends a clear message to the federal government that
current protections for health care in trade agreements must not be weakened. Future expansions and actions must be protected
in all future agreements.
The right to regulate health care policy should not be subject to claims from foreign companies.
Primary Care Reform
The Primary Care Transfer should drive changes to the
primary care system. We need a common national platform for health
care reform. Prevention and promotion initiatives would be a part of this. Primary care needs to be delivered in multi-disciplinary
teams in a community-based setting.
All funding sources for Aboriginal health care should be
pooled into a new Aboriginal Health Partnerships Fund. The goal is to
improve access to care and provide adequate, stable funding.
The system needs to reflect cultural diversity and language barriers to accessing care.
Funding - Making Medicare Sustainable
Civil Society organizations have called for the federal
government to increase its share of health funding to 25% of publicly
insured health services. The Romanow Report recommends that the federal government move to this standard by 2005-06 with
increased funding in each of the next three years.
The Report calls for new federal funds to bring the
federal share up to 25% of insured health spending provided under current
provincial plans. This will require additional investments to be added to the current level of funding. This would mean a new
investment of $3.5 billion next year, 2003-04, followed by an additional $5 billion the next year, 2004-05, and a $6.5 billion increase
in 2005-06. By 2005-06, these increases will bring the federal cash transfer to $15.3 billion per year. Romanow assumes that this
will equal 25% of the public health services insured under provincial health plans. An escalator clause will increase this cash floor
according to economic growth. These funding arrangements need to be stable and predictable.
These funds would be targeted to specific spending areas
over the next two years.
2003-04$ billion 2004-05$ billion
Diagnostic Services Fund
Rural and Remote Access .75 .75
Primary Health Care 1.0 1.5
Home Care 1.0 1.0
Drugs -- 1.0
In 2005-06, the federal transfer for that year would
rise from $5 billion to $6.5 billion, bringing the total federal cash transfer
$15.3 billion that year.