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Romanow Commission on the Future of Health Care in Canada On November 28, 2002 the Commission on the Future of Health Care in Canada delivered its Final Report to Canadians. Final
Report
Building on Values: The Future of Health Care in Canada
page contents Canadian
Council on Social Development CCSD |
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Response of the Canadian Council on Social Development to the final report by the Commission on the Future of Health Care in Canada November 28, 2002
"Finally we see a report that calls on the federal government to step up to the plate and articulate a national vision for health care, one which is both accountable and sustainable," said Katherine Scott, Senior Policy Associate for the CCSD. "This report rightly identifies the need for close collaboration by governments. We can only hope that all governments will take up Mr. Romanow's challenge to come together as leaders to meet the health needs of Canadians in the 21st century," says Marcel Lauzière, President of the Canadian Council on Social Development. The Romanow report makes a forceful argument in support of the core values that have defined the Canadian health care system to date and are needed to guide future reforms: equity, fairness and solidarity. The CCSD believes, as emphasized in our brief to the Romanow commission, that the broader social determinants of health, such as poverty and the environment, cannot be ignored. Confining reform to the formal health care system alone will not necessarily result in improved health among all Canadians. The report acknowledges the importance of prevention and health promotion – specifically regarding tobacco use, obesity and physical activity. It recognizes that health care reform needs to be linked to a broader social equality agenda and urges governments to take the next steps for making Canadians the healthiest people in the world. "We are hopeful that the dollar amounts quoted by the Commission will not preclude government spending in other social policy areas that are directly linked to good health, such as the alleviation of poverty," says Lauzière. And just as Mr. Romanow has articulated a plan for accountability in health funding across Canada under a new Canada Health Transfer, we would like to see a similar model used to craft a comprehensive social policy agenda for our country. source: http://www.ccsd.ca/pr/2002/romanow.htm 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
Ontario
Coalition of Senior Citizens' Organizations: November 28, 2002 - Toronto - The Ontario Society (Coalition) of Senior Citizens' Organizations (OCSCO) welcomes the Romanow Report’s emphasis on the value of keeping our public health care system universal, accessible to all on the basis of need, not the ability to pay. We were particularly pleased to see his recommendation for lifting the federal transfer payments out of the block funding introduced several years ago to make provincial spending publicly accountable, for reviewing our laws on pharmaceutical patents to enable generic drugs to come to the market faster and for providing financial support to family care-givers. While expanding our health care system to include home care, as the Report recommends, would be a significant step forward, we were disappointed that it omitted supportive care for the elderly as a priority in this area. Despite the clear proof provided last year by the National Evaluation of the Effectiveness of Home Care, that supportive care for those living with age-related and other disabilities was cost-effective, the Commissioner was content to leave it up to the provinces to expand home care into this area. With the record of Ontario’s present government in under-funding home care to a point where supportive care has been virtually squeezed out, it is hard for Ontario seniors to share Mr. Romanow’s confidence. "Our organization fully supports most aspects of the Romanow report, including his strong opposition to the privatization of diagnostic services and hospitals as currently planned by our Provincial Minister of Health. We are concerned, however, that the services most important to seniors – supportive home care and long-term residential care -- seem to have fallen off the Commission’s radar screen” says Ethel Meade, Co-Chair of the Ontario Society (Coalition) of Senior Citizens' Organizations. “This same low priority for elder care is what we have been experiencing in Ontario since the present government was first elected.” As an organisation representing over 140 organizations in Ontario with a combined membership of close to 500,000 seniors across the province, OCSCO has been and will continue to fight to keep seniors’ issues on the political agenda so that the quality of life for all seniors in Ontario and Canada can be improved. For more information please contact Victoria Boon or, Ethel Meade
Romanow Hears the Call to Care (Ottawa) - The Canadian Health Coalition issued the following statement in response to the release today of the Final Report of the Romanow Commission on the Future of Health Care in Canada: “Commissioner Roy Romanow’s Final Report is a comprehensive vision to protect and improve health care for all Canadians, now and into the future. This Report is a milestone in the history of Canada’s best loved social program. Canadians should be proud of the fact that our distinct identity as a country is linked to how we care for the sick. The interpretative key to the thousands of pages in the Commissions’s report and research papers is that health care is a human right that belongs in the public sector, and not a commodity to be sold to the highest bidder in the marketplace. The Romanow Report is about care, not wealth creation. Everything else follows from there. In the words of Commissioner Romanow: ‘It is a perversion of Canadian values to accept a system where money - rather than need - determines who gets access to care.’ Failure, therefore, to stop the commercialization and privatization of health care would represent a perversion of Canadian values and the principles of Medicare. Any government that proceeds to privatize and commercialize health care delivery - faced with the Final Report’s conclusive evidence that it is not in the public interest - will be deliberately destroying the foundations of Medicare, and the heart and soul of Canada. Today, Canadians are proud of the work of the Romanow Commission. They see and hear themselves reflected in this Report. Medicare belongs to the people of Canada and not to corporate and government elites. Mr. Romanow has tabled a plan from and for the Canadian people – grounded in ethics and based on evidence - to fix Medicare’s problems and secure its future. Canadians assume the Prime Minister did not ask Romanow to draw up a plan to save Medicare and then let it be sabotaged. Now the First Ministers must move quickly to implement what Canadians have so passionately asked Commissioner Romanow to report. In the coming days and weeks, the Canadian Health Coalition will be working with Canadians everywhere to ensure that the federal, provincial and territorial governments implement the Romanow plan at the First Ministers Conference. Failure to act quickly to save public health care will soon escalate into a crisis of democracy.” -30- For More Information:
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 does 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 upon. Public-Private Partnerships 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 pay. 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 this. CHST 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 prescription drugs. 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. Accountability 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.
OTTAWA, ONTARIO - The Romanow Report constitutes a major step in the right direction and it is hoped that the federal government will implement most of its recommendations, says the Council of Canadians. "Mr. Romanow has examined the empty rhetoric of the free-market ideologues and provincial politicians, and has proven that privatization will destroy, not improve our system," says Maude Barlow, Council chairperson and author of the book, "Profit is not the cure". "Mr Romanow has a solid plan to build upon Canada’s effective and cherished public health care system. He has examined the facts and demonstrated that the way forward is to expand the public health system and reject the right wing provincial governments’ plans to open our system to giant health corporations." Colleen Fuller, a health care researcher and Council Board Member read the full report in the lock up this morning. "I am very impressed with the comprehensiveness of the Commission’s work. It is crucial that government adopt the recommendations to expand its role and financial support for the public system and expand services in diagnostic, primary care, home care and drugs." However, while the body of the report addresses many crucial issues facing our health care system, Fuller believes many of the recommendations do not go far enough. "Romanow comes out against the ideology of greed represented by for-profit delivery, but it's nowhere in the recommendations. We need to be very concerned that the Liberal government will increase funding for health care but will then allow the provinces to pour that money into private health care delivery." "Canadians must be ready to speak out over the coming months to assure that the Liberal government will stand up to the corporate lobby and adopt the Romanow recommendations," says Council Health Campaigner, Anil Naidoo. "We must also block every attempt to include health care in the current trade negotiations in the FTAA and the WTO, and must convince the government to adopt recommendation 44 that would prevent trade agreements from allowing foreign corporations to sue us for our national health system." The Council of Canadians along with many partner organizations will be hosting a national forum on health care in Ottawa, February 7 – 9, 2003 to continue the efforts to improve our public health care system. -30- For more information,
please contact:
OTTAWA - The Romanow report is a clear rejection of the status quo and a pragmatic step in the right direction to secure the future of public health care, according to CCPA economist Armine Yalnizyan. Yalnizyan applauds Romanow¹s recommendation that the CHST be scrapped in favour of a dedicated health fund which would allow greater accountability for health care expenditures. She also cites the national drug formulary as an important way to help control pharmaceutical costs. Bruce Campbell, Executive Director of the CCPA, applauded the report¹s strong recommendation to protect Medicare from international trade agreements. "He clearly followed the recommendations of the CCPA¹s report to the Commission on globalization and Medicare." Yalnizyan points out, however, "The old saying Œyou get what you pay for¹ has never been more relevant. The report is strong on process but weak on money" While Romanow points to progressive taxation as the only sustainable way to fund Medicare, the report is silent on where the money comes from. "This is not the time to be coy," says Yalnizyan. Furthermore, the $3.5 billion injection into the health care system for this year is substantially less than recent estimates of what is needed, including the Kirby report and Romanow's own backgrounder on these issues. The Romanow report also does not address the issue of chronic care, a glaring omission at a time when we are faced with the prospects of an aging population. Given this renewed commitment to a strong federal role, Yalnizyan says, "The Prime Minister and federal leadership contenders should take note: there is a short window of opportunity to see meaningful movement. Without immediate action, you can kiss a national health care program good-bye." A more detailed analysis of the Romanow report is available on the CCPA web site at http://www.policyalternatives.ca
MEDICARE DEBATE IS OVER; TIME TO ACT, SAYS LABOUR OTTAWA and VANCOUVER – The Canadian Labour Congress, whose members’ families represent more than six million health care users, today expressed strong support for the key recommendations of the final report of the Commission on the Future of Health Care in Canada (the ‘Romanow Report’). “The Medicare debate is over; it’s time to act,” said Ken Georgetti, Canadian Labour Congress President. “The Romanow Report is a blueprint of what needs to be done to preserve and improve Medicare. Ottawa and the provinces must now get to work expanding Medicare to meet the public’s needs.” Georgetti commented from Vancouver, where he is attending the B.C. Federation of Labour Convention. In Ottawa, Barb Byers, Canadian Labour Congress Executive Vice-President, called for the Romanow Report to be “job one” for the federal government. She added that concrete proposals should be in place for next January’s First Ministers’ Conference and the February federal budget. “The Prime Minister has repeatedly said that his government was awaiting the findings of the Romanow Commission before acting,” Byers said. “Romanow has discredited the for-profit, private sector health care delivery model. The way is now clear for swift action.” However, Georgetti disagreed that such hospital services as laundry, food preparation and maintenance were medically non-essential, opening the door to privatization. “These in-house services are kept to high, exacting standards to ensure patient health and safety,” he noted. “The Canadian Labour Congress and its affiliates will vigorously fight any privatization moves at all levels of government.” The Canadian Labour
Congress, the national voice of the labour movement, represents 2.5 million
Canadian workers. The CLC brings together the majority of Canada's national
and international unions along with the provincial and territorial federations
of labour and 137 district labour councils. Web site: www.clc-ctc.ca
Contacts:
NUPGE
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Report Card on the Romanow Report
Since the beginning
of our campaign to protect and build Canada's Medicare, the National Union
of Public and General Employees has recommended that the different levels
of government work together to reach ten objectives. We believe that these
ten objectives are not only about the health of Canadians, they are also
about the economic health of Canada. Achieving these ten objectives is
the best way to ensure that we have a sustainable health care system that
reflects Canadian values and lives up to Canadian standards for efficiency.
We also believe that these ten objectives draw on the courage of the original
vision put forward by the pioneers of Canada's Medicare and fulfill that
vision by restoring, rethinking, and reinvesting in public Medicare and
the people who provide health services. This report card is intended to
evaluate how well the final report of the Romanow Commission stacks up
against the National Union's ten objectives. Objective 1 Adequate and stable public funding Romanow Report Grade: A The report recommends the federal government provide "adequate, predictable, and stable public funding for Medicare." To do so, the report recommends a multi-billion dollar injection of federal funds until it reaches a 25% minimum cash floor of Canada Health Act insured services - $6.5 billion more per year by 2006 - $3.5 Billion in 03/04, $5 billion in 04/05, and $6.5 Billion in 05/06. NUPGE, the CLC, other unions and many of our health coalition partners have called on the federal government to increase its share of health funding to 25% of publicly insured services. The Romanow report clearly reaches this benchmark.
As equally important as proposing increased federal funds, the report recommends that the new federal cash be used to "buy change" by attaching strings (through earmarked funding initiatives) to the new funds. In addition, the report recommends that the CHST be abandoned and replaced with a separate fund for health care transfers to the provinces (called the Canada Health Transfer) with a built-in escalator provision so that federal funding would keep pace with economic growth. This is the kind of accountability and transparency that's necessary to ensure that any new health dollars actually go to health care services rather than tax cuts or other areas and it is something the labour movement has called for over the last 8 years.
The Romanow report is much better that the Kirby report when it comes to increased public funding for Medicare. Kirby proposed what amounts to a permanent user fee, payable by all tax payers. Kirby's proposal would not raise enough funds and it does not meet the test of fairness.
While we could argue that Medicare needs more money than what is being proposed, what is being offered is significant (particularly if the federal government gets to the 25% minimum, using the existing progressive income tax system and its revenues, with a built-in escalator) and this section of the report is positive and comes very close to meeting our Objective.
Never for profit Romanow Report Grade: B The report states that: 'Medicare is a moral enterprise, not a commercial venture. Medicare is a right of citizenship ... 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 concludes that private, for-profit health care runs the risk of being more expensive, providing worse care and undermining the value of fairness.
The report clearly states that Romanow challenged those advocating private sector solutions to provide the evidence but that evidence was not forthcoming. The answer to Canadian health needs, the report concludes, does not lie in the private sector but in a better funded public system.
The Romanow report also recommends decisive action to curb the growing number of private for-profit MRI and other diagnostic services clinics, concluding that these private clinics lead to queue-jumping and this violates the principles of the Canada Health Act. The report recommends that diagnostic services be explicitly included under the definition of insured services under the Canada Health Act. The report recommends that there be no user fees, facility fees or extra billing for MRIs and CT scans; thus, making it illegal for anyone to be charged an out-of-pocket fee for these services. The report recommends that Ottawa penalize any provinces that allow private delivery of diagnostic services. The report also states that the current status of injured workers (WCB claims) getting preferred access to care and being sent to private clinics violates the principle of equal access. Further, the report proposes a Diagnostic Services Fund of $1.5 billion over 2 years to improve wait times.
The report looks at Public-Private Partnerships and essentially concludes that they're not a good idea and will end up costing taxpayers more than if the government had simply done the job itself in the first place. The report also notes that these arrangements can have the effect of hospital bed closures and a reduction in staffing levels.
The Romanow report also recommends that user fees, medical savings accounts, deductibles and tax-based co-payments continue to be banned by the CHA.
Clearly, this is much better than the Kirby report which has no problem with further commercialization, private for-profit ownership and delivery.
However, the report does have a major weakness on the issue of privatization. It offers reasons and suggests there is evidence that contracting-out of non-medical services such as food preparation, laundry, maintenance and cleaning is okay. This is not the right thing to recommend or the smart thing to recommend and therefore the report, on this point, is extremely disappointing.
Further, while the report gives strong rationale for opposing private for-profit care, the report is missing a specific recommendation of a specific mechanism for banning private, for-profit delivery of health services.
In addition, while the report is critical of P3s it stops short of recommending they be banned completely and even suggests that they might be useful in non-direct health areas such as "health information systems."
This section of the report went far, but could have and should have gone even further. In any health care institution, germ-free environments, properly sterilized laundry and food safety are critical to the well-being of patients - we can't afford to cut corners with for-profit laundry, dietary and maintenance services. The report should have said this but it didn't. Therefore, this section of the report does not completely meet our Objective.
Debunk private health care myths Romanow Report Grade: A The report is an eloquent defence of public Medicare. It offers unqualified support for the principles underlying public Medicare. It dismisses the myth that public Medicare is on the brink of collapse. It debunks the myth that public Medicare is unsustainable or unaffordable. It also challenges the myth that private, for-profit care is more efficient, would shorten waiting lines, and provides better care (except when it comes to support services and this is a problem with the report). It also concludes that 'innovations' such as user fees, medical savings accounts, P3s etc. are nothing more than standard right-wing nostrums that will do nothing to improve Medicare.
This part of the report is very positive and meets our Objective.
A comprehensive national health human resources strategy Romanow Report Grade: B The report suggests the need to look at changing the scopes and patterns of practice of health providers.
The report argues for a national database to analyze relevant human resource information, and track and forecast trends.
It also suggests that governments stop recruiting health care workers from third world countries.
The report calls for a Rural and Remote Access Fund ($1.5 Billion over 2 years) to attract and retain health care providers, including opportunities for health professionals to train and gain experience.
There are not enough substantial recommendations on this subject - i.e. it does not make specific suggestions for training and upgrading skills of existing health professionals and other workers. Most of the details of a national health human resources strategy are left to be developed by a new Health Council of Canada. We were hoping for more substantive recommendations and a national fund for a human resource strategy. We were also looking for a proposal to promote and market the various health professions.
On this subject, the Romanow report only partially addresses the Objective we set out.
Primary Care Reform - Develop a system of blended care Romanow Report Grade: A The report recommends a common national platform for primary care reform.
It recommends a $2.5 billion investment over 2 years through a Primary Health Care Transfer in order to remove barriers to change and kick-start reform. Of course, service delivery is provincial jurisdiction, so Romanow recommends the federal government link the new funding to provincial pursuit of the community clinic model.
The changes it proposes include: full-service community health clinics where patients can access a team of health professionals 24-7and receive everything from a doctor's prescription to nutritional advice to physiotherapy and psychiatric help.
There is also an emphasis on the need for cultural diversity and removing language barriers to improve access to care.
The report also talks about the need to put more emphasis on wellness and disease prevention programs - tobacco, obesity and physical activity are good choices to start with for health promotion.
In some ways this section of the Romanow report is similar to Kirby's proposal of creating primary-care groups of different types of health-care providers. However, Romanow's recommendation is better in that it calls on the federal government to use any new money to 'buy the changes needed in primary care reform' and it talks about wellness and prevention programs being critical to good health.
The focus on primary care reform, integrated with health promotion and disease prevention is long over-due. This section of the report and its related recommendations are very positive and come very close to meeting our Objective.
Add home care to the Canada Health Act Romanow Report Grade: B The report recommends that Ottawa kick-start a process (and provide the foundation for) a national home care program by covering all priority home care services - i.e. intervention services, home mental health services, palliative care, post-acute home care - through a Home Care Transfer of $2 billion over 2 years.
It is not clear what the report suggests should be done with home support / personal support services. It has no specific recommendation on bringing these services under the CHA so we must assume it is okay with those services being left out of the Act and therefore becoming out-of-pocket expenses for all intents and purposes. This would not be the right thing to do or the smart thing to do. These are services that allow people to live with dignity in their own homes. That both improves care and saves money by keeping people out of hospitals.
The Kirby report called for a national home care program that would cover only those just released from hospital or those near death.
This part of the report
does not go all the way and recommend a new national program immediately,
and not mentioning home support services is disappointing, but it does
propose a good step forward in the direction of including all home care
services under the CHA. It doesn't completely meet our Objective but it
brings us a closer to a national home care program. Objective 7 Add long term care to the Canada Health Act Romanow Report Grade: D The Romanow report is a dismal failure on this Objective. The report does not make any recommendations at all for institutional care.
It assumes, for the most part, that through home care reform and increased coverage of acute and palliative home care services under the CHA, you would be able reduce the demand for beds in long-term care institutions.
The report does not recommend national standards for long-term institutions and it does not recommend new immediate public funding for long-term care.
The total lack of recommendations in this area is clearly a major win for the huge private corporations involved in the long-term care industry i.e. Extendicare.
Objective 8 Add a national pharmacare program to the Canada Health Act Romanow Report Grade: A- The report concludes that the short term priority should be to provide public funding for "catastrophic drug costs" with the Canada Health Act eventually covering the cost of prescription drugs.
It recommends the establishment of a National Drug Agency and a National Drug Formulary as a national strategy for dealing with soaring drug costs, providing comprehensive coverage and objective and accurate information on drugs.
The Romanow report also calls for a review of current drug patent laws in Canada.
The Romanow recommendation is better than Kirby's proposal which calls for public coverage after $5,000 and does nothing to address the root causes of soaring drug costs (patent law).
This recommendation falls short of our Objective of a National Pharmacare Program but it offers a huge step in the right direction, especially on the recommendation to review patent laws.
Exclude health services from all international trade deals Romanow Report Grade: A The Romanow report offers a strong message on this issue. The report issues a 'warning flag' on globalization and trade deals and their impact on the future expansion of public health care. It recommends that governments must not delete from trade deals any of the current protections and exemptions for health care and it states that Canada should work with other nations to protect public health care from trade agreements.
It also states that any future efforts to expand public Medicare must also be protected from trade deals.
It also states that the right to regulate health policy should not be subject to claims from foreign companies.
The Romanow recommendation is better than the Kirby report which ignores altogether the risks posed by NAFTA and other trade agreements that further privatization of health services would open the door to US and other foreign corporations to penetrate our Medicare and take over its services.
The report could have called for a renegotiation of trade deals which would provide even stronger protection for public health services. There should have been a recommendation that the Canadian government take TeleHealth technology off any trade negotiation table.
On the whole, the Romanow report is strong on this subject and comes very close to meeting our Objective.
Objective 10 Women's equality in health care Romanow Report Grade: A- The report recommends that governments provide some kind of financial aid to those (overwhelmingly women) who have to stay at home to care for sick, elderly or disabled relatives. On principle this is an excellent recommendation and it takes us into any area governments have not yet ventured. Of course, the devil will be in the details with respect to how the assistance is provided - likely through the EI system
The recommendation of increased public funding and reversing the trend of privatization is also very helpful for health care workers the majority of whom are women. Contradicting this, however, is the section of the report that offers reasons for contracting-out support services. This would unevenly affect women workers and so this aspect of the report could have been better.
The report does not offer enough to address the unique health needs of women and related access issues.
The Romanow recommendation is much better than the Kirby report which ignores the uneven burden faced by women when it comes to unpaid care giving in the home. Further the Kirby endorsement of private for-profit ownership of facilities and services would actually exacerbate the uneven burden and unequal access to health services faced by women.
The report goes further than any other to address the uneven burden faced by unpaid care-givers (mostly women) and comes close to meeting our Objective.
FOR MORE INFORMATION:
CUPE
response to Romanow Commission November 28, 2002
Canadian Union of Public Employees November 28, 2002 The 47 recommendations
made by Roy Romanow in his long awaited report on the future of health
care The strength of Romanow’s
report lies in his steadfast promotion of publicly-funded health care
as the best There are other problems,
but Romanow’s most significant concession to the private sector is in
his statement that there must be a clear line drawn between direct health
services and support services and that only direct health services should
be free from private, for-profit delivery. This conclusion will embolden
employers and provincial governments to contract out dietary, laundry
and cleaning services. The consequence will be a transfer of well-paying,
unionized jobs with benefits to lower paying, non-union jobs with few
benefits. The livelihoods of women, minorities and immigrant workers are
being sacrificed to save money in the overall system. On the positive side, Romanow recommends that federal funding be increased to 25% of total health expenditures and that a separate health transfer be created. The federal government should inject $6.5 billion over the next two years to ensure that recommendations are implemented. Romanow reflects CUPE’s
critical analysis of public private partnerships and says that they are
“not a User fees, extra billing,
and medical savings accounts are all rejected as alternative funding mechanisms.
Home care services
(palliative care, post acute care and mental health) are to be incorporated
into the Canada Health Act and covered as “insured services.” This is
a significant step forward but does leave preventative care, care for
people with disabilities and long term care out of the equation. The creation of a
National Drug Agency and a national formulary will be major steps forward
in monitoring and controlling drugs, the fastest rising cost in the health
care system. Romanow is recommending
that MRIs and other medically necessary diagnostic services be clarified
and included in the Canada Health Act. This is welcome but does not represent
a substantive change from the current situation. Under Romanow’s suggestion
for-profit clinics are still likely to exist but may see their funding
flow dry up. Romanow is recommending the inclusion of workers’ compensation
injuries as a Canada Health Act insured service. WCB is currently a major
revenue source for private clinics. For other details see the CLC preliminary analysis at www.clc-ctc.ca CAW applauds Romanow
Commission TORONTO, Nov.
28 /CNW/ - Buzz Hargrove, president of the Canadian Auto Workers union,
sent the following letter to Prime Minister Jean Chrétien, following release
of the highly anticipated Romanow Report. As well, a similar letter was
sent to the Premiers urging the provinces to work with the federal government
to implement the Report's recommendations: November 28, 2002
Dear Prime Minister, I am writing to strongly
urge that your government act immediately on implementing the landmark
Romanow Report, especially with respect to providing increased federal
funding. We do however want to highlight some shortcomings which include
drawing a line between medical and non-medical services which I will elaborate
upon further. Sincerely BASIL "BUZZ"
HARGROVE cc: Hon, Anne McLellan,
Minister of Health (613-943-0044) -30- For further information:
Models for good health care management: Steelworkers applaud Romanow Report TORONTO, Nov. 28
/CNW/ - The United Steelworkers National Director Lawrence McBrearty says
Thursday's release of the Romanow Commission Report on the Future of Health
Care in Canada is an important milestone in the evolution and preservation
of Canada's comprehensive, single-payer health care system. For further information:
For immediate release
“Romanow
is right. Reforms will shorten waiting time and improve care,” Connors,
RN Ottawa: The
President of the largest organization of nurses in Canada predicted that
Health Care Commissioner Roy Romanow’s report would lead to a genuinely
revitalized Medicare. She also praised Prime Minister Jean Chrétien and
urged him to follow through on his intention to fully fund the Romanow
reforms. “Through this
report, Medicare could take a giant step forward. The Commissioner has
called for including the following in the Canada Health Act: Home Care,
Diagnostic Services, Pharmacare, and a mechanism for Accountability. He
has also recommended adequate additional funding. “Medicare’s
founder, Tommy Douglas, said long ago that Medicare needs to grow beyond
the services his Medicare covered. In this sense, Roy Romanow has offered
Canada Tommy Douglas II. It will greatly improve the quality of care in
our public system. “These values
led him to recommend expanding public, not-for-profit Medicare to include
Home Care and Pharmacare and to recommend a genuine system of Primary
Health Care. “The evidence
led him to ignore the pleadings of powerful private for-profit health
care interests and, instead, recommend that health care delivery remain
in not-for-profit hands. “On behalf of
Canada’s nurses, I’d like to thank the Prime Minister for his wise appointment
and I’d also urge him to not be swayed from implementing these important
reforms to Medicare. The provinces won’t do it. It will take strong leadership
from Prime Minister Jean Chrétien.
Government Must Act Now to Implement Romanow Recommendations on Drug Patent
In June 2002, the
House of Commons Standing Committee on Industry, Science and Technology
approved a motion by Liberal MP Dan McTeague to review the Patented Medicines
(Notice of Compliance) Regulations of Canada's Patent Act that allow brand-name
drug companies to extend their market monopolies beyond original 20-year
patent terms. Today the CGPA urged the Committee to initiate that review
immediately as recommended by Commissioner Roy Romanow. The CGPA, along with
private insurers, health-care organizations, unions and seniors groups,
had urged the Commission to recommend repealing or amending the Regulations.
Specific only to the
pharmaceutical industry, the Regulations allow brand-name drug companies
to stop Health Canada approval of generic drugs simply by alleging patent
infringement. The automatic 24-month stay under the Regulations means
that Health Canada cannot approve a generic drug until any claim of alleged
patent infringement is decided in court. Brand name drug companies
have developed a number of tactics, including filing several additional
patents on a single drug for minor changes like the product's monograph,
to prolong the litigation and delay competition from generics. These needless
delays have cost Canada's health-care system hundreds of million of dollars
by forcing provincial governments, hospitals, private insurers and consumers
to pay for higher-priced brand versions for longer than they should. The United States
is the only other country in the world with similar provisions under its
patent laws. But on October 21, President George Bush announced he is
taking action to close loopholes in U.S. drug patent laws (Hatch-Waxman
Act) that brand name drug manufacturers have manipulated to unfairly delay
the approval of competing generic drugs. "It is very telling
that the message from a Republican President and a former NDP Premier
is the same. Ending abuse of drug patent laws is just the right thing
to do to protect our health-care system," Keon said. About the Canadian Generic Pharmaceutical Association The Canadian Generic
Pharmaceutical Association represents Canada's generic drug industry -
a dynamic group of entrepreneurial companies that specialize in the production
of high quality, affordable generic drugs and fine chemicals and in conducting
the clinical trials required for government approval of generic drugs.
It plays an important role in helping control overall healthcare costs
by keeping the cost of medications down: generic drugs are priced, on
average, 45% less than their brand-name equivalents. -30- John
Gerretsen, Ontario Liberal Long Term Care Critic ROMANOW REFLECTS CANADIAN VALUES
“Ernie Eves and Mike Harris have been taking us down the road to a two tier system,” said Gerretsen. “Now, Mr. Romanow has made it clear that we need one universal system, open and accessible to all Canadians. The suggestion of including accountability as another cornerstone of the Canada Health Act is one the federal government should act on quickly to ensure that money transferred to the provinces is actually spent on health care and not on other whims like tax cuts for big business.” Gerretsen, Long Term Care Critic for the Official Opposition, was particularly pleased to see the inclusion of a recommendation for a national home care. “I have been talking to recipients and providers of home care in this province and I know that the Eves government is starving them. For many people, their first choice is to stay at home as long as possible but they need the supports and those supports are just not there now. Major studies show it is cost-effective to keep people in their homes. Now, as part of a national home care program with a dedicated transfer to provide the funding foundation, Ontarians can have that opportunity if the Eves government will cooperate,” said Gerretsen. “A recent poll showed that a great number of Canadians want a national home care program. Romanow heard them. Now, it’s time for Ernie Eves to get on with it and provide funding for home care in this province as Romanow points out “the next essential (health care) service.” Romanow’s recommendations point to an update for the Canada Health Act to reflect the needs and values of all Canadians. The specific recommendation to keep diagnostic tests like MRIs in the public domain is a vindication of the position taken by Dalton McGuinty and the Ontario Liberals. Treatment must be based on medical opinion and not a cheque book Gerretsen went on to say. “Commissioner Romanow has traveled the country and held extensive hearings. He is a pragmatist. I think the title of this final report ‘Building on Values’ is extremely apt. Canadians value their health care and, I believe, want their provincial governments to get down to the business of working with the federal government and make these recommendations a reality,” said Gerretsen. “I commend Commissioner Romanow on the work he has done on behalf of all Canadians.” -30- Contact: John Gerretsen,
M.P.P., Kingston and The Islands
CUPE
Ontario Division November 28, 2002
Eves’ government must heed Romanow, and stop for-profit hospitals, MRI, CT and cancer clinics
“It’s clear that the policies of the Eves’ government with their push to a for-profit, two-tier health care system, are in direct conflict to the recommendations made by Romanow. We are calling on Eves to stop the construction of for-profit private hospitals, and to stop the opening of private MRIs, CT scans and cancer care clinics,” says Ryan. In his commission report, released today, Romanow discounts the argument that for-profit-private solutions are the only way to reform our medicare system. “Romanow challenges the myths that the Harris/Eves government is perpetuating that the system is not sustainable and that privatization is the only way forward. “Romanow also says that he has seen no research to back up the myths that private delivery is cheaper and more efficient. He confirms what we have been telling the Conversatives that every dollar spent on for-profit health care is a dollar less for front line services, is a dollar less for bedside nurses, for quality home care and for direct patients services in long-term care,” says Ryan who commends Romanow for his progressive and comprehensive report. “However”, says Ryan, “it’s disheartening to see that despite his working class roots, Romanow has given a green light to contract out the jobs of the lowest paid workers in the health care system. What he is doing is promoting a low-wage underclass of workers, who are primarily immigrants and women. “It’s unfortunate
that he appears not have sourced the significant research available that
shows that the introduction of for-profit housekeeping and dietary services
leads to dirty hospitals that are a breeding ground for germs and infection
and inedible slop being served to the sick.” For more information
please contact:
Ontario
New Democratic Party (Ontario NDP) Romanow report hits right note Cancel healthcare privatization in Ontario Halt private hospitals
Romanow firmly concludes that the public sector is the most efficient way to provide health care. "This shows clearly that any scheme promoting private sector health care is a sham. It's time the Conservatives reverse privatization in this province," he said.
-30-
Ernie
Eves, Premier of Ontario "For almost 10 years now the federal government has been short-changing Ontario taxpayers. We pay more than enough in taxes to deserve a first rate health care system," said Eves. "The Ontario Government has done its part -- we have increased health care spending by $8 billion since 1995. Health care spending now represents 47 per cent of the provincial budget in the Province of Ontario. Now it’s time for the federal government to do its part." Eves said, "The question now is how quickly the federal government will act on the report and once again become a full partner with us in funding medicare programs." Eves said the Ontario government looks forward to working with provinces, territories, and the federal government to ensure our health care system continues to respond to the needs of Canadians throughout the 21st century. "As the administrators of our health care system, our focus remains increasing access for patients through innovation and co-operation with the federal government," said Minister of Health and Long-Term Care Tony Clement. "We await a quick and decisive response from Ottawa. In the meantime we have a responsibility to work with health care providers to find new and better ways to deliver quality health care to Ontario patients." Clement said that, in the summer of 2001, Ontario conducted its own Public Dialogue and heard back from more than 400,000 Ontarians and they said they wanted a universally accessible health system, additional health human resources, reduced waiting times, expanded access to diagnostic services and a focus on keeping people healthy before they get sick. "The Romanow Report has many interesting ideas and recommendations, and I look forward to working collaboratively with my counterparts across the country," said Clement. A federal/provincial/territorial health ministers’ meeting is planned on December 6 in Toronto. "There has been a long line of reports examining the problems with our health care system and recommending fixes," said Clement. "There is one constant in each of those reports. It’s the need for more federal money. I hope the Chrétien government will support, as the Eves government does, the overall conclusion of the Romanow Report, that federal contributions for health care must increase significantly." -30- For more information:
November 28, 2002 The Romanow Report: What Does it Mean for Women? We applaud Romanow for demonstrating the sustainability of Medicare. A publicly funded system delivered through non-profit services is crucial for all women in Canada. But like other reports on health care reform in the last decade, this report fails to recognize the significant ways in which health care is an issue for women. Women are 80% of paid health care providers, a similar proportion of those providing unpaid personal care and a majority of those receiving care, especially among the elderly. The sustainability of the system is not just about finances -- it’s about women’s work. As paid workers women provide medical, nursing and diagnostic care as well as cleaning, cooking and laundry services that are essential determinants of health in the delivery of care. By drawing a distinction between “direct” and “ancillary” health care services, Romanow ignores the skilled nature of women’s paid work and their contributions to care. Moreover, he fails to make recommendations to address the deteriorating conditions women face in providing care. Women also sustain the system as unpaid health care providers. Romanow’s report fails to adequately address the full range of home care women provide, especially long-term and chronic care. While he reports “that caregiving is becoming an increasing burden on many in our society, especially women,” his recommendation for caregiver leave through the Employment Insurance Program will not benefit the many women who do not have forms of paid work that would make them eligible for such leave. Romanow recognizes gender as a determinant of health. He also offers valuable recommendations for primary health care reform that could benefit women, but only if attention is paid to women’s particular needs. Finally, although women constitute up to 3/4 of those in long-term care facilities, the report is virtually silent on these services. Sustaining an efficient, affordable and effective health care system must mean sustaining women in providing and receiving care. Like Romanow, we agree that “we need more than rhetoric; we need action”. We need to make the health care system work for women. For interviews, contact: Or:
CEP For immediate release
OTTAWA -- Romanow has confirmed what Canadians believe - our public health system is less costly, more fair and of higher quality than privatized care. "Now it's time for the federal government to put the money behind our values," said Brian Payne, President of CEP. "This is also good news for the Canadian economy", Payne added, "and employers should be supporting public health care. With Romanow's help, we can avoid the US scenario of fighting for health care at the bargaining table." In the US, 55% of Americans rely on employer-based plans for health care. As costs have risen, employers have cut back on health care coverage, which has become the number one bargaining issue in the US. With the average premium for family coverage costing American employers $5800 (US) per worker per year, Canadian employers have everything to gain from our public system. "There's no doubt that public health care is a major competitive advantage for Canadian business," said Payne. In Canada, cutbacks in publicly provided services have meant more costs under extended health care plans provided at work. Employers have been faced with rapidly increasing insurance premiums to cover work-based health plans, especially the cost of drugs. Increased funds for public health care and controls on drug costs can only be good for the bottom line. Payne added a cautionary note: "In health care, public is best and this needs to be applied consistently. We oppose Romanow's acceptance of privatization of health care support services, like food and laundry in hospitals." "Let's keep health care off the negotiating table and get it back where it belongs - in a stable publicly funded program," concluded Payne. For more information:
Reading Romanow on Women's Health: Now is the Time for Governments to Reinvest in Medicare **For Immediate
Release** The Romanow Report on the Future of Health Care is clear: Canadians want a publicly funded health system that is universally accessible and offers equal and timely service to all. The Report also documents that such a system, built on the successes of Medicare and augmenting its role in publicly provided health services, is possible with provincial and federal cooperation. "Implementation of the Romanow Report is now the key issue", says Madeline Boscoe, Executive Director of the Canadian Women's Health Network (CWHN). "Romanow has provided a good first step for sustaining a publicly insured health care system that addresses the diverse health needs of Canadians -- now we need to see swift government action on the Romanow recommendations". The CWHN applauds the Report's emphasis on access to health care for those living in rural and remote areas, on holistic approaches to aboriginal health, on the health needs of new Canadians and visible minorities, and an expanded national homecare program. "But women have been left out of the equation", Boscoe observes, noting that women represent the majority of paid health providers, and also provide the bulk of unpaid caregiving in communities and homes. As well, women are the most frequent users of health care services, yet women's specific health needs do not receive comprehensive assessment in the Romanow report. This failure to appropriately address gender differences in health care use and delivery means that many of the recommendations in the Report fail to protect and promote women's health, leaving women vulnerable and without the necessary support. Abby Lippman, Professor
of Epidemiology at McGill University and Co-Chair of the CWHN notes, for
example, that the Report's recommendations on a national prescription The CWHN also believes that the report fails to focus meaningfully on measures that address health promotion and disease prevention, highlighting only methods of treatment and intervention, which are often costly and inefficient. Lippman states that "while we welcome attention to the provision of primary care, this seems to assume preventive approaches based on changes by individuals rather than on structural changes that will promote the diverse health needs of all women in Canada". Lippman also notes that the report does not address the impact of economic and social disparities on individual health status, "Government programs and policies should require health impact assessments and programs that address structural inequities", Lippman concludes. The CWHN believes that a renewed vision of healthcare must reflect and support the principles of equity and social justice for all Canadians, and strongly endorses the general recommendations of the Romanow Report. "A renewed commitment to access based on need and not on the ability to pay is an essential component of the Romanow Commission findings", Boscoe notes, "and it is one that is wholly supported by the Canadian Women's Health Network. The time for action is now". To see the complete CWHN "Submission to the Commission on the Future of Health Care in Canada" visit: http://www.cwhn.ca/resources/romanow/index.html For interviews, contact: Prof. Abby Lippman,
Co-Chair Kathleen O'Grady,
Director of Communications The Canadian Women's
Health Network is a national, voluntary bilingual organization of individuals
and groups concerned with women's health.
Canadian College of Health Service Executives CCHSE
APPLAUDS THE WORK OF THE COMMISSION ON THE FUTURE OF The Canadian College of Health Service Executives (CCHSE) welcomes the final report of the Commission on the Future of Canada’s Healthcare System. “The Commission has listened to the concerns of Canadians and mapped out an aggressive plan that, when adopted, will rebuild our health care system into one that better meets Canadians expectations," notes Gaston Levac, CCHSE President. The three central themes in the Report provide a framework for action. Sustained, committed, predictable investment in the health system will permit the executives and managers to focus on the business of planning and leading a strong, vital system - when the money comes. The addition of a 6th principle to the Canada Health Act (CHA), the outlining of a health covenant and the establishment of a National Health Council will ensure Canadians have an accountable health system that meets their needs. Finally, the recognition of the need for significant structural changes in the health system, the expansion of the CHA to include home care, implementing primary health care reform, outlining a strategy to address rural health needs and improving aboriginal health, complete a strong package. CCHSE especially welcomes the recommendations for investments in health human resources and the specific recognition of the impact of the reductions in the health system’s management cadre and the need to reinvest. “The recommendations for investments in health human resources will go a long way to revitalize the health care system work force. Managers and Executives of the system daily deal with the shortages being faced in the system and the pressures these create to provide quality health care,” notes CCHSE Chair, Robert Zed. “It has been demonstrated time and again that a health system which is well managed, appropriately resourced and that encourages leadership creativity, significantly improves the quality of services. Mr. Romanow has provided a good blueprint for these conditions to occur.” Never before has the need for strong government direction and political leadership in health care been more necessary. At a time when all Canadians are examining their values, and defining what is important to them, a strong and revitalized health care system remains a most cherished goal. The goal of a quality health care system for all Canadians is a realistic one. The College re-iterates its commitment to working with all stakeholders to support and implement the recommendations outlined in this report. For additional information, please contact: Jaime Cleroux, CCHSE Executive Offices Tel: (613) 235-7218
ext. 35 The Canadian College of Health Service Executives (CCHSE) represents and serves a broad range of health service executives throughout the country with over 3,000 members from across all sectors of health services. CCHSE has made a number of recommendations to the Commission on the Future of Health Care. If implemented, these recommendations will result in increased support for a strong executive and management workforce in the Canadian Health Care System.
ROMANOW REPORT ADDRESSES SOME KEY ISSUES Press Release November 28, 2002 "Romanow is taking a step in the right direction with his report." says Margaret Haworth-Brockman of the Prairie Women's Health Centre of Excellence, about the report Building on Values: The Future of Health Care in Canada. "He is addressing several issues identified by women in our Centre's research." PWHCE agrees with the report's call to reinforce Canada's universally accessible, publicly funded health care system. Such a system is more equitable for all Canadians, regardless of financial circumstance. Research has shown that women have lower average incomes than men and are more likely to live in poverty, especially single parent women and senior women. A significant portion of women are not employed outside the home or work part-time and may not be able to pay for additional health costs. These women, as well as those who are self-employed or farm operators, may have limited options for private medical plan coverage. Research has shown that the erosion of services due to cutbacks of the last decade has negatively affected women and the report's recommendation to increase health funding to the provinces is welcomed. Access to services is a major problem for people living in rural and remote areas. Romanow recognizes this in the recommendation for a Rural and Remote Transfer, and in recommending action to provide an appropriate mix of health care providers in these areas. More readily available diagnostic services will reduce the stress induced by lengthy waiting times and travel to other locations, and improve health outcomes. The majority of health care workers are women. Romanow acknowledges the stress that health care providers have experienced in attempting to deliver quality care under current working conditions, and does make some recommendations to improve health workforce planning. "Women carry a major responsibility for unpaid care-giving - for their families, their friends and their communities ", stated Ms. Haworth-Brockman. The proposed Home Care Transfer and the inclusion of home mental health case management, post-acute home care and palliative home care under the Canada Health Act would help support women and men who wish to remain in their homes, and those providing care to others. Unfortunately Romanow defers including expanded home care services for persons with chronic illnesses and disabilities under the Canada Health Act. The proposal to expand the Employment Insurance provisions to allow time off will only benefit those who are able to qualify for EI, and will provide a bigger benefit to those with higher incomes and full-time jobs. There are differences in the lives of women and men that become more apparent through the life cycle, as women fulfill their roles as mothers, family members and community leaders. The report cites the need for better information and accountability. Examining how women's health is different from men's and how access to services and use of services differs is necessary for better health planning. Unfortunately, the report contained few direct references to women or gender. Qualitative and quantitative gender-based analysis will be critical to effective implementation of the report's recommendations, and when the Health Council of Canada's measures the performance of the health system and health outcomes. "The health care system will be improved by listening to women's voices and ensuring they have a strong role in directing the upcoming changes", says Haworth-Brockman. Romanow cites the need for a more preventive approach to health. PWHCE agrees that Canadians need to look beyond health services, to the conditions that undermine or improve well-being. Low income, inadequate housing, social dislocation and family violence all negatively affect women's health. Aboriginal women face great rates of poverty and a higher prevalence of many health conditions. Women with disabilities, immigrant and racialized women, and women of different sexual orientations also face additional barriers to achieving well-being. By addressing social determinants of health and building on the many strengths of these and all women, the development of healthier communities will be supported. The PWHCE will be drawing on the resources of its organization - researchers, health service providers, and a diversity of ordinary women from many backgrounds - to examine Mr. Romanow's report in more detail. Margaret Haworth-Brockman states, "We hope that the recommendations he has made will truly lay the groundwork for a health care system that addresses women's responsibilities as caregivers and enhances women's health. " The Prairie Women's Health Centre of Excellence funds community-based research on the social factors affecting women's health in Manitoba and Saskatchewan. To date the Centre has supported over 60 projects dealing with a wide range of issues, for women from many backgrounds. PWHCE's current research is focusing on Aboriginal women, women living in poverty and women living in rural and remote areas. PWHCE studies are available at: http://www.pwhce.ca/ For more details or interviews contact: Margaret Haworth--Brockman,
Executive Director Joanne Havelock, Policy
Analyst
Romanow started off by stating that Medicare is sustainable if we want it to be. Canada’s healthcare outcomes are among the worlds best. Healthcare spending is not out of control.
Romanow clearly stated that the so-called new solutions of private care aren’t new. “We’ve been there before, they didn’t work then and they don’t work now.” The route to privatization is wrong.
Romanow calls for an extension of the Canada Health Act to cover post-acute homecare, palliative care and diagnostic services. He has also recommended changes to guarantee accountability for the process attached to the delivery of new funds to the provinces.
Romanow calls for an incremental creation of a pharmacare program. The pharmacare program will be introduced in phases starting coverage of catastrophic drug costs over $1500.
Romanow calls for new federal funding to allow for a cash transfer to the provinces that will be at 25% of healthcare expenditures by 2005/06. He also proposed interim funding for a number of program areas including homecare strategy, rural and remote access, primary health care, and catastrophic drug coverage.
Romanow also called for a National Health Council composed of federal and provincial officials, healthcare providers and citizen representatives to monitor the performance of the healthcare system and to set benchmarks for acceptable performance.
The Romanow Report states that the private sector has not made its case for the benefits of privatization. The Brampton Health Coalition calls on the Ontario Health Minister Tony Clement to act immediately upon the recommendations of the Romanow Commission and stop the private-public (P3) funding process that is proposed for Brampton’s badly needed new hospital. It is clear that it is not cost effective and the citizens of Canada, Ontario and Brampton do not want to go down this road.
If the Romanow Report is implemented there will be more money for healthcare and there will also be more accountability to the users of the healthcare system and to the taxpayers who support it. This should enable the Ontario government to proceed immediately to publicly fund our new Brampton hospital.
Mr. Clement pledged last night at the Mayor’s Town Hall meeting that value assessment of the private consortiums’ bids for the design, construction, financing, operation and maintenance of the new hospital will be done before any contract is signed by the Ontario Cabinet. He further pledged that if the P3 funding proposals show no benefits as compared to conventional public funding then the P3 option would not be followed. Mr. Romanow after extensive study and consultations has clearly stated that the private sector has not made its case for the benefits of privatization. The citizens of Brampton cannot wait while the province evaluates this pilot project. We need our new hospital now.
Health care workers urging immediate implementation of key recommendations of Romanow report "The federal government has an immediate and urgent role to play," says SEIU Canada spokesperson Sharleen Stewart. "We hope to hear Prime Minister Jean Chrétien's unequivocal support and commitment to the core principles set out in the report. This includes the infusion of $8.5 billion over the next two years and $6.5 billion in 2005-2006, bringing the federal share to 25%." In keeping with the message of the report, federal funding must be tied to expanded public services. The union, which represents more than 80,000 workers in Canada, is also warning provincial governments, such as Alberta, B.C. and Ontario, not to obstruct the citizens of Canada in their aspirations to see a revitalized and expanded public Medicare system. The key theme, running through Romanow’s report, and in his comments today, is that private and for-profit health care is fundamentally at odds with Medicare and with federal and provincial governments' ability to sustain quality health care. SEIU welcomes many
aspects of this landmark report. However, a number of the recommendations
do not go Specifically, many core home care services are not included in the recommendations. The report is also silent on absolutely crucial aspects of long-term care over which many battles to retain quality public, not-for-profit services are being fought. "This is the fastest-growing area of health care," said Stewart. "Seniors and 'boomers' are not well-served by Romanow's report." In addition, key in-hospital patient services, such as food services, cleaning, laundry and maintenance, must be returned to and kept in the public sector. FOR FURTHER INFORMATION:
OPSEU
Response Health care workers applaud Romanow TORONTO - Health careworkers across Ontario are applauding federal health commissioner Roy Romanow following the release of his long-awaited report on Medicare. "Roy Romanow has made the case, convincingly and conclusively, that a well-funded, publicly-operated Medicare system is best for all Canadians," said Leah Casselman, president of the Ontario Public Service Employees Union. "This report is a major setback for those who howl for the chance to profit from the sickness of others and line their own pockets with public dollars." OPSEU represents over 20,000 Ontario health care workers, including professionals and support staff in hospitals and in the community as well as in laboratories, ambulance services, home care programs, long-term care, mental health, and the Ontario Ministry of Health. "Health care workers will fight to make sure the new money Commissioner Romanow recommends is delivered to the front lines of the health care system and that some of it reaches the dedicated workers who have been subsidizing it with low wages and substandard working conditions for too long," she said. "Romanow gave the supporters of private profit, like the Ontario Hospital Association, ample opportunity to make the case for more private-sector involvement in the health care system and they failed to do so," Casselman said. "They failed because they have no case. Adequately-funded public Medicare is better, cheaper, and fairer than any private sector alternative. "We are calling on the Prime Minister and provincial leaders to throw their full financial and political support behind this fantastic national program that is the envy of the world." Casselman said the Romanow report identified several areas that could become key battlegrounds in the months ahead. "Canadians should watch carefully what happens with home care and diagnostic services like MRI and CT scans," she said. "These are the areas where the behaviour of our politicians will tell us whether we need to vote them out at the first opportunity. "If Ontario Health Minister Tony Clement understands what this report means politically, he'll drop his private clinic plans right now." - 30 - For more information:
November 28, 2002
We are also delighted
with the recommendation to establish a Health Council of Canada to set
benchmarks for care and ways to measure performance. Taxpayers are weary
of using universal health care as a political football. The Health Council,
with provincial representation including taxpayers, may help in defusing
the political rhetoric around this issue and deal directly with benchmarks
for care and measuring performance and outcomes. Part of Mr. Romanow’s support for funding for home care is most welcome, and supports our own longtime position that family caregivers be recognized as an important economic contribution to our health care system. (At this time, if you leave the workforce to provide care for an ailing family member you are penalized by the Canada Pension Plan.) The Romanow Report recommends that caregivers will be treated in the same manner as employees taking parental leave and will receive credit for the time they are out of the workforce providing home care. The Council’s
two concerns with the report are in regards its somewhat limited response
to home care needs and the fact that institutional long term care is not
addressed. Home care needs to go further. Seniors and disabled persons
need to be assured access to these services, to be able to live independently,
and both of these groups have been left out of home care recommendations.
With the dramatic increase in fees charged to people requiring long term care this past summer, it isbecoming obvious that chronic care in a long term care facility is going to be out of reach of most middle-income individuals. There were stories in the media a few days ago about seniors in Newfoundland being evicted from nursing homes because their nest eggs were depleted. Since people now enter nursing homes much older and frailer than ever before, The Council on Aging would like to see long term care become part of the provision of universal health care. With an aging population this is a tall order, but it is something we desperately need to address. The Council on Aging
commends The Romanow Commission on a thorough and transparent consultation
process. This report is reflective of what Canadians have said -and assures
that we will continue to have a national, universal health care programme.”
Kingston, Ontario
Contact:
“The Romanow Report maintains the integrity of the public system by reiterating that the principles of accessibility and universality are fundamental to our health insurance plan. And the Report also contains the key elements required to ensure continuity of health services and eliminate current barriers,” Mr. Le Blanc stated. However, the Report opens wide the door to an integrated health service approach by recommending, in particular, changes in home care, support for health prevention and promotion initiatives, and broader-scoped training for health human resources, with respect to medical and nursing staff as well as other health professionals. Mr. Marc Bisson, Executive Director of the Centre de santé communautaire de l’Estrie and Chair of the Network’s Communications Committee, stated that he was “pleased with the important role the Commission gives to health prevention and promotion.” Commissioner Romanow’s report recognizes that official language minorities’ access to health care in French remains a problem. In its submission, the Network had stressed the fact that language is an essential criterion to the quality and effectiveness of health services, a point that the Commissioner has confirmed. However, by limiting the scope of his recommendation on improving access for linguistic minorities, the Commissioner has failed in his duty to fully protect these minorities and, by the same token, to protect the Canadian public interest. This despite the fact that the Network urged the Commissioner to include the values of justice and equity as fundamental societal values in his reflections, by asking him to add the principle of linguistic duality to the Canada Health Act. Nevertheless, the Commissioner has adopted one of the values fundamental to the Network’s operations by recommending collaboration among federal and provincial governments, provincial and regional health authorities, health agencies, and minority language communities. The Network and its partners will insist that all stakeholders respect the spirit of the Commissioner’s recommendation and work toward developing, maintaining, and assessing quality French language health services in Ontario. With this goal in mind, the Network considers it essential to establish a federal/provincial official language health program as well as other French language health networks elsewhere in the province. The French Language
Health Services Network of Eastern Ontario works closely with the Ministry
of Health and Long-Term Care, hospital facilities, health care agencies,
and postsecondary educational institutions in the region to develop and
deliver quality French language health services to Francophones in Eastern
Ontario. - 30 – Spokespersons: Information:
FOR IMMEDIATE RELEASE…
Ottawa
NCWC notes with interest the recommendations to:
NCWC urges the Federal government, and through its Provincial and Local Councils, the Provincial and Territorial governments to begin working together immediately on implementing the recommendations of the Romanow Report. NCWC calls on Canadian women to contact their Federal, Provincial and Territorial members urging them to act on these recommendations. Contact: Shirley Browne,
Health Convener, Ottawa, 613 - 745 - 1303
NEWS RELEASE November 29, 2002 Nurses challenge provincial government to get in step with Romanow recommendations what’s needed is a public process for implementation Nurses are calling upon the provincial Liberal government to immediately put in place a plan to implement the Romanow report. "We want to see Premier Campbell and his health ministers working co-operatively with the federal government on Mr Romanow’s recommendations," says Patt Shuttleworth, Vice President of the BC Nurses’ Union. "And we expect full public participation and transparency in the process. Mr Campbell needs to go beyond his special interest cronies he’s put in charge of the health authorities. Seniors, patients, disability groups, doctors, nurses and other providers need to be consulted and involved." "Health Minister Sindi Hawkins is saying there’s no need for a National Council because her government is accountable to British Columbians. If her idea of accountability is massive cuts to health care services throughout the province delivered without warning and with no public consultation, then it’s obvious that British Columbians need the benefits of a National Health Council, which Romanow calls for." BCNU welcomed much of Romanow’s report, giving full marks to recommendations:
"There were a few areas we found disappointing," says Shuttleworth. "Thousands of Canadians and Mr Romanow himself gave an unequivocal no to private profit in healthcare yet this wasn’t fully reflected in the report. We were looking for a stronger rejection of all forms of privatization, including public-private partnerships and privatizing health care support services." "We’re also concerned about several comments in the chapter on health care providers," adds Shuttleworth. "Mr Romanow was critical of recent wage increases to nurses. He completely ignored the fact that for many years nurses wages lagged far behind and compensation became a critical element in the recruitment and retention of nurses in the system."
British Columbia Nurses'
Union
Active Living Alliance for Canadians with a Disability FOR IMMEDIATE RELEASE Romanow Report encourages increased physical activity Ottawa, ON - November 29, 2002 The Active Living Alliance for Canadians with a Disability applauds the Romanow Report's recognition that physical activity can save lives, save health care money and improve quality of life. Recommendation 23 of the report says, "All governments should adopt and implement the strategy developed by the Federal, Provincial and Territorial Ministers Responsible for Sport, Recreation and Fitness to improve physical activity in Canada." "Becoming more active is something everyone can do," says Jane Arkell, Executive Director of the ALACD. "It's especially important for people with disabilities because it can influence many aspects of life such as improved health, self-esteem, personal identity, productivity and relationships." Almost half of Canadians with a disability over the age of 5 perform no physical activity in their leisure time. Inactivity is a serious problem that can be fixed. Through online resources, a toll-free phone number and coast-to-coast contacts, the Alliance can help Canadians of all abilities lead healthier and more active lifestyles. The Romanow Report also stresses the importance of prevention over treatment. Physical activity can go a long way towards preventing or minimizing disabilities associated with conditions like diabetes, heart disease, cancer and obesity. Being active greatly improves quality of life and millions of dollars in health care costs could be saved. The ALACD is a national, non-profit organization formed in 1989. It has 17 national partners and has an affiliate in every province and territory to promote healthy and active lives for people with disabilities. For more information on the Active Living Alliance for Canadians with a Disability, log on at www.ala.ca. Media Contact:
For Immediate Release November
28, 2002 Winnipeg, November 28, 2002 – NDP leadership Jack Layton today responded to the Romanow Commission report on the future of health care, calling it an “action plan for hope.” “Romanow has listened to Canadians, looked at the facts and presented an action plan for hope,” he said. “It presents many of the innovations the New Democrats have been calling for some time and articulately debunks the myth that American-style health care is cheaper or better for patients. “The Romanow report lets us move forward with solutions, not turn the clock back. New Democrats need to ensure his solutions are implemented and need to ask ourselves how we’ll do that,” said Layton. Specifically, Layton said Canadians should heed Romanow’s words that public Medicare provides some of the best health outcomes in the world and the Liberals should show the political will to provide the $6.5 billion he recommended. “All NDP leadership candidates agree we need the Liberals to restore federal funding to 25 per cent of health care. And we all agree some of that should be used to expand Medicare and reflect modern realities through homecare, better diagnostic equipment and primary care reform. “Romanow’s recommendations on drug pricing and availability are also promising steps towards the pharmacare program Canadians want and need,” he said. “It is innovative to have a national drug agency to contain and negotiate costs – and help provinces.” Layton said New Democrats must ask themselves how best to protect and improve Medicare in the post-Romanow period, noting his report is complex, positive and will affect different regions differently. “Can we explain to Canadians why we should invest in the solutions Romanow recommends with two questions a day in Question Period? With five parties and only 14 MPs, I think we need to do more than Question Period – we need to work in communities with our allies, speaking about solutions and building real pressure for change,” he said. “Our demands in Parliament will carry more weight when the Liberals know we are also mobilizing for solutions in communities. And our members deserve the chance to work on important issues close to our heart, such as Medicare. That’s what my plan for campaigns is about – supporting work in Parliament, involving our members and being positive about solutions,” he said. “On January 27, let’s make our solutions heard right across this country – from Question Period to Qualicum Beach. “The best way to protect and improve Medicare is to be visible in communities, building profile and pressure to support our important work in Parliament,” he said. source: http://www.jacklayton.ca/campaign_updates/default.asp?articleID=144
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