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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 susta |