Remarks from the Honourable Jane Philpott, Minister of Health, to the CANADA 2020 Health Summit : "A New Health Accord for All Canadians"

September 29, 2016
Ottawa, ON

Check against delivery. This speech has been translated in accordance with the Government of Canada's official languages policy and edited for posting and distribution in accordance with its communications policy.

Thank you so much for inviting me today. I want to congratulate the organizers on putting together such a good program and list of speakers.

I am honoured to be able to speak to you today, just before a presentation by my colleague, Dr. Barrette.

First, for those of you who read the newspapers and are expecting a fight, you will be disappointed.

In fact, we have developed very effective ways of working together within this federation, even when it is not easy.

That includes healthcare, and I do not think that it is in the interest of Canadians to throw that out the window.

I believe the federal government can be an effective partner with provinces and territories in determining WHAT needs to be done to improve healthcare.

But let's be clear - we have no business telling Quebec, or any other province, HOW they should be delivering healthcare.

On a personal note, I was fortunate to spend some time in the province of Quebec this summer, while I was working on improving my French.

In addition to learning about the province, I also learned a lot about the Quebec healthcare system, where it is very different from elsewhere in Canada.

For example, Quebec pioneered new approaches to placing a much stronger focus on illness prevention, and population health - which I have also advocated for throughout my career.

I know that Quebec will pursue some things differently, as it has in the past, but is striving towards the same goals that we are.

That much has been clear to me in the discussions we have held so far.

I believe that Ottawa and the provinces and territories want the same things - an effective situation that provides the care that our citizens need, when and where they need it, and without financial barriers.

That was not always the case in this country, and sometimes I think we take for granted the fact that we can visit the doctor's office or the hospital, and be treated on the basis of medical need, not our ability to pay.

At the same time, I think our healthcare conversation has perhaps focused too heavily on cure-giving, at the expense of a much-needed focus on care-giving.

It's true that we have health systems providing excellent hospital and medical care on a universal, first dollar coverage basis. We have some of best-trained health professionals in the world and many of our healthcare institutions are recognized leaders in research, training and specialized care.

But 50 years ago, founders of medicare envisioned even better than that. They saw a nationwide adoption of public health insurance. But they went further, recommending comprehensive coverage beyond medical care.

Justice Emmett Hall said "The only thing more expensive than good healthcare is no healthcare."

There are reasons why we never got there. By the time the last province adopted universal insurance for medical care in 1972, Canada was on the verge of hyper-inflation, high unemployment, and slow growth. That led to belt-tightening at the federal and provincial levels.

Wrenching debates about national unity would soon follow. Further reforms of health systems moved to the back burner.

Healthcare delivery changed in the decades that separate us from Hall's Royal Commission on Health Services. Forty years ago, nearly 60% of Canada's health spending went to hospitals and doctors. Today, it's down to 45%.

At the same time demand for prescription drugs, long-term care, home care, and mental health needs continue to grow.

It's no surprise. Our population is aging, people are living longer, chronic diseases are on the rise. Technological progress is shifting focus of healthcare delivery away from institutions into the home and community.

But most public healthcare funding still goes to support hospital and physician services, while other services make due with a patchwork of limited public funding, private insurance and out-of-pocket payment.

A Health Accord for All Canadians

We talk a lot about Tommy Douglas as one of the founders of Medicare, and we all know him as a stalwart of the CCF and the NDP.

But Emmett Hall was a Progressive Conservative. And it was under Liberal Prime Ministers Pearson and Trudeau that we brought in the Medical Care Act and later the Canada Health Act.

And I don't want to overlook Monique Begin, the extremely capable health minister of the day. The CHA passed unanimously by Parliament, and you know how rare that is.

Health care is not a partisan issue.

It is also not an issue that is under the purview of any one level of government. While provinces bear the primary responsibility of providing health services, municipal governments also play a key role in many provinces, in areas such as public health.

In addition, the federal government is a key player. In fact, there has never been a major development in the history of healthcare in Canada, where the federal government did not play a critical role.

Which brings us to discussions about a new health accord with provinces and territories.

Unfortunately, the conversation more often revolves around how much we should spend on healthcare, rather than how we should improve health and healthcare for Canadians. This predicament far predates the appointment of anyone who is currently a first minister or minister of health.

Some insist that the problem facing Canadian medicare is a lack of money, and they decry the fact that future growth rate of the CHT will be brought more in line with the growth rate of the economy. The Government of Canada will transfer an additional $1B to the provinces and territories next year.

Beyond that, the facts simply don't support the notion that the major issues facing our health systems will be solved with more money.

Already, Canada is one of the world's highest spenders on healthcare and yet we are not achieving the kind of results Canadians need and deserve.

The health accords of the past, for all their good intentions, did not tackle the fundamental structural problems facing Canadian healthcare. We took the status quo and we inflated it.

As I have said repeatedly, I am convinced that we have an obligation as the Government of Canada to do more than simply open up the federal wallet.

We must ensure that new money doesn't simply inflate health systems, but helps to put healthcare on the road to long-term stability.

Every province, on its own, has been advancing important reforms over the past decade. I commend their resolve and creativity in adapting their healthcare systems to the new realities of an aging population.

Our Government comes to the table ready to invest new federal money in ways that will help provinces advance the transformation in healthcare.

When we do so, it will be prudent for us to know where that money is going, and to be able to report back to Canadians on the results we are achieving.

I don't believe that is a provocative statement, and I believe there is a strong will to do that among provincial and territorial health ministers for that type of accountability.

To date, we have agreed on shared priorities for health. These include home care, pharmaceuticals, mental health, innovation, and better healthcare for Indigenous Canadians.

We will meet again next month in Toronto, and I have every reason to expect productive conversations, contributing towards the achievement of a new Health Accord.

Home and Community-based Care

Allow me to discuss the priorities for a Health Accord a bit further, beginning with home care.

Instead of systems that, by default, keep patients in a hospital bed, imagine a "new normal" where, if it's in the patient's best interest, they are effectively cared for at home.

Today, some 15% of hospital beds are occupied by patients, who might be better off at home or in long-term care. This has a huge financial impact. For example, in Ontario, basic homecare costs $42 a day, compared to minimum of $840 a day in a hospital.

More importantly, it's not the best way to care for them - we know the hospital is not where they want to be, unless it's absolutely necessary.

This extends to the area of palliative care.

Often, patients could be in hospice or at home surrounded by friends and family, yet most Canadians live their final days in hospital. That's where 6 out of 10 patients die.

This is not by design. The reality is that a hospital bed is where many patients end up, because home care supports and services are inadequate and poorly coordinated.

In Canada we spend about $10 billion annually, or about 5% of total health spending, on home and community care.

That's a lot of money, but it's probably not enough, especially since our population is aging and burdened by increasing rates of chronic disease.

Where patients are receiving care at home, imagine a design that supports their families and caregivers so that they don't burn out.

While we need to expand home care supports more broadly, improvements are especially relevant for palliative and end-of-life care.

We have a golden opportunity to put in place robust systems of services and supports that will address these gaps.

We need to work with the provinces and territories as they further develop the infrastructure necessary to support home care and integrate it seamlessly with the rest of the circle of care.

That means supporting innovative delivery platforms like tele-homecare, where providers monitor their patients' health status remotely, offering education and health coaching.

It also means supporting innovative funding models that bundle the budgets for home care and acute care services - so that the right care is provided in the most cost-effective setting.

Taken together, these actions could fill critical gaps and lead to stronger home care that is rooted in primary care and integrated with other health and social services, better supported by technology.

Improving the affordability and accessibility of pharmaceuticals

Another area of priority is access to prescription drugs.

It is clear that we need healthcare systems where drugs are accessible, affordable and appropriately prescribed for every Canadian.

Health Canada is responsible for reviewing new drugs to make sure they are safe and work as intended.

But the review process is indifferent to whether these new drugs are any better than what is already on the market.

The result is that many of the new drug therapies approved each year offer little benefit over currently available, yet come at a significant extra cost.

To assess the cost-effectiveness of new drugs, the federal, provincial and territorial governments have created the Canadian Agency for Drugs and Technologies in Health - or CADTH.

CADTH conducts cost-effectiveness reviews of new therapies through a mechanism known as the Common Drug Review.

This advice has been crucial to provinces and territories in deciding which drugs to cover on their public formularies.

Unfortunately, there is a gap of as much as 6 months between when Health Canada approves a drug and when the Review advises on its cost-effectiveness.

In the meantime, virtually every private drug plan in the country has listed the new drug on its formulary, providing for its reimbursement even where the cost-effectiveness data are lacking.

We must explore ways to focus our regulatory system on the review of drugs that deliver a better standard of care or better value for money.

We also need to re-examine the role of the regulatory body whose job it is to protect Canadians from excessive brand-name drug prices.

Right now, the Patented Medicine Prices Review Board is required to use as its benchmark the prices charged by some of the highest-cost, most R&D intensive drug manufacturing jurisdictions in the world, including the United States.

It may therefore come as no surprise that prices for brand name drugs in Canada are among the highest in the world, behind only the United States and Germany.

I hope to explore with the provinces and territories ways to bring the benefits of joint price negotiation to private insurance plans.

I am pushing for agreement on a common national drug formulary for publicly funded plans, which will make it easier to leverage our buying power with pharmaceutical companies and make it harder to play one province off against another.

Investing in mental health

The founders of Medicare rightly believed that healthcare functions best when it responds to the needs of its citizens. So imagine if you will systems that make it easier for Canadians to get help when they are in mental distress or contemplating suicide, no matter where they live.

Every Canadian is impacted directly or indirectly by mental illness. The statistics are staggering.

• Depression and anxiety cost the Canadian economy almost $50B per year in lost productivity
• Suicide accounts for almost a quarter of all deaths among 15- to 24-year-olds
• Almost half of those who live with depression or anxiety have never seen a doctor about it

These aren't just numbers - they're human beings. They're your family members, friends, colleagues whose lives have been swept up in chaos, confusion and pain. Perhaps they include you.

For too long, mental illness was something to be hidden, something to be ashamed of.

Today, we talk about it somewhat more openly in our families and in our communities, and that's a good thing.

But as the full extent of the burden of mental illness in Canada becomes clear, it's become obvious that our systems are not well-equipped to heal the trauma caused by mental illness.

While responsive and supportive in some places in Canada, mental health services are non-existent and fragmented in others.

We make do with what we have. Doctors and other front line workers do their best but often don't have adequate training.

Patients with severe mental illnesses often face long waits for access to specialists. Others who require counselling or therapy may have private coverage, but most have to pay out-of-pocket, or more often, try to manage without.

The problem is most acute in rural and remote areas, including Indigenous communities, where health system resources are weak.

It is not too late to build systems where mental health services are widely available and supportive, regardless of whether you're living in downtown Ottawa or northern Canada.

Renewing our relationship with Indigenous peoples

All of the challenges I have outlined are magnified many times over for Indigenous peoples in Canada.

There is a shocking gap in health outcomes between Indigenous and non-Indigenous Canadians.

If you are an Indigenous, your life expectancy is up to decade shorter than for other Canadians. Your rates of diabetes are three times that of the national average. In First Nations, rates of tuberculosis are 33 times that of other Canadians. For Inuit, the rates of tuberculosis are 375 times higher than those for non-Indigenous Canadians.

These inequities are shameful, but they are not inexplicable. The lack of education, crowded housing, high unemployment and incarceration rates - all of these contribute, in some way, to poor health.

Our government has committed to invest more than $8 billion to begin the work of rebuilding Canada's relationship with Indigenous peoples.

Among other things, we will invest in better housing, clean water, early childhood learning.

We will move ahead with a new health accord that brings Indigenous voices to table. Instead of the status quo, where we respond to crises in Indigenous communities as they arise, I'm determined to work with Indigenous leaders and other stakeholders to build an approach to these health gaps that is proactive, effective and just.

Innovating in service delivery

So far, I have talked about specific areas of within healthcare that need attention. But the reality is that dysfunction and inefficiency are embedded in our systems.

Fixing this requires innovation. But innovation is not all about shiny new toys. It means adopting proven business models that can deliver better care and outcomes at lower cost.

Large enterprises, whether public or private, cannot thrive without innovation. Healthcare is no exception.

It's time to reclaim the political will, time and resources to develop and implement bold reforms in the funding and organization of front line delivery.

It's not easy, but other countries are doing it.

Americans have kick-started the development of a whole new suite of models to change the way health services are funded and delivered - accountable care organizations, medical homes, and bundled payment.

This is not about privatizing Canadian healthcare. It's not about how care is paid for - it's about putting in place more efficient and effective models of care delivery.

It's about reorganizing healthcare in ways that are more efficient and put the patient first, while maintaining our single-payer public model.

If we want to modernize healthcare systems and improve performance, we need to strengthen the underlying infrastructure, including digital health.

Despite billions of dollars invested federally and provincially in e-health over the past 15 years, huge gaps remain.

We've adopted a dizzying array of information systems across the health sector, but they rarely communicate with one another.

It's shocking that in the age of Facebook and e-commerce, we're still using fax machines in doctors' offices and most Canadians still can't go online for their health records.

We need to focus our efforts on building digital systems that are focused on patients and seamlessly integrated across care delivery.

We need to prioritize the connection of patients, service providers and institutions. That means making sure patients can access their health data electronically, book appointments and consult their physician without visiting an office.

The good news is that healthcare innovation is an area where there is a strong consensus for action, and where federal investment can help drive the adoption of better business models and accelerate change.

Targeted federal investments in pan-Canadian organizations have already paid dividends in spreading innovation, supporting digital health, reporting on performance, and evaluating health technologies.

We must seize the opportunity presented by a new health accord and a commitment to new funding to build on this strong foundation.

Conclusion

Canadians are proud of our health care systems, but we've taken them for granted and not recognized the gradual erosion and fragmentation.

We need to reclaim the vision that the founders of Medicare intended for our healthcare in this country.

We have a unique opportunity to bring real change to healthcare and this in an opportunity that we must not miss.

If Canada is to sustain the cherished, publicly funded and universally accessible healthcare systems we have long relied upon, we need to adapt to new ideas and renew our approach to health policy.

This can be an opportunity to shape the future of publicly funded healthcare in Canada, in order to make it more responsive to the needs and expectations of Canadians.

The role of the federal government is essential in this discussion.

By working together, Canada can be a world leader to ensure our ultimate collective goal, that is, health for all.