Finance Committee on Oct. 6th, 2014

[The Chair, Conservative, James Rajotte]

I call this meeting to order. This is meeting number 46 of the Standing Committee on Finance. According to our orders of the day, pursuant to Standing Order 83.1, we are continuing our pre-budget consultations for 2014.

Colleagues, we have two panels this afternoon and early evening. I want to welcome our guests for the first panel. We have with us this afternoon from the Canadian Doctors for Medicare, Dr. Richard Klasa. From the Canadian Foundation for Healthcare Improvement we have the president, Maureen O'Neil. From the Heart and Stroke Foundation of Canada we have the CEO, Mr. David Sculthorpe. From Hope Air we have the executive director, Mr. Douglas Keller-Hobson. From Sunnybrook Health Sciences Centre we have the president and CEO, Dr. Barry McLellan.

Welcome to all of you. You will each have five minutes maximum for your opening statement.

We'll begin with Mr. Klasa, please.

[Dr. Richard Klasa, Board Member, Canadian Doctors for Medicare]

I'd like to thank the House of Commons Standing Committee on Finance for this opportunity to present on behalf of Canadian Doctors for Medicare.

My name is Dr. Richard Klasa. I'm a medical oncologist at the BC Cancer Agency in Vancouver and a clinical research scientist at the research institute associated with that, and a professor of medicine at the University of British Columbia.

Canadian Doctors for Medicare has an abiding interest in the evolution of the federal role in health care. As medical professionals, we are firmly committed to evidence-based health care policy reform. We advocate for innovations in treatment and prevention services to improve the quality, sustainability, and equity of our health system. We believe our health care system can and should be improved, and we hope today's hearing will play an important role in providing more equitable high-quality and sustainable health care from coast to coast to coast.

As practising physicians, CDM members see first-hand the disparity in care experienced by Canada's marginalized and multi-barriered residents. CDM believes that improving the care experience of our most vulnerable communities is both necessary and achievable.

We advocate for action in three specific areas: first, in upholding the Canada Health Act; second, in developing a new health accord; and third, in improving access to prescription drugs through a national pharmacare program. These have all been outlined in the five-page brief that was circulated beforehand.

Each of these reforms begins with strong, accountable federal leadership to enforce standards across the country and to improve the care of our most vulnerable population.

As part of its commitment to the Canada Health Act, the federal government must recognize that new forms of privatization, including user fees and extra billing, have emerged since the act was passed in 1984. Some of these take advantage of legislative loopholes while clearly violating the spirit of the act. These loopholes must be closed, and violations must be penalized. An accountability framework that requires provinces to proactively regulate or investigate clinics for compliance with these laws is clearly needed to ensure the CHA is upheld.

Another area in which the federal government must demonstrate leadership is in establishing a new health accord. The absence of such a guiding document exacerbates current provincial disparities in health care, again with the greatest impacts experienced by vulnerable populations. Improving equity in care requires establishing a new 2015 health accord with improved measures for accountability and especially standardization of care across the country.

We also must take some starting steps towards a national pharmacare program. Canada currently pays at least 30% more than the OECD average for prescription drugs. By offering first-dollar coverage, a universal pharmacare program would generate savings of between 10% and 41% on various prescription drugs, representing total savings of up to $11.4 billion per year in Canada. Moreover, a national pharmacare strategy would improve the health and quality of life of our most vulnerable residents.

While one in ten Canadians can't afford their prescriptions, among those without any supplementary health insurance that number increases to one in four. Inability to access medically necessary prescriptions results in decreased quality of life for patients while increasing demand on our hospital resources as their untreated conditions eventually lead to hospitalizations.

At the provincial and territorial health ministers' meeting recently in Banff, the ministers agreed to work together to reduce the cost of some 53 commonly prescribed drugs. This decision will result in over $260 million in combined savings annually.

[The Chair, Conservative, James Rajotte]

You have one minute remaining.

[Dr. Richard Klasa]

Okay.

However, the capacity of provinces to implement pharmacare-like strategies is limited in the absence of a national formulary. C.D. Howe pharmacare expert Steve Morgan cautions that any attempt to institute a national pharmacare strategy requires active leadership from the federal government.

Canadian Doctors for Medicare is pleased to have the opportunity to contribute to this hearing. In conclusion, we recommend that the federal government close loopholes that allow for-profit clinics to violate the Canada Health Act, demonstrate leadership and vision by reopening the Health Accord negotiations with provinces and territories, and support the provincial and territorial health ministers' initiative to develop and implement a national pharmacare strategy.

Thank you.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

Ms. O'Neil, I understand you're beginning with a video presentation. Is that correct?

[Maureen O'Neil, President, Canadian Foundation for Healthcare Improvement]

No.

[The Chair, Conservative, James Rajotte]

That's the second panel. I'm sorry, I was mistaken.

[Maureen O'Neil]

Thank you, Mr. Chairman, and good afternoon.

I'm Maureen O'Neil, president of the Canadian Foundation for Healthcare Improvement, CFHI.

Thank you for this invitation to appear before the committee.

CFHI is a federally funded not-for-profit organization dedicated to accelerating health care improvement. We play a unique pan-Canadian role in supporting health care innovation on the front line, bringing together teams from different jurisdictions to improve continuity of care, focus on patients and families, and increase value for money. We work with leading organizations, such as Sunnybrook down the table here. These teams include patients and family members, health care providers, and executives.

Our work is in keeping with to the committee's priority, that is to say contribute to the health of Canadian men and women, a large number of whom are members of vulnerable groups.

My message today is that we are helping to save health care dollars while improving patient care and health outcomes right now, but for our work to continue we need funding in budget 2015.

We work in every province and territory, and we currently have more than one hundred projects ongoing in the field. More than half of these projects are innovative ones that have been tried and tested and are becoming more widespread. We benefit from considerable participation from Quebec organizations.

This year we are spreading innovative ways of working, with better care for people with dementia living in long-term care, and better support for patients with advanced chronic obstructive pulmonary disease, or COPD. One in three long-term residents receives strong antipsychotic medication without a diagnosis of psychosis. We helped the Winnipeg health region use data and proven approaches to take one-quarter of their residents off antipsychotics without any negative consequences. Now we're supporting 52 long-term care homes across the country to replicate Winnipeg's success: small investment, big savings, better care for patients and families.

The second collaboration focuses on a huge driver of hospital costs: COPD. When people with COPD have trouble breathing, they and their caregivers rush to the emergency room. In Halifax, home visits, teaching self-management, and advanced care planning have reduced hospital use by 60%. That's a good idea worth spreading.

Currently, we help teams in 10 provinces to adapt and implement their programs. These exchanges among regions and provinces are opportunities for mutual stimulation and learning.

We secured $600,000 from the private sector to leverage federal dollars in this program. This will improve care for more than 11,000 COPD patients. The potential cost savings are huge: once again, small investment, big savings, better care for patients and families.

We're also working with first nations, veterans, and the Canadian Forces. In our brief you can learn more about these initiatives, including pioneering work involving patients and families in the design and evaluation of health care. An independent analysis by RiskAnalytica has determined that just five of the innovations we have supported over the past 15 years could generate well over $1 billion in annual savings through fewer ER and specialist visits and hospitalizations. KPMG recently confirmed this finding in an independent evaluation: small investment, big savings, better care for patients and families.

In Budget 2015, we are asking for $10 million annually over five years. We will see to it that that modest investment bears fruit, as we will find ways of reducing health care costs and improving care and the health of Canadians.

We have had great support from parliamentarians, many around this table. Thank you very much for your time.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

We'll now hear from Mr. Sculthorpe, please.

[David Sculthorpe, Chief Executive Officer, Heart and Stroke Foundation of Canada]

Thank you, Mr. Chair and honourable members.

The Heart and Stroke Foundation is a national volunteer-based charity led and supported by more than 140,000 volunteers and close to two million donors. The aim of the foundation is to create healthy lives free of heart disease and stroke. We do this through the advancement of research and the promotion of healthy living.

We've come a long way since my grandfather suffered a heart attack many years ago. At that time he was put on enforced bedrest and only allowed to sit upright in a chair after a month. Only 15 years ago when someone had a stroke they were transported to the local hospital in an ambulance with no lights or siren on, and were told there was nothing that could be done.

Today a stroke is treated as a medical emergency. The ambulance quickly transports the person to the right hospital set up to handle strokes. Following an immediate CT scan or MRI, if a clot is present the person is given TPA and is often able to leave the hospital within days with no significant disabilities. It is the $1.4 billion in research funded by the Heart and Stroke Foundation and the leadership of the foundation and our partners that have made these changes possible.

Despite an impressive 75% reduction in the death rate from heart disease and stroke over the last 60 years, every seven minutes someone in Canada still dies from heart disease or stroke. That's unacceptable. It amounts to more than 66,000 deaths a year. That's unacceptable.

Heart disease and stroke are the leading cause of hospitalizations and the second leading cause of death in Canada. We clearly have much more to do.

Despite the shocking statistics, further investment in cardiovascular research has stalled. I'm before you today to seek a partnership with the federal government and our partner organizations to: one, sustain Canada's leadership in heart disease and stroke research to improve health, reduce death, lower health care costs, and improve Canada's overall productivity; two, launch programs to reduce vascular dementia; and three, improve the health of indigenous people.

With regard to cardiovascular research, we're looking for an investment of $30 million annually from the federal government to match funds that we have committed. This federal investment would be managed in partnership with the Canadian Institutes of Health Research. What's the opportunity here? In addition to saving lives and improving Canadians' quality of life, this investment would create high-value jobs. Some 70% of the funds would go toward job creation. It would also help to attract and retain young researchers in the field.

We're also working with the YMCA, the Alzheimer Society of Canada, and the Canadian Diabetes Association to have the federal government help address the prevention of dementia. The connection between cardiovascular disease and dementia is undisputed. In older adults, vascular disease is implicated in 80% of people with cognitive dementia, cognitive impairment. An investment here would reduce the risk factors that impact vascular dementia and many other conditions. Delaying the onset of dementia by five years could decrease the prevalence of the disease by as much as 44%, reducing health care costs, increasing productivity, and improving quality of life.

For this initiative we're seeking an investment of $20 million annually. Partnering with the foundation would also be consistent with the government's focus on healthy living, its recently released national research and prevention plan for dementia, and the announcement made by Minister of Health Rona Ambrose last Wednesday.

Dementia-related diseases currently cost the economy an estimated $33 billion a year. This figure is expected to soar to $293 billion by 2040. Our initiative will combat this prediction.

As a third initiative, the foundation is also working with the Canadian Diabetes Association and the YMCA on a plan to improve indigenous people's cardiovascular health. Indigenous people are twice as likely to develop cardiovascular disease and have a higher proportion of CVD risk factors. This simply can't continue, and we have programs that can help.

We have been in discussions with indigenous groups, and they're very enthusiastic about our commitment to work with them. We believe that an investment of $50 million annually will be needed to support locally based programs that build capacity and improve health.

Mr. Chair, thank you. I look forward to the questions and discussion with the honourable members.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

We'll now go to Mr. Keller-Hobson, please.

[Douglas Keller-Hobson, Executive Director, Hope Air]

Good afternoon. My name is Doug Keller-Hobson and I am the executive director of Hope Air.

I appreciate this opportunity to appear before the finance committee during the budget 2015 consultations and share with you our proposal for a very specific legislative change that would improve access to necessary health care services for low-income Canadians regardless of where they live across Canada.

Hope Air is a registered charity whose mission is to provide free flights for those who are in financial need and must travel long distances to reach specialist medical care. The only Canadian charity dedicated to providing this service from coast to coast, Hope Air helps low-income Canadians of all ages who are suffering from a wide range of illnesses.

Hope Air is not an airline. Rather, we are a lifeline for many fellow Canadians who need to access the advanced medical technology and specialists that are typically available only in larger urban centres across our country. Since its founding in 1986, Hope Air has arranged over 87,000 free flights for low-income Canadians, including over 7,000 flights last year. There are over 8,000 projected in 2014.

Hope Air's submission to this committee is focused and specific and can be enacted at little cost to the treasury. Our budget proposal seeks an exemption from the air travellers security charge for all flights being provided free of charge by a registered charity to low-income Canadians travelling to required medical appointments.

The air travellers security charge is a flat rate fee currently set at $7.12 plus HST for a one-way flight to cover security costs in place at the 89 airports across Canada. This proposed change would cost the treasury approximately $57,000 for 2014 and can be made by either revising or adding a clause to section 11 of the Air Travellers Security Charge Act.

More to the point, for today's mandate of exploring ways to support and help vulnerable Canadian families, this change would enable Hope Air to provide an additional 230 flights per year for fellow Canadians in need.

There is a precedent for enacting a change such as this. Although the act contained an exemption for air ambulance flights when it was passed in 2002, the ATSC still applied to other non-emergency medical flights. Recognizing the importance of excluding necessary medical travel from the ATSC, the government passed an amendment in 2007 making flights donated by air carriers to registered charities exempt from the ATSC.

Since that time, Hope Air's business model has adapted to changing circumstances to include more private donations and funding partnerships. This enables us to directly purchase many more flights for our clients, but also makes us still subject to the ATSC levy. The continuing impact of the current ATSC legislation is to restrict the number of clients we can serve.

Almost half of Hope Air's flights are provided for children and their parent or guardian, most of whom live in a household where the average income is close to their community's low-income line. This means that the vast majority of the families that Hope Air helps devote a larger share of their income to food, shelter, and clothing than the average Canadian family does.

Canadians who live in communities far from larger urban centres face many challenges in accessing the health care they need. They frequently face long-distance travel to get to their medical appointments at their own expense, and in winter they risk dangerous long drives. This puts low-income Canadians at risk, as they often decide to cancel or delay treatment due to the travel costs. It also takes people away from work, school, family, and community for much longer than is necessary.

Making the legislative change will benefit many Canadians by supporting families and vulnerable Canadians at a critical time when they are focused on improving their personal health.

I appreciate your consideration of this issue for inclusion in the 2015 federal budget, and look forward to your questions.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

We'll now hear from Mr. McLellan.

[Dr. Barry McLellan, President and Chief Executive Officer, Sunnybrook Health Sciences Centre]

Good afternoon, and thank you for the opportunity to appear before you today.

The growing global significance of diseases of the brain and mind, including dementia, stroke, and depression, is not a secret. The World Health Organization reports that depression is now the leading cause of disability worldwide, and that in people over the age of 65, stroke and dementia are the medical conditions with the greatest burden to society. With respect to dementia, over half a million Canadians suffer from this disabling condition, and the prevalence is set to double in the next 20 years.

When the health ministers met at the G-8 dementia summit in December 2013 to discuss how to shape an effective international response to the growing challenges of dementia, they committed to: a call for greater innovation to improve the quality of life for people with dementia and their caregivers, while reducing emotional and financial burdens; the ambition to identify a cure or disease-modifying therapy for dementia by 2025; and increase collectively and significantly the amount of funding for dementia research.

The vision of the brain sciences centre at Sunnybrook is to approach dementia, stroke, and depression, across the lifespan through a model of convergence, research embedded in care, a model tested and proven with remarkable success at Sunnybrook in the Odette Cancer Centre and the Schulich heart research program. At Sunnybrook we already provide local, regional, and national leadership for these three major neuro-psychiatric illnesses of our society. The brain sciences centre at Sunnybrook will enhance our proposed transformative role.

We are, of course, aware that the federal government does not directly fund the delivery of health care. This proposal is not about funding the delivery of health care. It is about creating an infrastructure that will enhance innovation and new discoveries that are relevant and beneficial to all Canadians, innovation that will have national and global impact. Bringing our model of convergence to fruition through the creation of a brain sciences centre will bring researchers together with specialists in neurology, psychiatry, neurosurgery, and neuro-radiology, to grow innovation. The centre will promote accelerated discovery and application of new cures and disease-modifying treatments, including unique diagnostic imaging capacity, genome analyses and drug development, and image-guided interventions, including novel models of drug delivery.

It will enhance networking. The centre will be part of a national network of brain sciences and brain health centres across Canada, including the brain health centre in Vancouver, enabling economies of scope and scale and accelerating national capacity. It will advance the development of commercial partnerships, create jobs, and help develop brain health-related companies. It will enhance care across the country and the globe by developing and evaluating new models of care. In so doing, it will protect vulnerable Canadians and their families. It will train and educate the next generation of brain science researchers and health care professionals. It will provide international recognition to the Government of Canada for not only taking a lead role in recognizing the burdens of these debilitating ailments, but for taking demonstrable action to create a better future.

The request of the federal government is to invest in the future for Canadians by contributing as close to $30 million as possible towards the estimated $60-million cost for this research embedded in care brain sciences centre. The Sunnybrook Foundation has committed to raising the balance.

This private-public partnership presents an unprecedented opportunity to mitigate the profound impact of the major illnesses of our time now and over the decades to come.

Thank you for your attention.

[The Chair, Conservative, James Rajotte]

Thank you very much for your presentation.

Colleagues, we should have enough time for seven-minute rounds, so we'll start with seven-minute rounds and see how long we get with them.

We will begin with Ms. Davies, for seven minutes.

[Libby Davies, NDP, Vancouver East, BC]

Thank you to the witnesses for coming today.

I'm the health care critic for the NDP and usually I'm at the health committee and not at the finance committee. I have to say though that often at the health committee when we raise questions about health care related to finance, they say, “Oh, you should be at the finance committee”, so I'm glad to be here today to ask some of those questions.

I'll start off by saying that I think the debate around health care in Canada is always a very topical issue. It's something that people care about deeply and think about. But it's about more than health care. It's very much about a very cherished Canadian value in that the public health care system we have should be accessible to everybody. It's a foundation of our Canadian society, so I'm very glad that you're here today.

Having listened to the issues you've raised and having read the briefs, I'd say that whether we're talking about the health accords or affordable drug coverage or prescription plans or brain science or dementia or research dollars, I think all of those coalesce around the question of what the federal role is. Again, the federal role is not just to sort of shovel money out the door, and there are certainly problems with doing that, because we do have a lot of independent assessment that says in the long run the provinces will probably be shortchanged by about $36 billion.

It seems to me that the central point is to recognize that the delivery of health care is a provincial matter although there is a role for the federal government. Since the health accords ended in March 2014 and they have not been replaced, what do you see as the federal role? We can talk about individual issues such as dementia or drug coverage, but how will any of that happen unless there is a clear federal responsibility at the table and there is sort of a proactiveness to what goes on?

Maybe, Dr. Klasa, you could begin by letting us know what you foresee needs to be done with regard to a new set of negotiations. The health accords we had previously were far from perfect. In fact, many of the things were never followed through on, so certainly accountability is very important. If you were at the table saying what a new agreement would look like, whether it's for a drug plan or for funding, what would that look like to you with regard to the role for the federal government?

[Dr. Richard Klasa]

As stated in our brief, we feel that for any plan—and we focused particularly on a pharmacare plan—to be successful, strong federal leadership would be required to engage the provinces and set the standards. We wish that all the provisions of the Canada Health Act and the Medical Care Act would be continued, which would mean there would be portability, accessibility, and basically equitable access to resources across the country.

It's very difficult if you're dealing with individual provinces to actually ensure that occurs; so, from our perspective, again, strong federal leadership to set the rules of the game and to set the stage for how programs would move ahead will be required. I do realize these will be enacted by the provinces, but given the kind of country we have and our federalist system, I think it is the role of the federal government to take the lead on this.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much.

To follow up, Mr. Sculthorpe, one of your recommendations deals with government investment for indigenous people. That's clearly a federal responsibility. You talk about partnerships with the Heart and Stroke Foundation, the Canadian Diabetes Association, and the YMCA, and it seems to me that this is a very critical issue that has really sort of fallen off....

Again, in terms of the federal role, do you foresee that as needing some kind of overall agreement with provinces, territories, and first nations? What is the federal role in actually guiding that? It's not just about the money. It's about actually delivering the health outcomes and having very clearly established goals. How do you foresee that happening?

[David Sculthorpe]

I'm going to speak specifically to this initiative, which is important for the first nations and for all those groups.

We want to work with the federal government. They have invested significant dollars there. We think that in partnership we can help engage the communities that are interested in the programs that we, ourselves, have to offer, with the Canadian Diabetes Association's programs, and with the reach of the YMCA.

We have programs that we have been activating, if you would say that, with first nation communities in many provinces across the country, with very, very substantial success and returns. We have picked those best in class from our initiatives that really get tremendous engagement with different bands and different communities. They range from very cheap, inexpensive greenhouses, where they can grow fresh vegetables very affordably, to hypertension initiatives, where we can actually show where we've reduced blood pressure, to education in schools.

We think that this partnership is very important because it takes a significant amount of money—it's a big investment—and it goes to areas where people are genuinely committed and willing to try to partner with us. It's not a cookie-cutter approach. We go to each band and work with them, and they figure out how to tailor the programs where we have the science and the arms and legs to make it work.

[The Chair, Conservative, James Rajotte]

Thank you very much, Ms. Davies.

We'll go to Mr. Saxton, please.

[Andrew Saxton, Conservative, North Vancouver, BC]

Thanks to our witnesses for being here today.

Each one of you in your opening remarks highlighted some important issues facing Canadians' health and also facing the health care system. One of the common themes for at least two of you is the looming problem with dementia and the potential crisis as the Canadian population ages.

My first question will be to the Heart and Stroke Foundation. Could you elaborate on the scenario that you highlighted in your submission to the committee?

[David Sculthorpe]

Thank you, I would love to.

The linkage between dementia and vascular disease is undisputed. In fact, 80% of dementia is vascular related.

The Heart and Stroke Foundation has been working in the vascular area ever since we started with cholesterol, hypertension. What we're doing is we're taking our prevention programs that we know prevent vascular disease—80% of vascular disease is preventable—and educating Canadians that, similarly, this can prevent dementia. Fifty-four per cent of Alzheimer's is preventable and 80% of the vascular dementia, because it's vascular, is preventable. People don't think in terms of dementia being caused by lifestyle or diet, and that's where we're trying to go. Working with the Alzheimer Society, the Canadian Diabetes Association, and the YMCA, we can get this message out.

The Alzheimer Society is doing great work. They are focusing primarily on research for a cure, and then what happens if you have dementia, as well as prevention. If you think about what Heart and Stroke has been doing for 60 years, we have been focusing a significant amount of our effort, whether it's research dollars or advocacy or health promotion, on preventing vascular disease. We have a very big footprint across the country, with all of our volunteers and health promotion specialists and major relationships with leading research institutions at hospitals and universities, where we can get this message out and do our program, which in our submission, the Alzheimer Society as well as Canadian Diabetes have completely supported, to prevent dementia.

[Andrew Saxton, Conservative, North Vancouver, BC]

Your ask that is specific to dementia is $20 million, if I'm not mistaken. A number of different organizations have asked for funding specifically for dementia. How can you assure us that there is going to be an avoidance of duplication? How are you going to be coordinating with the other groups that are also looking into a cure for and treatment of dementia?

[David Sculthorpe]

I have two answers for that.

First, we're partnering with the Alzheimer Society on this prevention initiative, which is significant. They're the biggest and they're focused on Alzheimer's. We're focused on vascular dementia. Those two universes cover most of it, so you're going with the two biggies in that instance. Then we can go the route to market with the YMCA, our outreach, the CDA, and also the Alzheimer Society.

Second, there is a tremendous need out here. I think that if you look at our program, which has $2 million for awareness, $12 million for reducing hypertension, $2 million to get Canadians walking through active transportation, and $2 million to educate around nutrition, you see that when you parcel those down, these are significant dollars in the area of vascular dementia, getting the message out, and changing behaviour. But if there are other organizations doing it, that's good too.

[Andrew Saxton, Conservative, North Vancouver, BC]

Thank you.

This question is for Sunnybrook.

How would what you're proposing for dementia complement what the Heart and Stroke Foundation is proposing?