Health Committee on Feb. 24th, 2009

[Dr. Karen Dodds]

It should be noted that the federal government doesn't provide all care to any specific population. We provide different care to different populations. So for first nations and Inuit people, it can be different if they're on-reserve or off-reserve. We are typically providing primary care, but if specialist services are needed, the story is that you are often flying people down to specialty hospitals that are obviously part of the provincial system. The same thing happens with all of the populations that the federal government has responsibility for. It's not the full bit of services, it's just a part.

That gives us a real challenge with respect to data, but we work with our colleagues in what's called the federal health partnership. So it's an organized forum of all of the departments that have any kind of responsibility for health, and it is very informative. We have worked on shared drug purchases. We've worked on electronic health records together, on health human resources. We need to hire doctors and nurses ourselves. It's just as much a challenge for the federal government as it is for the provinces and the territories to hire doctors and nurses. So we collaborate in that organization.

It's very helpful because such a variety of perspectives come to the table then. Correctional Service has a very different kind of model and set of priorities as compared to us, who are dealing with first nations and Inuit people. So you get a large amount of information gathered and sharing of best ideas.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Carrie. Our time is just up now. Thank you.

We have completed our two rounds of seven minutes and five minutes. Mr. Maxwell wanted to have some ending comments today to the committee, but first I want to ask the committee this. We do have about half an hour and I have some announcements to make, so it is the will of the committee whether or not someone else has questions they want to ask.

You do? Okay, we'll go to your question and answer, and then perhaps what we'll do is have Mr. Maxwell wrap up.

Ms. Murray.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Thank you.

Continuing the line of discussion about how we can be more effective with our health spending and get better outcomes so that we don't end up with the entire provincial budgets devoted to health twenty years from now, I'm interested in your comments about the use of trusts for federal funding. What I understand from your report is that there is perhaps even less accountability for how that money is spent than in regular transfers. Would that be correct?

[Neil Maxwell]

Thank you, Madam Chair.

I think it's difficult to say if it's more or less. It's different. The accountability is very much different, and as we describe in the study, the mechanism is essentially a trust. It's essentially an unconditional one in that there are some administrative things the provinces need to do, but once the money leaves the federal coffers, it essentially goes without any conditions. As has been described here—and I think the official from Finance Canada described this as well quite well—the federal government is relying very much on this notion that the provinces, having received that money and having made some public declarations, have in recent years.... One thing that Finance Canada has insisted on is that the provinces explain what they're going to use the money for. So it's all built on the principle, on the hope that there will be enough of a dynamic within each of the respective provinces that accountability will follow.

So I think that's the nature of the accountability that so much of this is structured on.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I appreciate that elaboration. I understood that from your remarks.

I'm curious that you've decided to make this a study and not an audit. Had it been an audit, what would your recommendations have been? Are you able to provide them? It sounds like you have some ideas.

[Neil Maxwell]

Well, it was a study for the very reason that essentially we asked ourselves a question: what kind of value-added could the legislative auditor add to our clients around this table and throughout Parliament? And our conclusion was that there was a lot of confusion about these transfers. Are they conditional? Are they not conditional? So really our decision to do a descriptive piece was largely because we thought the most important thing was that parliamentarians need to be much better informed about the implications on accountability of these different decisions.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

So do you think there shouldn't be trusts as a vehicle for transferring funds for no purposes?

[Neil Maxwell]

On that question, the reason we didn't do an audit is that essentially all the judgmental elements here are judgments about policy, and so much of that is the result of all the federal-provincial negotiations that have been described here.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

I have a last quick question, and maybe Finance would have a better ability to weigh in on this. Is there a way of distributing funds through trusts? I understand why governments do that towards the end of the year, for good public policy reasons. But is there a way to distribute a trust, have it have the integrity of the financial vehicle that it is, which is essentially independent of the donor, and still have accountability so that we can know that it is contributing or how it is contributing to the goals that the government has?

[Monika Bertrand]

The conditionalities surrounding trust funds are in terms of eligibility. So I think it was mentioned that there are operating principles, and operating principles outline the rationale for providing the funding and they give some broad examples of how the funding should be used. What Finance has asked provinces to do with recent trust funds is to make public announcements to their residents to make sure they understand what the operating principles are and to give some examples of how they intend to use these funds.

So those are eligibility conditions. Once they meet those, the funding flows to the trustee and provinces can then draw this funding and use it according to their own needs. Now, what we do in those operating principles—and this is really all we can do—is encourage provinces and territories to report back to their residents.

[Joyce Murray, Liberal, Vancouver Quadra, BC]

Can you force them to?

[Monika Bertrand]

No.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Murray.

Ms. Dodds.

[Dr. Karen Dodds]

Thank you.

I'd like to make some comments about health spending writ large, because we certainly do track health spending and track the drivers of health spending and that kind of information.

A study done internally looking at every year going back to 1970 has shown that the increase in health funding has not had a negative impact on other programs at the federal or provincial levels. When you look at our expenditure, GDP versus health expenditure, we're right in the middle of the pack with respect to other OECD numbers. When you look at GDP growth versus expenditure growth and compare us to other OECD countries, we're the lowest. So to put things in context internationally, we're all seeing increased health costs, clearly improvements are being made, clearly we are increasing our usage of the system, and yet our health spending is, over GDP, the lowest of the OECD countries.

[The Chair, Conservative, Joy Smith]

Thank you so much, Ms. Dodds.

Mr. Maxwell, would you now like to give some closing comments?

[Neil Maxwell]

Yes, thank you, Chair. Thank you very much for this opportunity to come here and talk about our work. This is what we live for, and this is why we do all this work.

The other thought I had to leave with your committee is in terms of what next steps might be. As I mentioned before, as the auditors we monitor annually what kind of action is done by departments, satisfactory or unsatisfactory. We will do that for the health indicators.

I might suggest that the interest that's been shown today might well lead your committee to revisit this question. It seems to me that in the coming year there will be two very important events. One will be when the 2008 Healthy Canadians is available, when people are no longer talking about it in theory but have something concrete to look at. Your committee might wish to revisit this topic then. I think the other very important thing in the next year—and we haven't talked much about this—is the response by Health Canada, but they intend to do quite a thorough evaluation by August 2009.

Again, I thank you for the interest.

[The Chair, Conservative, Joy Smith]

Mr. Maxwell, Ms. Dodds, and of course Ms. Dyer, Ms. Bertrand, everybody who's here, Ms. Dubé, Mr. Wheeler—I don't want to leave anyone out—I have to say that all of you have been contributors to this conversation today and to these questions. We really appreciate your coming. I know each one of us has gained a lot of insight from some of your questions and answers today to some of the questions we had. We really felt this was a real treat for our committee.

So thank you so much for doing that. And I would bid you goodbye. I'm sorry, we have to go right into another part of our committee, but certainly we will contact you again and speak with you on some of these issues. Thank you.

Committee, while our guests are departing, we'll talk about our future business. I think we need to go in camera for this. So we'll suspend for just a couple of minutes to allow our guests to depart as we go in camera.

[Proceedings continue in camera]