Health Committee on Feb. 24th, 2009

[Dr. Karen Dodds]

The reason for comparable indicators is so that you can, if all of the provinces report, have consistency in what they're reporting. The Auditor General has noted this in the past. One of the challenges is to become consistent in health reporting in each jurisdiction. That's been one of the benefits of having the federal government put a highlight or a spotlight on certain issues.

One of them, for example, is wait times. When we started work on wait times, you couldn't even find information about wait times. As your colleague said, how do you determine progress in something that you don't measure? Seeing that wait times was a priority in the accords, we started measuring it. You quickly find out that not just province by province are there differences, but region by region, and hospital by hospital, and specialty by specialty there are differences. This is an area in which all jurisdictions have worked very closely to try to improve the consistency of health data so we can do what you're interested in doing, and we're making great progress.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

The regional comparisons are so important.

The other thing I wanted to bring up—and I know I've thrown a lot of questions out there—is that when you actually look through so many of the indicators, they're voluntary reporting.

[Dr. Karen Dodds]

One of the institutions that does do regional reports at times is the Canadian Institute for Health Information.

[The Chair, Conservative, Joy Smith]

You have about 30 seconds. Did you have something?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Are you able to address even the idea of a table? If we're going to be truly transparent, that seems to me a very good way of becoming transparent.

[Dr. Karen Dodds]

What kind of table?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Indicators down the one side, regions across. I know that brings you back to the issue of regional disparity.

[Dr. Karen Dodds]

And regional reporting as well.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Madam Chair.

Thank you very much to the presenters for being here today. Certainly this is an issue of great importance to all of us and of great interest to us.

One thing I would like to return to and perhaps get some comments on from both Mr. Maxwell and Ms. Dodds is the transfers and the accountability and whether or not people have to be accountable for how they spend those transfers. This is the one thing I get the most comments on from residents, the fact that the federal government transfers all of these millions of dollars to the provinces but there is no accountability or no way to hold the provinces accountable for how they spend that money.

It may be determined that this money, when it leaves the federal coffers, is thought to be for a specific purpose, but it may not end up being used totally for that. I think this causes a great deal of concern to Canadians: the fact that we have a federal government, regardless of who that government may be, that is interested in health care and is contributing, and we've made the commitment that we're increasing the health transfers by 6%.... How can we assure people that those health transfers are going to go where they need to be going and that they're going to go where the federal government intends them to go? Is there a mechanism? It's my understanding that there is not a mechanism right now to do that, but is there something we can do once the accords are renewed, or once there is something else negotiated? Is there something we can put in those agreements that would allow for this?

Maybe, Mr. Maxwell, you could respond from your point of view, and Ms. Dodds or Ms. Bertrand, you could respond from yours.

[Monika Bertrand]

Let me start with a general comment on transfers. At the Department of Finance we are responsible for four major transfers. Two of those are unconditional transfers—and they're in support of health, of course, depending on provincial and territorial priorities. There's equalization, which is an unconditional transfer that exists to ensure that provinces can offer comparable levels of services at comparable levels of taxation. Territorial formula financing is a similar transfer that takes into consideration the needs and the costs of the north. These two transfers are unconditional, and provinces use them wherever their most pressing needs are.

Two other transfers, health and social transfers, are conditional transfers. The health transfer provides support to health care systems in provinces and territories, and there is a condition attached to them. It is the Government of Canada's main support for the Canada Health Act, so the condition is related to the five principles in the Canada Health Act and to extra billing and user fees. The social transfer is also a conditional transfer, and the condition attached to it is that there cannot be any minimum residency requirements. Those are the two conditions that guide these two large transfers to provinces and territories.

In terms of accountability, Canada is one of the most decentralized federations in the world. Provinces are free to set their own tax rates and to decide what they're going to tax. With that revenue, the provinces are free to set their own priorities as to what their key policies are and what policy priorities they wish to fund with these revenues. Similarly, with the transfers—the $52 billion that we provide to the provinces and territories—they are fairly free to use these large amounts to meet their own needs and priorities, and they're not obliged to report back to the federal government. In a mature federation, they are obliged or encouraged to report back to their own residents, but not to the federal government. This is how the transfers have evolved over time.

If you go back to when we were looking for national standards, our transfers were cost-sharing transfers, and there was a specific goal and purpose defining why these were cost-sharing transfers and why we expected provinces to report back to the federal government. Starting in 1977, we have pretty much moved away from that principle and towards the principle of public accountability.

This is just how the transfers have evolved and how the federation has evolved.

[The Chair, Conservative, Joy Smith]

Thank you very much, Ms. Bertrand.

Did you want to make another comment, Ms. Dodds? Did you want to add to that?

[Dr. Karen Dodds]

I would, if you don't mind.

[The Chair, Conservative, Joy Smith]

Sure. Go ahead.

[Dr. Karen Dodds]

Concerning the provinces' ability to set their priorities, no matter which area of the health accords you look at, the provinces have set different priorities. If you look at wait times, the provinces have chosen very different wait times and guarantees to emphasize. One of the issues is that provinces, depending on their population and the situation, are focused on improving something first that might be different from what another province chose.

A table of indicators might be helpful, but if you looked it would be very difficult to say that province X is making the most progress, because they're all picking different things upon which to put the emphasis, and their own citizens are the ones to hold them accountable.

[The Chair, Conservative, Joy Smith]

Thank you,Ms. Dodds.

Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much.

Thank you for coming today.

In her November 2006 report, the Auditor General concluded that: "Health Canada does not know whether regulatory responsibilities are fully met", with respect to the product safety, drug products and medical devices programs.

According to the report, failure to carry out these responsibilities could have consequences for the health and safety of Canadians, such as exposure to hazardous non-conforming products and to ineffective and dangerous therapeutic products.

Health Canada should undertake a review and establish program baselines in order to meet their regulatory responsibilities. What is the status of that review?

[Dr. Karen Dodds]

I'm not certain which Auditor General report you're referring to. I know there was one that looked at two of our regulatory programs, and indeed the department did report on progress with respect to those regulatory programs on a regular basis. As this committee was looking at this most recent report, I don't have all of the latest information available, but I know we were providing regular updates with respect to that older chapter from the OAG.

[Nicolas Dufour, Bloc, Repentigny, QC]

Fine.

[Louise Dubé, Principal, Office of the Auditor General of Canada]

Given that I was responsible for that report, allow me to expand on that information. Health Canada actually provides progress reports and one of these should be ready soon.

[Nicolas Dufour, Bloc, Repentigny, QC]

My second question is about anti-smoking programs. The minister recently told us that one of her priorities was tobacco control, mainly with respect to first nations. We know that the percentage of smokers is very high amongst aboriginals: 56%. In 2004 it was 71% for the Inuit. Yet, the government cut $10 million from anti-smoking programs that focused mainly on pregnant women and young Inuit.

Given that this was one of the minister's priorities, has Health Canada issued a directive to cancel those $10 million cuts, or demonstrated a will to establish an equivalent anti-smoking program?

[Dr. Karen Dodds]

I know when the minister was with the committee on the supplementary estimates there was some discussion, and as I recall, there were no reductions to any of the programs that were specific to first nations and Inuit people with respect to tobacco or any of their addiction strategies.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much.

[The Chair, Conservative, Joy Smith]

Do you have a question, Monsieur Dufour?

Then we will go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

I appreciate the comments so far.

There are a few indicators that I was curious about in terms of why we don't monitor them or whether there's been any effort to monitor them. One of them is capacity issues. Is there ever information that is shared, or has Health Canada looked into studying the capacity challenges that hospitals have? I know that in Simcoe Muskoka the number one challenge the hospitals have is capacity. RVH, for example, is at 98% capacity, and that's their biggest request right now with the provincial government.

Could there be some federal surveillance of that significant challenge to the health system?