Health Committee on March 21st, 2016

[Don Davies, NDP, Vancouver Kingsway, BC]

So in you're view it's working. Okay.

[Gigi Mandy]

That's right.

[Don Davies, NDP, Vancouver Kingsway, BC]

I have only a brief time. I want to get one more question, if I could, on a different subject. It's on the issue of access. I'm going to take the example of abortion services. We know that in Prince Edward Island—an entire province—and in vast rural areas in Canada, women do not have access to abortion services, and that's a medically necessary procedure as defined by the Supreme Court of Canada.

Why has P.E.I. not been penalized or addressed in some manner for failing to provide access to such an essential reproductive health service? Maybe give us the department's view on that.

[Abby Hoffman]

I'll start, and Gigi may want to add.

First of all I'll say that the issue of access to abortion services has been a long-standing concern. Over the last decade New Brunswick and P.E.I. have drawn the most attention and concern from us. There has been considerable evolution in New Brunswick, and some in P.E.I. It used to be, and is still the case today, that a woman in P.E.I. needed to go off the island. I think we would say it's hard to square that standard of care with real accessibility as we understand it under the Canada Health Act. There has been some flexibility in the criteria and conditions that apply to women who have to go off the island. We know that there are some discussions going on about dealing with the current situation of no access on the actual territory of Prince Edward Island. It continues to be a topic of discussion with respect to that part of the country.

In general we are concerned and we are having some discussions about it, about the fact that it is still the case not just in rural areas but elsewhere that often abortion services are available only in hospitals; they're insured only in hospitals. There may be a private clinic, but in some parts of the country, historically, if a woman went to a private clinic instead of a hospital she was charged and not necessarily reimbursed by the province, which is a clear Canada Health Act violation, because you cannot be charged for what is otherwise an insured service performed in a different institutional setting. It's an issue we continue to pay a lot of attention to.

It is a bit tricky under the Canada Health Act to say to a province, for example, that may have several hospitals that are performing abortions that they have to meet a threshold of availability—which might often mean either more hospitals or clinics—where abortion services could be provided. I think we would not be disinterested in this issue, but.... Finding a province in breach of the Canada Health Act on extra billing and user charges is, relatively speaking, straightforward: either an individual was charged or he or she wasn't. When it comes to determining whether the extent to which a service is available in a jurisdiction violates the accessibility principle is a lot different. We're having a conversation amongst ourselves right at the moment about New Brunswick, which has made considerable improvement over the last several years in this regard. But some people might look at the New Brunswick situation and say, “Well, that's great, but there are not enough locations”. We haven't made that determination yet.

I'll just simply say it's something we're concerned about, we pay a lot of attention to it, but it is very tricky to actually have us sitting here in Ottawa saying that this service is not available in a sufficiently geographically dispersed manner to meet an accessibility test. That's a tough one for us.

[The Chair, Liberal, Bill Casey]

You're done. You can come back, though.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

Well, thank you very much. That completes our round of questions. I had one myself.

You mentioned that the transfer payments are now determined on a per capita basis. What were they before, and what do you think they might be in the future, or what should they be?

[Abby Hoffman]

I think you might have to invite my colleagues from the Department of Finance to talk about that. It was a very complicated formula that has evolved over the years, but it took into consideration various issues related to taxation and fiscal capacity. People often said there was only a handful of people in Canada who could actually even understand what the basis was for the federal health transfer. There was a decision taken some time ago now, but brought into effect more recently, that the formula should be on an equal per capita basis.

I'll just simply say that the prior formula, which you really would have to talk to Department of Finance officials about, was much more complicated and had much more to do with the overall arrangements for fiscal federalism than it did for financing health care per se.

[The Chair, Liberal, Bill Casey]

Thank you for taking the time to do this. You certainly enlightened us on a lot of aspects of the Health Act.

I'm going to propose that we suspend the meeting for a few minutes and we go in camera. I know you don't like that. We're going to talk about people and people's names.

We'll suspend for a couple of minutes. Everybody will have to leave, except the members.

[Proceedings continue in camera]