Health Committee on Feb. 16th, 2022

[Majid Jowhari, Liberal, Richmond Hill, ON]

Yes. Thank you for going to virtual care. In the tail end of your opening remarks, you talked about challenges facing virtual care vis-à-vis the Canada Health Act.

Can you briefly make some comment on it and if you run out of time, could you make a submission? It is really important for us to understand what those challenges are. Thank you.

[Bacchus Barua]

This is really an unexplored area. I think it will not be a challenge for awhile, but it's very important.

Virtual health care is usually offered by services that are really outside the public health care system and these services are offered also for pay. As you well know, when you have user fees and charges, that creates conflicts with the Canada Health Act in the way it's structured in terms of sections 18 through 21, in terms of user fees and copayments.

If these services, which are considered like virtual services, are considered medically necessary, this may create a conflict in the future with the CHA. This is not explored right now and I hope that it doesn't get to that, but it is a potential problem in the future.

Again, I stress that virtual care right now is only a solution in the area of GPs. It's not going to help with specialists and it's not going to help with [Technical difficulty—Editor].

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Barua.

Mr. Thériault, go ahead for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Cloutier, also in your brief, you said, “The Canada health transfer has not kept pace with increasing health care costs caused by inflation, population growth, population aging, population health status and health system improvements.” We should add the pandemic to the list.

Based on what you said earlier, you doubt that the provincial governments and the Quebec government, which have not been listened to on issues related to health, are benefiting substantially from hindsight and what they are currently experiencing to properly use the health transfers given to them.

However, for 30 years now, the federal government has never pulled its weight on health care. If it did, we would not be having this conversation today. I find your position a bit strange.

Wouldn't it be preferable for Quebec and the provinces to show a united front to demand substantial, recurring investment that would give them predictability and allow them to fix what can be fixed within the system?

[Paul-Émile Cloutier]

You may have misunderstood my response. I think the brief that you mentioned is our pre‑budget brief, in which we agree that the federal government must increase transfers to the provinces when the time comes. Everyone is obviously in agreement on that issue.

[Luc Thériault, Bloc, Montcalm, QC]

Don't you feel that the time has come, given that if action is not taken now, the costs assumed by the health care system could continue to skyrocket over the coming weeks and months because of the pandemic? There are people who are not being screened for cancer right now. That will cost us dearly in the future.

[Paul-Émile Cloutier]

That's where the collaboration between the provinces and the federal government comes in. In some of our messages at HealthCareCAN, we have invited all the premiers and the prime minister to hold a first ministers' conference on health to try to assess the state of health‑related costs in the provinces. The costs of one province are perhaps not the same as another's.

[Luc Thériault, Bloc, Montcalm, QC]

Would you support a health funding summit being held?

[Paul-Émile Cloutier]

I would fully support that.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Cloutier.

Thank you, Mr. Thériault.

Next we have Mr. Davies, please, for two and a half minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm not sure which of you, Ms. Silas, Dr. Smart or Mr. Cloutier, can answer these, but I have two questions.

First, what steps can or should the federal government take to improve credential recognition for internationally trained health care workers? This is a perennial issue in this country.

Second, I suspect our immigration system is, at least, part of the solution here as we identify shortages. How can we more effectively use our immigration system to plug some of these holes?

That's for any one of the three of you who has an opinion on it.

[Paul-Émile Cloutier]

Mr. Davies, I'd like to ask Elaine Watson to respond to this one, if you don't mind.

[Don Davies, NDP, Vancouver Kingsway, BC]

Of course.

[Elaine Watson, Chief Human Resources Officer, Covenant Health, HealthCareCAN]

Good afternoon, everyone. I'm happy to provide some thought.

There are some elements of the application system for internationally trained health care workers. It is difficult to navigate. There can be some aspects of the labour market impact assessment that create a barrier. We could work more effectively with the licensing bodies and their counterparts in the countries that people are immigrating from, and we can also make it easier for people once they arrive in Canada.

As an immigrant myself, I can tell you that the application process and getting into the country did not match my experience when I got here. Helping people to settle in the country and be able to access those roles as quickly and effectively as possible, and making sure that those licensing requirements are all dealt with before people get into the country are ways that the federal government can help.

There are some quite straightforward elements to that that can be addressed quite quickly.

[Don Davies, NDP, Vancouver Kingsway, BC]

What about nurses, Ms. Silas?

[Linda Silas]

I agree with Ms. Watson. We have a system in Canada that is over-regulated by provinces and by territories. Dr. Smart talked about it. It is very difficult for all provinces and territories to go and recruit outside our country, because there's literally no support.

I'll reinforce, like Dr. Smart mentioned, that we need to grow our own. Ours is a large country. Nursing, medicine, radiology, etc., are all beautiful professions. We need to make them great.

The key is, as Ms. Watson said, that those internationally educated health care professionals who come to our country need to be facilitated, and we need to make it welcoming when they establish their roots in our country, especially in rural and remote areas. It is very difficult to go and live in rural and remote areas when you've never lived in Canada at all. The federal government can play a role there to help all the provinces and territories.

It goes back to our main recommendation. We need to bring all of the experts together to determine what the best strategies and the best practices across the world are, so that we can steal them. We can borrow them and implement them in our country.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Silas.

Thank you, Mr. Davies.

Next we have Mr. Lake, please, for five minutes.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

Thank you, Mr. Chair.

Thank you to all of the witnesses. I'm echoing my colleagues' thanks.

Mr. Barua, I'm going to come back to you. I'm going to make an admission. When I first voted in 1988, I voted for the NDP. There's full disclosure here.

[Some hon. members]

Oh, oh!

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

The reason I switched politically over the years—I speak to university students a lot and they ask me this question—is not because the things I care about changed, but because how we get there changed.

A big trigger for that for me was the cuts in the 1990s to the transfers, particularly the health transfer. I believe $35 billion over multiple years was cut. I pulled up a chart here, and it's more shocking when looking at the chart than I remembered, seeing those devastating cuts. It was a Liberal government at the time, largely instigated by debt that was run up in the 1970s and interest charges on that debt in the 1980s.

Mr. Barua, what was the impact of those cuts in the 1990s, and have we ever really fully recovered from them?

[Bacchus Barua]

I'm not entirely sure I can answer the question directly. I can say two things that may be relevant.

First, the situation with physicians is directly traceable to the Barer-Stoddart report of 1991, which recommended a 10% reduction in medical school enrolment, a 10% reduction in residencies and also less reliance on foreign physicians.

This was reversed somewhat at the end of the 1990s, as Dr. Silas mentioned, with the Canadian medical task force and enrolment started up again. However, and this is the important caveat, enrolment and residencies only make so much of a difference if there are no jobs. The jobs we have in Canada that are offered are restricted heavily by global budgets.

To that point, in 2013, there was a survey by the the Royal College of Physicians and Surgeons of Canada, which showed that 16% of newly graduated physicians could not get a job in Canada. These are things that are tied together. The reason I bring it up is to caution that one cannot simply look at increases in the medical workforce without looking at how those jobs and services are going to be funded.

The second thing I want to highlight, when it comes to things like the Canada health transfer and the federal government's role, it's important to start from the point that health care is technically a provincial responsibility. The federal government uses essentially spending power in order to dictate the characteristics of the provincial health care systems through the Canada Health Act.

It's important, because what works in British Columbia might not work so well in Prince Edward Island. One of the things that happens when you increase the Canada health transfer in excess of GDP growth rate, which is what has been done by the governments of Prime Minister Trudeau and former prime minister Harper, is that you actually have a further reliance of the provinces on the federal government, which means less ability for the provinces to actually tailor their own programs.

I know I didn't answer your question directly, but those are two important pieces of [Technical difficulty—Editor].

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

To that end, I think everybody in this committee agrees that we need to increase investment. I know our platform had a $60-billion investment over 10 years, including a significant focus on mental health.

In your opening remarks, you talked about us being very high in spending and very low in terms of some of the other numbers, sort of the outcomes of that spending. If that's the case, what are we spending the money on?

[Bacchus Barua]

That's the entire health care spending question.

I cannot answer that question directly. I can say that the policies that differentiate Canada from more successful universal health care systems are clear and stark. It is the attitude toward the private sector versus thinking about universal health care as a government only approach. It is thinking about the importance of copayments for tempering demand, which is something that's practised in pretty much every other universal health care country, even if it's purely within the public sector. It's how these hospitals are funded. Those factors are what dictate what we see in the more successful universal health care countries.

To give you an example, according to the Commonwealth Fund, 62% of Canadians reported less than four months for treatment. In Germany, that number was 99%. In Australia, it was 72%. In the Netherlands, it was 87%. In Switzerland, it was 94%. What puts these countries together? They all do universal health care differently.

I appreciate the discussions we're having right now. They will make an impact at the margin, but you're not going to see significant change unless you actually think about significant reform at some point.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Barua.

Thank you, Mr. Lake.

Next we have Ms. Sidhu for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair, and thank you to all the witnesses for their testimony.

We all know the heavy workload on health care workers. There is burnout, and mental health is impacted. There's now a shortage of health care workers. We are discussing that.

When we met last month, Ms. Silas, and Dr. Smart, you can also answer, the issue we were all hearing about was that even before the pandemic, trained health care workers were not being able to work in their field. They come here as skilled workers, but are limited by provincial regulations. When the pandemic began, some provinces gave them emergency authorization. Now there is no agreement. We don't disagree that we need more health care workers.

What is your organization going to [Technical difficulty—Editor] and barriers that skilled workers face? Do you think it's a lack of training resources?