Thank you very much.
Since much of what you've been looking at has to do with the private sector, I thought it would be good to start by addressing the need for health human resources, which in the health sector are quite different. Canada's single-payer medicare system is the primary source of divergence between the public and private sectors. While many health service occupations are outside of medicare, its influence remains substantial. As a result, the affected labour markets are not competitive, and what we normally think of as supply and demand do not operate.
Consider the extreme example of physicians. In each province there's only one employer, and fees are bargained collectively. On the supply side, the provinces, with some consultation, set the number of domestic applicants admitted to medical schools, as well as the number of international medical graduates admitted to practise. Provincial governments also legislate the regulatory colleges that provide quality control and oversight.
In determining the number of open slots for new physicians, provinces need to play a balancing game. They need to take into account the health care requirements of their populations. Also, they need to take into account the tax revenue or debt financing needed to fund those positions. This is extremely challenging. In this context, a lot of data and a lot of information and planning are required.
This process has generated a perceived shortage that is slowly being reduced. In fact, in the last decade, many provincial governments have moved very aggressively to increase the number of physicians per capita.
In Ontario, for example, beyond physicians, the Regulated Health Professions Act traditionally covered 24 professions and, at the moment, two or three occupations are in the process of being brought under the act. As well, many health services occupations that are not regulated are primarily employed by provincially funded hospitals or other institutions. None of these occupations operate in the way we traditionally think of labour markets operating.
So what's the federal role? I'd like to raise two issues for you to consider. First, my personal view is that while many of the appropriate institutions are in place, they are frequently not as active as they could or should be. I believe that communication and coordination among the provinces and the federal government are still not sufficient, and there's a need for increased information sharing. Health Canada and CIHI play very important roles, as does Statistics Canada. Also, since it has a lot of capacity in the area, HRSDC also plays a role, though it could play a larger one.
I should note that what I'm talking about is routine. It's what I consider well below the radar screen.
One of the examples that I might think of as a structure for facilitating this is the existing federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources. This is a standing committee of the federal-provincial-territorial Conference of Deputy Ministers of Health. In my ideal world, an invigorated version of this group would, in coordination with CIHI, generate substantial sharing of health human resource data and practical experience between governments and other relevant stakeholders, such as the Canadian Nurses Association and the Canadian Medical Association.
The second issue is a focus on immigration, which plays a very important role in these areas. I believe that immigrant selection for individuals working in health professions, where the provincial governments are the principal payers, should be taken out of the federal skilled worker program and put into the provincial nominee program.
The current points system is very poorly suited to regulated health professions under our single-payer system. A coordination problem arises from having immigrant selection at the federal level while employment and planning occur almost exclusively at the provincial level. This is completely different from private sector markets. I suspect that the most useful approach would be to shift this responsibility to the provinces, since they have the levers to verify credentials in the health area and to implement their health human resource planning.
Thank you very much.