Medical Device Daily Contributing Writer

VICTORIA, British Columbia — The author of a report on Canada's healthcare system is accusing the premier of Alberta of a “radical“ departure from commitments his government made last September concerning the reform of the country's healthcare system.

The comments by Roy Romanow, author of the heavily circulated Romanow Report, came in the wake of a first report from the newly created Health Council of Canada, which was designed to monitor the health status and health outcomes of Canadian citizens.

“To me one of the most hopeful signs surrounding healthcare reform is that the Health Council of Canada is finally up and running,“ Romanow told Medical Device Daily. “It is hobbled somewhat by the fact that Alberta is boycotting it, and Quebec is similarly not participating. This quite obviously doesn't make it as national an organization as it should be.“

The decision by Alberta Premier Ralph Klein to boycott the Health Council of Canada stems in large part from his belief that the Canadian healthcare system would benefit from more private healthcare delivery.

Publicly funded universal healthcare has held sway in Canada since the late 1960s and is based on the Medicare system that originated in Romanow's home province of Saskatchewan. But Klein was stung by accusations during last year's Canadian election that he had a “secret plan“ to institute “private for-profit“ healthcare delivery in Alberta. Romanow shares the concerns of others about Klein's support for increased private healthcare delivery.

“This is radically at odds with what the Canada Health Act and what the governments signed in September and the principles and purposes of reforming the system are all about,“ said Romanow.

What reforming the system is all about, he added, is contained in the Health Council's first report released in late January. Among other things, it recommends that “strong language“ be used when describing the disparities in healthcare that exist between groups in Canada, such as aboriginals and other Canadians. Reporting and highlighting those disparities is essential, says the report, but is difficult “when the public is preoccupied with funding for healthcare.“

The one group in Canada routinely skewered over its alleged preoccupation with funding is Canadian physicians, who commonly complain that reforming Canadian healthcare is pointless without a sufficient injection of money to provide the supports that health care professionals need to treat their patients.

The president of the Canadian Medical Association (Ottawa, Ontario), Albert Schumacher, MD, remains unimpressed with the $41 billion promised the Canadian healthcare system by provincial premiers last September. The Ontario family physician told MDD that physicians need some guarantee of long-term financial support for Canadian healthcare before they'll fully support reform.

“Most physicians in my province remember the claw back under the New Democratic Government 10 years ago, where 10 % was taken off the top,“ Schumacher said. “And we live in dread of something else going dreadfully wrong like that.“

Romanow said there is enough money now available to address the problems facing the Canadian healthcare system. The real question, he said, is whether doctors and politicians have the will to use that money to transform the system.

He cited the Medical Reform Group, a new organization of doctors, nurses and pharmacists exploring ways to relax their scopes of practice so that, for example, nurse practitioners could assume the duties traditionally handled by doctors. Such an experiment, said Romanow, could result in a “more coordinated, more seamless and a continuum of healthcare in a primary and ongoing way.

“But the problem is it hasn't moved very swiftly beyond the talking stage. There are some major ongoing difficulties to achieving that type of team approach,“ he said.

A stronger team focus among Canadian healthcare professionals also is a key recommendation of the Canadian Health Council's report.

“Existing planning models,“ it states, “will generate the wrong results if they continue to be supply-based and specific to each health profession. Serious effort is required to shift the planning focus towards teams.“

That approach, the report adds, must begin in the medical and nursing schools. Integrated programs where students from different disciplines train in teams, it concludes, will enable students “to work in the kinds of collaborative practice environments envisioned for the future.“

An even larger problem continues to be the lack of teamwork displayed by Ottawa and the provinces, a problem with deep historic roots. In 1981, as premier of Saskatchewan, Romanow attended a first ministers' constitutional conference in Victoria. When the lone province of Quebec repeatedly rejected constitutional proposals presented by Ottawa and the other nine provincial premiers, Romanow and the others decided to exclude Quebec from the final deal, a step that still rankles Quebecers nearly a quarter-century later.

Romanow said he thinks the country could take a similar approach towards Alberta and its decision not to participate in the Health Council of Canada. “Unfortunately, history has shown us sometimes it's the only way to make progress.“

A test of the council's relevance could come this spring when it releases a longer discussion paper on primary healthcare focused on the definitions and innovative practices across the country.

Schumacher said he believes equal attention should be paid to the council's ability to produce “an independent survey report card,“ one that explains where the deficiencies are in the Canadian healthcare system and how Ottawa and the provinces must act in order to address those deficiencies.

“It also needs to be able to hold both provinces and the federal governments accountable where there are needs for improvement,“ he said.

For his part, Romanow laments the fact that the Health Council was not given a stronger mandate when it was created in early 2004, with a stronger reporting and accountability mechanism. “The Health Council that's been set up is certainly of a different flavor than the one I recommended,“ he said.

He remains hopeful, however, that ordinary Canadians will come to see the council as “a reporting agency of high importance“ and begin to pressure the politicians to spend their health dollars on fixing the publicly funded healthcare system.

“The council will be of high importance to the public because it will be a demonstration of whether or not the money is being spent to buy change,“ Romanow said. “I can't say that enough times: money must buy the change.“

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