Provincial health systems making spotty progress

The latest report card on provincial health policy shows some improvement in offering home care and mental health services, but progress is spotty across the country.

The Health Council of Canada's 2012 progress report says the provinces are generally living up to their 2003 commitments to boost home care, increase the number of doctors and nurses, and develop indicators to show the public how well they are doing.

But the report says progress is far from uniform across the country, and is underwhelming.

"The accords have not brought about the large-scale change that was envisioned when they were created," the report says. The health council puts the blame on the vagueness of the 2003 agreements, and the emphasis on creating a common ground rather than pushing each jurisdiction toward improvement.

Instead of working together to share and implement great ideas, each province has worked by itself to meet poorly defined goals, the report says.

The health council questions whether the provinces are on solid enough footing to proceed with a meaningful plan for the future.

"While these accords were intended to deal with the health care challenges at the time, the country is still grappling with many of the same challenges today."

The provinces are in the midst of hashing out their own joint plan for the future of health care, now that the federal agreement has signalled it does not want to get deeply involved in such policy-setting. The aim is for the provinces to pool their ideas on innovation so that each province can cut costs, improve service, and avoid creating a patchwork of public health-care services across the country.

When the 2004 accord expires in 2014, Ottawa will continue to increase its health transfers to the provinces for the next decade, but at a lower rate of increase, and with no strings attached.

Cash-strapped provinces are struggling to keep their health-care costs down, even as demand for technology soars, drug costs rise, and the population ages.

Number of doctors is up

"In order to understand where Canada's health-care system should be headed, there must be an understanding of where it is today," the report says. Specifically, the health council found that many provinces are implementing mental health strategies, but that they don't always include them in their plans for home care.

The council also found inconsistencies in the way provinces were providing coverage for end-of-life care. The report also notes that the number of doctors grew 12 per cent from 2006 to 2010, while the number of nurses rose six per cent, and the number of pharmacists was up 16 per cent.

But the report notes that provinces are challenged in dealing with the huge costs associated with human resources. The territories also have major problems attracting and retaining health care professionals, the report says.

As for tele-health, the assessment found huge growth. Tele-health services have expanded by 35 per cent a year for the last five years, now encompassing 1,175 communities. The report also notes a major shortage of national, comparable indicators that allow the public to easily compare one jurisdiction to another.

The council said the provinces would be wise to heed the findings of its report card, and previous assessments, as they strike out on their own to reform health care in Canada.

"Real progress is made when comprehensive strategies with concrete targets are put in place," said council chairman Dr. Jack Kitts. "An improved approach to goal-setting and performance measurement in the health system will provide greater impetus to change and achieve higher levels of progress."