Also known as |
|
---|---|
Commissioner | |
Inquiry period | 3 April 2001– November 2002 |
Authorized | Order in Council P.C. 2001-569 |
Final Report |
The Royal Commission on the Future of Health Care in Canada, also known as the Romanow Report, is a committee study led by Roy Romanow on the future of health care in Canada. It was delivered in November 2002. [1]
Romanow recommended sweeping changes to ensure the long-term sustainability of Canada's health care system. The proposed changes were outlined in the Commission's Final Report, Building on Values: The Future of Health Care in Canada, which was tabled in the House of Commons on 28 November 2002.
Although the Report of the Royal Commission dealt with a wide range of issues, much of the early attention was paid to the recommendations with respect to the financing of health care in Canada and especially transfers from the federal government to provincial and territorial governments.
The Report set the stage for another round of federal-provincial/territorial bargaining leading to a significant agreement in September 2004 whereby the Government of Canada agreed to transfer an additional $41 billion over the next 10 years in support of an action plan on health. The new funding is meant to strengthen ongoing federal health support provided through the Canada Health Transfer (CHT) as well as focus resources on addressing the fact that Canadians, like citizens in other OECD countries, often have significant wait times for access to essential health care services.
The report identifies significant problems in the way that aboriginal health is managed. Surprisingly, this is largely not due to a lack of funding; there is simply a mismanagement of assets. Funding sources are fragmented and there is no established system to provide care. In addition, there are extensive equity concerns due to this fragmentation of funding and differential care available to different Aboriginal communities.
As a result, the report suggests that new administration procedures be put in place. Integration of on-reserve healthcare into the current system is not a popular option amongst aboriginal leaders, although serves as a reasonable option for urban aboriginal healthcare. Specifically, the report suggests the formation of Aboriginal Partnerships that are an administrative authority composed of representatives from different levels of government and the aboriginal community.
These partnerships may work in a method similar to a regional health authority. They will serve as an organization with a specific health goal, such as organizing the public health and primary care for a community. The partnership will be granted federal funds to pursue these health goals in a manner that Partnership executives agree upon. Aboriginal representation in the Partnership ensures that these services are fitting with the cultural needs of the Aboriginal community. Partnerships will also interface with the existing health system to coordinate access to resources such as diagnostics and specialized care.
In an urban setting, the Partnership will serve as a voluntary health organization that coordinates access to specific health facilities such as primary care and diagnostics. The Partnership will have similar representation from Aboriginal community ensuring that services provided in the urban environment are still sensitive to Aboriginal cultural and linguistic concerns. Partnerships are especially needed in urban settings due to the specific needs of urban Aboriginals for problems such as diabetes and addiction. Furthermore, Partnerships may serve as an additional urban community organization that interfaces with other such Aboriginal organizations to serve as activists for the socioeconomic status of Aboriginals.
An important point stressed by the Romanow report is that healthcare initiatives must be accountable towards the taxpayer and consumer. Aboriginal health is no different; Partnerships must be closely monitored and their effect on health outcomes determined. Changes in policy may be necessitated as this is a new approach. [2]
The conclusion of the Report set out 47 recommendations along with a timetable for their implementation.
Recommendation 1 – A new Canadian Health Covenant should be established as a common declaration of Canadians’ and their governments’ commitment to a universally accessible, publicly funded health care system. To this end, First Ministers should meet at the earliest opportunity to agree on this Covenant.
Recommendation 2 – A Health Council of Canada should be established by the provincial, territorial and federal governments to facilitate co-operation and provide national leadership in achieving the best health outcomes in the world. The Health Council should be built on the existing infrastructure of the Canadian Institute for Health Information (CIHI) and the Canadian Coordinating Office of Health Technology Assessment (CCOHTA).
Recommendation 3 – On an initial basis, the Health Council of Canada should: Establish common indicators and measure the performance of the health care system; Establish benchmarks, collect information and report publicly on efforts to improve quality, access and outcomes in the health care system; and coordinate existing activities in health technology assessment and conduct independent evaluations of technologies, including their impact on rural and remote delivery and the patterns of practice for various health care providers.
Recommendation 4 – In the longer term, the Health Council of Canada should provide ongoing advice and coordination in transforming primary health care, developing national strategies for Canada’s health workforce, and resolving disputes under a modernized Canada Health Act.
Recommendation 5 – The Canada Health Act should be modernized and strengthened by: Confirming the principles of public administration, universality and accessibility, updating the principles of portability and comprehensiveness, and establishing a new principle of accountability; Expanding insured health services beyond hospital and physician services to immediately include targeted home care services followed by prescription drugs in the longer term; Clarifying coverage in terms of diagnostic services; Including an effective dispute resolution process; and Establishing a dedicated health transfer directly connected to the principles and conditions of the Canada Health Act.
Recommendation 6 – To provide adequate funding, a new dedicated cash-only Canada Health Transfer should be established by the federal government. To provide long-term stability and predictability, the Transfer should include an escalator that is set in advance for five year periods.
Recommendation 7 – On a short-term basis, the federal government should provide targeted funding for the next two years to establish: a new Rural and Remote Access Fund; a new Diagnostic Services Fund; a Primary Health Care Transfer; a Home Care Transfer; and a Catastrophic Drug Transfer
Recommendation 8 – A personal electronic health record for each Canadian that builds upon the work currently underway in provinces and territories.
Recommendation 9 – Canada Health Infoway should continue to take the lead on this initiative and be responsible for developing a pan-Canadian electronic health record framework built upon provincial systems, including ensuring the interoperability of current electronic health information systems and addressing issues such as security standards and harmonizing privacy policies.
Recommendation 10 – Individual Canadians should have ownership over their personal health information, ready access to their personal health records, clear protection of the privacy of their health records, and better access to comprehensive and credible information about health, health care and the health system.
Recommendation 11 – Amendments should be made to the Criminal Code to protect Canadians’ privacy and to explicitly prevent the abuse or misuse of personal health information, with violations in this area considered a criminal offense.
Recommendation 12 – Canada Health Infoway should support health literacy by developing and maintaining an electronic health information base to link Canadians to health information that is properly researched, trustworthy and credible as well as support more widespread efforts to promote good health.
Recommendation 13 – The Health Council of Canada should take action to streamline technology assessment in Canada, increase the effectiveness, efficiency and scope of technology assessment, and enhance the use of this assessment in guiding decisions.
Recommendation 14 – Steps should be taken to bridge current knowledge gaps in applied policy areas, including rural and remote health, health human resources, health promotion, and pharmaceutical policy.
Recommendation 15 – A portion of the proposed Rural and Remote Access Fund, the Diagnostic Services Fund, the Primary Health Care Transfer, and the Home Care Transfer should be used to improve the supply and distribution of health care providers, encourage changes to their scopes and patterns of practice, and ensure that the best use is made of the mix of skills of different health care providers.
Recommendation 16 – The Health Council of Canada should systematically collect, analyze and regularly report on relevant and necessary information about the Canadian health workforce, including critical issues related to the recruitment, distribution, and remuneration of health care providers.
Recommendation 17 – The Health Council of Canada should review existing education and training programs and provide recommendations to the provinces and territories on more integrated education programs for preparing health care providers, particularly for primary health care settings.
Recommendation 18 – The Health Council of Canada should develop a comprehensive plan for addressing issues related to the supply, distribution, education and training, remuneration, skills and patterns of practice for Canada’s health workforce.
Recommendation 19 – The proposed Primary Health Care Transfer should be used to “fast-track” primary health care implementation. Funding should be conditional on provinces and territories moving ahead with primary health care reflecting four essential building blocks – continuity of care, early detection and action, better information on needs and outcomes, and new and stronger incentives to achieve transformation.
Recommendation 20 – The Health Council of Canada should sponsor a National Summit on Primary Health Care within two years to mobilize concerted action across the country, assess early results, and identify actions that must be taken to remove obstacles to primary health care implementation.
Recommendation 21 – The Health Council of Canada should play a leadership role in following up on the outcomes of the Summit, measuring and tracking progress, sharing information and comparing Canada’s results to leading countries around the world, and reporting to Canadians on the progress of implementing primary health care in Canada.
Recommendation 22 – Prevention of illness and injury, and promotion of good health should be strengthened with the initial objective of making Canada a world leader in reducing tobacco use and obesity.
Recommendation 23 – All governments should adopt and implement the strategy developed by the Federal, Provincial and Territorial Ministers Responsible for Sport, Recreation and Fitness to improve physical activity in Canada.
Recommendation 24 – A national immunization strategy should be developed to ensure that all children are immunized against serious illnesses and Canada is well prepared to address potential problems from new and emerging infectious diseases.
Recommendation 25 – Provincial and territorial governments should use the new Diagnostic Services Fund to improve access to medical diagnostic services.
Recommendation 26 – Provincial and territorial governments should take immediate action to manage wait lists more effectively by implementing centralized approaches, setting standardized criteria, and providing clear information to patients on how long they can expect to wait.
Recommendation 27 – Working with the provinces and territories, the Health Council of Canada should establish a national framework for measuring and assessing the quality and safety of Canada’s health care system, comparing the outcomes with other OECD countries, and reporting regularly to Canadians.
Recommendation 28 – Governments, regional health authorities, health care providers, hospitals and community organizations should work together to identify and respond to the needs of official language minority communities.
Recommendation 29 – Governments, regional health authorities, and health care providers should continue their efforts to develop programs and services that recognize the different health care needs of men and women, visible minorities, people with disabilities, and new Canadians.
Recommendation 30 – The Rural and Remote Access Fund should be used to attract and retain health care providers.
Recommendation 31 – A portion of the Rural and Remote Access Fund should be used to support innovative ways of expanding rural experiences for physicians, nurses and other health care providers as part of their education and training.
Recommendation 32 – The Rural and Remote Access Fund should be used to support the expansion of telehealth approaches.
Recommendation 33 – The Rural and Remote Access Fund should be used to support innovative ways of delivering health care services to smaller communities and to improve the health of people in those communities.
Recommendation 34 – The proposed new Home Care Transfer should be used to support expansion of the Canada Health Act to include medically necessary home care services in the following areas: Home mental health case management and intervention services should immediately be included in the scope of medically necessary services covered under the Canada Health Act; Home care services for post-acute patients, including coverage for medication management and rehabilitation services, should be included under the Canada Health Act; and palliative home care services to support people in their last six months of life should also be included under the Canada Health Act.
Recommendation 35 – Human Resources Development Canada, in conjunction with Health Canada should be directed to develop proposals to provide direct support to informal caregivers to allow them to spend time away from work to provide necessary home care assistance at critical times.
Recommendation 36 – The proposed new Catastrophic Drug Transfer should be used to reduce disparities in coverage across the country by covering a portion of the rapidly growing costs of provincial and territorial drug plans.
Recommendation 37 – A new National Drug Agency should be established to evaluate and approve new prescription drugs, provide ongoing evaluation of existing drugs, negotiate and contain drug prices, and provide comprehensive, objective and accurate information to health care providers and to the public.
Recommendation 38 – Working collaboratively with the provinces and territories, the National Drug Agency should create a national prescription drug formulary based on a transparent and accountable evaluation and priority-setting process.
Recommendation 39 – A new program on medication management should be established to assist Canadians with chronic and some life-threatening illnesses. The program should be integrated with primary health care approaches across the country.
Recommendation 40 – The National Drug Agency should develop standards for the collection and dissemination of prescription drug data on drug utilization and outcomes.
Recommendation 41 – The federal government should immediately review the pharmaceutical industry practices related to patent protection, specifically, the practices of evergreening and the notice of compliance regulations. This review should ensure that there is an appropriate balance between the protection of intellectual property and the need to contain costs and provide Canadians with improved access to non-patented prescription drugs.
Recommendation 42 – Current funding for Aboriginal health services provided by the federal, provincial and territorial governments and Aboriginal organizations should be pooled into single consolidated budgets in each province and territory to be used to integrate Aboriginal health care services, improve access, and provide adequate, stable and predictable funding.
Recommendation 43 – The consolidated budgets should be used to fund new Aboriginal Health Partnerships that would be responsible for developing policies, providing services and improving the health of Aboriginal peoples. These partnerships could take many forms and should reflect the needs, characteristics and circumstances of the population served.
Recommendation 44 – Federal and provincial governments should prevent potential challenges to Canada’s health care system by: Ensuring that any future reforms they implement are protected under the definition of “public services” included in international law or trade agreements to which Canada is party; and reinforcing Canada’s position that the right to regulate health care policy should not be subject to claims for compensation from foreign-based companies.
Recommendation 45 – The federal government should build alliances with other countries, especially with members of the World Trade Organization, to ensure that future international trade agreements, agreements on intellectual property, and labour standards make explicit allowance for both maintaining and expanding publicly insured, financed and delivered health care.
Recommendation 46 – The federal government should play a more active leadership role in international efforts to assist developing nations in strengthening their health care systems through foreign aid and development programs. Particular emphasis should be placed on training health care providers and on public health initiatives.
Recommendation 47 – Provincial, territorial and federal governments and health organizations should reduce their reliance on recruiting health care professionals from developing countries.
Medicare is an unofficial designation used to refer to the publicly funded, single-payer health care system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans that provide universal health care coverage to Canadian citizens, permanent residents, and certain temporary residents. These systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.
A patient's bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights.
The Canada Health Act (CHA) is a statute of the Parliament of Canada, adopted in 1984, which establishes the framework for federal financial contributions to the provincial and territorial health insurance programs, commonly called "medicare". To receive federal funding, the provinces and territories must comply with the terms of the CHA, which establishes the principle of universal, single-payer healthcare.
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a physician assistant, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.
Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."
The Canadian Health Coalition is a lobby group dedicated to preserving Canada's current Medicare system and to promoting the overall goal and policy of universal public health care. In 2002 and 2003 it was the leading national organization advocating that the Canadian federal government adopt the recommendations of the Romanow Report. Currently the Canadian Health Coalition and its provincial affiliates have been spearheading a campaign to prevent the privatization of health care, and to expand it to include a national public drug plan.
The National Health and Medical Research Council (NHMRC) is the main statutory authority of the Australian Government responsible for medical research. It was the eighth largest research funding body in the world in 2016, and NHMRC-funded research is globally recognised for its high quality. Around 45% of all Australian medical research from 2008–12 was funded by the federal government, through the NHMRC.
The Universal Service Fund (USF) is a system of telecommunications subsidies and fees managed by the United States Federal Communications Commission (FCC) intended to promote universal access to telecommunications services in the United States. The FCC established the fund in 1997 in compliance with the Telecommunications Act of 1996. The FCC is a government agency that implements and enforces telecommunications regulations across the U.S. and its territories. The Universal Service Fund's budget ranges from $5–8 billion per year depending on the needs of the telecommunications providers. These needs include the cost to maintain the hardware needed for their services and the services themselves. The total 2019 proposed budget for the USF was $8.4 billion. The budget is revised quarterly allowing the service providers to accurately estimate their costs. As of 2019, roughly 60% of the USF budget was put towards “high-cost” areas, 19% went to libraries and schools, 13% was for low income areas, and 8% was for rural health care. In 2019 the rate for the USF budget was 24.4% of a telecom company's interstate and international end-user revenues.
Canada Health Infoway is an independent, federally funded, not-for-profit organization tasked with accelerating the adoption of digital health solutions, such as electronic health records, across Canada. Infoway is focused on two strategic goals:
The Canadian Institute for Health Information (CIHI) is a government-controlled not-for-profit Crown corporation that provides essential information on Canada's health systems and the health of Canadians. CIHI provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada.
In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.
The National Tuberculosis Elimination Program (NTEP) is the Public Health initiative of the Government of India that organizes its anti-Tuberculosis efforts. It functions as a flagship component of the National Health Mission (NHM) and provides technical and managerial leadership to anti-tuberculosis activities in the country. As per the National Strategic Plan 2017-25, the program has a vision of achieving a "TB free India",with a strategies under the broad themes of “Prevent, Detect,Treat and Build pillars for universal coverage and social protection”. The program provides, various free of cost, quality tuberculosis diagnosis and treatment services across the country through the government health system.
Healthcare in Brazil is a constitutional right. It is provided by both private and government institutions. The Health Minister administers national health policy. Primary healthcare remains the responsibility of the federal government, elements of which are overseen by individual states. Public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, known as the Unified Health System. The SUS is universal and free for everyone.
The Canadian Indian Health Transfer Policy provides a framework for the assumption of control of health services by Indigenous peoples in Canada and set forth a developmental approach to transfer centred on the concept of self-determination in health. Through this process, the decision to enter into transfer discussions with Health Canada rests with each community. Once involved in transfer, communities are able to take control of health program responsibilities at a pace determined by their individual circumstances and health management capabilities.
GeoBase is a federal, provincial and territorial government initiative that is overseen by the Canadian Council on Geomatics (CCOG). It is undertaken to ensure the provision of, and access to, a common, up-to-date and maintained base of quality geospatial data for Canada. Through the GeoBase, users with an interest in geomatics have access to quality geospatial information at no cost and with unrestricted use.
The Alberta Health Insurance Act was an act passed by the Alberta Legislature in February 1935. It was the first Canadian health insurance act to provide some public funding for medical services, and as such is considered to be an early step toward the provision of medicare in Canada.
The Health Council of Canada was a national, independent, public reporting agency based in Toronto, Ontario, Canada. Announced as part of the 2003 First Ministers' Accord on Health Care Renewal with a mandate to report publicly to Canadians, the Health Council provided a system-wide perspective on health care reform related to the 2003 Accord’s policy and program commitments as well as those contained in the 2004 10-Year Plan to Strengthen Health Care. In 2010, the Health Council’s mandate was expanded to include the nationwide dissemination of information on best practices and innovation in health care.
Friendship Centres are non-profit community organizations that provide services to urban Inuit, Métis, and First Nations people. Friendship Centres were first established in the 1950s, and there are now more than 100 Centres across Canada. Friendship Centres typically provide a variety of programs and services to its members that can include youth programs, health services, housing, employment, cultural programs and more.
The Hospital Insurance and Diagnostic Services Act (HIDS) is a statute passed by the Parliament of Canada in 1957 that reimbursed one-half of provincial and territorial costs for hospital and diagnostic services administered under provincial and territorial health insurance programs. Originally implemented on July 1, 1958, with five participating provinces, by January 1, 1961, all ten provinces were enlisted. The federal funding was coupled with terms and conditions borrowed from the Saskatchewan Hospital Services Plan, introduced in 1947 as the first universal hospital insurance program in North America. In order to receive funding, services had to be universal, comprehensive, accessible and portable. This stipulation was dropped in 1977 with the Established Programs Financing Act and then reinstated in 1984 in the Canada Health Act. Widely acknowledged as the foundation for future developments in the Canadian health care system, the HIDS Act was a landmark example of federal-provincial cooperation in post-war Canada.
India has a universal multi-payer health care model that is paid for by a combination of public and private health insurance funds along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. At the federal level, a national publicly funded health insurance program was launched in 2018 by the Government of India, called Ayushman Bharat. This aimed to cover the bottom 50% of the country's population working in the unorganized sector and offers them free treatment at both public and private hospitals. For people working in the organized sector and earning a monthly salary of up to ₹21,000 are covered by the social insurance scheme of Employees' State Insurance which entirely funds their healthcare, both in public and private hospitals. People earning more than that amount are provided health insurance coverage by their employers through either one of the four main public health insurance funds which are the National Insurance Company, The Oriental Insurance Company, United India Insurance Company and New India Assurance or a private insurance provider. As of 2020, 300 million Indians are covered by insurance bought from one of the public or private insurance companies by their employers as group or individual plans. Indian nationals and expatriates who work in the public sector are eligible for a comprehensive package of benefits including, both public and private health, preventive, diagnostic, and curative services and pharmaceuticals with very few exclusions and no cost sharing. Most services including state of the art cardio-vascular procedures, organ transplants, and cancer treatments are covered. Employers are responsible for paying for an extensive package of services for private sector expatriates unless they are eligible for the Employees' State Insurance. Unemployed people without coverage are covered by the various state funding schemes for emergency hospitalization if they do not have the means to pay for it. In 2019, the total net government spending on healthcare was $36 billion or 1.23% of its GDP. Since the country's independence, the public hospital system has been entirely funded through general taxation.
Note that most of these references are from the Romanow Report.