Thursday, August 19, 2010 (Ottawa) - Nurses welcome any discussion aimed at improving health care for all Canadians.

 

We agree that “all Canadians must have timely access to an appropriate array of medically-necessary services across the full continuum of care, independent of their ability to pay.” But we can't see how the CMAs new vision for health care transformation can accomplish this.

 

The report focuses on physicians outlining an expanded role for physicians’ assistants, yet it does not acknowledge the importance of expanding the roles of other health professionals including nurse practitioners even though there is considerable evidence to support that direction. The CFNU believes that it is essential to consider the entire health care team if we are truly to improve both the efficiency of the system and to keep the focus "patient centered."

 

The support for “pay for performance” programs (also known as activity-based funding) comes in spite of the problems such an approach has created in the United Kingdom and elsewhere. At an institutional level, this approach encourages competition between departments and facilities where collaboration and mutual support ought to occur. It also drives the focus towards artificial benchmarks and away from the patient-centered care the CMA extols.

 

At an individual level, it is difficult to imagine defined measurements for something as subjective as quality that do not create new distortions, new conflicts and new opportunities for any who want to defraud the system. The majority of health professionals, we believe, already do their utmost for patients and their motivations could not be improved through a financial bonus. What could improve quality of care is attention to work environments for health care workers but CMA’s report does not address this in any substantial way.

 

We are also unable to reconcile the call for universal access to health services along a continuum of care with a continued and enhanced reliance on personal economic means for long-term care through the use of private RRSPs and tax-deductible long-term care insurance. As it is, most Canadians are unable to maximize their contribution to RRSPs. A proposal that links long-term-care to personal tax credits would inevitably result in the transfer of public finances to private insurance companies and individuals who can afford RRSPs, at the expense of those who can’t.  

 

The CMA report focuses on a transformation of medicare, some of it radical, rather than a focus on stable funding for a system Canadians want and value. While we welcome some of the specific proposals, particularly those calling for greater investments in homecare and pharmacare, we strongly reject the notion that 1) the system is in crisis, and 2) the Canada Health Act needs to be reopened. We have recently released our own economic and policy analysis concluding that medicare is as sustainable as we want it to be if we act now to make strides to achieve its original vision. You can find the full report here.

 

Read additional commentary from Canadian Nurses Association and Canadian Doctors for Medicare.