In September 2000, First Ministers agreed on a vision, principles and action plan for health system renewal. Building from this agreement, all governments have taken measures to improve the quality, accessibility and sustainability of our public health care system and all have implemented important reforms. Federal and provincial/territorial governments have also commissioned a number of task forces and studies that reflect the views of Canadians. These studies reflect a great convergence on the value of our publicly funded health system, the need for reform, and on the priorities for reform: particularly primary health care, home care, catastrophic drug coverage, access to diagnostic/medical equipment and information technology and an electronic health record.
Canadians want a sustainable health care system that provides timely access to quality health services. They recognize that reform is essential, and they support new public investments targeted to achieve this goal.
This Accord sets out an action plan for reform that reflects a renewed commitment by governments to work in partnership with each other, with providers, and with Canadians in shaping the future of our public health care system.
Canadian values are reflected in the five principles of public health insurance: Universality, Accessibility, Portability, Comprehensiveness and Public Administration. First Ministers reaffirm their commitment to these principles. They also commit to enhancing the transparency and accountability of our health care system while ensuring that health care remains affordable.
Drawing from this foundation, First Ministers view this Accord as a covenant which will help to ensure that:
First Ministers believe that the initiatives set out in this Accord will result in real and lasting change. The ultimate purpose of this Accord is to ensure that Canadians:
All governments have made significant investments in health care since the First Ministers' agreement of September 2000. First Ministers agree that public health care in Canada requires more money, but that money alone will not fix the system. While all jurisdictions are making progress on health reform, First Ministers agree that significant new investments must address immediate cost pressures and the reforms necessary to achieve timely access to quality care in a sustainable manner. The federal government will continue to work with territorial governments to address their unique challenges.
First Ministers agree that additional investments in primary health care, home care and catastrophic drug coverage are needed for a long-term sustainable public health care system in Canada. The federal government will create a 5 year Health Reform Fund which will transfer resources to the provinces and territories to address these three priorities. Recognizing that provinces and territories are at differing stages of reforms in these areas, the Fund will provide the provinces and territories the necessary flexibility to achieve the objectives set out below. Premiers and Territorial Leaders agree to use the Health Reform Fund to achieve these objectives. Therefore, these funds to be transferred to the provinces and territories will be available for any of the programs described within the Health Reform Fund, at their discretion. Achievement of the objectives of the Health Reform Fund by a province or territory will allow use of any residual fiscal resources in the Fund for other priority areas of their own health system.
The Government of Canada will establish a new long-term Canada Health Transfer (CHT) by March 31, 2004. It will include the portion of the current CHST (both cash and tax points) corresponding to the current proportion of health expenditures in provincial
social spending supported by this federal transfer. In establishing the CHT, the federal government will ensure predictable annual increases in health transfers.
Subject to a review of progress toward achieving the agreed-upon reforms and following a First Ministers' Meeting, by March 31, 2008, the federal government will ensure that the level of funding provided through the Health Reform Fund is also integrated into the CHT.
The key to efficient, timely, quality care is primary health care reform. First Ministers agree that the core building blocks of an effective primary health care system are improved continuity and coordination of care, early detection and action, better information on needs and outcomes, and new and stronger incentives to ensure that new approaches to care are swiftly adopted and here to stay.
First Ministers agree that the ultimate goal of primary health care reform is to provide all Canadians, wherever they live, with access to an appropriate health care provider, 24 hours a day, 7 days a week. Towards this goal, First Ministers agree to immediately accelerate primary health care initiatives and to make significant annual progress so that citizens routinely receive needed care from multi-disciplinary primary health care organizations or teams. First Ministers agree to the goal of ensuring that at least 50% of their residents have access to an appropriate health care provider, 24 hours a day, 7 days a week, as soon as possible and that this target be fully met within 8 years. First Ministers agree that each jurisdiction will publicly set out its own multi-year targets for verifiable progress towards achieving this objective.
Improving access to a basket of services in the home and community will improve the quality of life of many Canadians by allowing them to stay in their home or recover at home. First Ministers direct Health Ministers to determine by September 30, 2003, the minimum services to be provided. Such services provided in the home can be more appropriate and less expensive than acute hospital care. To this end, First Ministers agree to provide first dollar coverage for this basket of services for short-term acute home care, including acute community mental health, and end-of-life care. First Ministers agree that access to these services will be based on assessed need and that, by 2006, available services could include nursing/professional services, pharmaceuticals and medical equipment/supplies, support for essential personal care needs, and assessment of client needs and case management. The Government of Canada will complement these efforts with a compassionate care benefit through the Employment Insurance Program and job protection through the Canada Labour Code, for those who need to temporarily leave their job to care for a gravely ill or dying child, parent or spouse.
First Ministers agree that no Canadian should suffer undue financial hardship for needed drug therapy. Accordingly, as an integral component of these reforms, First Ministers will take measures, by the end of 2005/06, to ensure that Canadians, wherever they live, have reasonable access to catastrophic drug coverage.
As a priority, First Ministers agree to further collaborate to promote optimal drug use, best practices in drug prescription and better manage the costs of all drugs including generic drugs, to ensure that drugs are safe, effective and accessible in a timely and cost-effective fashion.
First Ministers agree to prepare an annual public report to their citizens on each of the above three areas commencing in 2004. They further agree to use comparable indicators and to develop the necessary data infrastructure for these reports. This reporting will inform Canadians on progress achieved and key outcomes. It will also inform Canadians on current programs and expenditures, providing a baseline against which new investments can be tracked, as well as on service levels and outcomes.
Enhancing the availability of publicly-funded diagnostic care and treatment services is critical to reducing waiting times and ensuring the quality of our health care system. To this end, First Ministers agree to make significant new investments, including support for specialized staff training and equipment, which improve access to publicly funded diagnostic services. The Government of Canada will establish a Diagnostic/Medical Equipment Fund for that purpose.
Commencing in 2004, First Ministers agree to report to their citizens on an annual basis on enhancements to diagnostic and medical equipment and services, using comparable indicators, and to develop the necessary data infrastructure for these reports. This reporting will inform Canadians on progress achieved and key outcomes. It will also inform Canadians on current programs and expenditures, providing a baseline against which new investments can be tracked, as well as on service levels and outcomes.
Improving the accessibility and quality of information is critical to quality care, patient safety and sustainability, particularly for Canadians who live in rural and remote areas. Better use of information technology can also result in better utilization of resources. First Ministers agree to place priority on the implementation of electronic health records and the further development of telehealth applications which are critical to care in rural and remote areas. The Government of Canada will provide additional support for Canada Health Infoway to achieve this objective. First Ministers are also committed to the appropriate protection of personal information in building a national system of electronic health records.
Canada Health Infoway will report to the Canadian public and to the members of Infoway, who are Deputy Ministers of Health of federal/provincial/territorial governments, on an annual basis on its progress in implementing these initiatives. This reporting will inform Canadians on current programs, investment expenditures and milestones.
The adoption of innovations and the sharing of best practices by health care providers and managers is critical to making health care more efficient and improving its quality. First Ministers commit to accelerate collaborative work on priority issues with respect to patient safety, health human resources, technology assessment, innovation and research, and healthy living. The federal government is committed to providing funding in support of this work.
Building from this, First Ministers direct Health Ministers to work on the following:
First Ministers recognize that addressing the serious challenges that face the health of Aboriginal Canadians will require dedicated effort. To this end, the federal government is committed to enhancing its funding and working collaboratively with other governments and Aboriginal peoples to meet the objectives set out in this Accord including the priorities established in the Health Reform Fund. Governments will work together to address the gap in health status between Aboriginal and non-Aboriginal Canadians through better integration of health services.
First Ministers direct Health Ministers to consult with Aboriginal peoples on the development of a comparable Aboriginal Health Reporting Framework. They further agree to consult with Aboriginal peoples in this effort, to use comparable indicators, and to develop the necessary data infrastructure. This reporting will inform Canadians on progress achieved and key outcomes. It will also inform Canadians on current programs and expenditures, providing a baseline against which new investments can be tracked, as well as on service levels and outcomes.
First Ministers agree that Canadians are entitled to better and more fully comparable information on the timeliness and quality of health care services. Enhanced accountability to Canadians and improved performance reporting are essential to reassuring Canadians that reforms are occurring. To this end, First Ministers agree that:
This will enable the development of nationally comparable information for Canadians on the themes of access, quality, system efficiency and effectiveness and on reform priorities and objectives set out in this Accord.
First Ministers recognize that Canadians want to be part of the implementation of this Accord. Accordingly, they agree to establish a Health Council to monitor and make annual public reports on the implementation of the Accord, particularly its accountability and transparency provisions. The Health Council will publicly report through federal/provincial/territorial Ministers of Health and will include representatives of both orders of government, experts and the public. To fulfill its mandate, the Council will draw upon consultations and relevant reports, including governments' reports, the work of the Federal/Provincial/Territorial Advisory Committee on Governance and Accountability and the Canadian Institute for Health Information (CIHI). Health Ministers will establish the Council within three months. Quebec's Council on Health and Welfare, with a new mandate, will collaborate with the Health Council.
First Ministers direct Health Ministers to develop further indicators to supplement the work undertaken in follow-up to the September 2000 Communique. This work is to be completed by September 2003, following review by experts and stakeholders, to ensure these new indicators measure progress on achieving the reforms set out in this Accord and meet the following objectives:
Ministers are to consider the following:
Nothing in this document shall be construed to derogate from the respective governments' jurisdictions. This Accord shall be interpreted in full respect of each government's jurisdiction.