Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 125
across provincial health systems, including the establishment of voluntary
(intergovernmental) forms of performance benchmarking (Fenna, 2010; Fafard,
2012).
Following the Romanow Royal Commission’s recommendations of 2002,
F/P/T first ministers met to decide which commission recommendations
could be implemented. In the resulting First Ministers’ Accord on Health
Care Renewal, they focused on re-igniting primary care reform, improving
catastrophic drug coverage, facilitating greater substitution of home care
services for hospital-based services and accelerating the adoption of EHRs
(CICS, 2003).
In 2004, F/P/T first ministers negotiated A 10-Year Plan to Strengthen
Health Care, the most significant intergovernmental health accord reached
in the last decade. In addition to increasing the level of the Canada Health
Transfer, the 10-Year Plan also guaranteed that the federal government would
increase federal health transfers to the provinces and territories by 6% per year
for the following decade. In return for this generous funding, the provincial
and territorial governments agreed on the proposed plan’s key policy priorities,
including waiting times, home care and pharmaceutical policy. While some
governments have made progress in one or more of these areas, as reviewed
below, the collaborative or pan-Canadian aspect of these efforts especially those
aimed at transformative changes, were not realised (Senate of Canada, 2012).
The 10-Year Plan was facilitated by a federal Wait Time Reduction Fund
(C$5.5 billion over 10 years) to assist provinces in meeting their waiting
time targets in five priority areas – cancer, cardiac, sight restoration, joint
replacement and diagnostic imaging. Provincial and territorial governments
worked with the CIHI to establish benchmarks for every priority area except
diagnostic imaging. 1 All provinces provide CIHI with comparable waiting times
data, and all provinces, 2 with the exceptions of Manitoba and Newfoundland
and Labrador, have set targets based on individually established benchmarks
(Fafard, 2012). In addition, all provinces inform their residents about waiting
times in these priority areas. Overall, they have made progress in managing
and reducing surgical and diagnostic waiting times since 2004. While there
remains considerable variation across provinces, most Canadians receive these
priority procedures within the benchmarks set by the provinces (CIHI, 2012b).
1 According to the majority of participants, there was insufficient evidence on the appropriate waiting times
for diagnostic imaging.
2 Since patients living in the territories are usually referred to hospitals in the provinces for elective surgeries,
the three territories are excluded in the remainder of the discussion on waiting times.