Federal politics

Federal budget

The CMA gave "qualified support" to the February 1999 federal budget, applauding Finance Minister Paul Martin for beginning to address the needs of the health care system. However, the association remained worried that the system's long-term sustainability remains in question.

"With the crisis situation now seen in so many emergency rooms and other facilities across the country, [this] announcement comes not a moment too soon," said CMA President Hugh Scully. The next step is to press forward to ensure the system's future sustainability. That work will include pressing Ottawa to index fully the total cash entitlement allocated to health care, based on a combination of factors that would account for the changing needs of Canadians and earmark federal funds specifically for health care.

"As we move into the next century, we need to focus on the expanding continuum of care, where acute care, home care and community care are more complementary to one another," said Scully. [CMA News 1999;9(3):1]

Health highlights in the federal budget

The February 1999 federal budget included a number of health initiatives:

• $8 billion will be transferred to the provinces for health care over five years
• Provinces can draw down on their share of a special, one-time $3.5 billion health care payment over three years
• $1.4 billion will be available over four years for new health programs dealing with health information systems, aboriginal health services, preventive care and rural health care, and for medical research
• Transfer payments to provinces will rise from $12.5-billion to $14.5 billion in 1999 and 2000, and then will rise to $15 billion where they will remain for the subsequent three years, effectively restoring federal cash contributions to health care to levels existing before cuts were introduced in 1995/96. [CMA News 1999;9(3):1]

Health ministers must heed physician shortage

The CMA took Canada's health ministers to task for failing to come up with an action plan to address the country's physician shortage. "It is of great concern to the CMA, and to all communities suffering from a shortage of physicians, that Canada's health ministers chose not to act on this problem immediately but have called for more study," Dr. Hugh Scully, the CMA president, wrote in a letter to the Ottawa Citizen.

Scully was responding to the mid-September meeting of Health Minister Allan Rock with his provincial and territorial counterparts in Charlottetown, which wrapped up without coming up with a plan to address the issue. Instead, Rock said that the ministers were waiting for the release of a report on the health human resource issues expected early next year. [CMA News 1999; 9(11):3]

Population health

Canada's ailing health care system not only needs more physicians but also a healthier population, Federal Health Minister Allan Rock told delegates attending CMA's 132nd annual meeting in August 1999. He pledged to make health promotion and disease prevention a priority from "this day forward. Sustaining our health care in the long term depends on our ability to improve the health of Canadians."

The minister promised that the money for prevention and promotion will come from other sources, not the acute health care budget. [CMA News 1999;9(10):1]; [CMAJ 1999;161(7):789]

The CMA reasserted physicians' role in health promotion but the debate about what role population health could - and should - play in the evolving health care system was a major feature of the recent CMA annual meeting. Participants were basically open to population health concepts but leery of expecting too much from them. "Many of us here agree that many of the population health ideas are self-evident, common-sense activities toward improving health care." said Dr. Victor Dirnfeld, immediate past president of the CMA. "The problem is that the population-health movement has also led to the medicalization of social ills to the point of taking money from acute care to solve them." [CMA News 1999;9(10):3]