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The 2003 Accord on Health Care Renewal: A Progress Report

September 2004

The 2003 Accord on Health Care Renewal was the result of a meeting of First Ministers in February 2003. The Accord is an action plan to improve timely access to quality care for all Canadians. It provided a blueprint to renew and sustain publicly funded health care into the future. Reflecting concerns expressed by Canadians and the recommendations of national and provincial studies of the health care system, the Accord set out commitments by First Ministers to reform the system and make it more accountable to citizens.

To support the Accord, the Government of Canada has committed $36.8 billion in additional funding for health care over the five-year period from 2003-04 to 2007-08. Most of this funding is being provided to the provinces and territories through increased transfer payments, including:

• $16 billion over five years through the Health Reform Transfer, targeted to primary health care, home care and catastrophic drug coverage;
• $14 billion (including $2 billion in additional funding in the 2004 Budget) through the Canada Health Transfer.
• $1.5 billion for diagnostic and medical equipment to improve access to publicly funded diagnostic services;

The remaining $5.3 billion has been allocated to meet other Accord commitments, including increased funding for federal health programs for First Nations and Inuit, the creation of a compassionate care benefit under Employment Insurance, establishment of an Electronic Health Record, creation of the Health Council and the Canadian Patient Safety Institute, health technology assessment and health research.

Progress on Accord reforms

Since the Accord, federal, provincial and territorial governments have been working on concrete measures to make the plan a reality.

Completed Commitments

• Diagnostic/Medical Equipment Fund: The Government of Canada has implemented the Diagnostic/Medical Equipment Fund. A trust agreement announced in March 2003 will provide $1.5 billion over three years. Funding is flowing to provide support for the acquisition and installation of equipment and specialized staff training to improve access to publicly funded diagnostic services and reduce waiting times.
• Patient Safety: Governments established the Canadian Patient Safety Institute in December 2003 as part of the Accord commitment to implement a national strategy for improving patient safety and the quality of care.
• Health Council: Governments have established the Health Council, which will monitor and make public reports on the implementation of the Accord. It is expected to issue its first report in January 2005.
• Comparable Indicators: Governments will report to the public on health system performance in November 2004.
• Compassionate Care Benefit: The Government of Canada has met its commitment in the Accord to establish a program to better enable workers to temporarily leave their jobs to provide compassionate care for a loved one. The Compassionate Care Benefit was implemented in January 2004 under Employment Insurance and provides up to six weeks leave for eligible Canadians.
• Health Technology: Agreement was reached with Canada Health Infoway in March 2003 on accelerating development of electronic health records and common information technology standards across the country (supported by $600 million in federal funding). This will improve patient safety.
• Official Language Minority Communities: The Government of Canada has begun disbursing five-year funding of $89 million to improve access to health services in both French and English in official language minority communities.
• Canada Health Transfer: The transfer, which replaces the Canada Health and Social Transfer, was established by the Government of Canada in April 1, 2004. It will increase transparency and accountability for health spending.

Commitments in Progress

• Primary Health Care: The Accord set a goal of providing all Canadians with access to an appropriate health care provider 24 hours a day, seven days a week within eight years through initiatives such as providing primary health care to citizens through multi-disciplinary teams.
  • Provincial and territorial governments are working toward these objectives.
• Pharmaceuticals Management: First Ministers committed to collaborate to better manage the costs of all drugs and promote optimal drug use and best practices in drug prescription.
  • A Common Drug Review has been established to provide regular reviews of the therapeutic effectiveness and cost-effectiveness of new prescription drugs to assist jurisdictions in their listing decisions.
• Health Human Resources: First Ministers committed to develop strategies to improve recruitment and retention of health professionals, lay the groundwork for better health workforce planning, promote interdisciplinary education to advance collaborative care, and ensure the supply of needed health care providers.
  • Governments have launched initiatives (with federal funding) to integrate more internationally educated health care graduates into Canada"s health care system. Governments are developing a framework for Canada-wide health workforce planning, taking steps to improve the information-base for such planning and beginning work on recruitment and retention.
• Innovation and Research: The Government of Canada has begun disbursing $1.45 billion for innovation and research, which are essential to developing new health technologies and more effective treatments. The Canadian Institutes of Health Research, which is among the recipients of this funding, is the country"s premier health research funding agency and is addressing emerging health challenges, supporting innovations that contribute to a more productive health system and strengthening Canada"s research community.
• Public Health:
  • On May 17, 2004, the Government of Canada announced details of the new Public Agency of Canada and the new position of Chief Public Health Officer. While not specific Accord commitments, these initiatives will advance the Accord objective of improving public health by taking a co-ordinated approach to dealing with chronic illnesses and infectious disease outbreaks. This will strengthen the health of Canadians and the viability of our health system.
  • On specific Accord commitments, representatives of federal, provincial and territorial governments have developed the framework for a Canadian Healthy Living Strategy and a National Immunization Strategy. Governments have taken measures to facilitate collaboration on public health issues and coordinate efforts in the event of emergencies.
• Technology Assessment: Governments are developing a comprehensive health technology assessment strategy for providing advice on how to maximize the effective use of new health technology.
• Aboriginal Health: The Government of Canada committed to work collaboratively with other governments and Aboriginal peoples to meet the objectives of the Accord. Governments committed to work together to address the gap in health status between Aboriginal and non-Aboriginal Canadians through better integration of health services. Health Ministers were also directed to consult with Aboriginal peoples on the development of a comparable Aboriginal Health Reporting Framework.
  • The Government of Canada has made strategic investments, such as providing new funding for Non-Insured Health Benefits, nursing services and immunization. The Government has also stepped up work on early childhood development and water quality, and discussed integration of health services with provincial and territorial governments and Aboriginal groups. A working group made up of federal, provincial, territorial and Aboriginal representatives is preparing for initial consultations with Aboriginal peoples on the Aboriginal Health Reporting Framework.
• Reporting and accountability: There has been some progress. Some comparable indicators have been developed but more are needed, particularly in areas of wait times and access to health professionals.

Outstanding Commitments

• Home Care: First Ministers committed to provide first-dollar coverage for a basket of services for short-term acute home care, including acute community mental health and end-of-life care.
• Drug Coverage: First Ministers committed to ensure that Canadians have reasonable access to catastrophic drug coverage by the end of 2005/06. Such coverage would help protect Canadians from suffering undue financial hardship for needed drug therapy.