Psychological services and the Future of Health Care in Canada

Canadian Psychology, Nov 2003 by Romanow, Roy J, Marchildon, Gregory P

Abstract

The implications of the Commission on the Future of Health Care in Canada's (GFHCC) recommendations extend beyond the necessarily limited scope of its report. This article explores the potential role of psychologists in a restructured public health care system that goes beyond hospital and physician care to home care and a revamped primary care system. Public plans would also benefit from the use of psychological alternatives to prescription drug therapies. Such evidence-based extensions to the existing Canadian model would improve both health and medical outcomes. They could also introduce new cost-savings to provincial health plans that are presently under immense financial strain.

The Commission on the Future of Health Care in Canada (CFHCC) was created to address some very specific problems facing Canada's public health care system. These included escalating costs, timely access to certain services and procedures, and shortages of some types of providers. Questions had also been raised concerning the quality of health care as well as the range of services that should be offered by the public sector and the role of the private sector in the delivery of those services. Beyond these specific challenges was the question of whether the governance of the health system was failing. There was also a growing dysfunction within the federal system as each order of government attempted to blame the other for the shortcomings of the public system and its perceived lack of adequate funding. These issues had already precipitated a number of arms-length government studies. In April 2001, when the CFHCC was established, the governments of Quebec (2000) and Saskatchewan (2001) had already been provided with their own Commission reports. Moreover, the Alberta government (2001) was about to receive its report. Given the provincial context of these studies, however, the reports barely touched upon the national dimensions of health care.

As for the federal government, it had already decided to reduce its social (including health) transfers to the provinces before receiving the recommendations of an earlier commissioned study. As a consequence, the recommendations of the National Forum on Health (1997) were initially sidelined as the federal and provincial governments began to debate their respective roles and responsibilities in the funding, administration, and delivery of public health care. By 1999, the Senate Standing Committee on Social Affairs, Science and Technology had begun to study the federal role in health care, but it was not perceived as acting on behalf of the federal government, nor was its mandate considered, at least initially, to be directly relevant to the provinces.

Unlike previous Royal Commissions that had three to five years to complete their work, the CFHCC was given a mere 18 months. The debate concerning the sustainability of public health care was then reaching a crescendo. Federal-provincial conflict in particular had escalated to the point of destabilizing the health care system itself. The sources of this conflict were varied, but the main fault lines were constitutional, institutional, financial, and ideological in nature. The debate that this conflict triggered was confusing, and it was unclear as to whether the fundamental values of the system were in question. Moreover, it was unclear whether governments agreed or disagreed as to the general framework within which change and reform could take place over the coming years. As a consequence, it was believed that any report released beyond the 18-month time period might be too late to provide answers directed to these basic questions and provide the recommendations that would help shape the policy outcome in the country.

In addition, the CFHCC was required by its original order-in-council to deliver an interim report, which was released in February 2002 (Canada, 2002a). This left nine months to conduct one of the most extensive and intensive public consultation processes ever engaged by a Royal Commission in Canada and to write a final report with a broad range of recommendations on the future of health care. This report was delivered in November 2002, amidst saturation-level media attention and at the peak of federal-provincial conflict over the future of public health care (Canada, 2002b). Although the recommendations went beyond at least some of the immediate issues that were of concern when the CFHCC was created, the extremely short time frame meant that the recommendations could not cover the entire waterfront of longer-term issues, including the role of psychology in the health of Canadians (Allon & Service, 1999). Instead, the report delivered a limited package of fiscally and politically feasible recommendations, many of which would be capable of implementation within a short period of time. Particular emphasis was placed on lancing the federal-provincial boils because of the difficulty of achieving positive health care change on the ground without addressing the malfunctions at the highest governance level. Moreover, contrary to most recent health care reports in Canada, much time was spent on how to achieve change, most significantly on how to create new intergovernmental structures and processes, such as the establishment of a Health Council of Canada, to replace existing intergovernmental processes and institutions (see CFHCC implementation plan, Canada 2002b, 255-256).