The proposal by Canada's federal health minister, Allan Rock, to save the country's healthcare system by paying half the cost of a national home care programme has been greeted contemptuously by provincial premiers. They say that he should restore billions of dollars of funding he has cut in past years before introducing such “boutique” programmes.
In a letter to the prime minister, Jean Chrétien, Ontario's premier, Mike Harris, said that Mr Rock's attempt to position himself as the saviour of Medicare (Canada's health insurance system) was “blatant hypocrisy.” “After all, the federal government is responsible for the largest funding cut in Canadian history,” they added.
Meeting later in Quebec city, the premiers agreed that the system needed fundamental reform but that without more money it would collapse. They want restoration of the Canada Health and Social Transfer Payments to 1994-5 levels, when Ottawa assumed 17%of total healthcare costs. This would add $C6.3bn (£2.7bn; $4.38bn) to the present spending level, they said. Prime Minister Chrétien said that the transfers have already been restored to the 1993-4 level.
The prime minister and the premiers agree that the healthcare system is in crisis, a fact which the public and health workers are acutely aware of as a result of emergency room overcrowding, shortages of nurses and doctors, and complaints by doctors of overwork. According to the latest poll, eight in 10 Canadians believe the system is in crisis, and only one in four rates it highly.
Alberta's premier, Ralph Klein, increased the controversy about solutions by proposing to use private hospitals for major surgery (BMJ1999;319:1520), thus taking the load off the public system. This was criticised by federal officials, who feared the plan would lead to a two tiersystem.
Full story in News Extra at www.bmj.com