17 York St. Perspective

1. 17 York St. Perspective Prepared by: Jennifer Kitts, BA, LLB, LLM Senior Policy Analyst Research & Policy

2. CHA’s Advocacy Cycle Begins in July - Continues until recess of Parliament (the following June): July/August – Prepare CHA’s pre-budget Brief to Finance Committee August – Submission of pre-budget Brief September/October – Respond to Speech from Throne (if required) September-November – Present Pre-Budget Brief to Finance Committee February/March – Respond to Federal Budget Throughout the year: Presentations to House of Commons and Senate Committees Monitoring the work of the House of Commons and Senate Meetings with politicians, government officials, etc.

3. Today’s Perspective from 17 York St. Federal Politics Polling on Health Care Provincial /Territorial Health Spending Update on CHA-Specific Issues CHA Working in Partnership Updates on Selected Reports International Issues What’s Next? What are we Watching?

4. 1. Federal Politics

5. 1.1 Introduction7th Anniversary of the Conservative Government -Prime Minister Harper, in speech to caucus: “….the economy is still job one…”

6. 1.2 Recent Polling Results Latest Nanos Poll, January 31, 2013 Conservatives 34.3% Liberal 27.6% NDP 27.1% (down from 33% in May 2012) Greens 4.7% Bloc Quebecois 4.6% Angus Reid Poll (between January 4 and 19th, 2013) Conservatives 35% NDP 29% Liberals 22%

7. Top National Issue of Concern: Source: Latest Nanos Poll, January 31, 2013 Jobs/Economy 22.4% Healthcare 14.8% The environment 7.9% Debt/Deficit 4.6% Politicians/government 4.1% Unsure 16.3%

8. 1.3 Liberal Leadership Race

9. Liberal Leadership Race Justin Trudeau is favoured to win in April 17 Liberal MPS have backed Trudeau 3 MPs supporting Marc Garneau (others neutral/undecided) Could Trudeau improve the Liberal’s fortunes?

10. 1.4 Aboriginal Issues Front and Centre: “Idle No More”

11. Aboriginal people have the poorest health and shortest life expectancy of all CanadiansMany Aboriginal people not seeking care in mainstream health care settings (due to racism, lack of trust, stereotypes, etc.) Health Council of Canada Report, Dec. 2012

12. 1.5 End of Parliamentary Budget Officer’s term: Uncertainly about successor

13. 1.6 Upcoming Budget expected at the end of March Modest budget expected with little new spending Government aims to balance books before 2015

14. 2. Polling on Health Care

15. Canadians More Confident about Health Care Environics, December 2012 49% think system basically in good shape Confidence Highest in Ontario (58%) and Saskatchewan (53%), as well as among women, rural residents and those in lowest income bracket Confidence lowest in Quebec (31%)

16. Problem of “Inefficient Management” 62% think the main cause of the problem is “inefficient management of the system” (instead of “insufficient funding”- 26%) This proportion is steadily growing In 2002, 41% cited inefficient management and 44% cited insufficient funding

17. “Alberta’s Fred Horne and Ontario’s Deb Matthews, rather than blathering on about Canada’s having the best health-care system in the world, now tell audiences that this country has an underperforming, expensive one by international standards.” – Jeffrey Simpson, Globe and Mail andAuthor of Chronic Conditions.

18. 3. Provincial/Territorial Health Spending

19. Many jurisdictions have budget deficits Modest increases in health care spending are expected in 2013/2014. • Alberta: • Premier Redford hints that health care may be cut in next budget (March 7th) • Slump in oil revenue in Alberta • Alberta doctors make 20-29% more than national average

20. Dealing with budget deficits • Manitoba • Government has identified almost $46 million in savings at Manitoba Health • Ontario • Kathleen Wynne, new leader of Ontario’s Liberal Party and new Premier, takes on a $12 billion deficit • Ottawa Hospital – cuts 290 positions • New Brunswick • Looking for efficiencies in the health sector

21. But in Quebec, increases in health care spending in 2013-2014 • Increase of 4.8% in 2013-2014. • Forthcoming change in leadership of Quebec Liberal Party • Leadership Convention, March 16-17, Montreal

22. 4. Updates on Selected CHA-Specific Issues

23. 4.1 Changes to Refugee Health Benefits CHA Position Paper widely circulated in the health care and health policy communities and amongst those working on the issue.

24. Changes to Refugee Health Benefits Op-Ed in the Hill Times, December 2012: “Feds should review decision to cut refugee claimants access to health care, says health coalition” Signed by CCPH21 Co-Chairs, Pamela Fralick and Debra Lynkowski Lots of misinformation out there re: changes to refugee health benefits Some provinces have stepped in to pick up the tab for services no longer covered (e.g., Manitoba, Quebec)

25. 4.2 Drug Shortages Continue to be a Problem

26. Survey of Pharmacists and Doctors, October 2012 (released January 2013)

27. 4.3 Council of the Federation 1.Work together to bulk purchase six generic drugs 2.Quebec pulls out of health care working group

28. 4.4 Canada Adopts Voluntary Workplace Mental Health Standard 1 in 5 Canadians experience a mental health problem each year. Cost of mental illness represents 2.8% of GNP Workplaces can do a number of things, including: Review and commit to standard Identify workplace champion Identify gaps in the organization Develop policy statement for psychological safety in workplace Adopt mental health promotion practices

29. A Psychologically Healthy Workplace For example: • Civility and respect in the workplace; • Employees feel supported and valued; • Praise, recognition, acknowledgement; fairness; • Recognition of need for balance (personal life, family, work); • Responsibilities can be accomplished within time available; • Workers have some control over how they organize their work; their opinions and suggestions are considered; • Availability of psychological services and supports to employees with mental health issues.

30. 4.5 Greater Attention to Social Determinants of Health

31. “Wouldn’t it be more responsible from an economic standpoint, not to mention more compassionate, to tackle the reasons for the high demand for health care in the first place?”-Dr. Anna Reid, CMA President

32. 5. CHA Working in Partnership

33. 5.1 The Health Action Lobby (HEAL) Mr. Glenn Brimacombe (ACAHO) and Dr. Karen Cohen (CPA), Co-Chairs of HEAL Forthcoming HEAL Report: “Changes to the Canada Health Transfer Arrangements: Issues and Options” CHA’s Involvement in HEAL Working Group (Role of Federal Government in Health and Health Care) HEAL Contributes to Council of the Federation’s Health Care Innovation Working Group

34. 5.2 Canadian Coalition for Public Health in the 21st Century (CCPH21) Finalized government relations strategy CHA – member of the Advocacy Committee and Communications Committee Monitoring House of Commons Standing Committee on Health Advertorial in The Hill Times – February 4, 2013 Working with the Council of the Federation

35. 5.3 Taming of the Queue Wait times remain an issue. Canada’s performance is poor compared to other countries. Last year of the 2004 Health Accord. No more money for wait time reduction after this year. CHA – Steering Committee of Taming of the Queue. Meeting at the end of March 2013.

36. 5.4 Canadian Alliance on Mental Illness and Mental Health (CAMIMH) Works to ensure that mental health is placed on the national agenda Supports first ever Mental Health Strategy for Canada Meeting February 14-15, 2013 CHA sits on the Policy Committee

37. 6. Updates on Selected Reports

38. 6.1 Report on the Compensation of Physicians (CIHI) • Average gross clinical payment - $307,000 per physician • BC 273,000 • Alberta: 350,000 • Saskatchewan 324,000 • Manitoba 304,000 • Ontario 340,000 • Quebec 254,000 • New Brunswick 264,000 • Nova Scotia 250,000 • PEI 236,000 • Newfoundland 260,000

39. 6.2 Survey of Primary Care Physicians (2012 Commonwealth Fund) Canadians have a harder time getting quick access to their doctors, especially outside working hours (compared to other countries) Canadian doctors least likely to make home visits On the positive side, improvements in the use of electronic medical records

40. 7. International Issues

41. 7.1 Comprehensive Economic and Trade Agreement (CETA) between Canada and Europe

42. CETA • EU wants stronger intellectual property protection • May keep generic drugs off the market for a longer period of time • Concerns that additional costs may burden provincial health care systems • US – EU negotiations

43. 7.2 Health Spending in Europe Falls for the first time in Decades (OECD and European Commission Report): European governments curb health spending to help cut budgetary deficits

44. 8. What’s Next? What are we Watching? Upcoming Budget CETA Negotiations Council of the Federation – next meeting at Niagara-on-the-Lake, Ontario, in July Federal and Provincial Politics

45. Thank you!

46. Presenter: Jennifer Kitts Tel: (613) 241-8005, ext. 210 E-mail: jkitts@cha.ca www.cha.ca 17 York Street Ottawa, Ontario K1N 9J6 Tel: (613) 241-8005 Fax: (613) 241-5055