Kirby takes Romanow to task over

(December 2, 2002) The head of a Senate committee on healthcare says he agrees with Roy Romanow’s conclusion that the system needs reform as soon as possible, but Senator Michael Kirby says there’s disagreement between the two on how that goal can best be achieved.

The Romanow commission’s report on the future of healthcare in Canada was released last week. It recommends immediate new spending in a number of areas, such as pharmacare and home care, and a commitment by Ottawa to create a stable funding base for future health needs.

“We’re all in the same camp,” said Kirby, whose own report was released in October. “The Senate committee and Mr. Romanow agree on the basic objectives to be pursued and the need to pursue them vigorously and without delay. Where we disagree is on the means to achieve those ends.”

Canada’s healthcare system is too complex to be micro-managed by government, Kirby said today in Toronto, arguing that Romanow’s “old-fashioned, top-down, command-and-control” approach won’t work.

Kirby has recommended a “service-based” funding approach, under which fixed prices would be established for medical procedures and hospitals would be funded based on how many of those procedures are actually performed. Kirby says the Romanow report is “silent” on hospitals as well as other issues, such as the shortage of doctors and nurses.

The role of the private sector in healthcare is another contentious issue. In his report, Romanow flatly ruled out expanding private sector involvement, arguing that concepts such as pay-as-you-go, user fees and fast-track treatment have already been tried and rejected.

Kirby says while he agrees that the public insurance system must be maintained, there is a role for the private sector in the delivery of services. “Funding and delivery of healthcare services are separate issues,” Kirby says. “We believe the funder should be neutral or indifferent with respect to who owns and operates the organizations responsible for service delivery.

“This means opening delivery systems to greater competition among providers,” he says. “Mr. Romanow wants to close the door on testing the variety of approaches to service delivery which involve the private sector.”

Kirby also suggests the Romanow report is short on specifics, claiming that the Senate committee’s proposals for rebuilding and developing the country’s healthcare infrastructure program are “vastly more extensive and concrete.”

Both the Senate committee and the Romanow reported recommended Ottawa commit to billions of dollars in new healthcare funding. Kirby’s report suggested the price tag would be around $5 billion annually, while Romanow tagged the cost at around $15 billion over four years.

Romanow said the new health spending could be funded entirely from surpluses, while Kirby’s report suggested the implementation of a new, dedicated health tax added to the GST, or an annual healthcare premium tied to income. Kirby defended his approach, suggesting that healthcare funding should not be reliant on a prediction of “permanent” federal surpluses.

Kirby will speak further on the Romanow report and its recommendations on Wednesday in Halifax.

Filed by Doug Watt, Advisor.ca, dwatt@advisor.ca