17 York St. PerspectivePrepared by:

Jennifer Kitts, BA, LLB, LLMSenior Policy Analyst Research & Policy

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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.

CHA’s Advocacy Cycle

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1. Federal Politics2. Polling on Health Care3. Provincial /Territorial Health Spending4. Update on CHA-Specific Issues5. CHA Working in Partnership6. Updates on Selected Reports7. International Issues8. What’s Next? What are we Watching?

Today’s Perspective from 17 York St.

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1. Federal Politics

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1.1 Introduction7th Anniversary of the Conservative Government -Prime Minister Harper, in speech to caucus:

“….the economy is still job one…”

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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%

1.2 Recent Polling Results

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Jobs/Economy 22.4% Healthcare 14.8% The environment 7.9% Debt/Deficit 4.6% Politicians/government 4.1% Unsure 16.3%

Source: Latest Nanos Poll,January 31, 2013

Top National Issue of Concern:

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1.3 Liberal Leadership Race

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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?

Liberal Leadership Race

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

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Health Council of Canada Report, Dec. 2012

Aboriginal people have the poorest health and shortest life expectancy of all Canadians

Many Aboriginal people not seeking care in mainstream health care settings (due to racism, lack of trust, stereotypes, etc.)

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

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

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2. Polling on Health Care

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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%)

Environics, December 2012

Canadians More Confident about Health Care

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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

Problem of “Inefficient Management”

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“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.

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3. Provincial/Territorial Health Spending

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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

Many jurisdictions have budget deficits

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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

Dealing with budget deficits

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Increase of 4.8% in 2013-2014.

Forthcoming change in leadership of Quebec Liberal Party

Leadership Convention, March 16-17, Montreal

But in Quebec, increases in health care spending in 2013-2014

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4. Updates on Selected CHA-Specific Issues

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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.

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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)

Changes to Refugee Health Benefits

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4.2 Drug Shortages Continue to be a Problem

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

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

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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

4.4 Canada Adopts Voluntary Workplace Mental Health Standard

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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.

A Psychologically Healthy Workplace

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4.5 Greater Attention to Social Determinants of Health

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“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

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5. CHA Working in Partnership

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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

5.1 The Health Action Lobby (HEAL)

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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

5.2 Canadian Coalition for Public Health in the 21st Century (CCPH21)

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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.

5.3 Taming of the Queue

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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

5.4 Canadian Alliance on Mental Illness and Mental Health (CAMIMH)

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6. Updates on Selected Reports

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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

6.1 Report on the Compensation of Physicians (CIHI)

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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

6.2 Survey of Primary Care Physicians (2012 Commonwealth Fund)

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7. International Issues

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

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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

CETA

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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

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Upcoming Budget

CETA Negotiations

Council of the Federation – next meeting at Niagara-on-the-Lake, Ontario, in July

Federal and Provincial Politics

8. What’s Next? What are we Watching?

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Thank you!

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Presenter:

Jennifer KittsTel: (613) 241-8005, ext. 210

E-mail: jkitts@cha.ca

www.cha.ca17 York Street

Ottawa, Ontario K1N 9J6Tel: (613) 241-8005

Fax: (613) 241-5055