The Health of Canadians The Federal Role

Transcription

1 The Senate Standing Senate Committee on Social Affairs, Science and Technology The Health of Canadians The Federal Role Final Report on the state of the health care system in Canada Chair: The Honourable Michael J. L. Kirby Deputy Chair: The Honourable Marjory LeBreton October 2002 Volume Six: Recommendations for Reform

2 Ce document est disponible en français. Available on the Parliamentary Internet: (Committee Business Senate Recent Reports) 37 th Parliament 2 nd Session

3 The Standing Senate Committee on Social Affairs, Science and Technology Final Report on the state of the health care system in Canada The Health of Canadians - The Federal Role Volume Six: Recommendations for Reform Chair The Honourable Michael J. L. Kirby Deputy Chair The Honourable Marjory LeBreton OCTOBER 2002

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5 TABLE OF CONTENTS TABLE OF CONTENTS... i ORDER OF REFERENCE...vii SENATORS... viii LIST OF ABBREVIATIONS... ix ACKNOWLEDGEMENTS... xi FOREWORD...xiii INTRODUCTION...1 PART I: ACCOUNTABILITY...3 CHAPTER ONE... 5 THE NEED FOR AN ANNUAL REPORT ON THE STATE OF THE HEALTH CARE SYSTEM AND THE HEALTH STATUS OF CANADIANS Summary of Some Key Points from Volumes One through Five The role of the federal government Objectives of federal health care policy The current system is not fiscally sustainable A national health care guarantee is critical to successful reform Improving Governance The Need for a National Health Care Commissioner Canadian Medical Association (CMA) Colleen Flood and Sujit Choudry Tom Kent Duane Adams Lawrence Nestman The Committee s Proposal...17 PART II: EFFICIENCY MEASURES...23 CHAPTER TWO HOSPITAL RESTRUCTURING AND FUNDING IN CANADA Funding Methods for Hospitals in Canada: Advantages and Disadvantages Line-by-line Ministerial discretion Population-based Global budget Policy-based Facility-based...32 i

6 2.1.7 Project-based Service-based Service-Based Funding: Review of International Experience United States United Kingdom France Denmark Norway Review of international experience by the Comité Bédard The Rationale for Service-Based Funding in Canada Appropriateness of service mix Over-servicing and up-coding Rates, information and data Innovation Comprehensive health care Escalation of costs Lack of simplicity Committee commentary Academic Health Sciences Centres and the Complexity of Teaching Hospitals Small and Rural Community Hospitals Financing the Capital Needs of Canadian Hospitals Public Versus Private Health Care Institutions...53 Appendix 2.1 Academic Health Sciences Centres in Canada and their Affiliated Hospitals and Regional Health Authorities...59 CHAPTER THREE DEVOLVING FURTHER RESPONSIBILITY TO REGIONAL HEALTH AUTHORITIES RHAs Across Canada: A Portrait RHAs: Goals and Achievements Barriers that Prevent RHAs from Functioning to Their Fullest Potential RHAs and the Potential for Internal Markets Committee Commentary...74 CHAPTER FOUR PRIMARY HEALTH CARE REFORM Why is Primary Health Care Reform Needed? The Provinces and Primary Care Reform Recent reports The Ontario Family Health Network Quebec New Brunswick Overcoming the Barriers to Change The Federal Role...90 Appendix 4.1: GP Fundholding in Great Britain...93 ii

7 PART III: THE HEALTH CARE GUARANTEE...97 CHAPTER FIVE TIMELY ACCESS TO HEALTH CARE The Right to Health Care Public Perception or Legal Right? The Extent to which Publicly Insured Health Services are Available Outside the Publicly Funded Health Care System Timely Health Care and Section 7 of the Canadian Charter of Rights and Freedoms Committee Commentary CHAPTER SIX THE HEALTH CARE GUARANTEE The Public Perception of the Problem of Waiting Lists The Reality of the Waiting List Problem Canadian Experience Cardiac Care Network of Ontario The Western Canada Waiting List Project International Experience Sweden Denmark Committee Recommendations The Potential Consequences of Not Implementing a Health Care Guarantee Concluding Thoughts on the Health Care Guarantee PART IV: CLOSING THE GAPS IN THE SAFETY NET CHAPTER SEVEN EXPANDING COVERAGE TO INCLUDE PROTECTION AGAINST CATASTROPHIC PRESCRIPTION DRUG COSTS Trends in Drug Spending International Comparisons Coverage for Prescription Drugs in Canada Public prescription drug insurance plans Private prescription drug insurance plans Plan features and their relation to protection from severe drug expenses An Emerging Issue: Catastrophic Prescription Drug Expenses Protecting Canadians Against Catastrophic Prescription Drug Expenses How the plan would work The benefits of the plan How much would the plan cost? Committee s Proposal for a Catastrophic Prescription Drug Insurance Plan The Need for a National Drug Formulary CHAPTER EIGHT EXPANDING COVERAGE TO INCLUDE POST-ACUTE HOME CARE Brief Review of Key Points about Home Care from Volumes Two and Four Other Options iii

8 8.3 The Extra-Mural Program in New Brunswick Building on the New Brunswick example: direct referrals to home care Organizing and Delivering Post-Acute Home Care Definition of post-acute home care When does Post-Acute Home Care (PAHC) servicing start? When does PAHC servicing end? Organizational arrangements for PAHC Who provides PAHC? The Cost of a National Post-Acute Home Care Program How to calculate the cost of a national PAHC program What about hidden costs? How much will a national PAHC program cost? Paying for Post-Hospital Home Care CHAPTER NINE EXPANDING COVERAGE TO INCLUDE PALLIATIVE HOME CARE The Need for a National Palliative Home Care Program Financial Assistance to Caregivers Providing Palliative Care at Home Caregiver Tax Credit Job Protection Concluding Remarks PART V: EXPANDING CAPACITY AND BUILDING INFRASTRUCTURE CHAPTER TEN THE FEDERAL ROLE IN HEALTH CARE INFRASTRUCTURE Health Care Technology Electronic Health Records Evaluation of Quality, Performance and Outcomes Protection of Personal Health Information CHAPTER ELEVEN HEALTH CARE HUMAN RESOURCES The Extent of Health Human Resource Shortages Health Human Resources: The Need for a National Strategy Increasing the Number of Physicians Trained in Canada Integrating International Medical Graduates Alleviating the Shortage of Nurses Allied Health Professionals Funding Post-Graduate Training Health Human Resources: Scope of Practice Rules Review Committee Commentary CHAPTER TWELVE NURTURING EXCELLENCE IN CANADIAN HEALTH RESEARCH Assuming Leadership in Canadian Health Research Engaging the Scientific Revolution Securing a Predictable Environment for Health Research Federal funding for health research iv

9 Federal in-house health research Enhancing Quality in Health Services and in Health Care Delivery Improving the Health Status of Vulnerable Populations Commercializing the Outcomes of Health Research Applying the Highest Standards of Ethics to Health Research Research involving human subjects Issues with respect to research involving human subjects Animals in research Privacy of personal health information Genetic privacy Potential situations of conflict of interest PART VI: HEALTH PROMOTION AND DISEASE PREVENTION CHAPTER THIRTEEN HEALTHY PUBLIC POLICY: HEALTH BEYOND HEALTH CARE Trends in Diseases Infectious diseases Chronic diseases Injury Mental health The Economic Burden of Illness The Need for a National Chronic Disease Prevention Strategy Strengthening Public Health and Health Promotion Toward Healthy Public Policy: The Need for Population Health Strategies PART VII: FINANCING REFORM CHAPTER FOURTEEN HOW THE NEW FEDERAL FUNDING FOR HEALTH CARE SHOULD BE MANAGED More Money Is Needed for Health Care The Financing Role of the Federal Government How New Federal Funding for Health Care Should Be Managed CHAPTER FIFTEEN HOW ADDITIONAL FEDERAL FUNDS FOR HEALTH CARE SHOULD BE RAISED The Amount of Increased Federal Funding Required Potential Sources of Increased Federal Funding General Taxation Earmarked Taxation Payroll Taxes National Health Care Premiums User Charges Medical Savings Accounts Pre-Funding for Health Care Committee Commentary Current Federal Funding for Health Care v

10 CHAPTER SIXTEEN THE CONSEQUENCES OF NOT MAKING THE HEALTH CARE SYSTEM FISCALLY SUSTAINABLE Private Health Care Insurance in Canada and Selected OECD Countries Review of Recent Literature on the Impact of Private Health Care Insurance and Private For- Profit Delivery Committee Commentary PART VIII: THE CANADA HEALTH ACT CHAPTER SEVENTEEN THE CANADA HEALTH ACT Universality Comprehensiveness Accessibility Portability Public Administration Committee Commentary CONCLUSION APPENDIX A...A-1 LIST OF RECOMMENDATIONS BY CHAPTER... A-1 APPENDIX B...A-19 LIST OF PRINCIPLES FROM VOLUME FIVE (APRIL 2002)... A-19 APPENDIX C... A-23 LIST OF WITNESSES... A-23 vi

11 ORDER OF REFERENCE Extract from the Journals of the Senate of Tuesday, October 8, 2002: Resuming debate on the motion of the Honourable Senator Kirby seconded by the Honourable Senator Pépin: That the Standing Senate Committee on Social Affairs, Science and Technology be authorized to examine and report upon the state of the health care system in Canada. In particular, the Committee shall be authorized to examine: a) The fundamental principles on which Canada s publicly funded health care system is based; b) The historical development of Canada s health care system; c) Health care systems in foreign jurisdictions; d) The pressures on and constraints of Canada s health care system; and e) The role of the federal government in Canada s health care system; That the papers and evidence received and taken on the subject and the work accomplished during the Second Session of the Thirty-sixth Parliament and the First Session of the Thirty-seventh Parliament be referred to the Committee; That the Committee submit its final report no later than October 31, 2002; That the committee retain the powers necessary to publicize its findings for distribution of the study contained in its final report for 60 days after the tabling of that report; and That the Committee be permitted, notwithstanding usual practices, to deposit any report with the Clerk of the Senate, if the Senate is not then sitting; and that the report be deemed to have been tabled in the Chamber. The question being put on the motion, it was adopted. ATTEST : Paul C. Bélisle Clerk of the Senate vii

12 SENATORS The following Senators have participated in the study on the state of the health care system undertaken by the Standing Senate Committee on Social Affairs, Science and Technology: The Honourable Michael J. L. Kirby, Chair of the Committee The Honourable Marjory LeBreton, Deputy Chair of the Committee and The Honourable Senators: Catherine S. Callbeck Joan Cook Jane Cordy Joyce Fairbairn, P.C. Wilbert Keon Yves Morin Lucie Pépin Brenda Robertson Douglas Roche Ex-officio members of the Committee: The Honourable Senators: Sharon Carstairs, P.C. (or Fernand Robichaud, P.C.) and John Lynch- Staunton (or Noel A. Kinsella) Other Senators who have participated from time to time on this study: The Honourable Senators Atkins, Banks, Beaudoin, Carney, Cochrane, Cohen,* DeWare,* Ferretti Barth, Grafstein, Graham, P.C., Hubley, Joyal, P.C., Lawson, Léger, Losier-Cool, Maheu, Mahovlich, Meighen, Milne, Murray, Rompkey, St. Germain, Sibbeston, Stratton, Tunney*, and Wilson* * retired viii

13 LIST OF ABBREVIATIONS ACAHO ACMC ACST AHSC CAN CAPE Association of Canadian Academic Healthcare Organizations Association of Canadian Medical Colleges Advisory Council on Science and Technology Academic Health Sciences Centre Canadian Nurses Association Clinicians Assessment and Professional Enhancement CT DND DRG EHR EI EMP EPF Computed Tomogram (scan) Department of National Defence Diagnostic Related Group Electronic Health Record Employment Insurance Extra-Mural Program Established Programs Financing CBAC Canadian Biotechnology Advisory Committee F/P/T federal/provincial/territorial CCAC Canadian Council on Animal Care FAE Fetal Alcohol Effects CCHSA CCN Canadian Council on Health Services Accreditation Cardiac Care Network of Ontario FAS FFS Fetal Alcohol Syndrome Fee-for-service CCOHTA CDPAC CFI CHA CHSRF CHST Canadian Coordinating Office for Health Technology Assessment Chronic Disease Prevention Alliance of Canada Canada Foundation for Innovation Canada Health Act Canadian Health Services Research Foundation Canada Health and Social Transfer FHN FMG GDP GP HRDC HTA Family Health Networks Family Medicine Groups Gross Domestic Product General Practitioner Human Resources Development Canada Health Care Technology Assessment CIAR CIDA CIHI CIHR CLSC CMA CPP CRC CSTA Canadian Institute for Advanced Research Canadian International Development Agency Canadian Institute for Health Information Canadian Institutes of Health Research Centre local de services communautaires (community health centre) Canadian Medical Association Canada Pension Plan Canada Research Chairs Council of Science and Technology Advisors HTF ICH ICT IDRC IMG IT JPPC LPN MEF Health Transition Fund International Conference on Harmonization information and communications technologies International Development Research Centre International Medical Graduates Information Technology Joint Policy and Planning Committee Licensed Practical Nurse Medical Equipment Fund ix

14 MOHLTC MRC MRI MSA NACA NBEMH Ontario Ministry of Health and Long-Term Care Medical Research Council of Canada Magnetic Resonance Imaging Medical Savings Account National Advisory Committee on Aging New Brunswick Extra-Mural Hospital PPP PPS QPP REB RHA RHC RN Purchasing Power Parity Prospective Payment System Quebec Pension Plan Research Ethics Board Regional Health Authority Regional Hospital Corporation Registered Nurse NCEHR NHEX NHRDP NHS National Council on Ethics in Human Research National Health Expenditure Database National Health Research and Development Program National Health Service Rx&D SSHRC TCPS UBC Canada s Research -Based Pharmaceutical Companies Social Sciences and Humanities Research Council Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans University of British Columbia NRC National Research Council URS Urgency Rating Score NSERC Natural Sciences and Engineering Research Council WCB Workers Compensation Board ODB Ontario Drug Benefit WCWL Western Canada Waiting List OECD Organisation for Economic Cooperation and Development OFHN Ontario Family Health Network OHA Ontario Hospital Association OMA Ontario Medical Association PAHC Post-Acute Home Care PCG Primary Care Groups PCN Primary Care Network PCR Primary Care Reform PCT Primary Care Trust PENCE Protein Engineering Network of Centres of Excellence PET Positron Emission Tomography (scan) PHCTF Primary Health Care Transition Fund PIPEDA Personal Information Protection and Electronic Documents Act PMSI Programme de Médicalisation du Système d Information x

15 ACKNOWLEDGEMENTS The Committee wants to publicly acknowledge the enormous assistance it has received during the past two years from those who have worked so hard in helping the Committee to produce its six reports. The Committee particularly wants to express its deep appreciation to: Odette Madore and Dr. Howard Chodos of the Research Branch of the Library of Parliament, the full-time research staff of the Committee, who have been deeply involved in all drafts of the six reports that the Committee has released during this study. Without their extraordinary help, these reports would not have been completed in such a short time, nor in such a competent manner. Catherine Piccinin, the Committee Clerk and her Administrative Assistant, Debbie Pizzoferrato, who were responsible for organizing all the meetings the Committee held on the health care issue, including scheduling the appearances of all the witnesses, for overseeing the translation and printing of all six reports, and for responding to thousands of requests for information about the Committee s work and for copies of the Committee s reports. Dr. Duncan Sinclair, the former chair of the Health Services Restructuring Commission of Ontario, who gave so generously of his time and expertise in reviewing, editing and offering suggestions for improvement in all of the drafts of the Committee s reports. The staff of each of the members of the Committee, who have had to endure a substantially increased work load for the past two years. To all of these people, we express our heartfelt thanks for a job very well done. The Committee worked long hours over many months, requiring the services of a large number of procedural, research and administrative officers, editors, reporters, interpreters, translators, messengers, publications, broadcasting, printing, technical and logistical staff who ensured the progress of the work and reports of the Committee. We wish to extend our appreciation for their efficiency and hard work. xi

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17 FOREWORD This report is the culmination of a two-year study by the Standing Senate Committee on Social Affairs, Science and Technology. During this period, the Committee has heard the views of over 400 witnesses. The Committee wishes to express its sincerest thanks for the effort these witnesses made to give us their advice on what needs to be done to reform Canada s health care system and make it fiscally sustainable. As one would expect, given the complex, ideological and political nature of health care issues, the advice we received was often conflicting. Nevertheless, the Committee considered seriously the views of all the witnesses in arriving at our recommendations. The recommendations in this report reflect the unanimous view of the eleven Senators on the Committee (seven Liberals, three Progressive Conservatives, and one Independent). The experience of the eleven Committee members in public policy and healthrelated issues is as deep as it is varied. The Committee includes: two doctors: Yves Morin, a former Dean of Medicine at Laval University, and Wilbert Keon, the Chief Executive Officer of the Ottawa Heart Institute; two former provincial ministers of health: Brenda Robertson and Catherine Callbeck, who was also a provincial premier; two former Members of Parliament: Douglas Roche and Lucie Pépin, who was also a nurse; a former federal cabinet minister and former journalist: Joyce Fairbairn; two community activists: Joan Cook, who served for many years on various hospital boards, and Jane Cordy, who was also a teacher; two former senior members of a Prime Minister s office: Marjory LeBreton and Michael Kirby, who was also a former federal Secretary to the Cabinet for Federal-Provincial Relations. The Committee believes that its recommendations meet the four objectives the Committee set for itself at the outset of its work: To formulate a detailed, concrete plan of action that did not focus heavily on governance issues or intergovernmental structures; To attach a cost to its recommendations and propose a specific revenue raising plan. For its report to be truly useful, the Committee felt it could not be vague on the question of precisely how its recommendations would be funded; To specify clearly the changes that each of the major stakeholders individual Canadians, health care professionals, provincial and federal governments, etc. would have to make so that the Committee s reform plan could be implemented successfully. xiii

18 To make clear the consequences of not changing, and hence of not reforming, the health care system. The Committee feels that there is a real window of opportunity for implementing the kind of reform that is needed to ensure the long-term sustainability of Canada s health care system. The Committee believes it has worked out a detailed, concrete and realistic plan which, if implemented integrally, would lead to the strengthening of the publicly funded health care system in Canada and help guarantee its sustainability for the foreseeable future. It looks forward to pursuing its work in this direction, along with all those who share this objective. xiv

19 The health of the people is really the foundation upon which all their happiness and all their powers as a state depend. Benjamin Disraeli July 24, 1877 It is to the Canadian people, and their improved health, that the Committee dedicates this report.

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21 INTRODUCTION For the past two years the Standing Senate Committee on Social Affairs, Science and Technology has been studying the state of the Canadian health care system and the federal role in that system. The Committee has sat for over 200 hours and held 76 meetings. Most of these meetings were public sessions during which the Committee heard from over 400 witnesses, many of whom represented organizations that have thousands of members (such as the Canadian Medical Association and the Canadian Nurses Association). To date the Committee has published five reports. This sixth report contains the Committee s final recommendations for reform and renewal of the Canadian health care system. These recommendations flow from the principles enunciate in Volume Five.The major topics covered in the five previous reports, as well as the subjects to be treated in future reports, are summarized in the following table: Phases Content Timing of Report One Historical Background and Overview, March 2001 Myths and Realities Two Future Trends, Their Causes and January 2002 Impact on Health Care Costs Three Health Care Models and January 2002 Practices in Other Countries Four Issues and Options September 2001 Five Principles for Restructuring the Hospital and Doctor April 2002 System and Recommendations on Several Health Care Issues Six Recommendations with respect to Financing and Restructuring the Hospital and Doctor System and Closing the Gaps in Drug and Home Care Coverage October 2002 Thematic Studies Aboriginal Health, Women s Health, Mental Health, Rural Health, Population Health, Home Care and Palliative Care At future dates to be determined As the table indicates, following the release of this report, the Committee intends to examine a number of additional health-related issues. These studies will result in a series of thematic reports on: 1) Aboriginal health; 2) women s health; 3) mental health; 4) rural health; 5) population health, including literacy issues; 6) home care; and 7) palliative care. In addition, the Committee held public hearings in September 2002 to examine the document French-Language Healthcare Improving Access to French-Language Health Services, a study coordinated by the Fédération des communautés francophones et acadiennes du Canada for the Consultative Committee for French-Speaking Minority Communities. The Committee will be 1

22 releasing a report on this issue, and readers of this volume are strongly encouraged to read that report as well. categories: The recommendations contained in Volume Six can be grouped into six recommendations on restructuring the current hospital and doctor system to make it more efficient and more effective in providing timely and quality patient care; recommendations on enacting a health care guarantee that would ensure that patients receive treatment within a specified maximum amount of time for major hospital or diagnostic procedures; if the waiting time is exceeded, the health care guarantee would require the insurer/government to pay the cost of the patient receiving the necessary service in another jurisdiction or another country; recommendations on expanding public health care insurance to include coverage for catastrophic prescription drug costs, immediate post-hospital home care costs, and costs of providing palliative care for patients who choose to spend the last weeks of their lives at home; recommendations that strengthen the federal contribution to, and role in, developing health care infrastructure, including health information systems, health care technology, the evaluation of health care system performance and outcomes, the supply of health human resources, health research, wellness promotion and illness prevention, and the nation s 16 Academic Health Sciences Centres; recommendations on how additional federal revenue should be raised, and on how this new revenue should be administered in a transparent and accountable manner in order to implement the recommendations in this report; observations on the consequences that would arise if the additional federal revenues that the Committee recommends be raised are not invested in the health care system. As some of these recommendations will require the financial participation of the provincial and territorial governments if they are to be implemented, the Committee is keenly aware of the importance of fostering a spirit of cooperation and collaboration amongst the various levels of government in the course of working to reform and renew Canada s health care system. As some of these recommendations will require the financial participation of the provincial and territorial governments if they are to be implemented, the Committee is keenly aware of the importance of fostering a spirit of cooperation and collaboration amongst the various levels of government in the course of working to reform and renew Canada s health care system. 2

23 3 Part I: Accountability

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25 CHAPTER ONE THE NEED FOR AN ANNUAL REPORT ON THE STATE OF THE HEALTH CARE SYSTEM AND THE HEALTH STATUS OF CANADIANS To formulate realistic recommendations to improve the provision of health care services to Canadians, it is necessary first to have a clear view of the health care system now and an assessment of its strengths and weaknesses. From the outset, the Committee has sought to portray accurately the reality of Canada s health care system and to separate myth from fact. 1 The Committee believes that an ongoing evaluation of the health care system is essential, conducted in as objective a fashion as possible. In this chapter the Committee presents its recommendations for the creation of a new National Health Care Council chaired by a Health Care Commissioner charged with carrying out this task by producing an annual report on the state of the health care system and the health status of Canadians. Before turning to this, however, we begin with a brief review of some key elements from previous volumes of the Committee s study. These summarize the basic approach that the Committee has adopted in the course of its multi-volume study, as well as the objectives it has sought to achieve in developing its recommendations. 1.1 Summary of Some Key Points from Volumes One through Five The role of the federal government The Committee identified the various roles of the federal government in health and health care; Volume Four set out these roles, together with a set of policy objectives for each. 2 The Committee also affirmed the legitimacy and importance of the federal government s roles from a number of perspectives: First, it is clear that Canadians strongly support national principles in health care and look to the federal government to play an important role in maintaining these principles; Second, federal funding for health care is especially critical at this time of reform and renewal. As the Committee makes clear in the present volume, making changes in the way the health care system is structured and operates will require spending more money - money that must be raised primarily by the federal government; Third, and some would say most important, only the federal government is in a position to make sure that all provinces and territories, regardless of the size 1 See Volume One, The Story So Far, Chapter Six, Myths and Realities, pp. 93ff. 2 See Volume Four, Issues and Options, Chapters Three and Four, pp

26 of their economies, have at their disposal the financial resources to meet the health care needs of their citizens. This redistributive role of the federal government is fundamental to what many call the Canadian way. Fourth, fundamental changes to the health care system should not be confined to one or two provinces. Our national system requires interprovincial harmonization in which the federal government has a crucial role to play, through, for example, its use of financial incentives and/or penalties to encourage provincial and territorial governments to adopt country-wide standards. Fifth, the Committee believes It is very clear to the Committee that strongly that the substantial sums of Canadians want the provinces, the money transferred by the federal territories and the federal government to government to the provinces and work collaboratively in partnership to territories for health care should ensure that the federal government facilitate health care renewal. has a seat at the table when Canadians are impatient with blamelaying; they want intergovernmental restructuring of the health care system is discussed. The principle of cooperation and positive results. accountability to the taxpayers requires the federal government to have a say in how that money is spent. Finally, it is very clear to the Committee that Canadians want the provinces, the territories and the federal government to work collaboratively in partnership to facilitate health care renewal. Canadians are impatient with blame-laying; they want intergovernmental cooperation and positive results Objectives of federal health care policy The Committee has pointed out that federal policy in health care flows from two overarching objectives objectives that the Committee strongly supports as the primary goals to be pursued by the federal government in the field of health care. These two objectives are: To ensure that all Canadians have timely access to medically necessary health services regardless of their ability to pay for these services. The Committee believes that federal policy in health care flows from two objectives: To ensure that all Canadians have timely access to medically necessary services regardless of their ability to pay for these services. To ensure that no Canadian suffers undue financial hardship as a result of having to pay health care bills. To ensure that no Canadian suffers undue financial hardship as a result of having to pay health care bills. Implicit in these two objectives, particularly the first, is the requirement that the medically necessary services provided under Medicare be of high quality. Clearly, providing access to services of inferior quality would defeat the purpose of Canada s health care system. 6