NIAGARA FALLS, Ont. - Canadians have no way of judging whether the health-care system is providing good value for their tax dollars because of a lack of solid information to assess its performance, Canada's auditor general says.
Speaking Tuesday at the annual meeting of the Canadian Medical Association, Sheila Fraser said Ottawa and the provincial and territorial governments need better reporting of health-related data if the system is to meet the future needs of Canadians.
Fraser said governments also need to focus their crystal balls farther into the future and produce long-term projections critical for planning health services that will be needed by Canada's aging population.
"This information will help government, at all levels, improve health-care planning as well as increase accountability for the use of health-care dollars," she told about 250 delegates attending the CMA meeting in Niagara Falls, Ont.
"There's certainly improvement that is needed in reporting to Canadians on how effective their health-care systems are," Fraser later told a media briefing. "We don't know if we're getting good value for money."
The auditor general said an assessment by her office of federal transfer payments to the provinces found that in most cases there were no conditions surrounding how the money was used.
"So even if the public announcement is that the money is going, for example, to medical equipment or to health care or to increase the number of police officers, there is no actual condition in those agreements requiring the provinces to spend the money that particular way."
"But it means at the end of the day that they don't know, the federal Parliament has no assurance, as to how the money is being spent, except to rely on the provincial governments, and then of course to look at what the provincial financial statements would be saying."
"So there is a bit of a disconnect as to how some of these transfers are being presented and the actual conditions."
Fraser said an audit of Canada Health Infoway, the body charged with promoting the implementation of electronic health reporting across the country, shows it has a good system in place and does rigorous assessment of projects before agreeing to fund them.
But she said it's not clear how much progress Infoway has made in its goal to have electronic health records available to half of Canada's population by the end of this year.
"To date, it only reports if systems are completed, not whether health-care professionals are using the systems or whether completed systems are compatible. Consequently, parliamentarians and Canadians do not have a real sense of progress achieved to date."
Yet, full implementation of electronic health records by doctors, clinics and hospitals would help provide key information for assessing how well the health-care system is performing, Fraser suggested.
One issue of concern to both governments and the public is whether there will be enough cash in the country's coffers to provide Canadians with universal health care in the future, given spiralling costs.
In other words, is universal health care as enshrined in the spirit of the Canada Health Act, sustainable?
"The problem with that question is that no, we don't have the answer," said Fraser. "That is why these long-term projections are really important."
Outgoing CMA president Dr. Anne Doig said the doctors group wants sustainability added as a sixth principle of the Canada Health Act, which sets out federal conditions for health funding to the provinces and territories.
The five principles of health care enshrined in the act include universality, accessibility and portability across jurisdictions.
"Add sustainability," said Doig, "and you begin to round out the things that will make it possible for the system to continue to serve Canadians over time."
