41st Annual Premiers’ Conference

WINNIPEG, AUGUST 11, 2000 --Premiers today reaffirm their commitment to publicly funded and accessible medicare and to the principles of universality, comprehensiveness, portability and public administration.

Premiers agree to develop high levels of quality for the provision and reform of health care and have committed provinces and territories to a transparent review of the delivery of health care in Canada.

Premiers are releasing this statement today in advance of the First Ministers' Meeting in Ottawa.

Premiers look forward to the cooperation of the federal government in restoring sustainability of Canada's health care systems.

Consequently, Premiers issue this declaration:

Vision

Premiers' vision of health is that:

          Canadians will have publicly funded health systems that provide
          quality health services and that promote the health and well-being
          of Canadians in a cost-effective and fair manner.

Premiers believe that the key goals of the health systems in Canada are t preserve, protect and improve the health of Canadians; ensure that Canadians have reasonable access to an appropriate and effective range of health services anywhere in Canada, based on their needs, not their ability to pay; and, ensure long-term sustainability so that health care services are available when needed by Canadians in future years.

To achieve these goals, Premiers make the following commitments on health. Their governments will:

   
• continue to lead in the renewal of health care services by working with other governments, communities, service providers, and citizens;    

   

     
   
• support the principles of universality, accessibility, comprehensiveness, portability, and public administration for insured hospital and medical services;    

   

     
   
• promote those public services, programs and policies which extend beyond care and treatment and which make a critical contribution to the health and wellness of their citizens;    

   

     
   
• further address key priorities for health care renewal and support innovations to meet the unique and emerging needs of their citizens;    

   

     
   
• expand the sharing of information on best practices and thereby contribute to continuing improvements in the quality and efficiency of their health care systems;    

   

     
   
• report to their citizens on the health status of their populations, their publicly funded health services, and the actions taken to improve these services; and    

   

     
   
• continue to seek an adequate and sustainable federal contribution to health and other social programs through the existing Canada Health and Social Transfer (CHST) and the Equalization Program.

Priorities for Action on Renewal and Innovation

Recognizing the needs of their citizens, all provinces and territories are actively pursuing and implementing priority areas for renewal and innovation. The range of priority areas includes:

   
• Access to Care    

  Premiers agree to work to improve the quality of and access to the health services of highest priority to their citizens.    

   

     
   
• Health Promotion and Wellness    

  All provinces and territories are engaged in health education and strategies to prevent illness. Premiers are committed to strengthening their investments and commitments in this area, including the development of strategies and policies that recognize the determinants of health, enhance disease prevention and improve public health.    

   

     
   
• Appropriate Health Care Services - Primary Care    

  Improvements to primary care are crucial to health systems' renewal. All provinces and territories are committed to ensuring that those who enter their health systems receive the most appropriate care, by the most appropriate providers, in the most appropriate settings. Premiers will continue to make primary care reform a high priority.    

   

     
   
• Action on Health Human Resources    

  The Premiers' objective is to ensure that each province and territory has the people with the skills needed to provide appropriate levels of care and health services. Premiers directed their Ministers of Health to work together to identify approaches to improve the education, training, recruitment and retention of our future health workforce. They also directed their Ministers of Health to collaborate on identifying approaches that can improve work life conditions, for example: flexible working arrangements and continuing education. Premiers asked Ministers to report back to them on both of these issues at the next Premiers' Conference.    

   

     
   
• Home Care and Community Care    

  All provinces and territories have expanded home care and community care programs. Home care and community care have been among the fastest growing health services. Premiers are committed to continued investment in home care and community care as critical components of their health systems.    

   

     
   
• Action on Pharmaceutical Management    

  In order to ensure Canadians continue to have access to new, appropriate and cost-effective drugs, Premiers agreed to work together and mandated their Health Ministers to develop strategies for assessing and evaluating prescription drugs. These strategies could include the creation of a common interprovincial/territorial advisory process to assess drugs for potential inclusion in provincial/territorial drug plans. They will be informed by an examination of current provincial/territorial best practices and various means of addressing drug purchasing costs.    

   

     
   
• Health Information and Communications Technology    

  All provinces and territories have made major investments in their health information technologies in recent years to improve care and health systems management. This will lead to more integrated delivery of health care services. Premiers are also committed to enhancing technologies like telehealth and to protecting the privacy, confidentiality and security of personal health information.    

   

     
   
• Health Infrastructure    

  Consistent with the needs of their residents and communities, Premiers are committed to ongoing investment in equipment, new technologies and facilities required for sustaining and renewing the modern health system.

     

Provinces and territories, given their constitutional jurisdiction over health, and their responsibility for managing and delivering health care, are best suited to assess the needs and priorities of their respective citizens and to identify the priority health care services to meet these needs.

Sustaining Health Care Services - Ongoing Health Renewal and Innovation

In order to meet the future challenges facing their health systems, Premiers stress that their governments will continue to manage their systems effectively to address the significant expenditure pressures and will further innovate to improve the quality, accessibility, appropriateness, efficiency and effectiveness of health services. Their governments have demonstrated their commitment to publicly funded health care. Total provincial and territorial health care spending increased from $11 billion in 1977/78 to $56 billion in 1999/2000 - an average annual growth rate of 7 percent. Cumulative federal funding reductions to the CHST total more than $24 billion over the past six years.

Every province and territory faces a continuous growth in demand for health services, fuelled by demographic changes, new technologies, growing costs of service provision and renewal activities. The report, Understanding Canada's Health Care Costs, makes it clear that provinces and territories cannot meet these pressures alone.

Premiers call upon the Prime Minister to fully and immediately restore the cash portions of the existing CHST to $18.7 billion annually. They also call for the establishment of an appropriate escalator to ensure that funding for health and social programs through the CHST keeps pace with the economic and social factors, which have impacted on the sustainability of the system and which will do so in the future. In concert with the restoration of the CHST cash funding and adoption of an appropriate escalator, they call for a strengthening of the Equalization Program, including the immediate removal of the ceiling on Equalization payments.

In January 1999, Premiers committed that any additional funds made available for health care through the CHST would be fully committed to existing health services and programs. They fulfilled this promise. Today, they are confirming that they will commit any further CHST funding provided for health care services and social programs, in accordance with the pressures and priorities in their respective provinces and territories.

Clear Accountability - Reporting to Citizens

Premiers believe in the importance of being accountable to their own citizens. Clear public reporting will enhance accountability and improve the performance of their health systems.

Premiers direct their Health Ministers to collaborate on a transparent provincial/territorial approach to outcome measurement, which would include the development and use of comparable indicators where appropriate. Each province and territory will continue to provide public reports to its citizens on a regular basis.

Possible key items for measurement include:

   
• health status (e.g. life expectancy, infant mortality, low birth weight, people reporting their health as excellent);    

   

     
   
• health outcomes (e.g. increase in life extension, improved quality of life, reduced burden of disease and illness);    

   

     
   
• quality of service (e.g. patient satisfaction).

Premiers direct their Health Ministers to begin work immediately on an approach to outcome measurement and to provide a progress report within six months.

Working Together

Provincial and territorial governments have constitutional responsibility for health and accordingly play the primary role in the design, management, and funding of the health system within their jurisdictions. Premiers recognize that maintaining and improving health involves the cooperation of health care providers, communities, individual citizens, and governments.

Health care providers are in the front lines ensuring that Canadians receive quality health services. Communities play a key role in promoting health, wellness, and preventing disease. Individuals can make important contributions to Canada's health systems through numerous volunteer activities and by making wise choices in the use of health care services and by living healthy lifestyles. Through the sharing of best practices and information on health care systems, health care providers, communities and individuals will have better tools to take action to improve their own health and the health of others.

The federal government plays an important role by providing resources to provinces and territories through the Canada Health and Social Transfer. It also has the constitutional commitment to the principle of making equalization payments to ensure that provincial governments have sufficient revenues to provide reasonably comparable levels of public services at reasonably comparable levels of taxation. The federal government also plays a significant role in the regulation of food and drugs, funding health research and in promoting the health and wellness of Canadians.

Furthermore, Ottawa has a fiduciary responsibility to Aboriginal Canadians, including the provision of health services. The federal government must work with provinces, territories and Aboriginal peoples on more effective delivery of health services and supports for Aboriginal peoples.

Premiers believe that high quality health services are the result of collaboration and consultation with Canadians, service providers, and governments. Their governments are taking steps to engage citizens in processes to enhance and improve their health systems. Each jurisdiction is selecting the methods of consultation and involvement most appropriate to its circumstances. These steps will contribute to meeting the health care needs of their citizens in the 21^st century.

The issue of privatized health care was raised but the agenda did not permit full discussion. However, Premiers remain committed to the statements in this communiqué and reiterate their ongoing determination to renew and innovate in order to sustain and improve Canada's publicly funded health care services.

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