by Claudia von Zweck, CAOT Executive Director
January 1999
Table of Contents
In this Article
Consumer confidence
decreases
February brings a new federal budget and with it, renewed hope for increased spending at the national level on health. This year, there are positive indications for additional budget monies for health. There are extra dollars in the federal coffers and over the course of the past year, both the Prime Minister and the Federal Minister of Health have identified health as the next priority for federal spending. It is CAOT’s role to work with other national groups to ensure that this happens.
Why?
The need for a federal reinvestment in health is acute. For over one decade,
cash transfers from the federal government to the provinces for medicare
have declined. Between 1986/1987 and 1995/1996 $30 billion in cash transfers
have been withheld by the federal government. Since 1996 it is estimated
that there has been an additional $2.5 billion annual reduction in federal
cash allocated to health services (HEAL, 1998).
Consumer confidence decreases
These reductions in federal health care spending have not occurred without
consequence. We are all well aware of the health reform initiatives which
have been spurred across Canada as a result of reduced health funding.
These changes to our health services have led to plummeting rates of consumer
confidence for access to quality health care. In 1991, 61% of Canadians
ranked their access to quality health services as very good. In 1998,
this figure dropped to 29% of Canadians. (Angus Reid, February, 1998).
Contributing to this consumer loss of confidence is the rising level of
private funding for the delivery of health care in Canada. Between 1987
and 1997, it is estimated that the private share of total health expenditures
increased from 25% to 31%. One half of the six percent increase occurred
since 1994 (Hanspal, 1998).
Two tier access to our services
Most certainly, private spending for occupational therapy services has
become commonplace. Health reform has restricted the ability of Canadians
to receive publicly funded occupational therapy services. Shorter hospital
stays provide less time for clients to receive inpatient occupational
therapy services. Hospital bed closures in addition to shorter lengths
of hospital stays have pushed the provision of many health services to
the community. Publicly funded outpatient and home care occupational therapy
services have experienced huge increases in demand without a corresponding
expansion in service capacity. In some areas hospital outpatient occupational
therapy departments have been closed. As a result, we have seen the emergence
of a two tier level of access to occupational therapy services. As public
funding has become less available, occupational therapists have increasingly
tapped private sources of funding as payment for their services. Clients
who cannot afford to pay for services or who do not qualify for third
party sources of funding may experience extended waits for their therapy
services, receive only limited services or worst of all not receive the
occupational therapy they require.
CAOT’s actions
CAOT, as a member of the Health Action Lobby (HEAL) has lobbied for a
federal budget this February which reverses this tide of privatization
and commits our government to a reinvestment in the health of Canadians.
During a presentation made in the fall of 1998 to the Federal Finance
Committee, HEAL asked the federal government for an increase in cash payments
to the provinces from $12.5 billion to $15 billion to enhance and support
the existing medicare system. HEAL also recommended that an additional
$1 billion in health spending be provided to support new health and social
services which do not fall under the definition of medicare.
The Canada Health Act defines the principles and services of medicare. The Act was designed to ensure Canadians have access to medically necessary services which are provided by a physician or which are provided in a hospital setting. Occupational therapy services as well as all other non-physician health services which are not provided by a hospital fall outside of the jurisdiction of the Canada Health Act. Federal health transfer dollars and the medicare principles of universality, accessibility, portability, comprehensiveness and public administration are therefore not applicable for such services. To fill the gap left by reductions in facility based services, there has been a sporadic development of provincially funded programmes such as home care which lack national standards for continuity and consistency and operate on restrictive budgets.
HEAL advocates that allocation of funding for new health and social services must be contingent upon the implementation of accountability measures with the provinces for the use of these monies. This poses a difficult challenge for the federal government. To provide designated funding for new health and social services, the federal government must impose national standards on programmes which many provinces in Canada have already developed.
Federal government health legislation has not kept pace with the shift of health services to the community. Substantive federal commitment and federal dollars are required to allow our national government to successfully work with the provinces to develop and support the continuum of health services Canadians need in the post health reform era.
CAOT’s close relationship to provincial professional associations through the Presidents Advisory Council is imperative. Through a coordinated effort, and monitoring of government action both federally and provincially, occupational therapy will continue to grow as a viable and important health service for all Canadians.
Angus Reid Poll, February 1998
Hanspal, Kiran (1998). Understanding the Public/Private Interface in
the funding of Health Care in Canada: Setting out the Facts. Proposal
submitted to the Health Action Lobby, author.
The Health Action Lobby (HEAL) (1998). Medicare and the Federal Spending
Power: Pre-budget submission. Unpublished manuscript, author.
CAOT Executive Director Claudia von Zweck can be reached
at 1 (800) 434-2268, ext. 224 or cvonzweck@caot.ca.
January 1999 Table of Contents
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