Insights (Essays) September 2013

Turning the page on the health accords: Where do we go from here?

John G. Abbott


Ten years ago, the federal, provincial, and territorial governments set out to fix an ailing healthcare system. The solution was straightforward: the 2003 and 2004 health accords, a promise of health reform and the funds to make it happen.  

But did the health accords deliver?

As a new report from the Health Council of Canada concludes, the last decade brought few notable improvements on measures of patient care and health outcomes, and our performance compared to other high-income countries is disappointing. Worse still, disparities and inequities persist across Canada.

In Better health, better care, better value for all: Refocusing healthcare reform in Canada, the Health Council suggests that the health accords failed to stimulate health system reform. Despite progress in areas such as wait times, electronic medical records, and cardiac and cancer care, 10 years of efforts and investments have not transformed our health system into a higher-performing one.

Canadians have every right to be concerned—and to ask pointed questions of our governments and our healthcare leadership.

The growing risk of divergent systems

Most Canadians assume that their province or territorial health system provides care and yields outcomes similar to those in other parts of the country. Yet this isn’t the case. Where you live does matter.

Our country is characterized by 13 different health systems, as well as federal responsibility to deliver care for Aboriginal communities, veterans, military, and the RCMP. In the past, provinces and territories have had significant latitude in how they use the dollars provided by the federal government’s Canada Health Transfer (CHT) to fund healthcare services. That will not change in the formula that is to succeed the health accords.

But the federal government has traditionally played a central role in ensuring a level of equity across the country by bringing a critical “Canadian” perspective to all discussions and decisions about healthcare. That is shifting. Today, the federal role in shaping healthcare is far less evident than it was 10 years ago. Meanwhile, the provinces and territories are largely focused on healthcare within their own boundaries. The result is increasingly divergent systems—a pattern that inevitably will lead to more explicit differences in access to, and the quality of, health services across the country.

The Health Council argues that provincial and territorial governments need to think beyond their own borders. They need to consciously recognize that they are co-owners of a national system and have a shared responsibility to ensure that all jurisdictions deliver comparable results.

Many will point to the Healthcare Innovation Working Group of the Council of the Federation (COF) as an example of collaboration taking place among the provinces and territories. Although cooperative action has occurred through the COF on specific issues such as drug pricing and clinical practice guidelines, the COF is not achieving the results necessary to transform the health system to meet our future needs. And without a willing federal government at the table, real transformation within and across all of Canada’s health systems is unlikely.

An approach for the future

Transformation is not easy. However, in our report, the Health Council outlines a way forward. We call for a shared vision of a high-performing health system and the pursuit of a set of goals based on the Institute for Healthcare Improvement’s Triple Aim framework adapted to suit a Canadian context. The framework clearly resonates with policy-makers; several provinces already use variations on the Triple Aim.

We propose the explicit system goals of better health, better care, and better value with the complementary, overarching aim of equity as a starting point to guide the pursuit of a higher-performing health system in Canada.In addition,based on our work and that of others, we have identified a number of key enablers that must be sustained if we are to succeed: leadership, policies and legislation, capacity building, innovation and spread, and measurement and reporting.

Embedded in the act of measurement and reporting is the principle of accountability. It is noteworthy that the 2003 health accord established the Health Council of Canada, marking the first time that an independent reporting body was created to monitor and report on the performance of Canada’s health system against a series of policy, program, and funding commitments. With the health accords ending in 2014, the federal government has decided to wind up funding for the Health Council. But there is still work to be done.

Which leads me back to where I began—accountability to the Canadian public.

The results of the last 10 years make it clear that the status quo is not defensible. Our pattern of disparate and tentative approaches to health reform cannot continue. It is time for strong leadership on the part of all governments, healthcare organizations, and healthcare providers in order to do the business of healthcare reform differently. This will take, as a first step, a renewed commitment to pan-Canadian collaboration that involves provincial, territorial, and federal governments.

We have the means to create one of the world’s highest performing health systems—one that delivers better health, better care, and better value for all Canadians. With the resources currently committed to our healthcare system, Canadians expect, and deserve, no less. p

To download a copy of the Health Council of Canada report, Better health, better care, better value for all: Refocusing healthcare reform in Canada, please visit

About the Author

John G. Abbott is CEO of the Health Council of Canada



Dennis Kendel wrote:

Posted 2013/09/24 at 11:49 AM EDT

Through my service on the Board of the Health Quality Council in Saskatchewan, I have come to appreciate the capacity of provincial Health Quality Councils to be agents of transformative change in their own jurisdictions. However we still lack political will and effective political leadership in this country to establish and sustain any effective pan-Canadian strategy for healthcare transformation. The COF Healthcare Innovation Working Group is a noble concept but it will not deliver substantive pan-Canadian improvements so long as it is operated off the side of a few desks in otherwise preoccupied provincial/territorial Health Ministry offices.


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