Health system analysis stymied by poor
collection of data
TORONTO – While the federal, provincial and territorial governments are
making gains on some commitments to renew healthcare, Canadians are not
getting the detailed information they need to measure progress, the
Health Council of Canada concludes in its annual report to Canadians.
The report was released Feb. 1.
Four years after the 2003 First Ministers’ Accord on Healthcare Renewal
– and following the infusion of billions of dollars in additional health
investments – how far has healthcare renewal advanced?
cases, we know governments are measuring up; in other areas, we know
they’re missing the mark. But all too often, we just don’t know, or we
don’t know enough. We don’t have sufficient evidence to evaluate the
strength and sustainability of healthcare renewal on a system-wide
basis,” said Jeanne Besner (pictured), Interim
Chair of the Health Council.
“We need to strengthen our collective capacity to measure the
performance of healthcare systems across the country; we need to
strengthen transparency and accountability in healthcare,” said Besner.
The Health Council’s 3rd annual report to Canadians, “Healthcare Renewal
in Canada: Measuring Up?”, tracks the progress governments have made in
meeting such commitments as reforming primary healthcare, reducing wait
times and health inequalities, modernizing health information systems,
and improving drug coverage. And while there is good news to share, the
Health Council was struck by the lack of comparable data and the
prevalence of inconsistent or incomplete reporting across the country.
First Ministers did not report on comparable health indicators this
year, as they had agreed to do, and the federal/provincial/territorial
committee that oversees this work has been disbanded.
Information about how provinces and territories spend targeted federal
funds is not easily accessible, or in some cases, not available at all.
As of mid-January, it was not known if, or how fully, Health Ministers
had reported to First Ministers on home-care goals related to a Dec. 31,
2006 deadline. Without better data, jurisdictions will fall short of
their commitment to more transparent public reporting and greater
The Council’s report identifies both positive developments and troubling
shortcomings, and highlights regional successes in making healthcare
renewal a reality. Findings include:
• There has been progress in primary healthcare reform with further
development, expansion and training of inter-professional teams across
the country. But it is difficult to measure and compare this progress in
a meaningful way, because jurisdictions do not collect and report
information using agreed-upon indicators.
The implementation of the electronic health record is a crucial
component of these reforms, yet the rate of adoption in primary
healthcare settings remains slow.
• Wait times are being reduced in most of the five targeted areas
(cancer treatment, heart procedures, joint replacement and sight
restoration – benchmarks for diagnostic imaging are still needed, except
In the absence of a pan-Canadian approach to monitoring wait times for
all procedures, it is not clear whether these efforts are inadvertently
increasing wait times for other services. The Council advises that we
standardize wait times measurement and reporting, create centralized
registries, and continue to assess the impact of the focus on the five
• Medical and nursing school enrollments are up and most jurisdictions
have developed health human resources plans, but only a few have set
targets based on the needs of their respective populations.
• A progress report on the implementation of a national pharmaceuticals
strategy was released with options for coverage of catastrophic drug
costs. But to date, there has been no action on implementation and no
indication if the federal government will help cover the costs.
Meanwhile, 3.5 million Canadians – including 600,000 in Atlantic Canada
– have little or no drug coverage and are financially vulnerable should
they require expensive drug therapies.
• There are more patient safety initiatives underway across Canada than
last year. But because information about adverse events – unintended
injuries or complications caused by the delivery of healthcare that
result in prolonged hospital stay, disability, or death – is not
collected and evaluated in a coordinated fashion, it is difficult to
determine whether patient safety is improving.
At a minimum, each jurisdiction should create a central mechanism for
the mandatory reporting of all defined adverse events.
• In a study of eight jurisdictions, the Health Council found no
uniformity in accreditation practices for healthcare facilities. Some
have 100 per cent participation, while others do not, and it varies by
province. Some accreditation reports are made public, but most are not.
The Council is again recommending that all healthcare facilities be
accredited as a condition of funding, and that the findings from
accreditation surveys be made public.
• The development of national public health goals is complete, but to
date only Nova Scotia has established targets. There has been a fair
amount of activity at the provincial and territorial level in developing
and implementing healthy living programs, but the federal government has
not yet announced any projects from the Healthy Living Fund.
• Many governments – federal, provincial and territorial – offer
programs to address health inequalities experienced by Aboriginal
peoples, but the federal government’s intent with respect to
implementing the Blueprint on Aboriginal Health and the Kelowna accord
“While there are many instances of progress and innovation, the picture
we have of healthcare renewal in Canada remains clouded. In too many
cases, the information is incomplete, inconsistent, or simply
unavailable,” said Council Vice-Chair Ian Bowmer. “With billions of
dollars being spent on this historic undertaking, Canadians expect
This is supported by public opinion data. According to a
Council-commissioned synthesis of public opinion polling from
2002-2006,Canadians clearly want to know what their governments are
doing to improve the healthcare system, how money is being spent, and
whether investments are resulting in a healthier population. This
overview – Canadian Perceptions of the Healthcare System by Professor
Stuart Soroka – was released as a companion document to the Council’s
The Council will be working closely in the coming months with
governments, stakeholders, and the policy and research communities to
develop a clearer picture of healthcare renewal. This will help build on
successes, and provide Canadians with a more transparent accounting of
how their healthcare system is measuring up.
The Health Council of Canada, created by the 2003 First Ministers’
Accord on Healthcare Renewal following the recommendations of the
Romanow and Kirby reports, is mandated to monitor and report on the
progress of healthcare renewal in Canada. The 26 Councillors were
appointed by the participating provinces, territories and the Government
of Canada and have expertise and broad experience in community care,
Aboriginal health, nursing, health education and administration,
finance, medicine and pharmacy. The report,
federal/provincial/territorial information tables, public perceptions
paper and a summary of the report’s success stories can be downloaded at