SASKATOON, SK, July 11, 2019 – Premiers are committed to ensuring that all Canadians receive high-quality health services while keeping the healthcare system sustainable, in the future. Mental health continues to be an area of focus for all provinces and territories, as all Canadians are affected by mental health issues.
Premiers are committed to improving the quality and sustainability of Canada’s healthcare systems. New technology, advances in treatment and an aging population are putting continued pressure on healthcare budgets, despite efforts to improve the efficiency and effectiveness of healthcare spending. This means that provinces and territories, which are responsible for the delivery of healthcare services to Canadians, have less money to invest in operating rooms, medical equipment, the hiring of more healthcare professionals and the provision of supports to help keep Canadians in their own homes.
When Medicare was established in Canada, the federal government was a sustainable partner. Over the years, the share of federal funding has declined significantly. The federal government needs to return to a sustainable partnership so that Canadians can continue to access high-quality, timely healthcare services. Various fiscal analyses, including third party expert reports, such as that by the Parliamentary Budget Officer, clearly show that the federal government has the fiscal capacity to increase its healthcare funding and return to a more equitable partnership with provinces and territories. As a starting point, Premiers called on the federal government to increase funding by an annual escalator of 5.2% to the Canada Health Transfer, consistent with independent analysis by the Conference Board of Canada of budget pressures. The Conference Board of Canada also notes the Canada Health Transfer does not factor aging into its payments, and as such, federal transfers are not sufficient to support the additional care needs of Canada’s aging population.
Provinces and territories have implemented innovative service delivery options to ensure their residents have access to timely, quality services consistent with Canada’s universal healthcare systems. Premiers call on the federal government to respect provincial constitutional and territorial jurisdiction over health to ensure provinces and territories have the flexibility needed to deal with emerging issues while ensuring federal funding continues to flow. Premiers also acknowledge federal funding should be allocated to provinces and territories in a fair and transparent way, and be flexible in how the funding is used to meet the priorities of Canada’s diverse regions.
Premiers emphasized their commitment to providing access to affordable medicine to Canadians. Since 2010, provinces and territories have also been leaders in reducing the costs of prescription drugs through the pan-Canadian Pharmaceutical Alliance (pCPA) and, as of April 1, 2019, the pCPA has saved $2.26 billion a year in combined jurisdictional savings. Given this record of accomplishment Premiers urge the federal government to work with provinces and territories regarding any changes to pharmaceutical policy, to build on work already done by provinces and territories to avoid duplication and to further build on the good work that already exists.
Any proposed national program must be designed and implemented in partnership with provinces and territories, as provinces and territories have experience and expertise in delivering pharmacare services to Canadians and are accountable for these services. Premiers reiterated that any national pharmacare program must respect the following principles:
- Improving access through removing cost barriers for patients should be the focus;
- Development should be based on the best available evidence about potential benefits, risks, costs, and reliability of supply;
- Provinces and territories must retain responsibility for the design and delivery of public drug coverage; and
- Federal pharmacare funding must be long-term, secure, flexible and fully offset present and future cost pressures experienced by provinces and territories.
Over the years provinces and territories have made significant investments in their own drug plans that deliver high quality coverage and services to their citizens. The federal government must ensure that any national pharmacare program does not penalize any jurisdiction for investments it has made to improve drug coverage for its citizens. Premiers emphasized that a national pharmacare program requires the federal government to provide funding that fully offsets the present and future incremental cost pressures experienced by provinces and territories.
Premiers also reiterated their support for the principle of asymmetrical federalism and that any jurisdiction that wishes to maintain full control over drug insurance should have the right to opt out unconditionally, with full financial compensation, should the federal government participate financially in the establishment of a national pharmacare plan. Quebec has already indicated its intention to follow that path and all provinces and territories reserve the right to do the same.
Mental Health and Addictions
Mental illness and addictions affect all Canadians at some time, whether it be personally or through family, friends, or colleagues. Culturally-appropriate and patient-centred care is the basis of delivering appropriate mental health and addictions recovery services to patients across Canada. Premiers discussed the delivery of services through the continuum of care from: prevention, screening, community services and early intervention to harm reduction enhanced treatment for those who need it, and longer-term follow-up and recovery programming. All aspects of the continuum of care are critical to addressing mental health and addictions crises in Canada. Premiers urged the federal government to increase work on interdiction of illicit drugs at Canada’s ports and through the postal service, as well as stronger enforcement against traffickers.
Premiers discussed the unique challenges of delivering mental health services for those living in rural, agricultural, remote and northern communities, and noted the need to address housing shortages and homelessness to support sustainable mental health, address substance use challenges and support stabilization and addiction recovery.
Mental health issues are often intertwined with addictions and trauma. Premiers stand united in their commitment to addressing mental health and addictions issues, including problematic alcohol use and related harms. This includes increasing supports for programming, raising awareness and reducing the stigma associated with seeking treatment. Harms related to addictions – including opioids, alcohol and methamphetamines continue to have devastating impacts on families and communities across Canada. The opioid overdose epidemic caused by a toxic illegal drug supply continues to inflict tragic results, with over 3,200 Canadians losing their lives to opioid-related overdoses in 2018. Similarly, evidence suggests the use of methamphetamines is on the rise across the country, leading to a significant increase in adverse outcomes. Alcohol continues to be the substance that accounts for the majority of drug-related deaths and hospitalizations in Canada.
Provinces and territories continue to provide supports and programs to respond to mental health and addictions challenges within their own communities. To reduce stigma and to learn from each other, Premiers agreed to hold a provincial and territorial symposium on mental health and substance use with the aim to further spur innovation and collaboration between governments, ministries and non-governmental organizations.
Premiers further emphasized the need for an integrated continuum of care that is both culturally appropriate and person-centred. Care at the community level that focuses on education, early intervention, effective treatment for those who most need it, and follow-up and recovery services to ensure positive outcomes provides a demonstrable way forward for all jurisdictions.
First responders are often a line of support for Canadians dealing with mental health crises. They need to be able to provide culturally-appropriate, safe responses, and be supported in their own mental health. Premiers encourage the federal government to fund programs for the RCMP and other first responders in support of this. They also commit to looking at their own first response programs to ensure necessary supports are available.
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