Provinces need to have a plan for health care funding — or they shouldn’t get the money

This column by Armine Yalnizyan,  Pat Armstrong, Marjorie Griffin Cohen & Laurell Ritchie was originally published by the Toronto Star on Saturday August 13, 2022. Armine is a Contributing Columnist to Toronto Star Business featured bi-weekly.

Every day brings fresh evidence of profound mismanagement in health care: closing emergency departments, burned-out nurses quitting the profession, fewer Canadians with family doctors, hospitals full of older people with nowhere to go.

Meanwhile, premiers want the federal government to ship them another $28 billion for health care, no questions asked — on top of the $45 billion they already get yearly.

What’s wrong with this picture? Accountability.

With our most critical social program in chaos in every part of the country, it’s not enough for provinces to say “just give us the money.” What’s the plan to use more public money to buy lasting change? We’ve learned over the past year that you can’t buy change unless there’s an explicit agreement about the transformations you’re buying.

The early learning and child-care deals used an infusion of federal cash to achieve specific goals within a clear time frame. Every jurisdiction has agreed to three goals: lower parent fees, expanded availability of licensed care and improved working conditions.

It’s not a cookie-cutter approach. Some provinces emphasize recruitment and retention, others the need to add spaces in care “deserts.” Some are cutting parent fees faster. But the cash is only handed over when there’s a plan for — and reports on — progress in affordability, access and quality care.

We need the same approach to health care. A common framework. Measurable outcomes. Written agreements. Dedicated funding for mutually negotiated goals in recruitment and retention, improved primary care and new services. Multi-year action plans that can prevent the erosion of high quality not-for-profit and public care. Consequences if goals are not met.

As premiers raise the heat on the feds, both journalists and citizens need to raise more pointed questions about the lack of plans. Here are five areas that desperately need a blueprint for change.