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Improving the Healthcare System: Dialogues, Reflections, Inspirations and Worries, by Doris Grinspun RN PhD

In November 2002, Roy Romanow issued his report Building on Values: The Future of Health Care in Canada which strongly supported Canada’s publicly administered and financed universal healthcare system, with its cornerstone being Medicare. The Commission came squarely against privatization of healthcare, stating that there was no evidence in support of such a move, and it was not congruent with the values of Canadians as expressed throughout the robust consultative process that informed the report.

Doris Grinspun, CEO of RNAO consulting with ARNBC President Susan Duncan and President-Elect Julie Fraser on strategies to ensure the future of core nursing values in Canadian health care.

The Commission supported the current inter-governmental approach to health policy and funding, and did not recommend designating health care as either a strictly federal or provincial/territorial responsibility.

The Commission did recommend significant and comprehensive reforms including improving public administration of the system; making health care policy and delivery more responsive and accountable to Canadians; improving health care access and quality; and, ensuring the system’s financial stability. It also recommended targeted funding to five priority areas: Rural and remote fund to improve access, diagnostic services fund to improve wait times, primary health care transfer to accelerate interprofessional care and move from pilot projects to whole system change, home care transfer to serve as the foundation for a national home care program, and catastrophic drug transfer to expand coverage and diminish financial burden.

Much has improved since the Romanow Report:

  • Prime Minister Jean Chrétien and the Provincial Premiers and Territorial Leaders signed the 2003 Health Accord, an historic agreement with an action plan for change to renew and sustain public health care for Canadians.
  • Federal funding was substantively increased.
  • The Health Council of Canada was created to report regularly to Canadians on the quality of their health-care system.
  • Primary Care has advanced greatly in most Canadian jurisdictions with many focusing on interprofessional teams. Yet, in comparison to other OECD countries we lag behind.
  • Wait times for diagnostic tests and various clinical procedures such as cataracts, hip and knee replacements were targeted and improved.
  • Universal programs for palliative care were introduced at the community level, and catastrophic drug coverage was launched in selected jurisdictions.

Looking back and looking forward gives me reasons for optimism and reasons for being worried - as much has changed since 2002 and today we have a federal government that has a different view of Federalism and interprets healthcare as a jurisdictional responsibility. Nurses should, and most are, alarmed with the Federal Government attack on Social and Environmental Programs, which is often accompanied with a hands-off approach to national programs and standards, such as the Prime Minister’s refusal to participate in negotiations around renewal of the Health Accord that is due to expire in 2014. By decreasing funding after 2017, the government’s hands-off approach threatens to undermine the publicly-funded, not-for-profit healthcare system that Canadians treasure, and foster the growth of for-profit health care that will cost taxpayers more and deliver less.

Recognizing this, the community of practice for health services and policy research in Canada, CAHSPR and the Health Council of Canada, organized an invitational Forum on November 9th entitled Ten Years Since the Romanow Report: Retrospect … and Prospect.  The forum brought health policy experts from across Canada together to look back on the issues that gave rise to the report and look forward to the challenges that remain.  I was among those at the forum raising probing questions about current federal threats to the core Canadian values associated with a publicly funded and not-for profit health care system and the silencing of civil society.

On November 15 and 16, 2012, I had the great pleasure of two days of lively dialogue with the Board of Directors of the ARNBC. Clearly, for ARNBC, this forum represents one of the most important conversations Canadians have had on the future of our publicly funded health care system. I am committed to ongoing close collaboration with BC’s professional association and others, to ensure that the expertise and knowledge that nurses bring to the table is recognized and integrated into health system planning and delivery across our country.

To view the proceedings and participate in the ongoing discussion, visit http://www.youtube.com/cahspr


Doris Grinspun is the Chief Executive Officer of the Registered Nurses' Association of Ontario (RNAO), the professional association representing registered nurses in the province of Ontario. RNAO’s mandate is to advocate for healthy public policy and for the role of registered nurses. Grinspun assumed this position in April 1996.  From 1990 to 1996, Grinspun served as Director of Nursing at Mount Sinai Hospital in Toronto. She has also worked in practice and administrative capacities in Israel and the United States.

Grinspun is an Adjunct Professor in the Faculty of Nursing at the University of Toronto; an adjunct professor at the School of Nursing, York University; an associate member of the Centre for Health Promotion at the University of Toronto; an affiliate member of the Centre for Health Studies at York University; and an Associate Fellow of the Centre for Latin American and Caribbean Studies (CERLAC) at York University.  In 2003, Grinspun was invested with the Order of Ontario. The award was created in 1986 by the Government of Ontario to recognize the highest level of individual excellence and achievement in any field.

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