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Medicare became a national program in 1957

the new funding deal the ministers are praising was imposed on the provinces by Ottawa

50-50 was the norm well into the 1970s, when the federal government began to weasel its way out of its commitment by replacing the straightforward promise to pay for half of provincial health spending by introducing complex funding formulas.

The upshot is that the federal government now covers less than one-quarter of publicly funded health spending – $30-billion of the $135-billion that comes out of the public treasury. So, actually, federal funding is at a historic low.

The agreement was that Ottawa would provide 50 per cent of costs.

And let’s not forget that the money is being transferred with no strings attached.

Ottawa changed how the money is distributed among the provinces so that it will now be allocated strictly on a per capita basis, with no provision for the fact that delivering health care is more expensive where the population is older and living in remote or rural areas; that means young, fast-growing provinces such as Alberta will get a lot more money, and aging, struggling provinces such as Nova Scotia will get a lot less.

The Conservative government takes the position that health care is uniquely a provincial responsibility. In doing so, it rejects the traditional role of the federal government to level the playing field, to ensure that health services are reasonably comparable for all Canadians, regardless of where they live. In recent years, the disparities in access to care have grown substantially because Ottawa has abdicated that role.

The United Kingdom and Australia consider an 85% acute care bed occupancy rate to be the safe upper limit, according to the OECD. But Campbell, who says the OECD’s figures on Canadian occupancy rates are probably accurate, is not interested in debating appropriate overall rates.

It may come as a surprise that despite these statistics, Ontario Hospital Association president Pat Campbell is not advocating for more hospital beds.

Between 1998 and 2011, the number of all types of hospital beds in Ontario remained “virtually constant at approximately 31,000” while the population increased by 16%, according to a 2011 Ontario Hospital Association document.

Rose says, for example, that occupancy rates in surgical critical care units, characterized by rapid turnover and short stays, should be about 75% to be efficient.

This kind of cooperation could also work when hospital crowding becomes excessive, for example when flu season hits, says Mike Tierney, vice-president for clinical programs at The Ottawa Hospital and one of the editors of Healthy Debate. What is needed is “an ability to look at hospital occupancy

Still, Schull does not advocate for more hospital beds. “It would be a mistake to add beds to a dysfunctional system,” he says.

Occupancy rates matter if you accept the premise that high rates lead to poor access for patients who need to be admitted from emergency departments, notes Michael Schull, an emergency room doctor at Sunnybrook who has published on wait times in emergency and overcrowding risks.

and bed availability across a region in real time, rather than each hospital trying their best to manage on their own

The sobering reality is that Ontario hospitals are tight for capacity largely because of the number of beds occupied by patients, most of them elderly, waiting for admission to another facility (such as rehabilitation or long-term care) or for support to return home.

Administrators at Health Sciences North in Ontario have discovered the benefit of very active cooperation between the 459 bed Ramsey Lake Health Centre (formerly the Sudbury Regional Hospital) and the local Community Care Access Centre (CCAC).

Working together, the result has been a reduction of ALC patients at the health centre from 133 to 78 in the period between September and December 2012, says David McNeil, vice president of clinical services and chief of nursing.

The challenge for the CCAC was to expand its capacity for community-based care, and some funding was received from the province for new programs including behavioural support and mobility programs. For its part, the hospital recruited a new geriatrician, gradually closed beds at the former Memorial Hospital site that had been used for ALC patients, and redirected money towards chronic disease management.

As well, community groups have been engaged “to help them understand that the hospital is no longer the centre of the universe,” McNeil says

There is a crisis in our hospitals - we are dramatically understaffed and under-resourced in terms of both nursing staff and other health-care staff. But rather than trying to beggar their neighbours, we suggest that the RN association focus on working with all nurses and all health-care workers and the local community to increase the staffing of all nurses and health-care workers in Ontario hospitals. That is where CUPE Local 1974 will be putting our energies - and wherever possible we will do this with our registered nurse colleagues. Mike Rodrigues President, CUPE Local 1974

the impact of Liberal health-care policy in southern Ontario is "bad enough." The model Mehra said the province is using to centralize services into fewer communities is especially detrimental to the North. "That doesn't work for the south," she added. "It definitely, in no way, works for Northern Ontario." The state of Northern health care was brought to the floor of Queen's Park this week when, on Wednesday during Question Period, NDP health critic France Gélinas called on the government to stop continued cuts to care in the region. Funding based on volumes doesn't jibe with regional population distributions, Mehra said. "It just doesn't make any sense at all," she said, adding Northern Ontario has many common complaints with small, rural southern Ontario communities.

The coalition argues the entire Ontario system has received short shrift for years and is below the Canadian per capita average by about $350 per person. The provincial Liberals ended a four-year hospital base funding freeze in its latest budget, pledging to spend $60 million on hospital budgets, along with $75 million for palliative care and $130 million for cancer care. The Ontario Health Coalition - and Sault and Area Health Coalition - are not impressed. The local group argues on a regular bases, 22 admitted patients often wait in SAH's Emergency Department for inpatient beds and admitted patients stay in emergency for as long as five days. Patients are lined along hallways on the floors or put in areas that were designed to be stretcher storage areas or lounges with no call buttons, oxygen, out of the nurses' usual treatment areas. Late last month, the Ontario Health Coalition launched an Ontario-wide, unofficial referendum to raise awareness about what it contends is a system in critical condition. The unofficial referendum asks Ontarians if they're for or against the idea: "Ontario's government must stop the cuts to our community hospitals and restore services, funding and staffto meet our communities' needs for care." Ballot boxes will be distributed to businesses, workplaces and community

centres across the province before May 28, when votes will be tallied and presented to Premier Kathleen Wynne. "We have to make it so visible, and so impossible to ignore, the widespread public opposition to the cuts to local public hospitals so the province cannot continue to see all those cuts through," Mehra said. Similar public OHC-led lobbying helped limit and "significantly" change policy in a past Sault Area Hospital bid to usher in publicprivate partnerships (P3s), she added. "The referendum is a way to make that so visible, so impossible to ignore by the provincial government, that we actually stop the cuts," Mehra said. Other speakers Thursday included Sault coalition member Peter Deluca, who spoke of the many challenges his elderly parents have endured thanks to what he dubbed less-than-stellar hospital experiences. "We deserve the truth, we deserve answers, not just political talk," said Deluca, adding concerned citizens must band together in order to prompt change and halt healthcare cuts.

Sharon Richer, of Ontario Council of Hospital Unions/CUPE, said as a Health Sciences North employee, she's seen "first-hand" how cuts affect health care. "There won't be change if we don't make a ripple," she said. Laurie Lessard-Brown, president of Unifor Local 1359, told the meeting of how SAH's recent "wiping out" of the personal support worker classification is wreaking havoc on staff and patients, alike. Registered nurses and registered practical nurse must now pick up the slack, she added. "Morale is lowest I've ever seen," Lessard-Brown said. And, as recent as last Tuesday, Unifor learned of a further four full-time RPN positions being cut while supervisor positions were being added. "Cutting front-line workers is not acceptable," Lessard-Brown said. jougler@postmedia.com On Twitter: @JeffreyOugler © 2016 Postmedia Network Inc. All rights reserved.

Natalie Mehra, Ontario Health Coalition executive director, decries what she describes as the profound lack of funding being divvied out to Ontario hospitals during a town hall meeting Thursday evening, hosted by the Sault and Area Health Coalition at Royal Canadian Legion, Branch 25.

In its 2012 budget, the Harper Conservatives made significant cuts to health care. Health Canada faced reductions of $200.6 million;  the Public Health Agency of Canada planned cuts of $68 million, a reduction of almost 11 per cent;  and the Canadian Institutes of Health Research faced a budget decrease of $45 million

The 2014 federal budget takes yet another run at Medicare. The Harper government is eliminating the equalization portion of the Canada Health Transfer (CHT) and replacing it with an equal per capita transfer.

“This means that less populous provinces with relatively larger and more isolated populations will have more and more difficulty delivering more expensive universal services,” McBane wrote in an article published in The Hill Times in February.

Studies suggest administrative costs make up 20 to 30 per cent of the U.S. healthcare bill. The U.S. had a per capita expenditure on healthinsurance administration in 2011 of $606, compared to Canada at $148. This is neither a cheap nor an effective way of providing health services. Let's not jump on the private-sector bandwagon without thinking this through. Gene Tillman Calgary

w Brunswick has more doctors and more hospital beds per capita than the national average, yet our health outcomes are poorer. In education, we continue to add to the budget but our enrolment has dropped 20 per cent in 15 years and our learning outcomes still trail the pack. Albert Einstein once said the definition of insanity is doing the same thing over and over and expecting different results. That's the point we have reached.

New Brunswick needs different results and it needs new ways of achieving them -- more cost-efficient ways that do not harm the effectiveness of public service delivery. That's what the program review is about and it is time all New Brunswickers got on board for what will be a painful but purposeful ride.

People in the province are getting sicker, she said, noting an aging population and the Conference Board of Canada’s recent D-minus grade and description as being unhealthy and inactive. Newfoundland and Labrador has a per capita health care services spending of more than $5,000 per person, according to the doctor who practices out of Port aux Basques.

Most recently, the government allowed teachers to strike for five weeks before they ultimately surrendered last fall. The wage package they accepted - a 7.25 per cent increase over six years - was essentially the same one the government had been offering throughout most of the negotiations. It remained steadfast that teachers accept the same measly terms to which other public-sector unions had agreed. This brings us to Alberta. Of the many pre-budget signals that Premier Jim Prentice has been sending out, one of the strongest has been to public-sector workers. The rich deals they have struck over the years can't be sustained in the current economy. In fact, Mr. Prentice believes they can't be managed even when the economy improves.

These contracts have always been a pet peeve of provincial governments across the country because of the domino effect they created. Alberta wages for virtually any group - nurses, teachers, doctors, civil servants - have always been the benchmark used by counterpart unions and professional associations elsewhere.

Not only have other provinces been forced to cough up more money than they've wanted to, they've also had to watch many of their top people flee to Canada's version of the United Arab Emirates to earn the kind of living they could never hope for at home. The most recent Statistics Canada numbers from January put Alberta on top for salaries among nurses, teachers and unionized workers generally (which would include the bureaucracy). The latest figures from the Canadian Institute for Health Information also indicate Alberta doctors earn the highest wages in the country.

As Mr. Prentice has pointed out, many of these deals have been achieved only by pillaging oil profits that rightly should have been put aside for future generations. That oil and the riches they produce are not the sole domain of the generation alive today. The Alberta Premier is right: The province has been living beyond its means for years now.

And there is a long-term reckoning on the short-term horizon. The B.C. Premier, meantime, has no doubt Mr. Prentice will use this crisis as an opportunity to get public-sector wages in line with the rest of the country.

"Over the years other [Alberta] premiers have been big spenders on public-sector wage increases and it's been a real problem, especially for B.C., because nurses, doctors, teachers, they all have the chance to go right across that border. "We, on the other hand, have had to go through strikes and our unions have had to swallow a lot of zeroes over the years and yet it's made us more efficient in many areas like health care, where we have the secondleast expensive system in the country per capita and yet we have great health outcomes."

t may sound like bragging, but much of it is true. Now B.C. and the rest of the country will watch as the Alberta government struggles to get control of wage costs that were always too rich for the province's blood.

the job cuts obviously won't be targeted solely - or perhaps at all - at the nursing workforce

Tarjan admitted she thinks health care in the province needs to be "right-sized" but she wouldn't comment on specifics of what she would like to see, except to say that she thinks there is a surplus of acute service

Using a health equity impact assessment tool 1

Surprisingly little attention has been paid to how to improve health care systems across Canada.

Our system was recently ranked 10th out of 11 in a study of OECD countries, outperforming only the United States. Timeliness of care and system efficiency were particular issues.7 Our per capita spending on health care is high so we should be able to improve performance.8

The federal parties have made important, but limited, commitments to improving Canada’s health care system.

Manitobans should hope for cuts, in the right places. Patients in Manitoba suffer longer wait times trying to see a doctor in the ER than in almost all jurisdictions across Canada. The numbers have been repeatedly crunched by the Canadian Institute for Health Information, a national health-care analysis agency. Manitobans wait, on average, 5.7 hours in the ER, compared with the national average of just over three hours. Repeated interventions and promises to cut queues here have failed and the lines are growing longer.

But that might have been expected, since data also show that more patients who need admission onto medical wards are lying in wait in the ER, because (for example) there aren't enough nursing home beds for elderly people ready to be discharged. This may explain why the NDP government's strategy to open quick-care community clinics has not eased the pressure on emergency rooms.

And despite the addition of hundreds of millions of dollars more in the health budget, Manitobans are still waiting too long for services such as knee replacements, ultrasounds or MRIs that are key to getting in to see a specialist and then get surgery, months down the road.

There is room to cut costs in government and public services, to use money more efficiently in smarter ways -- Manitoba spends more per capita, and as a share of its GDP, on health than most provinces. Yet, Mr. Pallister, an MLA in the cost-cutting days of the Filmon era, has chosen to tiptoe around the idea of cutting government expenses in the areas of health and education. He has said no frontline workers will lose their jobs, but that still leaves a lot of room for change.

Manitoba hospitals are run and funded much the way they have been for decades, which suits the institutions' needs, not those of patients. Budgets, for example, are funded basically to match hospital spending in the previous year, with a bit more for inflation or for new programs. Other jurisdictions with as good or better systems (including those in Canada) have moved to tie budgets instead to the volume of services delivered. This helps spur innovation that puts patients at the centre of service. Further, European countries, outperforming Manitoba and Canada's medicare system for quality and cost, have universal systems that blend private and public funding.

The fear of private health care is almost palpable in Canada because Canadians can't see past the U.S. model, which sits next door like an elephant waiting to roll over. But Canada has more in common with, and more to learn from, the European experience, where social-welfare systems are equally strong and tied to national identity.

Mr. Selinger's sacred-cow analogy means he will milk the scare tactics to death. Manitobans need a better prescription for what ails our health system. It's up to opposition parties to start talking about that.

the Manitoba model, which offers the highest-end version of home care in the country: Unionized employees work shifts, allowing patients to receive service up to 24 hours a day, seven days a week.

in Manitoba, where a universal home-care program was created in 1974

There's a high turnover because they aren't paid good wages or benefits

There's no training and little regulation, so that doesn't help either

a spokeswoman for the Department of Social Development said offering home care all the time would also be too expensive

"The implementation of a 24/7 subsidized home support service would definitely be challenging in light of the current fiscal situation of the province," Judy Cole wrote in an email. "We would also have to examine our ability to recruit and train home-support workers to provide round-the-clock service. Home-support agencies would be called upon to revamp their operations to 24/7."

Cole said the province provides up to a maximum of 336 hours a month of home support or about 11.2 hours a day. The cost of the program in New Brunswick is about $120 million a year to serve 8,000 clients. Manitoba, on the other hand, served a monthly average of about 23,000 clients in 2009-2010, the latest figure available. Even taking Manitoba's bigger population into account, it still offers many more seniors home-care services than New Brunswick does on a per capita basis.

A single, provincewide health system is the right structure to tackle the problems facing Alberta. It allows sharing of good ideas and expertise, and fosters co-operation

stop using health spending as a pork barrel

When the province stopped consolidation of ambulance dispatch, for example, it cost money and resulted in longer dispatch times

invest in community care and accommodation for seniors before you promise any more hospital beds

Over the last decade, other provinces invested in these areas, while Alberta's per capita spending to build seniors' accommodation went down

The province needs to open 1,000 seniors' beds every year for the next decade to meet the emerging needs

maintain constraint in collective agreement negotiations

give priority to primary care

encourage self management and community support

continue to pursue efficiency strategies such as equitable funding based on activity

five-year commitment

"Well, that's partly what we're saying," Harper said

"Look, most provinces are already projecting reductions in their own growth rates and health-care spending. But the provinces themselves, I think, are going to have to look seriously at what needs to be done to make the system more cost effective."

the new 10-year funding arrangement will be allocated to the provinces based purely on a per-capita basis, eliminating any consideration for poorer provinces, fragile tax bases or higher costs in remote areas.

Health care has not always been directed through a federal-provincial accord. That practice started in about 1999 with social-union talks that morphed into the more formal 10-year accord of 2004.