The Romanow Report, officially titled Building on Values: The Future of Health Care in Canada, was the end result of a government-sponsored commission created to investigate the state of Canada's public health care system. It proposed a number of sweeping changes to the way health care is administrated, mostly to limit privatisation and the creation of a two-tiered system, and called for a greater degree of government accountability to Canadian citizens whose tax dollars funded the system; all very positive things, with an end goal of preserving health care for future generations. Unfortunately, since the report was completed and tabled in the House of Commons, it seems to have been all but forgotten.
In 2000, Prime Minister Jean Chrétien hired former Saskatchewan premier Roy Romanow to head the Commission on the Future of Health Care in Canada. The commission was created to look into the health care system and the way it was being run; judging by an alarming increase in private diagnostic clinics providing better services to the wealthy, its administration left a great deal to be desired. The commission was then to make suggestions to improve the system and reduce the risk of further privatisation, thus ensuring that health care would not deteriorate any further.
According to the government, the commission was to
... inquire into and undertake dialogue with Canadians on the future of Canada's public health care system, and to recommend policies and measures respectful of the jurisdictions and powers in Canada required to ensure over the long term the sustainability of a universally accessible, publicly funded health system, that offers quality services to Canadians and strikes an appropriate balance between investments in prevention and health maintenance and those directed to care and treatment ...
However, it was common knowledge that Romanow had no intention of completely overhauling the system; rather he intended to restore it to what Tommy Douglas, Canada's own "Father of Medicare", and the Canada Health Act had intended. Recall Trudeau's "just society" campaign of the late 1960s; even after the idealism had faded somewhat by 1984, when the Act that managed health care was formed, the idea that it should apply equally to all was still a governing principle, as evidenced by its "Universality" clause.
The Canada Health Act prohibited extra-billing by doctors and user fees in hospitals to prevent the formation of a two-tiered system where wealthy Canadians could get better and faster treatment than those who couldn't afford to pay. It was mostly successful, but it fell down when it came to diagnostic services: nowhere in the Act was it forbidden that these be privatised, and waitlists in public clinics were (and still are) often months or even years long. With the advent of private for-profit diagnostic clinics, anyone who could pay for it could receive faster diagnosis, essentially queue-jumping and undermining the ideas behind the Act if not the letter of it.
This was why the Romanow Commission was necessary; even though the health care system was still mostly fine, more and more companies and private investors were finding ways to get around the Canada Health Act, and it could only get worse.
The commission was given a $15 million budget to work with, to span an 18-month period from April 2001 to November 2002. $1.3 million was set aside for "dialogue with citizens", to determine the public's view on health care; $2.4 million was earmarked for professional analysis, mostly conducted in universities.
Public input was a key part of the commission's research. Three weeks of public hearings in eighteen Canadian cities, 640 formal submissions from the public, seven thousand letters received, forty papers prepared for discussion, and forty-five speeches from Romanow made across the country ensured that the voices of average Canadians were heard. After a year and a half of touring around the country and writing furiously, the commission's final report was ready on schedule.
Spanning 392 pages, the Romanow Report was divided into twelve chapters, each focussing on a different aspect of the health care issue:
Sustaining Medicare. This chapter cites public input which proves that most Canadians support a public health care programme. In light of this, it calls for both increased financial and political commitment from the federal government.
Health Care, Citizenship, and Federalism. Serving as an introductory chapter to the rest of the Report, here the major recommendations are introduced, to be explained in greater detail in later chapters.
Information, Evidence, and Ideas. Here was the first concrete suggestion for improvement of public health care: better management of health records, likely through electronic systems, to increase the efficiency of the programme.
Investing in Health Care Providers. Here Romanow points out the severity of the problem of a shortage of doctors and nurses. A historical background is included in his analysis.
Primary Health Care and Prevention. Another recommendation, this time for increased focus on "wellness" and preventative medicine to ultimately save money and keep Canadians in better health. Currently, this is not a key focus of Medicare; Romanow's proposal would mean radical reforms.
Improving Access, Ensuring Quality. This chapter focuses on the lengthy waiting periods before medical services can be obtained, and the sometimes dubious quality of care received once one reaches the head of the queue. Access to appropriate medical services is also addressed; this is a concern which for the most part is specific to rural Canada, where the nearest hospital is sometimes hundreds of kilometres away.
Rural and Remote Communities. A continuation of the previous chapter. Here, Romanow identifies disparity between urban and rural health care services and availability as an issue that must be dealt with.
Home Care: The Next Essential Service. Home care is often necessary for sick Canadians, but the Canada Health Act does not include it in its list of services deemed to be essential (and therefore paid for). This chapter recommends that the Act be amended to incorporate it.
Prescription Drugs. More recommendations; this chapter calls for the creation of a national standard pertaining to prescription drugs, including a National Drug Agency and provisions to cover "catastrophic drug costs".
A New Approach to Aboriginal Health. The First Nations people in Canada are undeniably marginalised; as with nearly everything else, a disparity exists in the health care that they receive as compared with the health care received by Canadians of non-Aboriginal descent. Romanow presents a new viewpoint with the aim of improving on these inequalities.
Health Care and Globalisation. The penultimate chapter examines changes that must be made to Canada's health care in order for it to survive in an international context.
Recommendations. This is the last chapter of the Report, and it contains the meat of the project: things that Romanow and his commission feel should be done in order to preserve Medicare. In total there were forty-seven recommendations made, covering nearly all facets of the system.
The Report calls for a $15 billion dollar increase in health care funding by 2006; in 2002 when the report was tabled, a budget surplus meant that increased taxation would not be necessary, at least not immediately, to cover the extra funding. It also recommended that the federal government's share of health care costs should never make up less than a quarter of the total expense.
On an administrative level, Romanow called for the creation of a Health Council of Canada to oversee the implementation of the Report's recommendations. This would also see the creation of a set of nationalised standards and benchmarks to ensure equality between provinces.
It was also recommended that the Canada Health Act be amended to include new areas, as discussed in the Report: home care, coverage for mental health patients, day surgery expenses, palliative care, more comprehensive coverage for prescription drug costs, and diagnostic services would all be incorporated into the Act, under the Report.
Romanow also suggested that a system of electronic personal health records be implemented. The problem of Aboriginal health care would be solved by the creation of Aboriginal Health Partnerships, to provide better services tailored to specific needs. Preventative steps would be taken to promote general health and well-being; an anti-smoking campaign would be undertaken in earnest, and programmes to curb rising obesity rates would also be implemented.
The final recommendation was that a National Health Summit be held, where all of the issues pertaining to health care could be brought forward and more solutions discussed.
The Romanow Report met with a mostly positive response from the public; this is unsurprising, as most of the recommendations stemmed from the public's very vocal desire to preserve the system. Politicians have brought forward two major concerns with the Report, calling its merit into question: funding for the proposed changes, and federal versus provincial control of health matters.
Health care has always been a provincial matter. Alberta, Quebec, and Ontario have voiced the concern that Romanow's proposals and the creation of national standards would allow the federal government to encroach too far onto provincial territory; besides, they claim, the provinces are more aware of their own health needs than the federal government could ever be.
This is a reasonable point, though a relatively minor one. The benefits of implementing Romanow's recommendations would far outweigh this disadvantage. However, the biggest obstacle to getting provincial support is the question of federal funding. The report was tabled in the House of Commons on November 28, 2002; only days afterward Prime Minister Chrétien indicated that the federal government could not meet Romanow's funding standards, even with a budget surplus.
Another criticism of the Romanow Report is that it fails to recognise gender differences and the specific needs of women's health programmes, despite its recognition of Aboriginal needs. This is a surprising omission, as women make up the majority of those who receive health care benefits and also the majority of those whose medical needs fall outside "essential services" under the Canada Health Act and therefore are not covered.
The release of Romanow's report followed a smaller-scale investigation into health care by a Senate committee led by Senator Michael Kirby in autumn of 2002. The conclusions drawn by the two reports were vastly different.
Where Romanow called for the preservation of a publicly-funded system, the Kirby report has been vilified as promoting privatisation and undermining the integrity of Medicare as a public institution. Despite its call for increased federal funding to health care via increased taxation, Kirby's report also suggested that patients who could not receive timely medical services receive care in the United States, to be paid for by the government.
This again seems reasonable, but it opens the door for privatised clinics, particularly the for-profit diagnostic services that Romanow strived to avoid. The competition that naturally arises when medical services must be paid for whether by a government or by insurance might well force Canada to open its borders to American medical corporations and pharmaceutical companies, in accordance with the North American Free Trade Agreement. This in turn would endanger Medicare as it stands, and make private medical insurance all but necessary.
The Kirby report was met with far more cynicism than was Romanow's work.
Nearly two years later it remains an unsolved issue. The Romanow Report is still occasionally brought up in the media, but few if any of its recommendations (with the notable exceptions of increased funding for home care and drugs) have been implemented on any meaningful level.
Sources:
Romanow, Roy J., Q.C. Commission on the Future of Health Care in Canada. Health Canada.
http://www.hc-sc.gc.ca/english/care/romanow/index1.html
"Boost taxes to cure health care: Senate report". CBC News, 26 October 2002.
http://www.cbc.ca/stories/2002/10/25/kirbyreport_021025
"Kirby opens back door to privatisation of health care". Council of Canadians. October 2002.
http://www.canadiandimension.mb.ca/extra/d1101gc.htm
"Kirby's report greeted with cynicism, optimism". CBC News, 29 October 2002.
http://www.cbc.ca/stories/2002/10/25/kirbyreact
More About the Romanow Report. Friends of Medicare.
http://www.keepmedicarepublic.ca/romanow/about.shtml
"Recommendations". Canadian Centre for Cyber Citizenship.
http://www.mapleleafweb.com/features/medicare/romanow/part_1/recommend.html
"Romanow Hears the Call to Care". Canadian Health Coalition.
http://www.healthcoalition.ca/romanow-report.html
"Romanow's Mission". Canadian Centre for Cyber Citizenship.
http://www.mapleleafweb.com/features/medicare/romanow/part_1/mission.html
"Romanow Report Proposes Sweeping Changes to Medicare". 28 November 2002.
http://www.hc-sc.gc.ca/english/care/romanow/hcc0403.html
"Romanow Report Contents". Canadian Centre for Cyber Citizenship.
http://www.mapleleafweb.com/features/medicare/romanow/part_1/content.html
"The Commission and its Process". Canadian Centre for Cyber Citizenship.
http://www.mapleleafweb.com/features/medicare/romanow/part_1/commission.htm
The Health of Canadians: The Federal Role. The Standing Senate Committee on Social Affairs, Science and Technology. October 2002.
http://www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.htm
"The Matter at Hand". Canadian Centre for Cyber Citizenship.
http://www.mapleleafweb.com/features/medicare/romanow/part_1/matter.html
Cheers to anthropod for alerting me to failings and prodding me in new directions. | 
