Federal-provincial relations exclude social issues in health care policy. (Health).

ST. CATHERINES, ON -- Current federal-provincial health care relations not only undermine the ability of those governments to engage in dynamic policy changes but also exclude crucial social issues from the health care policy debate states Candace Johnson Reddler in a discussion paper presented to the Commission on the Future of Health Care in Canada.

In her paper, Health Care Politics and the Intergovernmental Framework in Canada, Johnson Reddler contends that while current intergovernmental relations has helped to create a "stable and efficient set of arrangements for health care", they have not been entirely successful in developing an effective system.

The author asserts that the very stability of federal-provincial relations and the efficiency produced from those relations are a constraint to much needed change. She also argues the many macro-level policy discussions that would improve the health care system do not occur due to federal-provincial disagreements and deadlock, Many of those disagreements are directly linked to the fiscal arrangements between the provinces and the federal government, whereby the provinces are concerned about securing appropriate funding and autonomy in policy making, while the federal government is concerned about cost control and national standards of service as outlined in the Canada Health Care Act.

To rectify this situation Johnson Reddler suggests a more harmonious federal-provincial relationship. An improved relationship would produce more macro-policy discussions which, in turn, might create "more wide-spread and successful innovation in the system".

In addition, she notes that social issues, such as social rights, civil society and bioethics, which are often excluded from the health care debate, are the very issues that demonstrate the breadth of the heath care policy field. The impact of acknowledging these social issues by the provinces and the federal government, might, in fact, provide a clarity to the existing process of federal-provincial decision making. A process, she claims, "overshadows many issues relevant to health care and eclipses substantive policy issues".

www.healthcarecommission.ca