Professional Documents
Culture Documents
irpp.org
Overview
Current impasse and rationale for bilateral health
agreements
History of use
Extracting policy lessons
Desirability of instrument
Fiscal and and political sustainability
Conclusion
Impasse
Canada Health Transfer (CHT) and
escalator: from 6% to 3% in 2017
Election promise of real change
$3 billion to improve home care
No bilateral health
transfer agreements
Bilateral health
transfer agreements
Tight
Degree of Conditionality
Loose
Past and Future
bilateral health
transfer agreements
Tight
Accountability
Bilateral agreements create an
accountability relationship
between orders of government
But hardly the end of the story
Practical utility of bilateral
agreement depends on:
Nature and degree of oversight
Enforceable sanctions
Clarity and effectiveness of dispute
resolution provisions in event of noncompliance by either party
Amount of information sharing and
transparency afforded the parties
through the agreement
Conditionality
No entitlement: entirely
separate from CHA
Formal opting in through
agreement
Framework set by federal
government
$ envelope
Maximum years
Transparency
Rigorous (independent)
evaluation from beginning
Flexibility
Federalism as a Laboratory of Natural Experiments
Within terms of conditional
framework, agreement can
be tailored to:
Individual P/T priorities,
pressures and policy ambitions
Need to evaluate impact of
different approaches (access,
quality, cost effectiveness,
patient responsiveness, etc.)
10
Fiscal Feasibility
Marginal amount relative to
Canada Health Transfer (CHT)
Far less expensive than the
alternative (>3% CHT escalator)
Fiscally neutral whether done by:
Time-limited CHT top-up
Special purpose transfer or trust
without bilateral agreements
Special purpose transfer or trust
accompanied by bilateral agreements
11
Political Feasibility
P/T arguments and
expectations re: CHT
Log-rolling in other policy
domains (e.g. environment)
P/T desire for money
Qubec
Precedent
Primary Health Care
Transition Fund
Canada Health Infoway
12
Conclusion
Bilateral agreement approach can work in defined areas:
Reforms that are carefully limited (e.g. medically necessary home care
or home care for specified complex conditions)
Innovations that individuals P/Ts willing to invest in but could act as
demonstration effects