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Foreword: Looking for answers, achievements and accountability
The Health Council of Canada’s first annual report to Canadians focused on access; in the second, we zeroed in on quality. This year, the Council believes it is time to examine our collective capacity to measure the performance of health care systems across the country and to suggest ways to strengthen transparency and accountability in health care. Four years after the 2003 First Ministers’ Accord on Health Care Renewal – and following the infusion of billions of dollars in federal health transfers as well as provincial and territorial investments – how far has health care renewal advanced? It is difficult to make global statements about the extent to which health care renewal is taking root because the pace of progress varies by sector and jurisdiction. We do, however, have some good news to report. The country has been awash in announcements as initiatives from the health care agreements proceed. Work on wait times and primary health care reform, for instance, is beginning to bear fruit. Enrolments in medical and nursing schools are up everywhere, and health care providers are beginning to be educated in a way that encourages them to break down professional silos and focus on the patient. Jurisdictions are getting on board – across the board – with healthy living strategies. However, to answer questions about the strength and sustainability of health care renewal, too often we have to rely more on anecdote than evidence. We are unable to specify where the provinces and territories are investing funds from the federal health care agreements because no financial breakdowns are provided. And in important areas, like catastrophic drug coverage, health inequalities, and the health status of Aboriginal peoples, we know we are missing the mark. After three years of monitoring commitments from the 2003 and 2004 health care agreements, it is clear that the accuracy and precision of our reporting to Canadians depends on several factors:  | the capacity of hard-working governments to report in a transparent and meaningful way on health care spending and results;
| | the clarity, comprehensiveness and utility of the questions being posed and the quality of the responses received; and
| | the capacity of data collection systems across this country to provide the comparable and comprehensive data needed to draw conclusions from a national perspective. |
It is troubling that First Ministers have not reported this year on comparable health indicators as agreed in the 2003 accord and disturbing that the federal/provincial/territorial (F/P/T) committee that oversees this work has been disbanded. Data were posted on the website of the Canadian Institute for Health Information in late December, and Health Canada has produced a federal level report, but provincial/territorial reports have not been created. This falls short of agreement commitments. To evaluate the promise of accountability that heralded the health care agreements, the public needs a more detailed and transparent account of how historic investments have helped strengthen the health of the system and the people it serves. According to a companion document being released with this year’s report, Canadian Perceptions of the Health Care System, the vast majority of Canadians “believe that five years or less is a reasonable time frame within which to expect to see real change in Canada’s health care system.” As the Health Council of Canada heads into the fourth year of our first five-year mandate, we call on governments, providers and policy makers to create mechanisms to facilitate the collection and reporting of high-quality, standardized data to strengthen accountability and guide decision-making to improve health and health outcomes. Jeanne Besner, RN, PhD
Interim Chair, Health Council of Canada
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Foreward 
