royal commission on the future of health care in canada royal commission on the future of health care in canada the royal commission on the future of health care in canada, also known as the romanow report, is a committee study led by roy romanow on the future of health care in canada. it was delivered in november 2002. commission on the future of health care in canadaalso known asromanow reportcommissionerroy j. romanowinquiry period3 april 2001 (2001-04-03) – november 2002 (2002-11)authorizedorder in council p.c. 2001-569final report romanow recommended sweeping changes to ensure the long-term sustainability of canada's health care system. the proposed changes were outlined in the commission's final report, building on values: the future of health care in canada, which was tabled in the house of commons on 28 november 2002. although the report of the royal commission dealt with a wide range of issues, much of the early attention was paid to the recommendations with respect to the financing of health care in canada and especially transfers from the federal government to provincial and territorial governments. the report set the stage for another round of federal-provincial/territorial bargaining leading to a significant agreement in september 2004 whereby the government of canada agreed to transfer an additional $41 billion over the next 10 years in support of an action plan on health. the new funding is meant to strengthen ongoing federal health support provided through the canada health transfer (cht) as well as focus resources on addressing the fact that canadians, like citizens in other oecd countries, often have significant wait times for access to essential health care services. issues highlighted by the romanow report aboriginal issues the report identifies significant problems in the way that aboriginal health is managed. surprisingly, this is largely not due to a lack of funding; there is simply a mismanagement of assets. funding sources are fragmented and there is no established system to provide care. in addition, there are extensive equity concerns due to this fragmentation of funding and differential care available to different aboriginal communities. as a result, the report suggests that new administration procedures be put in place. integration of on-reserve healthcare into the current system is not a popular option amongst aboriginal leaders, although serves as a reasonable option for urban aboriginal healthcare. specifically, the report suggests the formation of aboriginal partnerships that are an administrative authority composed of representatives from different levels of government and the aboriginal community. these partnerships may work in a method similar to a regional health authority. they will serve as an organization with a specific health goal, such as organizing the public health and primary care for a community. the partnership will be granted federal funds to pursue these health goals in a manner that partnership executives agree upon. aboriginal representation in the partnership ensures that these services are fitting with the cultural needs of the aboriginal community. partnerships will also interface with the existing health system to coordinate access to resources such as diagnostics and specialized care. in an urban setting, the partnership will serve as a voluntary health organization that coordinates access to specific health facilities such as primary care and diagnostics. the partnership will have similar representation from aboriginal community ensuring that services provided in the urban environment are still sensitive to aboriginal cultural and linguistic concerns. partnerships are especially needed in urban settings due to the specific needs of urban aboriginals for problems such as diabetes and addiction. furthermore, partnerships may serve as an additional urban community organization that interfaces with other such aboriginal organizations to serve as activists for the socioeconomic status of aboriginals. an important point stressed by the romanow report is that healthcare initiatives must be accountable towards the taxpayer and consumer. aboriginal health is no different; partnerships must be closely monitored and their effect on health outcomes determined. changes in policy may be necessitated as this is a new approach. romanow's recommendations the conclusion of the report set out 47 recommendations along with a timetable for their implementation. recommendation 1 – a new canadian health covenant should be established as a common declaration of canadians’ and their governments’ commitment to a universally accessible, publicly funded health care system. to this end, first ministers should meet at the earliest opportunity to agree on this covenant. recommendation 2 – a health council of canada should be established by the provincial, territorial and federal governments to facilitate co-operation and provide national leadership in achieving the best health outcomes in the world. the health council should be built on the existing infrastructure of the canadian institute for health information (cihi) and the canadian coordinating office of health technology assessment (ccohta). recommendation 3 – on an initial basis, the health council of canada should: establish common indicators and measure the performance of the health care system; establish benchmarks, collect information and report publicly on efforts to improve quality, access and outcomes in the health care system; and coordinate existing activities in health technology assessment and conduct independent evaluations of technologies, including their impact on rural and remote delivery and the patterns of practice for various health care providers. recommendation 4 – in the longer term, the health council of canada should provide ongoing advice and coordination in transforming primary health care, developing national strategies for canada’s health workforce, and resolving disputes under a modernized canada health act. recommendation 5 – the canada health act should be modernized and strengthened by: confirming the principles of public administration, universality and accessibility, updating the principles of portability and comprehensiveness, and establishing a new principle of accountability; expanding insured health services beyond hospital and physician services to immediately include targeted home care services followed by prescription drugs in the longer term; clarifying coverage in terms of diagnostic services; including an effective dispute resolution process; and establishing a dedicated health transfer directly connected to the principles and conditions of the canada health act. recommendation 6 – to provide adequate funding, a new dedicated cash-only canada health transfer should be established by the federal government. to provide long-term stability and predictability, the transfer should include an escalator that is set in advance for five year periods. recommendation 7 – on a short-term basis, the federal government should provide targeted funding for the next two years to establish: a new rural and remote access fund; a new diagnostic services fund; a primary health care transfer; a home care transfer; and a catastrophic drug transfer recommendation 8 – a personal electronic health record for each canadian that builds upon the work currently underway in provinces and territories. recommendation 9 – canada health infoway should continue to take the lead on this initiative and be responsible for developing a pan-canadian electronic health record framework built upon provincial systems, including ensuring the interoperability of current electronic health information systems and addressing issues such as security standards and harmonizing privacy policies. recommendation 10 – individual canadians should have ownership over their personal health information, ready access to their personal health records, clear protection of the privacy of their health records, and better access to comprehensive and credible information about health, health care and the health system. recommendation 11 – amendments should be made to the criminal code to protect canadians’ privacy and to explicitly prevent the abuse or misuse of personal health information, with violations in this area considered a criminal offense. recommendation 12 – canada health infoway should support health literacy by developing and maintaining an electronic health information base to link canadians to health information that is properly researched, trustworthy and credible as well as support more widespread efforts to promote good health. recommendation 13 – the health council of canada should take action to streamline technology assessment in canada, increase the effectiveness, efficiency and scope of technology assessment, and enhance the use of this assessment in guiding decisions. recommendation 14 – steps should be taken to bridge current knowledge gaps in applied policy areas, including rural and remote health, health human resources, health promotion, and pharmaceutical policy. recommendation 15 – a portion of the proposed rural and remote access fund, the diagnostic services fund, the primary health care transfer, and the home care transfer should be used to improve the supply and distribution of health care providers, encourage changes to their scopes and patterns of practice, and ensure that the best use is made of the mix of skills of different health care providers. recommendation 16 – the health council of canada should systematically collect, analyze and regularly report on relevant and necessary information about the canadian health workforce, including critical issues related to the recruitment, distribution, and remuneration of health care providers. recommendation 17 – the health council of canada should review existing education and training programs and provide recommendations to the provinces and territories on more integrated education programs for preparing health care providers, particularly for primary health care settings. recommendation 18 – the health council of canada should develop a comprehensive plan for addressing issues related to the supply, distribution, education and training, remuneration, skills and patterns of practice for canada’s health workforce. recommendation 19 – the proposed primary health care transfer should be used to “fast-track” primary health care implementation. funding should be conditional on provinces and territories moving ahead with primary health care reflecting four essential building blocks – continuity of care, early detection and action, better information on needs and outcomes, and new and stronger incentives to achieve transformation. recommendation 20 – the health council of canada should sponsor a national summit on primary health care within two years to mobilize concerted action across the country, assess early results, and identify actions that must be taken to remove obstacles to primary health care implementation. recommendation 21 – the health council of canada should play a leadership role in following up on the outcomes of the summit, measuring and tracking progress, sharing information and comparing canada’s results to leading countries around the world, and reporting to canadians on the progress of implementing primary health care in canada. recommendation 22 – prevention of illness and injury, and promotion of good health should be strengthened with the initial objective of making canada a world leader in reducing tobacco use and obesity. recommendation 23 – all governments should adopt and implement the strategy developed by the federal, provincial and territorial ministers responsible for sport, recreation and fitness to improve physical activity in canada. recommendation 24 – a national immunization strategy should be developed to ensure that all children are immunized against serious illnesses and canada is well prepared to address potential problems from new and emerging infectious diseases. recommendation 25 – provincial and territorial governments should use the new diagnostic services fund to improve access to medical diagnostic services. recommendation 26 – provincial and territorial governments should take immediate action to manage wait lists more effectively by implementing centralized approaches, setting standardized criteria, and providing clear information to patients on how long they can expect to wait. recommendation 27 – working with the provinces and territories, the health council of canada should establish a national framework for measuring and assessing the quality and safety of canada’s health care system, comparing the outcomes with other oecd countries, and reporting regularly to canadians. recommendation 28 – governments, regional health authorities, health care providers, hospitals and community organizations should work together to identify and respond to the needs of official language minority communities. recommendation 29 – governments, regional health authorities, and health care providers should continue their efforts to develop programs and services that recognize the different health care needs of men and women, visible minorities, people with disabilities, and new canadians. recommendation 30 – the rural and remote access fund should be used to attract and retain health care providers. recommendation 31 – a portion of the rural and remote access fund should be used to support innovative ways of expanding rural experiences for physicians, nurses and other health care providers as part of their education and training. recommendation 32 – the rural and remote access fund should be used to support the expansion of telehealth approaches. recommendation 33 – the rural and remote access fund should be used to support innovative ways of delivering health care services to smaller communities and to improve the health of people