PRIMARY CARE IN ONTARIO

Primary care in Ontario, Canada

Primary care in Ontario, Canada

Introduction

The history of the development of mental health services in Canada parallels that of Great Britain, France, and to a lesser extent, the United States of America. Beginning in the 1830s, when county asylums were built in Great Britain, many jurisdictions in British North America, which was to become the Dominion of Canada, were starting to build their own places of refuge or “asylums” for the mentally ill. As “asylums” grew, they could not keep pace with the flood of admissions (Leiter, 2008). Eventually, overcrowding and the deteriorating conditions in the asylums made it difficult to use “moral therapy,” an influential, benign treatment modality for the mentally ill popularized by Quakers. Crumbling, overcrowded, and understaffed asylums became scarcely better than the infamous “madhouses” of Europe.

Establishment of the Romanow Commission

In April 2001 Prime Minister Jean Chrétien appointed former Saskatchewan Premier Roy Romanow as a one-man Commission on the Future of Health Care in Canada. Romanow reported directly to the Prime Minister. He started his work on May 1, 2001 and the final report of the Commission was tabled in November 2002.

Romanow Commission Terms of Reference

Supported by a small secretariat, Mr. Romanow was given the task of looking at the long-term challenges of maintaining a public, universal health care system in Canada - including changing demographics, rising costs, and new technologies - and recommending government policies and programs to balance health maintenance with health care and treatment.

The Romanow Commission was expected to build on the September 2000 Health Agreement endorsed by the Prime Minister and the provincial and territorial premiers, which included a federal infusion of funds to help with the medium and short-term pressures on the Canadian health care system. It was also expected that the Romanow Commission would draw on the work of recent provincial commissions, such as the Clair Commission in Quebec and the Fyke Commission in Saskatchewan (Leiter, 2008).

Romanow Commission Hearings

The first nine months of Romanow's mandate were spent on fact-finding and public education. In February 2002, the Romanow Commission released an interim report to be used as the basis for a dialogue with Canadians.

The public hearings phase of the Romanow Commission began in March 2002, as the Commission crossed the country to consult with Canadians face to face in 18 cities. Romanow's consultations included provincial and territorial governments, health professionals, stakeholders and concerned Canadians.

Romanow made it clear that Medicare in Canada needed "remodeling but not demolishing." He asked Canadians to identify what they wanted and expected from the health care system, and what they and politicians had to do to meet those objectives.

The First Ministers' Accord on Health Renewal

On February 5, 2003, the Prime Minister and Premiers of seven provinces signed an agreement, the First Ministers' Accord on Health Care Renewal, outlining the direction of public healthcare in Canada in the near future. The Accord addressed several key issues in healthcare, namely prescription drug coverage, home care, diagnostic services, timeliness of care and primary healthcare ...