The provincial premiers are asking that the Prime Minister meet with them so that they can negotiate more money targeted to healthcare innovation (Ottawa Citizen). The reality is that the provincial premiers have it in their grasp to lead healthcare innovation and have not taken ownership in leading the effort. They have continually diverted the issue to the federal government funding formula instead of make advances.

The provinces fund 80% of the healthcare expenditures whereas the federal government contributes 20%. Whether the federal government adds another few percentage points to the funding formula will not change the reality that the provinces have the majority share. It is up to the provinces to lead the innovation in healthcare. To paraphrase Prime Minister Harper, I want to see “what their plan and their vision really is to innovate and to reform”. It is not a money discussion but a leadership issue where the prime responsibility lies with the provincial premiers.

Where can we look for innovation in the healthcare system? Two thirds of Canadian healthcare expenditures are in three areas. I offer some ideas on reforming them.

Hospitals. Hospitals need the most modern health care delivery systems. Yet there has been little progress on basic issues like electronic health records to help streamline administration.

Physician Salaries. There are reports on the performance of the healthcare system but only from a hospital delivery point of view. It is time that the performance of physician based health care delivery be examined. Like many other professions, they can be required to report on performance metrics and be asked to improve them.

Drug Costs. Each province has their own formulary for approved medicine pricing. Some provinces will only allow generics to be sold at 25% of the innovator price while other allow 54%. Collaboration instead of redundancy and competition for drug availability would lower drug costs.

Each one of these categories requires not only innovative solutions but collaboration amongst the provinces. By banding together to move on these issues, instead of crying for more money from the feds, they would show leadership in establishing a sustainable healthcare system for Canadians.