Senate committee recommends that 9% of proposed new federal surtax go to CIHR

The Canadian Institutes of Health Research (CIHR) would be the third largest beneficiary under a proposed new federal surtax on health care. If approved by Parliament, the agency’s share of the surtax would boost its budget by $440 million annually. In a report released October 25, the Standing Senate Committee on Social Affairs, Science & Technology recommends that 9% of the $5 billion raised from the new surtax go to CIHR, boosting its funding from $592 million this year to more than $1 billion. It would amount to the single largest disbursement under the so-called National Health Care Insurance Premium, after post-hospital home care ($550 million) and catastrophic drugs ($500 million).

Predictable and stable funding for the CIHR appears likely, even if the surtax is not introduced. The ruling Liberals have already committed to boost funding for extramural health research to 1% of health care spending. They just haven’t announced when the new money will begin, or how it will be funded.

CIHR president Dr Alan Bernstein says the additional funding, which could be ramped up over three-to-five years, would enable the granting council to kickstart the second half of its mandate. “We haven’t really in a major way yet begun the second half of our mandate from Parliament, which is to do knowledge translation,” he says. “We’ve started to think about it and develop some programs on paper, but that easily could be a $500-million endeavour, and turn Canada into a leader in turning health research into action.”

One such initiative, revealed in CIHR’s submission to the Innovation consultation process, would see “Centres for Health Innovation” established across the country. These interdisciplinary centres, involving CIHR institutes, Health Canada, provincial governments, industry and health charities, would focus on disease, population groups, or broad S&T or health services platforms. Centres would be selected through competitive review.

How much Canadians would pay under the proposed premium would depend on how much they earn. The surtax would range from $185/year for individuals earning less than $31,677, to $1400/year for those earning over $103,000. Of $4 billion raised, 30% would be spent on expanding public health care coverage and on health promotion and disease prevention. Another 40% would go to doctors and hospitals, and to boost enrolment in health care professions. About 10% would be directed to health research, outcome evaluation and performance reporting. The remaining $1 billion would be for contingency, reflecting the uncertainty in forecasting health costs.

Since CIHR’s new funding would come from this premium, Senator Dr Yves Morin says it’s important that it be spent on research that improves health care quality and delivery for Canadians. The report states that research in population health, health services delivery, clinical practice guidelines, early child development and women’s and Aboriginal health “should be given the highest priority”.

“If we ask (Canadians) to pay for this research, they should have some assurance that it will have an impact on their health, on health care and on health promotion,” says Morin, a member of the committee and a former dean of Laval Univ’s medical faculty. “We’re not putting strings on this (new money), but we think it’s important and preferable that it focus on these areas because Canadians would be paying under a very specific premium that is earmarked for health care delivery.”

The report, entitled The Health of Canadians – The Federal Role: Recommendations for Reform, is the sixth in a series of reports produced on the health care system. The chapter on health research includes more than 30 recommendations, most of which were tabled in the committee’s previous report (R$, May 22/02). The call for $440 million in new CIHR funding, and the introduction of a health care surtax are among the new recommendations. Other recommendations include:

• That health research and its translation into the health care system be routinely on the agendas of federal and provincial ministers and DMs of health

• That the federal government work with CIHR and Health Canada to develop a strategy to encourage the interchange of research scientists between government, academia, the private sector, and voluntary organizations

• More financial and human resources in health research at Health Canada

• Increased resources to the Global Health Research Initiative (<a class="micro" href="http://">R$, Jan 23/02)

ETHICS IN HEALTH RESEARCH

About a third of the committee’s recommendations pertaining to health research focus on the complex issue of research involving human subjects. “This is one area where I think we’re lagging behind the US,” says Morin. “I think there are major problems, and we really need to move quickly.”

The committee’s main concern is with some 300 local research ethics boards operating in universities, government labs, community organizations and hospitals. These review boards have the power to approve, reject or terminate any clinical research project in their institution involving human subjects. But as the committee points out, there is “no process of certification, accreditation or regular inspection” to ensure compliance with these standards.

“The first thing we need is a process for standards and then accreditation,” says Morin. “We should start with the research that the federal government performs itself, funds through its councils, and uses in its regulatory processes.” The report recommends that Health Canada take the lead in developing this joint governance structure.

ROMANOW REVIEW

The Senate report comes just a month before Roy Romanow is to release his own report on the future of Canada’s health care system. Bernstein says he and several of CIHR’s scientific directors have met with Romanow to stress the importance of health research to a strong health care system.

One senior source suggests the Romanow report will draw heavily from the Senate committee’s report when drafting its recommendations for health research.

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