Ten or so years from now, we may look back and circle Dec. 19, 2011 as the day our health-care system embarked on a new path. Whether it will ultimately be a good or bad path remains to be seen.
That was the day federal Finance Minister Jim Flaherty dropped a bombshell on his provincial counterparts by informing them they could no longer rely on billions of new dollars in federal funding for health care every year.
Flaherty announced the new policy - which takes effect in 2015 - without any consultation. The finance ministers were shellshocked, since federal funding would drop from six per cent annual boosts to a percentage tied to the nation's economic growth.
Even though it means a likely reduction of only a couple of percentage points, when applied to the massively expensive health-care system the dollars amount to a significant amount. B.C. stands to lose about $250 million a year, while Alberta will see a windfall in excess of $1 billion.
Fast forward to last week, when the country's premiers and territory leaders met in Victoria and stomped their collective feet about the new funding policy.
They are also upset by what they view as Prime Minister Stephen Harper's refusal to even talk about it.
But then a funny thing happened. The premiers did something that probably would not have happened if Flaherty hadn't arbitrarily changed the rules of the game.
The premiers agreed to launch a six-month initiative aimed at doing things better and saving money in three critical areas of the health-care system: scope of practice, human resource management and clinical guidelines. All three areas consume billions of dollars. Finding ways of delivering good health outcomes while saving money is desirable and necessary as treating the population gets ever more expensive.
While Canada has a national health system, how it operates differs from province to province. Rules governing what precise duties doctors and nurses per-form (or don't perform), how much they are paid and what constitutes the proper time for medical intervention can vary depending on the province in which you reside. All of these areas have cost implications.
And clinical guidelines - which set out standard directions and approaches to allow physicians to provide appropriate care for specific conditions - vary in their application from province to province, particularly when it comes to emergency care.
These guidelines not only play a major role in determining health outcomes of patients, they can also have a potentially huge impact on health-care costs. New guidelines are often developed and are shown to be cost-effective while maintaining strong outcomes, (for example, a new examination for ankle injuries called "Ottawa Ankle Rules" was found to improve both quality and timeliness of care for patients; it also saved Ontario about $60 million in unneeded ankle X-rays).
A more uniform approach to clinical guidelines, where provinces spend more time learning from each other and implementing the good ideas that can emerge from changing guidelines, obviously has financial ramifications for provincial health-care systems.
But it's fair to ask whether the premiers would have acted with the same urgency on these issues if Flaherty hadn't served notice he was turning off the tap (or at least significantly reducing the flow) of federal dollars.
The premiers, despite their grousing about Harper not talking to them about health-care funding, now realize they have more power when it comes to setting the standards and rules of the health-care system.
Whether this shift, which directly results from Flaherty's Dec. 19 announcement, ends up paying dividends won't be known for some time. But whether it does or not, a decade from now we may look back and point to that day as the day our health-care system underwent the beginning of a fundamental change.
Keith Baldrey is chief political reporter for Global B.C.
