The federal government is offering the provinces and territories a health funding deal worth $196.1 billion over 10 years, including $46.2 billion in new money.
But the premiers say the plan appears to offer less money than they were looking for, especially in the first year of the proposed deal.
“One of the things that we did see today is that there wasn’t a lot in the way of new funding that is a part of this package… to say the least I think we were a little disappointed in that,” Manitoba Premier Heather Stefanson said in reaction to the federal government’s proposal Tuesday.
She said premiers need to take time to digest the details and what they would mean for individual provinces and territories.
“What we see this as is a starting point, and so it’s a down payment on further discussions,” Ontario Premier Doug Ford added.
“I always look at the glass as half-full… I’ll never refuse new funding, but let’s see, once we all absorb it and we go back and back home and we’ll have questions.”
Quebec Premier Francois Legault said premiers need to have more conversations with the federal government to see whether there is any room for negotiation on the terms, especially when it comes to amounts that have been offered.
The proposed financial package, unveiled Tuesday, includes a number of elements, some of which are tied to conditions that would see provinces continue investing their own dollars into health care and move forward on a number of key priorities.
Speaking to reporters after the meeting, Prime Minister Justin Trudeau said negotiations on how provinces will fund those priorities would be held “within this envelope” of the proposal — appearing to suggest there was little to no wiggle room on the amount of money being offered by Ottawa.
“This is the offer we put forward on the table,” he said.
“This is the billions of dollars that are there for provinces, and we certainly look forward to working with them to be able to deliver not just that money, but those health care improvements to citizens across the country.”
Proposed increase to the Canada Health Transfer
The first priority measure would see an immediate, unconditional $2 billion top-up to the annual Canada Health Transfer (CHT) to the provinces to address immediate pressures in the health-care system.
This money is meant to relieve significant strains being experienced in pediatric hospitals and emergency rooms, and long wait times for surgeries.
Federal officials say legislation will be tabled before the end of March to see this money flow as quickly as possible within the current fiscal year.
The federal government is also proposing a change to the CHT formula, which currently sees health funding to the provinces increase to either match the rate of GDP growth or three per cent every year — whichever is greater.
The Liberals are offering to increase that three-per-cent escalator to five per cent for the next five years, which will be provided to provinces and territories through annual top-up payments.
The last top-up payment would then be rolled into the base amount of the annual CHT at the end of the five years to ensure a permanent funding increase.
The federal government estimates this measure would provide an additional $17.3 billion over 10 years in new support.
To access this funding measure, provinces and territories will have to sign an agreement with the federal government to improve how health data is collected, shared and used to improve transparency and better identify needs and gaps in services.
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The offer to increase the CHT formula addresses part of what the premiers were asking for in their request for a five-per-cent escalator, Legault acknowledged Tuesday.
But some of the premiers expressed dismay at not seeing the $28 billion boost to the base amount of funding provinces receive through annual health transfer that premiers have been demanding for the last two years.
“The $28 billion, of course, was an injection that we were looking for in the first year to get us up to the 35 per cent (funding) on the part of the federal government, and what we see from this is — it’s actually less than than $5 billion,” Stefanson said.
“So that’s the comparative it’s significantly less than what we were looking for in terms of the baseline funding injection into the Canada Health Transfer.”
British Columbia Premier David Eby also called the offer “fiscally limited.”
Trudeau dismissed those criticisms, calling Ottawa’s offer “a massive investment” for both current and future health-care needs.
He stressed provinces and territories will have flexibility to negotiate how much of the federal money will go to certain priorities, and that those legislatures will have to step up with their own money as well.
“We looked at our fiscal framework, we looked at the needs of the provinces, and there are a number of provinces who are actually looking at a budget surplus,” he noted in French.
$25 million in bilateral deals focused on key priorities
As part of its proposed new spending, Ottawa is also offering $25 billion in new money over 10 years in bilateral deals that will be tailored to the individual needs of the provinces and territories.
However, this money would need to go toward investments in four priority areas, including: improved access to family health services; addressing health worker shortages through recruitment, retention, training and recognition of foreign credentials and multi-jurisdictional licensing; better access to mental health and substance use treatment and improvements to long-term care and home care.
As part of these agreements, provincial and territorial governments will be asked to develop action plans that will describe how funds will be spent, including how this compares to existing spending, and they will have to detail how progress will be measured.
Ottawa says provinces will have flexibility in designing their action plans, including the addition of targeted results with indicators tailored to the unique needs and circumstances of their individual jurisdictions.
These action plans with targeted results and indicators will be made available publicly by both federal and provincial and territorial governments.
Underpinning all of these priorities is the need to modernize health data to measure and report on annual progress, federal officials said Tuesday.
Included in its desired list of metrics for enhanced data, the federal government wants all levels of government to measure:
- The percentage of Canadians who report having access to a regular family health team, a family doctor or nurse practitioner
- Sizes of COVID-19 surgery backlogs
- Net numbers of new family physicians, nurses and nurse practitioners
- Percentages of youth aged 12-25 with access to integrated youth services for mental health and substance use
- Median wait times for community mental health and substance use services
- The percentage of Canadians with a mental disorder who have an unmet mental health care need
- Percentages of Canadians who can access their own comprehensive health record electronically
- Percentages of family health service providers and other health professionals such as pharmacists and specialists, who can share patient health information electronically.
The federal government says it will provide $505 million over five years to the Canadian Institute for Health Information (CIHI) and other federal data partners to work with provinces and territories on developing new health data indicators.
This will enable jurisdictions and CIHI to report to Canadians based on comparable indicators and data on how health care is delivered across Canada and how it is performing and how it compares internationally, federal officials say.
In addition to these funding pledges to the provinces and territories, Ottawa says it will also invest $2.5 billion over 10 years to support Indigenous health priorities to enhance culturally safe and equal health services.
The federal government will work with Indigenous partners to prioritize these investments, federal officials said.
The premiers say they plan to reconvene in a few days before they gather together for a meeting of the Council of the Federation to decide how to respond to the deal.
In addition, Ottawa is proposing to spend another $1.7 billion over five years to support hourly wage increases for personal support workers and related professions while different levels of governments work recruitment and retention of health workers.
The feds are also promising $150 million over five years for the Territorial Health Investment Fund in recognition of medical travel and the cost of delivering health care in the territories.
Speaking to reporters ahead of the meetings with the premiers today in Ottawa, Trudeau didn’t mince words about the troubles facing the health system and the impact it is having on patients and burned-out nurses and doctors.
“Canadians are proud of our universal public health-care system, but we all have to recognize it hasn’t been delivering at the level that Canadians would expect,” he said.
“That’s why sitting down with the provinces, working collaboratively, investing significantly in priority areas is going to move us forward in the right way.”
In addition to these funding pledges to the provinces and territories, Ottawa says it will also invest $2.5 billion over 10 years to support Indigenous health priorities to enhance culturally safe and equal health services.
The federal government will work with Indigenous partners to prioritize these investments, federal officials said.
The premiers say they plan to reconvene in a few days before they gather together for a meeting of the Council of the Federation to decide how to respond to the deal.
—With additional files from Sean Boynton
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