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Leona Aglukkaq, Minister of Health, speaks at the MARS centre in Toronto on March 10, 2011.

Peter Power/The Globe and Mail

Ottawa plans to negotiate a single national health accord, not separate agreements with each of the provinces and territories, the federal health minister says.

"We want one agreement," Leona Aglukkaq said Monday in St. John's. She said the position was non-negotiable.

Beyond that, the minister offered few clues on the government's approach to the country's most politically delicate health file – renewing the deal that sets out the terms of $30-billionin annual health transfers from Ottawa. The current health accord, which includes annual increases of 6 per cent annually, expires in 2014.

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Ms. Aglukkaq told delegates to the Canadian Medical Association general council meeting that the 6-per-cent increases will continue beyond the year 2014, but would not say for how long. "Those are discussions that will have to take place with all the jurisdictions," she said.

Ms. Aglukkaq would not say what form the discussions would take, other than to say they will not begin before December of this year, when a Senate committee is set to publish a report reviewing the 2004 health accord.

Asked specifically if there will be a first ministers' meeting to hash out a deal – as most premiers have demanded – the Health Minister said: "I can't speculate."

But she did hint strongly that, in the future, the money Ottawa transfers to the provinces for health care will come with strings attached.

"There will be a clear emphasis on accountability," Ms. Aglukkaq told the CMA.

Asked to elaborate on what that means, she said: "We want to be able to ensure the dollars we invest in health care will go where they're most needed …We want accountability and we want results."

Jeff Turnbull, president of the CMA, said the quest for results was welcome because the "accord should be the foundation for transforming the health system."

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But he expressed consternation about Ottawa's lack of urgency in getting a deal done. "Time is passing very quickly. We would like to see a first ministers' meeting very soon," he said.

While 2014 seems a long way off, reaching consensus with 14 governments can be painfully time-consuming; also, about one-quarter of all health spending comes from federal coffers, so provinces need to know the level of transfers well in advance for planning purposes.

Libby Davies, health critic for the opposition New Democratic Party, said she was also frustrated by the Conservative government's foot-dragging and secrecy.

"Where does the government stand as we approach 2014? We all want to know. That's the elephant in the room on the health-care file," she said.

Ms. Davies said it is important to remember that, when the previous health accord was signed in 2004, health transfers were boosted by $41-billion over 10 years and that was supposed to pave the way for initiatives such as pharmacare and a national home care strategy, but there was no follow through.

This time around, she said, it is essential that there be reforms.

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On Monday, a blue-ribbon panel presented a report to CMA delegates entitled Resourcing Options for Sustainable Health Care in Canada.

The gist of the 32-page report is that Canada's health system needs to be transformed from one in which the focus is acute care, to one in which the focus is chronic care and, to do so, services have to be funded differently.

"The problem with our system is not a lack of money, but rather the failure to realize that an acute care model is not our best option," said Sister Elizabeth Davis, a long-time healthcare administrator. She is one of six expert advisers to the CMA. The others are former Quebec health minister Philippe Couillard, economist Don Drummond, former hospital CEO Tony Dagnone, health economist John Horne and director of McGill University school of social work Wendy Thomson.

The panel made a series of 10 recommendations for reforming the system including discussing new ways of funding services including user fees and insurance schemes (although they should be done without violating the Canada Health Act, which prohibits user fees), changing the way hospitals are funded and physicians are paid to reward quality and performance, rethinking the strategy for implementing electronic health records, promoting more competition among service providers and paying more attention to the socioeconomic determinants of health.

In 2010, Canadians spent almost $192-billion on health care: $135-billion came from the coffers of federal, provincial and territorial governments, and the balance was for care paid with private insurance and out-of-pocket.

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