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Prime Minister Paul Martin and Canada's premiers and territorial leaders signed a deal early this morning worth $18-billion over six years to reform medicare after a day-long closed-door bargaining session.

At a signing ceremony with the assembled leaders, Mr. Martin called the pact "a deal for a decade that will lead to better health care for all Canadians."

The deal includes measures to set benchmarks by Dec. 31, 2005, for reasonable waiting times for medical procedures and a special separate arrangement for Quebec on accountability.

Also included are commitments from the provinces to create a national home care program, complete with a minimum basket of services that would apply across the country. Under the program, governments by 2006 would pay for two weeks of home care for mental-health and discharged hospital cases and care for dying patients.

The agreement came at the end of a day when the Prime Minister and premiers cancelled televised talks on health-care changes to focus on backroom discussion to salvage a deal. Sources said the talks, which had been going on in Ottawa since Monday, were in trouble early yesterday after the two sides remained far apart despite bargaining sessions into the wee hours.

The deal calls on Ottawa to inject $18-billion into provincial health systems over the next six years and for automatic increases of 6 per cent a year that will last until 2015 for a total of $41-billion. Of that 10-year total, $5.5-billion will be used to reduce waiting times.

Benchmarks are to be developed by medical professionals and academics and would be published, giving Canadians information on appropriate waiting times for key operations and treatments.

The first ministers also agreed to a framework for a deal on reworking equalization payments to so-called have-not provinces, with details to be concluded at a first ministers meeting on Oct. 26. Those negotiations would start from a federal offer, made this week, to increase equalization payments by $1.3-billion.

Federal sources said Ontario Premier Dalton McGuinty was a linchpin in the final hours of negotiations.

He convinced fellow premiers of the need for Mr. Martin to establish comparable standards for measuring reduction of waiting times.

Mr. McGuinty and three other premiers -- B.C.'s Gordon Campbell, New Brunswick's Bernard Lord and Quebec's Jean Charest -- were appointed by their colleagues to negotiate on their behalf.

Striking a health-care deal was politically crucial for Mr. Martin, who made it a central piece of his spring election campaign. But the deal struck yesterday was substantially different from the $9-billion blueprint he originally laid out.

That plan included special tied funding for a national home-care program and a one-time fund to attack waiting lists.

Premiers, however, insisted that the waiting-list fund be transformed into permanent funding.

Details of the provisions to set comparable benchmarks and targets for reducing waiting lists had not been made public by midnight.

But sources explained that separate benchmarks would be established by individual provinces and published at a national level, which raised questions as to whether the information would be readily comparable from province to province. Each province would also set targets for bringing down wait times in their own jurisdiction.

The two sides opened the day yesterday $6-billion apart after an all-night bargaining session at the Prime Minister's official residence. But the split had been even larger as premiers and the Prime Minister went into a supper Tuesday night.

"We've covered a lot of ground. The premiers are continuing to meet and I'm more hopeful now than I was earlier in the day," Mr. McGuinty said before a final bargaining sprint last night.

Mr. McGuinty and other premiers had earlier expressed pessimism that a deal could be reached, arguing that the federal government was unwilling to budge from what they considered an inadequate financial offer.

After two days of posturing during televised talks, the first ministers went behind closed doors yesterday, in contradiction of Mr. Martin's election-campaign pledge for an open conference that would allow Canadians to see how any health deal was constructed.

The two sides bickered throughout the day over what the actual sticking point was, with the federal government saying the provinces were unwilling to set real targets and standards for reform, while provincial governments said the problem was Ottawa's reluctance to pony up more cash.

Mr. Martin told reporters that it was impossible to put together a deal on money until the provinces agreed to certain objectives in return for cash.

"Let's put the horse before the cart," Mr. Martin said before entering a direct negotiation with four premiers sent as emissaries for the whole group. "Let's have the plan, and on the basis of that plan, then we can come to a final arrangement on money."

Ottawa has been requesting that the provinces report progress on reducing waiting lists and that they agree to national benchmarks for how long a patient should wait before receiving coverage in key areas, such as cardiac care, cataract surgery and joint replacements. The word benchmarks, however, riled some provinces, which argued that it sounded too much like an imposed standard. They preferred more flexible terms, such as targets.

As part of that offer, the federal government agreed to increase to 6 per cent the "escalator" clause to boost health transfers, rather than the 5 per cent it had offered earlier in the week.

Officials broke into four work groups yesterday afternoon -- on funding, the general terms of the deal, Quebec's side deal and equalization payments.

The deal was said to include separate terms for Quebec that would allow the province different terms for collecting and sharing information on waiting lists and targets to reduce them.