After that, however, things may very well change in the battle with the deficit.
If the federal government reduces its payments, the provinces will be hard pressed to pick up the slack. Except for Saskatchewan, they are heading into budget season deep in deficit, and unwilling or unable to keep pace with rising costs, leaving many hospitals awash in red ink.
The situation is destined to get worse, but for now provincial governments appear content to address their problems in an ad-hoc fashion.
This month, Alberta provided $759-million in one-time funding to erase the deficit of its health-care agency. Facing public pressure, it also retreated on plans to close acute-care and rehabilitation beds at an Edmonton hospital.
In British Columbia, the Fraser Health Authority is trying to cut $160-million from budgets for its 12 hospitals by April. It will close a six-bed psychiatry unit for adolescents in Abbotsford this year and 10 beds at an addiction-treatment facility in Chilliwack, but has dropped controversial plans to reduce emergency-room hours in Mission.
Even in Ontario, hardest hit by the economic downturn and especially keen to contain costs, the government has quietly topped up funding for several cash-strapped hospitals. Just last week, Niagara Health received another $14-million, all but erasing its deficit.
With a shortfall expected to reach $24.7-billion this year, Ontario has launched the biggest restructuring of hospitals since the mid-1990s cuts of Premier Mike Harris.
As a result, health-care insiders say, hospitals are making major decisions even though there have been no policy statements on what type of system works best, how far patients should be required to travel and what services medicare should cover.
The 10-year strategic plan the province was supposed to unveil early in 2007 remains unfinished, and the Health Minister acknowledges that "we really do need to have a more thoughtful conversation about ... what we need to do to make sure that the health-care system that we value so much is there for the next generation," Ms. Matthews says.
However, governments are less inclined to engage the public in a discussion about health care when they lack the resources to meet its expectations, says John Church of the University of Alberta's School of Public Health.
The gap between "what the public wants and what governments feel they're in a position to give" is widening, he says.
Bureaucrats insist that changes they are making are all about improving the care the public receives as medicine becomes more sophisticated and highly specialized. But that's a tough sell when cutting costs is the real goal, says James Ducharme, chief medical officer of AIM Health Group Inc., which helps hospitals find temporary doctors for their emergency departments.
"What you're doing," he says, "is choosing what health care you offer by budget cuts rather than having a global vision of how to spend money."
Cuts can backfire
Niagara Health's experience shows how trying to save by streamlining services can have unexpected consequences, leading to a disgruntled work force and, in some cases, even greater expense.
Its current difficulties were triggered by plans in late 2008 to save $28-million by converting hospital emergency rooms in Fort Erie and Port Colborne into around-the-clock urgent-care centres - essentially walk-in clinics. As well, it is closing beds for patients with chronic illnesses and consolidating services for mothers and children at one site.
But the Niagara strife is rooted in the 1990s, when the Harris government's Health Services Restructuring Commission oversaw the biggest shutdown of hospitals in Canadian history. It closed or merged 35 facilities, with Niagara's amalgamation the biggest of all: seven hospitals under one administrative roof.
But the communities affected weren't pleased, says Ms. Sevenpifer, Niagara Health's CEO. "It was essentially a shotgun marriage. That sort of laid the groundwork for some of the difficulties we faced."
She insists that many of the changes now being made truly are designed to improve the quality of care - an argument that fails to impress the parents of Reilly Anzovino, a Fort Erie teenager who died after being involved in car accident on Boxing Day. They have joined calls for a public inquest to determine whether their daughter might still be alive had the local emergency room still been operating and made a longer trip to the hospital in Welland unnecessary.Report Typo/Error