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Saskatchewan Premier Brad Wall, right, and PEI Premier Robert Ghiz, left, strain to hear a question from a member of the media during an availability following their first session of meetings with provincial health ministers at The Royal York Hotel in Toronto on March 15, 2013.

Peter Power/The Globe and Mail

The provinces will look to expand a collective drug-purchasing plan, set new guidelines to cut the number of unnecessary medical procedures and improve home care for senior citizens. These strategies were on the table Friday as provincial health ministers hunkered down in Toronto for two meetings on overhauling the nation's universal health-care system and wrestling down its cost.

The first session was part of the Health Care Innovation Working Group, a year-old interprovincial body presided over by Saskatchewan Premier Brad Wall and Robert Ghiz of Prince Edward Island.

The second, chaired by Ontario Health Minister Deb Matthews, focused on dealing with the nation's aging population. The provinces set up the working group after the federal government encouraged them to take more of a lead on developing health-care policy.

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Last year, the working group produced a deal that saw the provinces and territories, with the exception of Quebec, team up to purchase six generic drugs in bulk, which resulted in savings of $100-million annually.

They want to take a similar approach to buying name-brand medicines. Mr. Ghiz estimated such a plan could save $25-million to $100-million more.

The provinces are also looking at ways to cut back on pricey diagnostic tests and surgeries such as MRIs, knee replacements and cataract removals. After consulting with health-care professionals, they hope to draw up a series of voluntary guidelines, to be presented this summer, on when such procedures are necessary and when they can be skipped.

"When we have providers giving us good counsel and advice on what the most appropriate care is for patients in any particular instance, I think we're going to be listening to that advice," Mr. Wall said outside the meeting. "We think there might be savings, yes, but the point is better care. The point is health professionals driving it."

The greatest cost pressure on the system, however, may be the demographic shift and the steady rise in the number of senior citizens requiring chronic care.

"Our health-care system was built when we had a much, much younger population and most people, when they had an interaction with the health-care system, it was for an acute episodic course of care. They had a gallbladder attack or appendicitis or a broken bone or something – they'd be treated in a hospital, then go back home," Ms. Matthews said in an interview. "That's totally shifted now … and we need a different model of care."

Most of the new model involves finding ways to keep seniors out of hospital. Ontario, for instance, is pumping money into providing more home care. Manitoba is looking toward preventive medicine. Saskatchewan is reviewing ways to improve long-term care. Nova Scotia has a system where paramedics treat some ailments in long-term care facilities to avoid tying up hospital beds.

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For all the provinces' innovations, however, Mr. Ghiz said they could use more help from Ottawa.

"Hopefully, some day, the federal government will be at the table with dollars and with ideas – we're open – when it comes to our aging population," he said. "If you were a smart federal party, you would be looking at an aging population and how you can help the provinces deal with that challenge."

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