Federal Health Minister Jane Philpott has agreed with her provincial and territorial colleagues on new areas of care that need investment, but the health ministers punted more difficult negotiations to Prime Minister Justin Trudeau and the premiers after hitting a stalemate over how much Ottawa should pay to sustain the existing system.
The two levels of government met at a Toronto hotel on Tuesday to continue negotiations around the drafting of a new accord to guide responsibilities for this country's health system.
Dr. Philpott entered the room with a much different idea than the premiers about how much her government should add annually to the Canada Health Transfer, which distributes dollars for health from Ottawa to the other jurisdictions. And the two sides walked away no closer to an agreement on the difficult question of money.
The federal Liberals have adopted a plan, put in place by the previous Conservative government, to cut the annual increase in the transfer from 6 per cent to a minimum of 3 per cent, starting next year. Although Dr. Philpott has committed to giving provinces and territories another $3-billion over four years to improve home care, and says she wants to hear ideas for spending additional amounts on other targeted initiatives, she did not back down on that reduction in the growth of health transfers.
In the end, the health ministers and finance ministers who joined a provincial and territorial meeting on Monday reiterated a call that has been made twice previously by the premiers for Mr. Trudeau to commit to meet with them to settle the health funding issue before a scheduled First Ministers meeting on climate change later this year.
"The next step is a meeting between the premiers and the Prime Minister somewhere in December, as I understand it, where I hope this item will be on the agenda, and after which I hope we will have better news," said Gaétan Barrette, the Quebec Health Minister. "Because, I would say, the future, at this point, is a bit dire."
The Prime Minister's Office did not respond to questions about whether Mr. Trudeau is receptive to such a meeting. He has said previously that he would await the outcome of this week's gathering of health ministers before agreeing to discuss health care.
Although the increases to health care costs across the country have barely hit 2 per cent annually over the past five years, according to the Canada Institute for Health Information, more than one provincial minister said increases to the transfer of 3 per cent in the future would "not be enough to keep the lights on." The provinces say a growing proportion of elderly people will put increasing demands on a system that, in some jurisdictions, is already under considerable strain.
"It's not about the issues. It's about the funding," Dr. Barrette said. "Because even at 6 per cent, it's going be difficult. Imagine how it will be at 3."
Dr. Philpott points out that the money transferred to the provinces by Ottawa will continue to increase under her government's plan.
"We got a bit sidetracked into a desire on the part of the provinces and territories to focus on the numbers," she said of the discussions on Tuesday. "The numbers are clearly important but health ministers have a responsibility to make sure that Canadians are healthy."
To that end, she and the provincial and territorial ministers have agreed that new money should be directed toward some specific initiatives, including home care, mental health and addiction, indigenous health, innovation and pharmacare.
On Monday, Dr. Philpott said the federal government has no way of knowing how money from the Canada Health Transfer, which flows into the general revenues of the provinces, is spent. On Tuesday, she explained that she did not mean to imply that the amount of money being transferred, "and then some," is not used to deliver care.
Eric Hoskins, the Ontario Health Minister, said he and his provincial and territorial colleagues did get the impression Dr. Philpott was questioning whether they are spending the transfer on health and "took issue" with her comments. Dr. Hoskins said the cut to the increase in the transfer will take $400-million out of the system next year in his province alone, and $1-billion across Canada.
"I can say that every single dollar that's provided through the Canada Health Transfer goes to provide the best quality of care for Ontarians," he said. "But equally we feel, and are united in believing, we need a fair and respectful federal partner that agrees with us that 3 per cent is inadequate."