The looming expiry of a major national health accord is creating large uncertainties around future funding but health will likely get scant mention in the federal budget that is scheduled to be released next week.
Although it now eats up more than 40 per cent of provincial budgets, health care consumes less than 13 cents of every federal spending dollar. That's an equation the federal government is not eager to change as it grapples with a deficit of tens of billions of dollars.
Still, the provinces and the people who deliver health care in a system they say is straining at the seams hold out hope that the budget will provide a glimmer of financial relief.
"We have not been able to break the back on getting the right capacity," said Tom Closson, president and chief executive officer of the Ontario Hospital Association. His wish list for the budget includes receiving a signal on what will happen to the health accord that sends federal money to the provinces and is due to expire in 2014.
Alberta is looking for an increase in the federal health transfer - a request Finance Minister Lloyd Snelgrove acknowledges is a long shot. Alberta gets a lower per-capita health transfer than the standard rate received by every other province, a formula that costs the province $1-billion a year.
"As long as we're treated fairly," Mr. Snelgrove said of his expectations for the federal budget. "Even a commitment to go partway [to $1-billion]or at least accept that the responsibility for the funding is theirs. We can have a discussion on this."
But that dialogue will likely have to wait.
A critical evaluation of the Canada Health Transfer - the deal that will send about $27-billion from Ottawa to the provinces in 2011-12 - must be conducted every three years. It is a job that has normally been given to the health committee of the House of Commons. But Health Minister Leona Aglukkaq has instead asked the Conservative-dominated Senate social affairs committee to conduct the final review before the accord expires.
The Senate committee has only recently begun to hear from interested parties. If there is no election, the earliest it is expected to report back to Parliament is the fall. If a federal vote is called, it could be delayed well beyond that.
Liberal Senator Art Eggleton, who chairs the committee, said the report is expected to chart the path for any health transfers that take place past 2014.
Some people might suggest that the Senate committee has been handed the job of reviewing the CHT "because the Conservatives have a majority in the Senate and not in the House," Mr. Eggleton said. "But I also like to think it's because of the competence of my committee [which]has a long reputation and a solid reputation for dealing with various social and health issues."
Those who harbour suspicions about Ms. Aglukkaq's motives in turning the review over to the Senate include opposition critic Ujjal Dosanjh, a Liberal MP and former health minister.
The Conservatives are placing one of the most important issues facing Canadians in the hands of unelected senators, Mr. Dosanjh said.
Megan Leslie, the NDP health critic, said Ms. Aglukkaq's decision is extremely troubling.
"The minister is hiding behind an unelected and unaccountable Senate to review this. I think it's undemocratic," said Ms. Leslie, who has raised the issue several times in the House of Commons.
Prime Minister Stephen Harper has repeatedly stressed that health care is the purview of the provinces, but Ms. Leslie said she would like to see some acknowledgment by the Harper government that it has a role to play in health care - especially if that meant budget money for items like home care and pharmacare that she said would save money in the long run.
Bob Bell, the president and chief executive officer of University Health Network, which comprises three Toronto hospitals, said he would like to see a national pharmacare program, with common purchasing power of all the provinces that would allow for substantial savings, and a common approval process. But he is also looking for some word on the Canada Health Transfer.
"To have the stability of knowing the health accord is not going to be pulled out from under the province's feet at a time when they are struggling to restore a fiscal balance, that's crucial," Dr. Bell said. "Canada has a great health system but we need to be better and we need to make sure it is sustainable."
With reports from Lisa Priest in Toronto, Josh Wingrove in Edmonton and Rod Mickleburgh in Vancouver