Saskatchewan has become the most recent province to strike a health-care deal with Ottawa, further eroding provincial and territorial opposition to a federal offer tabled in December.
The deal announced on Tuesday will give the province new targeted money for home care and mental-health initiatives over the next 10 years, but will reduce the annual increase in the amount it receives through the Canada Health Transfer. The three northern territories reached similar arrangements a day earlier.
"Our original preference was that we reach a pan-Canadian deal, but that ship has sailed," Saskatchewan Health Minister Jim Reiter told reporters. Mr. Reiter said his government is disappointed the deal "wasn't everything we asked," but it will mean more money for health priorities Saskatchewan shares with Ottawa.
New Brunswick, Nova Scotia, and Newfoundland and Labrador have also signed agreements. That means seven of the 13 provinces and territories – which represent a combined 10 per cent of the population – have accepted health funding the larger provinces say is insufficient.
After the Saskatchewan deal was announced, the premiers of British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, PEI and the three territories said in a statement they remain determined to seek a multilateral agreement.
Federal Finance Minister Bill Morneau has been urging his provincial counterparts behind the scenes to accept the federal deal. Jurisdictions that have reached side deals face no risk in doing so because any better deal reached would include them.
The premiers wrote that they "recognize that provinces and territories face unique local circumstances, which led some of them to sign bilateral health agreements." But, they wrote, "we believe the future of our health-care systems will benefit from continued fair and constructive discussion, and we will continue to call for a meeting with the Prime Minister to advance this vital priority before the upcoming federal budget."
The Canada Health Transfer (CHT) payments of all the provinces that have struck deals to date will rise by 3 per cent or a three-year average of nominal GDP growth, whichever is higher. The transfer has increased by 6 per cent since 2004 and, even though health-care costs have climbed by less than the rate of inflation since 2011, the larger provinces say an aging population will increase costs in the future.
Mr. Reiter said the provinces wanted a 5.2-per-cent increase in the CHT, but the federal government clearly indicated that is not on the table. The current economic forecasts suggest growth in the GDP will be below 3 per cent for the next two years but will then rise above that level, which will increase the transfer, he said.
Saskatchewan will get an additional $190.3-million for home care and $158.3-million for mental health over the next decade as a result of its deal with Ottawa.
The federal government also has agreed to wait a year before imposing any sanction on Saskatchewan for the way it allocates MRI scans. Federal Health Minister Jane Philpott told the province last fall that its system, in which people who pay for private MRI scans can jump the queue as long as the private clinics they use to do so perform an equivalent number of scans for free, violates the Canada Health Act.
"This gives us a year to advocate for it, to point out why we think two-for-one MRI … helps the public system, and I am going to make that case as strongly as I can," Mr. Reiter said.
Ian Culbert, the executive director of the Canadian Public Health Association, a national non-profit advocacy group, said a pan-Canadian accord on health care would instill a greater sense of equity across the country than a succession of bilateral deals.
But "the important thing is that the government, in additional to providing annual increases for the base funding for provinces and territories, is able to target some of these funds" for specific health priorities such as home care and mental-health care, he said. "That's crucial if we are going to make any transformative change within the health-care system."