Working together to improve health care for Canadians

Author: Government of Canada

February 7, 2023

Today, Prime Minister Justin Trudeau and his provincial and territorial counterparts discussed actions needed to improve the health care system while adapting to the changing needs of Canadians.

The Government of Canada intends to work collaboratively with provinces and territories on four shared health priorities to improve integrated health care for Canadians:

• expanding access to family health services, including in rural and remote areas;
• supporting our health workers and reducing backlogs;
• improving access to quality mental health and substance use services; and
• modernizing the health care system with standardized health data and digital tools.

Helping Canadians age with dignity, closer to home, with access to home care or care in a safe long-term care facility is another area of priority.

Canadians and their families deserve timely access to the health services they need, when and where they need them. The federal government will continue to work with provinces and territories, in the best interest of Canadians, their families and health workers to deliver concrete results for Canadians and improvements to the health care system.

Upholding the Canada Health Act (CHA) remains critical to protect Canada’s publicly funded health care system. The Government of Canada will continue to make sure provinces and territories respect the principles of the CHA by ensuring all Canadians have equitable access to medically necessary care based on their needs, not their ability to pay.

Ensuring real results for Canadians

The Government of Canada announced today an investment of $196.1 billion over 10 years, including $46.2 billion in new funding, for provinces and territories to improve health care services for Canadians. This funding will be distributed partly through the Canada Health Transfer (CHT) and partly through tailor-made bilateral agreements with provinces and territories that allow for flexibility for jurisdictional health care system needs. In addition, it will invest $2.5 billion over 10 years to support Indigenous priorities and complementary federal support, for a total of $198.6 billion over 10 years.

These investments, on top of already significant funding, will further help provide Canadians with health care that includes:

• access to high-quality family health services when they need them, including in rural and remote areas, and for underserved communities;
• a resilient and supported health workforce that provides them high-quality, effective and safe health services when they need them;
• access to timely, equitable and quality mental health, substance use and addictions services to support their well-being; and
• access to their own electronic health information, which is shared between the health professionals that they consult.

Collaborative work is already underway with provinces and territories to help support access to home care and long-term care. This includes existing investments of $6 billion for home and community care and $4 billion to improve the quality and safety of long-term care. Included in the investment announced today is an additional $1.7 billion over 5 years to support wage increases for personal support workers and related professions.

Canada Health Transfer (CHT)

The Canada Health Transfer (CHT) is the largest major federal transfer to provinces and territories ($49.4 billion in 2023-24). Since 2004-05, through cash and tax point transfers, the federal government has supported, on average, 32% of provincial and territorial health expenditures.

• The Government is proposing to provide further support though the CHT as follows: An immediate unconditional $2 billion CHT top-up to address immediate pressures on the health care system, especially in pediatric hospitals, emergency rooms and surgical and diagnostic backlogs; and
• Guaranteed 5 per cent growth to the CHT for the next five years (expected value of $17.3 billion over 10 years), to be paid through annual top-up payments as required. The last top-up payment will be rolled into the CHT base at the end of the five years to ensure a permanent funding increase, providing certainty and sustainability to provinces and territories.

To access their share of the federal funding, including the guaranteed 5% growth top-up payments to the CHT, for the next five years, provincial and territorial governments are asked to commit to improve how health information is collected, shared, used and reported to Canadians to promote greater transparency on results, and to help manage public health emergencies. This will include an agreement to develop and use comparable indicators through the Canadian Institute for Health Information (CIHI) and its data partners, starting with the indicators outlined below. A broader suite of indicators, including for Indigenous Health, will be developed in collaboration with provinces and territories, experts, CIHI and Indigenous Peoples.

Building on the work by federal, provincial and territorial officials over the past several years on health data and digital strategies, provinces and territories will also be asked to agree to adopt common standards and policies related to data. Canadians should be able to access their own health information and benefit from it being shared between health workers across health settings and across jurisdictions.

Bilateral Agreements

Today, the Government of Canada announced that it would provide $25 billion over 10 years to provinces and territories to support shared health priorities through tailored bilateral agreements.

The Government of Canada recognizes that provinces and territories have their own unique circumstances. As such, the bilateral agreements are intended to be flexible, and tailored, so that provinces and territories can address the unique needs of their populations and geography.

As part of these agreements, provincial and territorial governments are asked to develop action plans that will describe how funds will be spent (incremental to existing spending) and how progress will be measured. As there is no health without mental health, an integrated, inclusive approach to investments in health service teams, the health workforce, and data and digital tools will help to meet the health and mental health needs of Canadians.

While investments are to be centered around the four shared health priorities, jurisdictions will have flexibility in designing their action plans, including the addition of targeted results with indicators that are tailored to their jurisdiction's needs and circumstances. Action plans with targeted results and indicators will be made available publicly by both federal and provincial and territorial governments, and provinces and territories would publicly report on results to their own residents.

Additionally, provinces and territories are being asked to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional credential recognition for key health professionals.

The bilateral agreements will mutually respect each government's jurisdiction, and be underpinned by key principles, including:

• A shared responsibility to uphold the Canada Health Act that protects Canadians' access to health care that is based on need and not ability to pay;
• Principles agreed to in the 2017 Common Statement of Principles on Shared Health Priorities;
• Reconciliation with Indigenous Peoples, recognizing their right to fair and equal access to quality and culturally safe health services free from racism and discrimination anywhere in Canada, including seamless service delivery across jurisdictions, requires meaningful engagement and work with Indigenous organizations and governments; and
• Equal access for equity-seeking groups and individuals, including those in official language minority communities.

Provinces and territories are further being asked to commit to negotiate and implement action plans for the remaining four years of funding for Home and Community Care and Mental Health and Addiction Services ($11 billion over 10 years), as well as the $3 billion investment announced in Budget 2021 to improve safety in long-term care.

Supporting Indigenous Priorities

To provide additional support for Indigenous health priorities:

• $2 billion over 10 years to address unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services. The Indigenous-specific funding stream will be distributed on a distinctions basis through a health equity fund. The Minister of Indigenous Services, the Minister of Crown-Indigenous Relations, and the Minister of Northern Affairs will work with Indigenous partners to prioritize investments.

Commitment to Complementary Federal Support

The Government of Canada will also commit to dedicated action to advance and integrate our shared health priorities, and support collaboration, in areas such as immigration, credential recognition, official language minority communities and data infrastructure and standards. This includes the following additional funding:

• $505 million over 5 years to CIHI, Canada Health Infoway and federal data partners to work with provinces and territories on developing new health data indicators, to support the creation of a Centre of Excellence on health worker data, to advance digital health tools and an interoperability roadmap, and to underpin efforts to use data to improve safety and quality of care.
• $175 million over five years for the Territorial Health Investment Fund in recognition of medical travel and the cost of delivering health care in the territories.

Shared Health Indicators and Results

What is measured, matters. By collecting and sharing health information the same way, Canadians can see the progress being made by each jurisdiction to deliver results on the shared priorities in health care for their populations.

The federal government is prepared to measure and report annual progress on the following common indicators with disaggregated data and is asking the provincial and territorial governments to do the same as part of their data commitment.

• Percentage of Canadians who report having access to a regular family health team, a family doctor or nurse practitioner;
• Size of COVID-19 surgery backlog;
• Net new family physicians, nurses, and nurse practitioners;
• Percentage of youth aged 12-25 with access to integrated youth services for mental health and substance use;
• Median wait times for community mental health and substance use services;
• Percentage of Canadians with a mental disorder who have an unmet mental health care need;
• Percentage of Canadians who can access their own comprehensive health record electronically; and
• Percentage of family health service providers and other health professionals (e.g., pharmacists, specialists, etc.) who can share patient health information electronically.

CIHI will lead a process with provinces, territories and experts to review and refine these existing common indicators and develop a broader list, including new indicators. This will enable jurisdictions and CIHI to report to Canadians based on comparable indicators and data on how health care is delivered across Canada and how it is performing and how it compares internationally. Bilateral agreements will include indicators tailored to provincial and territorial needs.

Provincial and Territorial Funding Allocation Table