Canada's health-care system isn't working anymore, and Tuesday's first minister's meeting in Ottawa will require the provinces and the federal government to agree on common priorities while allowing regional flexibility if it's going to get back on track, says Health Minister Jean-Yves Duclos.
"In 2023, it doesn't work anymore," Duclos told Rosemary Barton Live in an interview airing Sunday. "We have to change the way we deliver health care in Canada."
"There will be challenges for many years to come and Tuesday is going to be an important step to working toward these longer challenges," he said.
On Tuesday, Canada's premiers will meet in Ottawa with Prime Minister Justin Trudeau to pursue fixes to both long and short term challenges impacting health-care delivery in Canada in the hopes of laying the foundation for a new federal/provincial health accord.
"We first must acknowledge that A, we must repair the damage caused by COVID-19, but B, we must prepare for the challenges that we know are with us and we'll be with us in the next years and decades," he told Barton.
"Our population is aging. Our population of workers is also aging. More family doctors, more nurses will be leaving in the next years. More chronic diseases, more infectious diseases, there will be future pandemics."
Health-care funding has always been a contentious topic between the provinces and the federal government. The pandemic's effects on an already strained system have made the need for a new funding agreement more urgent.
The last health-care summit involving federal and provincial ministers of health took place in Vancouver in early November. It ended in failure.
Before that meeting had even concluded, the premiers issued a statement saying "no progress" had been made. They argued that the federal government had to put up more money sooner rather than later.
"Substantive resources are required to support and accelerate this essential work, and provinces and territories need a predictable federal funding partner," provincial leaders said then.
The numbers game
The first sticking point in the negotiations has to do with math.
Canada's premiers say the federal government is only paying 22 per cent of the cost of providing health care. They want that boosted to 35 per cent — an increase of $28 billion to the $45.2 billion Canada Health Transfer (CHT), starting this year — and for the CHT to increase by six per cent annually after that.
The federal government has said that while the CHT only covers 22 per cent of health-care costs, taxation powers transferred to the provinces in 1977 to pay for health care — and funding for things like mental health services, home care and long-term care — bring the federal government's share up to as much as 38.5 per cent.
Duclos told Barton that he thinks it's "unfortunate" that so much of the public debate between the federal and provincial and territorial levels of government has centred on who pays for what rather than how to fix the system.
"We and others certainly spent too much time, in my view, focusing on percentage points and tax points," he said. "The money comes from the same pockets, from the same taxpayers, and serves the same people for the same purposes."
A deal with conditions
The federal government's stated priorities include reducing backlogs, working to better support and retain health care workers, improving access to primary care with reforms and more doctors, improving mental health services, reforming how palliative care is delivered and changing the way health-care data is shared within provinces and across the country.
The provinces initially balked at the suggestion that any additional money from the federal government would have to be earmarked for specific initiatives.
Provincial and territorial premiers have argued that health care falls under their jurisdiction. Since that November meeting, there have been signs that premiers may be willing to meet the federal government's demands.
Last month, Ontario Premier Doug Ford said he would accept conditions on new money because "there always has to be accountability," providing the provinces get "a little bit of flexibility." Quebec Premier François Legault also said last month that he would accept some conditions, specifically on sharing health-care data.
Successfully incorporating conditions in any health accord, Duclos said, will require an agreement on what needs to be done, while allowing the provinces to meet those conditions in a way that makes sense in their jurisdictions.
"We need to recognize that there is a level of variability in Canada when it comes to access to family doctors, when it comes to reducing backlogs," he said. "We need to be flexible.
"Some [provinces] might be investing more in terms of recruiting international nurses, others might want to recognize those already in Canada. [Others] might want to invest in more training and more retention of existing workers."
The federal government, Duclos said, wants any new health agreement to be about results, rather than meeting a funding target.
"At the health ministers level, I have been working with my colleagues for a whole year now, 13 meetings, speaking about the results that Canadians want," Duclos said. "But we'll need to see what happens on Tuesday."