Question Period Note: Health Funding Agreements and Transfers

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• The Government remains committed to working collaboratively with provinces and territories (PTs) to strengthen Medicare and provide funding through transfers and bilateral agreements. In addition to the Canada Health Transfer, the Government has provided significant funding to PTs to support their fight against COVID-19, as well as targeted funding to support specific health care priorities, such as home care, mental health, substance use, and long-term care.
• Moving forward, the Government is committed to work with provinces and territories to improve our health care systems by addressing our shared priorities. The Government wants to ensure that any additional federal funding will improve Canada’s health care system and focus on delivering health care outcomes for Canadians.
KEY MESSAGES
• The pandemic has highlighted the need for resilient health care systems in Canada. That is why the Government is committed to working collaboratively with provinces and territories to provide pandemic supports and to strengthen Medicare.
• Through the Government’s plan, “Working Together to Improve Health Care,” we will continue to work closely with provinces and territories and provide them nearly $200 billion over 10 years for health care, including $46.2 billion in new funding to improve health care services for Canadians across the country.
• In addition, Budget 2023 announced $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.
• Canadians deserve high quality health care and our Government is confident we can build on our strong partnership with provinces and territories to transform health care.
IF PRESSED (GENERAL) …
• To address immediate pressures on the health care system and to transform it for the long-term, our Government is providing over $46 billion in new funding to provinces and territories.
• This new funding includes $25 billion over 10 years to provinces and territories, to support shared health priorities through tailored bilateral agreements focused on four priorities:
o family health services;
o health workers and backlogs;
o mental health and substance use; and,
o a modernized health system.
• This builds on continued collaboration with provinces and territories on shared priorities, supported by targeted federal investments:
o $11 billion over 10 years in Budget 2017. Of that amount, $4.8 billion remains available over four years, to improve access to home and community care and mental health and addiction services; and,
o $3B over 5 years in Budget 2021 to improve the standard of care in their long-term care facilities.
IF PRESSED ON RESULTS …
• Our Government is committed to working closely with provinces and territories to ensure results for Canadians.
• We are working with provincial and territorial governments to improve how health information is collected, shared, used and reported to Canadians to promote greater transparency of results, and to help manage public health emergencies.
• As part of the recently announced bilateral agreements, action plans will be developed by each province and territory to describe planned activities, targets and timeframes. Results against the four shared health priorities will be reported publicly through a set of eight initial headline common indicators, and with a broader set of additional indicators to be developed. Provinces and territories are being asked to provide disaggregated data to enable reporting on progress for underserved and disadvantaged populations.
• In addition to providing funding to provinces and territories, Budget 2023 also included an investment of $505 million over five years, starting in 2023-24, to the Canadian Institute for Health Information, Canada Health Infoway, and other federal data partners.
• The Government of Canada will also work together with provinces and territories to streamline foreign credential recognition for internationally educated health professionals, and to advance labour mobility.
IF PRESSED ON QUEBEC …
• Our Government is committed to ensuring it is there to meet the needs of the people of Quebec, and continues to work with all provinces and territories to strengthen public health care.
• Through the investments announced as part of the “Working Together to Improve Health Care” plan, Quebec is eligible to receive $37.3 billion in federal funding over 10 years, which includes approximately:
o $4.8 billion for a new bilateral agreement focusing on the four shared health care priorities; and,
o $30.8 billion through the CHT, including $447 million through the immediate, one-time CHT top-up to address urgent needs, especially in pediatric hospitals and emergency rooms, and long wait times for surgeries.
• This funding builds on the $1.7 billion over five years that has yet to flow to Quebec for mental health and substance use, home and community care, and long-term care.

Budget 2023 lays out the federal government’s plan to provide close to $200 billion over ten years in health transfers to provinces and territories, including $46.2 billion in new funding through new Canada Health Transfer measures, tailored bilateral agreements to meet the needs of each province and territory, funding for personal support workers, and an increase to the Territorial Health Investment Fund. In addition, Budget 2023 announced $2 billion over 10 years to address Indigenous health priorities and $505 million over five years, starting in 2023-24, to the Canadian Institute for Health Information, Canada Health Infoway, and other federal data partners.

GDP-Driven Growth: As the Canada Health Transfer's escalator is based on GDP growth, an additional $141.8 billion is projected to be provided over the next ten years through the Canada Health Transfer, over and above the $45.2 billion provided in 2022-23.

Canada Health Transfer Top-Up: The federal government will provide $2 billion in 2022-23 to address urgent pressures in emergency rooms, operating rooms, and pediatric hospitals, building on $6.5 billion in top-ups provided throughout the pandemic.

Canada Health Transfer Five Percent Guarantee: The federal government will provide top-up payments to achieve Canada Health Transfer increases of at least five percent per year for the next five years. The last top-up payment will be rolled into the Canada Health Transfer base at the end of the five-year period, resulting in a permanent funding increase. This represents an estimated $17.1 billion over ten years in additional funding through the Canada Health Transfer.

Tailored Bilateral Agreements: The federal government will provide $25 billion over ten years through a new set of bilateral agreements to address individual provincial and territorial health system needs, such as expanding access to family health services, supporting health workers and reducing backlogs, increasing mental health and substance use support, and modernizing health systems.

These new agreements build on the approach used in the previous home and community care and mental health and addiction services agreements. Agreements work toward overarching results for the shared health priorities, measured through a set of key common headline indicators and supported by disaggregated data.

PTs will also work to develop comparable indicators through the Canadian Institute for Health Information (CIHI) and federal data partners, starting with the 8 key common headline indicators outlined below, organized by health priority. A broader set of indicators, including for Indigenous Health, will be developed in collaboration with PTs, CIHI, experts and Indigenous peoples.

Family Health Services
1. Percentage of Canadians who report having access to a regular family health team, a family doctor or nurse practitioner, including in rural and remote areas.
2. Percentage of family health service providers and other health professionals (e.g., pharmacists, specialists, etc.) who can share patient health information electronically.

Health Workers and Backlogs
3. Size of COVID-19 surgery backlog
4. Net new family physicians, nurses, and nurse practitioners

Mental Health, Addictions Services and Substance Use
5. Median wait times for community mental health and substance use services
6. Percentage of youth aged 12 to 25 with access to integrated youth services (IYS) for mental health and substance use.

Modern Health Data System
7. Percentage of Canadians with a mental disorder who have an unmet mental health care need.
8. Percentage of Canadians who can access their own comprehensive health record electronically.

Provinces and territories will provide action plans within these new agreements will describe how funds will be spent incremental to current activities, and information on how the activities will address the needs of underserved and disadvantaged populations, including official language minority communities.

Personal Support Worker Wage Support: The federal government will provide $1.7 billion over five years to support hourly wage increases for personal support workers and related professions.

Territorial Health Investment Fund: The federal government will provide $350 million over ten years in recognition of medical travel and the higher cost of delivering health care in the territories. This represents $35 million per year, an increase from the previous $27 million.

Previous bilateral agreements on home and community care and mental health and addictions services:

In 2017, the federal government committed $11 billion over 10 years specifically targeted to improve home and community care, and mental health and addiction services and provinces and territories agreed to a Common Statement of Principles on Shared Health Priorities.
At that time, the federal government negotiated and signed Agreements with each province and territory that set out details of how each jurisdiction would use federal funding to improve access to home and community care, and mental health and addiction services. Initial agreements expired after five years and new agreements covering fiscal year 2022-23 were established.
Currently, $4.8 billion of the $11 billion commitment remains available to support targeted provincial and territorial efforts to improve access to home and community care and mental health and addiction services over the next four fiscal years (2023-24 to 2026-27).
A further $3 billion was proposed in Budget 2021 for Health Canada to help provinces and territories ensure standards for long-term care are applied and permanent changes are made. This funding will be available to provinces and territories over five fiscal years (2023-24 to 2027-28).

• Budget 2023 lays out the federal government’s plan, “Working Together to Improve Health Care for Canadians,” to provide nearly $200 billion in additional funding over ten years to provinces and territories.
• This includes $46.2 billion in new funding for provinces and territories, which includes:
o An immediate, unconditional $2 billion top-up to the Canada Health Transfer (CHT) to address immediate pressures on the health care system, especially in pediatric hospitals, emergency rooms and surgical and diagnostic backlogs;
o A 5 percent CHT guarantee for the next five years, which will be provided through annual top-up payments as required;
o $25 billion over 10 years to advance shared health priorities through tailored bilateral agreements;
o $1.7 billion over five years to increase the hourly wages for personal support workers; and,
o $350 million over 10 years to support territories through the Territorial Health Investment Fund.
• In addition to the funding for provinces and territories, the government’s plan also announced:
o $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; and,
o $505 million over five years to the Canadian Institute for Health Information, Canada Health Infoway, and federal data partners.
• Furthermore, our Government continues to collaborate with provinces and territories on shared priorities, supported by targeted federal investments of:
o $11 billion over 10 years for provinces and territories to improve access to home and community care and mental health and addiction services; and
o More recently, $1 billion for safe long-term care, and $3 billion to help provinces and territories improve the standard of care in their long-term care facilities.
• For more information on federal spending, please see the Background.