The members of the Council of the Federation met last Thursday by conference call. They mainly discussed the “urgent need to close the structural financing gap facing our health care systems” according to the press release issued by the office of John Horgan, Premier of British Columbia and Chairman of the Council. He announced plans to meet in person earlier this year to negotiate a First Ministers’ Accord on Sustainable Health Care Funding before the budgets of the various governments are tabled in the spring.
As François Legault demanded during his presidency of the Council, the specific request is to increase from 22% to 35% the share of the health spending of the provinces and territories assumed by the federal government, and this, by means of the Canada Transfer in health matters. health. The most critical sentence in the press release states that they “also agree on the importance of focusing on results, to be accountable to their own citizens that their tax dollars are being invested responsibly and meeting urgent needs for better health care across the country. »(Author’s emphasis)
Provincial responsibility
This means that they agree that they are not accountable to the federal government. Health is a provincial responsibility; provincial governments are accountable to their taxpayers, whose taxes go into the federal treasury. The members of the Council are right to insist on this distinction.
Imposing national Canadian priorities and common accountability would slow the transfer of funds and tie the hands of the provinces, preventing them from changing direction depending on the context or if a certain mechanism did not produce the desired results.
In Quebec, when the budget is tabled, the government unveils an annual expenditure management plan for each department. That of the Ministry of Health last year breaks down all the costs associated with the pandemic. It also shows the increases planned in several services to the population. This is particularly the case for the positions of beneficiary attendants in CHSLDs, for mental health and homelessness care and services, home support, as well as for improving the organizational structure of services for the elderly.
Quantified objectives accompanied by indicators to measure results are also found in the Ministry’s Strategic Plan. These results are included in the Department’s Annual Management Report tabled each fall in the National Assembly. It contains objectives, for example, on mental health, services for young people and families, emergency room wait times.
In addition to budgets, strategic plans and annual reports, there are auditors, the Québec Ombudsman, coroner’s and public inquests. There is therefore no added value in reporting health spending to the federal government as well.
The context of each province is different, the priorities can be too. The long-term care system is undergoing a profound reassessment these days in Quebec. British Columbia faces the worst year of illicit drug overdose deaths. Manitoba is preparing to open more private, publicly funded surgeries to lower waiting lists. Is it really up to the federal government to determine the priorities that vary so much from one part of the country to another?
Important and urgent needs
Accountability for health transfers has evolved since the 1950s and 1960s. The federal government’s own website points out that from the original conditional cost-shared grants, federal aid has since taken “the form of block funding based on on the acceptance of general principles and common objectives. “
This program is now called the Canada health transfer referred to in the Council’s press release. The federal text continues: “The block funding structure gives provinces and territories more flexibility in the development and delivery of programs. As a result of this evolution, governments are now focusing on accountability to the people rather than to other levels of government. This recognizes the fact that governments must be accountable directly to their citizens for their spending in their areas of responsibility. “
Health needs are great and urgent. It is up to the Trudeau government and all opposition parties at the federal level to recognize the spirit of the program and to support the Council of the Federation’s demand for a simple and significant increase in the Transfer.