441-00774 (Health)

Medicare is a fundamental part of Canada’s national identity and represents Canadians’ ongoing commitment to the values of equity, fairness, and solidarity. The Canada Health Act, Canada’s federal health care insurance legislation, sets out the broad principles (namely public administration, comprehensiveness, universality, portability, and accessibility), as well as penalty provisions that discourage patient charges, that must be satisfied by provincial and territorial health care insurance plans in order to qualify for their full share of the cash contribution available under the federal Canada Health Transfer.

The penalty provisions under the Act allow for Canada Health Transfer deductions from provinces and territories who do not comply with the principles of the Act. The aim of the Act is not to levy deductions but rather to ensure that all eligible residents of Canadian provinces and territories have reasonable access to medically necessary hospital and physician services, on a prepaid basis, without charges related to the provision of insured health care services. As such, when provinces and territories have been subject to a deduction due to patient charges, they are eligible to receive a reimbursement if they choose to work with Health Canada and take the necessary steps to put a stop to the charges and eliminate the circumstances that led to them.

The Government of Canada recognizes that access to care for individuals living in remote and rural area remains a challenge. The intent of the accessibility criterion under the Act is to ensure that insured persons have reasonable access to insured services on uniform terms and conditions. Reasonable access in terms of physical availability has been interpreted using the “where and as available” principle. Thus, residents of a province or territory are entitled to have access on uniform terms and conditions to insured health care services at the setting “where” the services are provided and “as” the services are available in that setting. The provinces and territories have various programs and initiatives, including the expansion of virtual care, to help support access to health services for individuals living in rural and remote areas.

The roles and responsibilities for health are shared between the federal, provincial and territorial governments. The provincial and territorial governments have primary jurisdiction in health care administration and delivery. This includes setting their own priorities, administering their health care budgets and managing their own resources. Nonetheless, the Government of Canada is committed to working in partnership with provincial and territorial governments to strengthen health care systems so that they continue to meet the needs of Canadians, and has taken leadership in engaging with the jurisdictions to address key health care priorities.

As part of the Budget 2017 commitment to improve access to home and community care and mental health and addiction services, the Government is investing $11 billion over 10 years to increase supports for Canadians. Bilateral agreements, detailing how federal investment between 2017-18 and 2021-22 would help improve access to home and community care and mental health and addiction services, were negotiated with all provinces and territories and posted to Government of Canada’s website. Additional funding agreements will be negotiated with provinces and territories for the remaining years (2022-23 to 2026-27).

Home and Community Care

As part of the Common Statement of Principles on Shared Health Priorities, federal, provincial, and territorial Health Ministers have committed to working together to improve access to appropriate services and supports in home and community, including palliative and end-of-life care, by pursuing one or more of the following actions:

• Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
• Enhancing access to palliative and end-of-life care at home or in hospices;
• Increasing support for caregivers; and,
• Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Home care services help people receive needed care at home, rather than in a hospital or long-term care facility, and to live as independently as possible in the community. Home care usually includes professional services at no cost to the client (e.g., physiotherapy, nursing, and occupational therapy) and home support/personal care (e.g., personal hygiene, dressing, feeding, and toileting), which is income-tested in most provinces and territories.

Examples of initiatives funded under the bilateral agreements include improved respite services and benefits for caregivers, offering a range of care and services in the community to avoid unnecessary hospital or long-term care admissions, enhanced palliative home care programming, and implementing care assessment tools to allow clinicians to develop care plans and monitor home care clients.

This supports Canadians to get the care they need closer to home through enhanced home care services, greater access to palliative care in the community, and strengthened supports for families who are caring for their loved ones.

Mental Health and Addictions

As a result of investments to date from Budget 2017, provinces and territories have implemented new initiatives to improve access, and spread evidence-based models of mental health and addiction services, with a particular focus on strengthening integrated supports for children, and youth.

The appointment of a Minister of Mental Health and Addictions in November 2021 underscores the importance the Government of Canada places on both mental health and substance use services. The Government is committed to ensuring that mental health is treated as a full and equal part of our universal health care system and the need to continue to apply a whole-of society approach to harms resulting from substance use.

The Government of Canada is currently providing a range of supports for mental health and substance use, including:

• Support for mental health promotion for children, youth, young adults and populations susceptible to mental health inequities;
• Support for the development of mental health and substance use standards which will help to formalize what Canadians can expect in terms of the quality of services; and,
• Wellness Together Canada, an online mental health and substance use support portal which provides free and confidential online mental health and substance use supports accessible 24/7 to individuals across Canada in both official languages. 

Recently, the Government of Canada announced the launch in November 2023 of a new three-digit suicide prevention line providing mental health crisis and suicide prevention intervention by trained responders.

The federal government also funds two pan-Canadian Health Organizations, the Canadian Centre on Substance Use and Addiction, and the Mental Health Commission of Canada, which play key roles in coordinating and mobilizing diverse sectors for common action and innovation.

Health Workers

In addition, the Government of Canada is working with provinces and territories, as well as key health partners to develop concrete actions to address the health workforce crisis. The Government recently announced a Coalition for Action for Health Workers which will inform immediate and longer-term solutions to address significant health workforce challenges. The Coalition's initial priorities will include: providing advice on workers' retention so health workers continue to stay in their jobs; increasing the supply of health professionals in the country; improving health workforce data; and opportunities to scale new models of care to address key barriers.

While the licensing of immigrant health care workers is under the purview of the provincial and territorial colleges, the federal government has recently announced changes to make it easier for foreign-born physicians to remain in Canada, so they can continue to practice in the country and bolster our health care system. The Department of Immigration, Refugees and Citizenship Canada continues to prioritize temporary resident work permit applications for essential workers in health care, and in 2022, the department has accepted over 8,600 temporary and permanent resident applications from foreign nationals intending to work in the health sector. More information on this initiative can be found here.

Additional Federal Investments in Health

Building on progress made in the first five years on agreed health care priorities with federal funding, the Government is currently working with provinces and territories to advance new bilateral agreements that will outline how they will use the $6 billion that remains available over the next five years.

In addition to these investments, when short-term pandemic funding was needed, the federal government made significant investments in health care and all other areas of the economy and worked hand in hand with provinces and territories in the fight against COVID-19. Eight out of every 10 dollars invested to help support Canadians during the pandemic has come from the Government of Canada.

In July 2022, the Government provided provinces and territories with an additional $2 billion one-time top-up to the Canada Health Transfer, to further help them to address pandemic-related health system pressures, particularly the backlog of surgeries, medical procedures and diagnostics. This is in addition to the $5 billion health care funding our Government provided to provinces and territories in July 2021, including a $4 billion one-time top-up to the Canada Health Transfer to support provinces and territories to clear the backlog of procedures caused by the pandemic, and $1 billion to support vaccine roll-out. 

Beyond this, the Government of Canada also provides funding to a number of pan-Canadian Health Organizations such as the Canadian Partnership Against Cancer (CPAC), which works with partners across Canada to accelerate and introduce programs to: restore and sustain cancer care in the wake of the pandemic; drive faster innovation to improve access to world-class screening; address inequities in care for underserviced populations; and, advance the priorities and actions of the Canadian Strategy for Cancer Control (2019-29).

Going forward, the Government remains ready to work with provincial and territorial governments to further discuss health system priorities, actions and results, including:

1. Addressing the health workforce crisis, surgical backlogs and hospital capacity issues;
2. Implementing integrated, team-based care;
3. Improving health data and digital access to health care;
4. Improving mental health and substance use services; and,
5. Helping Canadians to age with dignity, close to home.

As we build on the federal government’s track record of providing support, we are committed to working with provinces and territories to develop a shared vision for the future — one that includes improved efficiencies, strong accountability measures, intuitive reporting, and more. Canadians expect results for their investments. We need to find innovative solutions to our challenges by working together constructively with provinces and territories partners.