e-4113 (Health)

We share the deep concerns of Canadians regarding the significant challenges our health care system is experiencing, and we are working with provinces and territories to ensure Canadians get the care they deserve. Universal, accessible, and publicly funded health care is a point of pride for Canadians. The Canada Health Act ensures that all Canadians have reasonable access to medically necessary insured services based on need and not the ability or willingness to pay.  We will always protect Canadians’ equitable access to universal health care services and will never hesitate to take action to uphold the Act.

Regarding concerns related to private billing and the Canada Health Act, the Prime Minister has publicly stated that the Government of Canada will ensure that every province follows the requirements of the Canada Health Act. This is why the Minister of Health’s mandate letter includes specific direction from the Prime Minister to strengthen compliance with the Canada Health Act on matters of patient charges for publicly insured services, where they occur.

The Canada Health Act, Canada’s federal health care insurance legislation, establishes the conditions and criteria related to medically necessary hospital and physician services (i.e., insured health services) that the provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer (CHT). These criteria are public administration, comprehensiveness, universality, portability, and accessibility.

The Canada Health Act does not preclude the use of private or for-profit facilities in the delivery of insured health services, as long as the services are fully covered under the provincial and territorial health care insurance plan and patients are not charged for the services received. Provinces and territories are responsible for ensuring that facilities and providers of insured health services operate in a manner that is consistent with the requirements of the Act.

In fact, the Government of Canada has been clear: when provinces and territories permit private facilities to deliver insured health services, those services must be covered by provincial or territorial public health insurance plans. Health Canada is aware of a number of provinces that do not cover medically necessary diagnostic services when provided in private clinics.  That is why, in a 2018 letter, the former Minister of Health communicated the Canada Health Act’s Diagnostic Services Policy to her provincial and territorial colleagues. Through the Policy, which has been in effect since April 1, 2020, the Government of Canada aims to ensure that no Canadian is charged for medically necessary diagnostic services. The aim of the Act is not to levy deductions but rather to work with the provinces and territories to ensure that Canadians have access to the care they need without barriers.

On March 10, the Minister of Health announced mandatory Canada Health Transfer (CHT) deductions totalling over $82 million in respect of patient charges levied during 2020-21 for medically necessary services that should be accessible to patients at no cost. This includes the first deductions taken under the Diagnostic Services Policy (DSP), totalling over $76 million for patient charges levied for medically necessary diagnostic imaging services. An additional $6 million was also deducted for other patient charges, including those levied for insured services provided at private surgical clinics and for access to insured abortion services.

He also announced next steps to curb private medically necessary health care being paid out-of-pocket by Canadians, with a focus on virtual care and other medically necessary services that Canadians are being asked to pay for. The Minister of Health has also sent a letter to his provincial and territorial colleagues reiterating our collective responsibility in ensuring Canadians’ ability to access medically necessary services without having to pay out of pocket, no matter where they live in the country or how care is delivered.

Regarding concerns related to the Minister of Health's public health care funding mandates, the Minister’s mandate letter states that he will “lead our renewed commitment to work in partnership with and increase funding to provinces and territories to strengthen our universal public health system.”

On February 7, 2023, the Government of Canada announced an investment of $198.6 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 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.

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 on February 7, 2023 is an additional $1.7 billion over five years to support wage increases for personal support workers and related professions.

Finally, regarding the auditing of hospital boards, the Government of Canada tracks health care developments across the country. Although the federal government plays a role in supporting health care by providing funding to the provinces and territories, the provincial and territorial governments have primary jurisdiction in the administration and delivery of health care services. As such, the management of health care services, including those services provided by hospital boards, is the responsibility of provincial and territorial governments. As a result, there is no federal oversight of these activities so long as their actions remain compliant with the Canada Health Act.

Canadians and their families deserve timely access to health care services they need, and they expect their governments to work together to find immediate and longer-term solutions to these challenges. The federal government will continue working closely with provinces and territories s to help ensure all Canadians have equitable access to medically necessary care based on their needs, not their ability to pay.