e-4207 (Employment and labour)

Provincial and territorial governments have exclusive authority to legislate employment standards for workers in the care economy. However, provinces and territories (P/Ts) can look to recent amendments made to Part III of the Canada Labour Code that helped improve employment standards in the federally regulated private sector (e.g., banking, telecommunications, inter-provincial and international transportation). These amendments include increasing the minimum wage to $15 in 2021 (currently at $16.65 as of April 1, 2023), introducing 10 days of paid medical leave (as of December 1, 2022) and prohibiting differences in rates of wages based on the employment status of employees (not yet in force).

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 to improve health care services for Canadians. This investment will accelerate efforts already underway with P/Ts to support the retention of health workers within the public health care system, as well as focus on increasing the supply of health workers through recruitment by increasing training, residency and practicum spots for health professionals, and training professionals in rural and remote communities where they live. It will also support regulatory bodies and associations in streamlining their processes to get more trained and qualified professionals working in the health care system faster, which in turn will help increase Canadians’ access to health service providers.

This funding also includes $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as federal/provincial/territorial governments work together on how best to support recruitment and retention.

Lastly, to help drive significant change in the care economy sector, the federal government established a Coalition for Action for Health Workers in November 2022. The Coalition will provide a forum for discussion on complex issues related to health workforce planning and management, which could include compensation and benefits, and advice from members (i.e., experts and representatives from key groups, including nurses, doctors, PSWs, unions, academia, patients, and equity deserving communities) will inform immediate and longer-term solutions to address health workforce challenges, so that all Canadians can access the quality care they need and deserve.

Our government recognizes the tremendous and sustained work of our health care providers throughout the pandemic, as well as all the frontline and essential workers who put their lives on the line to protect Canadians. Canadians working in health care have made significant personal sacrifices by putting themselves and their families at risk and working extremely long hours?often under great stress-to help people in Canada get through the worst of the pandemic.

Our government is committed to working with provinces and territories to improve the quality of Canada’s health care system. This commitment was reiterated through Budget 2023 where close to $200 billion in additional funding over ten years was confirmed for a comprehensive plan to improve the health care system. The plan includes:

• A $2 billion top up to the Canada Health Transfer (CHT) which was provided in 2022-23 to address urgent pressures in emergency rooms, operating rooms and pediatric hospitals, building on the $6.5 billion in top-ups provided throughout the pandemic.
• Top-up payments to achieve CHT increases of at least five percent per year for the next five years. The last top-up payment will be rolled into the CHT base at the end of the five-year period, resulting in a permanent funding increase.
• $25 billion over ten years through a new set of tailored bilateral agreements to address provincial and territorial health system needs in four priority areas including expanding access to family health services, supporting health workers and reducing backlogs, increasing mental health and substance use support, and modernizing health systems.
• $1.7 billion over five years to support hourly wage increases for personal support workers and related professions.
• A total of $350 million over ten years to renew the Territorial Health Investment Fund in recognition of medical travel and the cost of delivering health care in the territories.
• $505 million over five years to the Canadian Institute for Health Information, Canada Health Infoway and federal data partners to work with provinces and territories on developing new health data indicators, and to support the creation of a Centre of Excellence on health workforce data and underpin efforts to use data to improve health care.
• $2 billion over ten years to work with Indigenous partners to provide additional support for Indigenous health priorities, to be distributed on a distinctions basis through the Indigenous Health Equity Fund.

In addition, the government is also making transformative investments in dental care. Budget 2023 proposed $13.0 billion over five years (starting in 2023-24), and $4.4 billion ongoing, for Health Canada to implement the new Canadian Dental Care Plan. The plan will provide dental coverage for uninsured Canadians with annual family income of less than $90,000, with no co-pays for those with family incomes under $70,000. Details on eligible coverage will be released later this year.

This latest investment builds on the launch of the Canada Dental Benefit in 2022 which is now providing eligible parents or guardians with payments of up to $650 per child under 12 years of age and up to $1,300 over two years to cover the cost of dental care for their children. To date, the Canada Dental Benefit has helped close to 300,000 children receive the dental care they need.

To further help Canadians access the dental care they need, Budget 2023 proposed $250 million over three years (starting in 2025-26), and $75 million ongoing, for Health Canada to establish an Oral Health Access Fund. The fund will complement the Canadian Dental Care Plan by investing in more targeted measures to address oral health gaps among vulnerable populations and reduce barriers to accessing care, including in rural and remote communities.

The government is committed to preserving and improving our publicly funded health care system, which values equity, fairness, and free access to medically necessary health care for all Canadians. Our government does not support a two-tiered health care system where patients may choose, or be required, to pay for quicker access to medically necessary services.

As it makes historic investments in the health care system, the government will continue to work with provinces and territories to make sure they are used in the best interest of health workers and patients. Budget 2023 noted that provinces and territories are asked to uphold the Canada Health Act to ensure that access to insured services is based on health needs, and not ability or willingness to pay. No Canadian should be paying out of pocket for medically necessary services and our government will not tolerate it. As the nature of care evolves, we must protect Canadians’ ability to access medically necessary services, including diagnostics at no cost - no matter how or where care is delivered. 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.

The Government of Canada has been clear that, when provinces and territories permit private facilities to deliver insured health services, those services must be fully covered by provincial or territorial public health insurance plans. That is why, on March 10, 2023, the Minister of Health announced mandatory Canada Health Transfer deductions, totalling over $82 million in respect of patient charges levied in private clinics during 2020-21. This includes the first deductions taken under the Diagnostic Services Policy, for patient charges levied for medically necessary diagnostic imaging services provided by private clinics. You can view the Minister of Health’s statement on these deductions.

Additionally, the Government of Canada is committed to ensuring that patients have access to medically necessary services, regardless of how, or by whom, they are delivered. For example, during the pandemic, virtual care was implemented by provinces and territories at an unprecedented speed to help meet the health care needs of Canadians during a time when in-person medical care was not always an option. As provinces and territories begin to fully integrate virtual care, the federal government will continue to work with them to ensure our publicly funded health care system is dynamic, while remaining true to the fundamental principle of Medicare, (i.e., access based on need). To that end, on March 9, 2023, Minister Duclos sent a letter to his provincial and territorial colleagues outlining his concerns with reports of patient charges for medically necessary services delivered virtually or by health care providers providing physician-equivalent services, and noting the need to have further engagement on this issue. Whether it is improving access to family health services, supporting our health workers, shorter wait times, or better access to mental health care—we are committed to getting real results so Canadians can get the care they deserve, when and where they need it.