e-4273 (Health)

Health is an area of shared jurisdiction among the federal, provincial, and territorial governments. Under the Constitution Act (1867) exclusive authority to make laws in the health sector are derived from matters under the subject areas of the establishment, maintenance and management of hospitals, local matters, property, and civil rights. These powers have been interpreted by the courts as vesting provinces and territories with legislative authority for health care delivery, the administration of provincial health insurance plans, and the regulation of health professions and their practices. As such, the Government of Canada does not have the Constitutional authority to nationalize healthcare insurance, health system administration and governance, or health colleges.

This is why instead of a single national plan, the Canadian health care insurance system is achieved through 13 separate provincial and territorial health care insurance plans, which are broadly linked through adherence to national operating principles defined by the Canada Health Act, Canada’s federal health care insurance legislation. The Act establishes broad program criteria for publicly funded health insurance plans (comprehensiveness, universality, portability, accessibility, and public administration) and provisions to discourage patient charges for medically necessary hospital and physician services. The provinces and territories must fulfill these requirements to receive the full federal cash contribution under the Canada Health Transfer.

The government remains committed to upholding the Canada Health Act and to working closely with the provinces and territories to protect Canada’s publicly funded healthcare system ensuring all Canadians’ ability to access medically necessary care based on their needs, not their ability to pay.

Similarly, jurisdiction over matters concerning the quality of care delivered by health care facilities and providers lie with the provincial and territorial governments, or organizations to which they delegate that authority. As such, the federal government does not have the jurisdiction to unilaterally establish an independent national body to oversee patient safety concerns and complaints.

With respect to a national no fault harm in care compensation system, all practising physicians in Canada are required to have liability insurance coverage, either directly through provincial or territorial legislation or delegated to the regulatory college to determine the amount required.  Liability insurance requirements for medical practitioners (including the criteria for reimbursement of membership fees and the amount reimbursed) and any systems in place to support patients with medical errors (including but not limited to compensation and dispute resolution mechanisms) are all determined by provincial and territorial governments, or organizations to which they delegate that authority.

The Government of Canada will continue to work to improve patient safety within our healthcare system where it is possible within its jurisdiction, such as mandating reporting on adverse drug events under the Protecting Canadians from Unsafe Drugs Act (also known as Vanessa’s Law) or supporting national leadership and coordination on patient safety by funding Healthcare Excellence Canada (formerly the Canadian Patient Safety Institute), whose programs aim to shape a future where everyone in Canada has safe and high-quality health care. In addition, the Government of Canada will continue to work collaboratively with provinces, territories and other key partners to ensure that care is safe.

This continuing feedback from Canadians ensures timely responses to health system challenges, as shown by Budget 2023, which outlined the Improving Health Care for Canadians Plan that provides an additional $198.3 billion in health investments over 10 years to PTs to support health system and to transform services to meet the evolving needs of Canadians. This funding includes:

1. Top-up payments to achieve Canada Health Transfer (CHT) increases of at least five per cent 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, beyond the ongoing GDP-driven growth CHT growth.
2. $25 billion over ten years through a new set of bilateral agreements with PTs to address individual provincial and territorial health system needs.
3. $1.7 billion over 5 years to support hourly wage increases for personal support workers and related professions.
4. $350 million over ten years in recognition of medical travel and the higher cost of delivering health care in the territories.
5. A $2 billion top-up to the CHT 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.
6. $2 billion for an Indigenous Health Equity Fund.

As part of the Government of Canada’s Improving Health Care for Canadians Plan, federal, provincial and territorial governments have committed to work together to modernize the health system. This includes improving the way health information is managed as well as adopting common standards and policies related to data. These commitments are expected to improve the quality and safety of patient care and provide decision makers with a more complete picture of the health system.