Federal and provincial health ministers emerged from a day of tense talks in Toronto still at odds over the federal government's planned cut to the annual increase in federal funding for health care.
Next year the Canada Health Transfer, the amount of money the federal government gives the provinces each year to pay for health care, will stop increasing by six per cent and instead will only increase by three per cent.
Quebec Health Minister Gaétan Barrette said the single "concrete" takeaway from the meeting is that the federal government is cutting health-care funding and forcing the provinces and territories to make tough choices.
"For today we know there will be a cut of $60 billion of funding from the federal government over the next 10 years," Barrette said.
"That means all provinces and territories must make difficult choices because we are being asked to do more with less. And on top of that we are being told what to do. So I don't think this is the end of the story."
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Barrette said the premiers are frustrated not only with the prospect of less money, but also with having any additional money tied to delivering specific programs, such as home care. He is optimistic the overall system can be improved, however.
Philpott defended the government's funding position, insisting that any new investments must be made with a clear plan to improve patient care.
"It's really important for Canadians to know that we are going to continue to contribute to the Canadian Health Transfer," she said. "In fact over the next five years there will be an additional contribution, something in the order of $19 billion on top of the already $36 billion per year."
Philpott said that amount will continue to rise over time and the Liberal government will give additional funds, first for home care, and then down the line for other areas such as mental health, she said.
"Canadians want to see their health-care system get better and we have a responsibility to do that," she said.
'Responsibility' to deliver
Philpott said discussions over dollars will continue, but the "bottom line" is that there is a desire to put patients first.
"I've been pleased there is so much common ground," she said, noting that all the ministers agreed on improving care and services in a number of areas including:
- Making prescription medication affordable.
- Taking action on the opioid crisis.
- Working toward a new health accord.
- Committing to further talks on home care.
- Increasing access to mental health.
- Fostering innovation in the health-care sector.
But the most pressing issue remained the federal government's plan to cut the annual funding increase from six per cent to three per cent.
Ontario Health Minister Eric Hoskins called the reduction in the increase of the transfer "inadequate" and said it signalled a "declining partnership" with Ottawa as health-care costs continue to increase at a greater rate than the health transfer.
"So to put that in context," Hoskins said, "Ontario stands to gain in home and community care [with] the $3-billion commitment made by the federal government, to the tune of probably $250 million next year, roughly, but we will lose approximately $400 million if the federal government goes through with their position that the [health transfer] will be limited to three per cent."
He also said many of the ministers took offence at Philpott's suggestion that federal funds earmarked for health care went into general revenues without certainty it was being spent on health services.
Laying out her demands Monday, Philpott said there must be more innovation and accountability measures.
"If we are going to make more investments, they need to go to health," she said, drawing some criticism for suggesting the provinces aren't adequately managing health spending.
The federal government has also pledged more than $3 billion in targeted funding for home care, including palliative care.
A reduction in the rate of increase of the Canada Health Transfer will mean a $1-billion shortfall nationally in 2017-18, Hoskins said.
The six per cent annual increase has been in place since the last health accord was negotiated in 2004.
The provinces and territories are pushing to postpone the reduced rate until Prime Minister Justin Trudeau meets with premiers in a meeting scheduled for Dec. 8-9.