Ontario announced a health-care agreement with the federal government on Thursday morning, and several other provinces followed suit shortly after.
The 10-year, $8.4 billion bilateral agreement-in-principle covers four areas of “shared priorities” by the governments of Canada and Ontario. The focus areas include supporting better access to family doctors in rural and remote areas, the health-care workforce, mental health and substance use, and digitizing health records.
The $8.4 billion will come with conditions that will allow the federal government to track progress on the priority areas to ensure its expectations are met.
As of now, there are no real details on how that accountability process will work because Thursday’s agreement is only an outline of the deal that's yet to be signed.
Ontario Finance Minister Peter Bethlenfalvy didn’t provide any details when pressed on when the money will start to flow from the federal government.
“In terms of the specifics of the timing, that's what we're working on. What we announced today is that we've reached an agreement in principle. That's an important next step,” Bethlenfalvy said.
The federal government's press release provided a bit more detail. “Work will now begin on a bilateral agreement based on an initial three-year action plan that will detail targets, timelines and additional common indicators related to shared health priorities in each jurisdiction,” it said.
Thursday’s announcement also included re-upping past commitments, including an immediate $776 million top-up of the Canada Health Transfer (CHT) for Ontario.
The CHT is the federal government's main way of funding health care in the country. It’s a block payment given to provinces and there’s no guarantee that money will be spent on health care. Provinces can use CHT any way they choose.
Bilateral deals, however, give the feds the ability to ensure some form of provincial accountability.
Earlier this month, the federal government promised an immediate $2 billion top-up of the CHT. Ontario's $776 million is roughly 38 per cent of the total, equivalent to Ontario’s share of Canada’s total population.
The press release said the CHT increase will “address urgent needs, especially in pediatric hospitals and emergency rooms, and long wait times for surgeries,” but the money is not specifically targeted at those priorities.
Bethlenfalvy was asked whether he’d commit to spending the CHT top-up money on health care — and health care alone — as opposed to using it to cover tax cuts or other policies.
“We will spend the health-care money because our number 1 priority is to make sure that not only do we have the investments today for health care to make sure that we can deliver timely access to health care, but we need to make sure that it's sustainable for the future,” he said.
The money included in the bilateral deal and the immediate CHT infusion are on top of a broader reworking of the CHT.
During a meeting with premiers on Feb. 7, Prime Minister Justin Trudeau promised to increase the federal government's rate of increasing CHT payments each year from its previous floor of three per cent to a five per cent annual floor.
In the 2017 round of bilateral negotiations that focused on long-term care and mental health, Ontario was one of the last provinces to sign on, and was the last province to sign on to the recent child-care agreements.
Having the agreement in principle also gives Ontario a better understanding of its financial situation ahead of budget season. Hours after the bilateral agreement was announced, Bethlenfalvy announced in a tweet that Ontario's budget will be released on March 23.
After the Feb. 7 meeting between the prime minister and provincial premiers, the federal government put out a press release outlining its proposal to the provinces.
The agreement struck with Ontario today is virtually identical, “so it does appear that what the feds have put forward is what Ontario has accepted,” said Katie Heelis, vice president at EnterpriseHealth, a Toronto-based political consulting firm.
Heelis also served as a senior policy adviser to former Ontario health ministers Dr. Eric Hoskins and Dr. Helena Jaczek. Heelis said the fact that mental health was included in this round of bilateral deals, while long-term care was not, shows how important it is to the governments of Canada and Ontario.
Unlike long-term care, which also has an existing bilateral framework, mental health being included in both the 2017 and 2023 deals further signals to the public and stakeholders that this is something both governments want to be seen as acting upon, Heelis said.
“I think there was a feeling that that had to be in there," she said. "And it would have looked like a huge gap if it wasn't.”
Seeing the Ontario deal, and the other provincial deals, signed so quickly after the Feb. 7 meeting suggests there was a lot of alignment on the priorities, Heelis said.
As a whole, Heelis likes the agreement.
“There are very, very serious and very real health-care challenges in Ontario and across Canada, especially after COVID-19,” she said. “So the collaboration between the federal and the provincial governments is essential. It's good news that they're working together.”
