No real strings attached to health-care deal


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The only thing certain about the $6.7-billion agreement in principle Manitoba signed last week with Ottawa on health-care funding is that more federal dollars will flow to provincial coffers over the next 10 years.

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The only thing certain about the $6.7-billion agreement in principle Manitoba signed last week with Ottawa on health-care funding is that more federal dollars will flow to provincial coffers over the next 10 years.

How, specifically, that money will be spent — including whether it will result in shorter hospital wait times or improved access to family doctors — is anyone’s guess.

The new money is Manitoba’s share of a 10-year, $196-billion health-care funding deal the federal government signed with the provinces earlier this month. Most of that money will flow to provincial governments through the existing Canada Health Transfer, which provinces can spend any way they choose. Nearly a quarter of the new funding will be delivered through bilateral agreements negotiated with each province, where some conditions can be set.

However, in the complex world of federal-provincial divisions of power — where provinces have constitutional jurisdiction over health care — attempts to tie funding to specific outcomes is more political theatre than binding, cash-for-services deal making.

Prime Minister Justin Trudeau confirmed as much last week when asked how federal officials plan to hold provinces accountable for the new money they will receive. For the most part, they won’t, he said. It will be up to the public, not Ottawa, to demand results from their respective provincial governments.

The federal government has no plans to impose national standards on the provinces, such as wait-time benchmarks established by the Canadian Institute for Health Information. Instead, provinces will be allowed to set their own “targets” through “action plans” they must submit to Ottawa.

Those targets will be made public. However, provinces will not face consequences of any kind from the federal government if they fall short of them. Provincial governments that don’t measure up will have to answer to their own constituents, Mr. Trudeau said.

And if a province sets the bar too low when establishing its targets, it will be up to the public to hold them accountable, not Ottawa, the prime minister said. If, for example, a province determined that only 75 per cent of the population is guaranteed access to primary care, they would have to explain to the public why a quarter of its citizens may not have access to a family physician, Mr. Trudeau explained.

It appears that is the extent to which Ottawa is willing to attach strings to the new funding, beyond the ongoing requirement that provinces adhere to the Canada Health Act (which does include financial penalties for non-compliance).

The only part of the new deal that may demand a more concrete commitment from the provinces is a requirement for them to modernize their health-data systems. But even that is a nebulous part of the agreement. There are no details around what that requirement might look like, including possible penalties for non-compliance, nor any specifics about what type of data collection Ottawa plans to focus on.

There is a lot of talk about targets, expectations and common goals in the new health-care funding deal, but few, if any, enforceable conditions attached to it.

Perhaps, realistically, that is the best Ottawa can do, given jurisdictional issues and the disparities that exist between provincial health systems. It may, as the prime minster says, be up to the court of public opinion to ensure provinces, including Manitoba, spend their new health-care dollars wisely.

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