Money, Politics and Health Care: Reconstructing the Federal-Provincial Partnership

Edited by Harvey Lazar and France St-Hilaire
Table of Contents | Sample Chapter
January 2004

The First Ministers' Accord on Health Care Renewal, announced in February 2003 just a few months following the release of the Romanow and Kirby reports on the future of health care in Canada, gave rise to high expectations. Many Canadians hoped that the accord signalled the beginning of a process of renewal and fundamental reform, based on a common vision among governments and a solid financial commitment for the long term. Instead, there has been little evidence of a more collaborative stance between Ottawa and the provinces, as disputes over health care funding, accountability mechanisms and the role of the federal government continue unabated. As a result, substantive progress remains elusive.

While disagreements are part of the normal jockeying for power in a federation, in the case of Canadian health care they are symptomatic of an intergovernmental dynamic that is detrimental to the cause of health care reform and the proper functioning of the social union.

This collection of essays, based on earlier work prepared for the Romanow Commission, analyses key issues in federal-provincial health care relations, especially the fiscal component. It begins with an essay on competing interpretations of the federal government's role in health care and the implications of different conceptions of the sharing community and the nature of the Canadian federation for fiscal arrangements and Ottawa's policy role. It proceeds from there to consider the issues at the heart of recent intergovernmental conflicts in health care, including the debate on fiscal imbalance, how much the federal government does and should contribute financially to provincial health care programs, and the dispute resolution process. The last chapter summarizes policy options and lays out a set of principles that might guide the conduct of intergovernmental health care relations and the use of fiscal arrangements under alternative views of the sharing community. The overall assessment is that major improvements in federal-provincial fiscal relations are required in order to sustain Canada's publicly insured health care system.