The Political and Economic Sustainability of Health Care in Canad ...

In summary, federal fiscal grants to the provinces were tied to provincial agreement under the 2000 accord in order to provide clearer reporting, information regarding third-party actors, and more detailed indicators—leading to the establishment in 2002 of a Performance Indicator Reporting Committee. The 2003 Health Accord included a $16 billion health reform fund targeting increased primary care, home care, and catastrophic drug coverage. Furthermore, the 2004 ten-year plan focused on the development of benchmarks, the development of performance indicators, and the reduction of waiting times in five targeted areas, and it granted a mandate to the CIHI to monitor provincial progress on waiting times. It also expanded the role of the Health Council of Canada, created in 2003 to report on the progress of health care renewal, on the health status of Canadians, and on the health outcomes of the system, an initiative that proved unproductive. Nevertheless, by 2007 it had become clear that these federal grants had produced neither dramatic structural changes in Canadian health care nor a willingness among the provinces and territories to develop pan-Canadian performance indicators. The 2007 federal budget included a provision to spend $400 million on the Canadian Health Infoway to develop both a health information system and electronic health records that would, it was hoped, facilitate the reduction of waiting times at the provincial and territorial level. The 2009 budget provided an additional $500 million for the Canadian Health Infoway, to support the goal of providing electronic health records for 59 percent of Canadians by 2010 and to support the development of an electronic medical-record system for physicians, hospitals, and other health institutions (Flaherty 2009).

A new federal equalization payment was established, also in 1999, to enable poorer provinces to maintain existing programs in a number of areas (O’Reilly 2001). Because provinces do not report to the federal government on the allocation of such funds in the provincial budgets, the federal government does not estimate how such funds are used for health care services in its assessments of national health care funding. Fiscal federalism is an important dynamic that significantly affects the financing of provincial and territorial infrastructure in Canada’s health