The Health of Canadians – The Federal Role

Interim Report

Volume One – The Story So Far


  1. Debates of the Senate (Hansard), 2nd Session, 36th Parliament, Volume 138, Issue 23, December 16, 1999.

  2. In this report, the testimony received by witnesses printed in the Minutes of Proceedings and Evidence of the Standing Senate Committee on Social Affairs, Science and Technology will be hereinafter referred to only by issue number and page number within the text.

  3. Keith Banting (9:62).

  4. Tom Kent (13:30).

  5. Payments due to the provinces under the Hospital Insurance and Diagnostic Services Act were calculated as follows: a province’s entitlement in a given year was equal to 25% of the average national per capita cost of the insured services, plus 25% of the cost of the insured services per resident of that province multiplied by the population of that province in that year. Overall, the federal government’s contribution was equal to about 50% of the cost of insured services in Canada, although it was more in the provinces where the per capita costs were lower than the national average and less in the other provinces.

  6. Under the Medical Care Act, a province’s entitlement in a given year was equal to 50% of the average national per capita cost of insured services multiplied by the population of that province in that year. As a result, all provinces received equal per capita transfers, although the federal contribution as a proportion of total provincial expenditures varied from one province to another.

  7. Hon. Marc Lalonde (15:7).

  8. Tom Kent (13:33).

  9. Hon. Marc Lalonde (15:6-7).

  10. Under EPF, the federal tax transfer was 13.5 tax points on personal income tax and one tax point on corporate income tax. The provinces whose fiscal strength was lower than a provincial standard received equalization payments to bring their transfer up to that standard (the provinces making up the standard were Quebec, Ontario, Manitoba, Saskatchewan and British Columbia). As part of its opting-out agreements, Quebec received a special abatement of 8.5 additional tax points on personal income. Because of this additional abatement, Quebec received a relatively larger share of its federal contribution than the other provinces in the form of transferred tax points and a smaller share in the form of cash. In total, however, Quebec’s per capita entitlement under EPF was exactly the same as those of other provinces.

  11. The GDP measures the value of all goods, services and investment in a country during a defined period of time, usually a year.

  12. The initial per capita entitlement amounted to $144.34 for hospital and medical care, $68.31 for post-secondary education and $20.00 for extended health care.

  13. Hon. Marc Lalonde (15:7).

  14. Ibid.

  15. The cash floor provision of the CHST was abolished in 1999 as the amended legislation (Bill C-71) provided a level of cash transfer over and above the $12.5 billion limit.

  16. The main reason for these discrepancies was the funding disparity under the CAP: the provinces that used to receive a greater than average share under the CAP continued to receive a greater than average share under the CHST.

  17. Finance Canada, History of the Canada Health and Social Transfer, Submission to the Standing Senate Committee on Social Affairs, Science and Technology, 7 June 2000, p. 3.

  18. Ibid., p. 6.

  19. Provincial Premiers and Territorial Leaders, Letter to the Prime Minister of Canada, 3 February 2000. A copy of this letter is available on the Canadian Intergovernmental Conference Secretariat’s Internet site at Also see the following statement: "Premiers’ Commitments to their Citizens", 41st Annual Premiers’ Conference, News Release, 11 August 2000 (available at

  20. Provincial and Territorial Ministers of Health, Understanding Canada’s Health Care Costs – Interim Report, June 2000, p. 10.

  21. Hon. Marc Lalonde (15:13).

  22. Hon. Marc Lalonde (15:10-11).

  23. Keith Banting ( 9:65).

  24. Federal direct funds refer to direct health care spending by the federal government in relation to health services for specific groups (Aboriginals, the Armed Forces and veterans), as well as for health research, health promotion and health protection.

  25. Tom Kent (13:34-35).

  26. Guillaume Bissonnette (17:12).

  27. Hon. Monique Bégin (16:5).

  28. Tom Kent (13:32).

  29. Hon. Claude Castonguay, Canada’s Health Care System: An Urgent Need for Change, Brief to the Committee, pp. 3-4.

  30. Guillaume Bissonnette (17: 11).

  31. Michael Bliss (13:37-38).

  32. Abby Hoffman (13:11).

  33. Hon. Marc Lalonde (15:11).

  34. Tom Kent (13:30).

  35. Abby Hoffman (13:25).

  36. Health Canada, History of Dispute Resolution under the Canada Health Act, Information binder prepared for the Committee, section 6, 9 February 2000.

  37. Hon. Marc Lalonde (15:21).

  38. Hon. Monique Bégin (16:5).

  39. Tom Kent (13:40).

  40. Chris Baker (9:31-32).

  41. Chris Baker (9:32).

  42. Chris Baker (9:32).

  43. Abby Hoffman (13:27).

  44. Graham Scott (20:13)

  45. Dr. Scott Evans (9:38).

  46. Conference Board of Canada, Canadians’ Values and Attitudes on Canada’s Health Care System: A Synthesis of Survey Results, 6 October 2000, p. 12.

  47. Ibid., pp. 31-32.

  48. Ibid., p. 2.

  49. Dr. Scott Evans (9:34-35).

  50. Dr. John S. Millar (14:35).

  51. Dr. John S. Millar (14:35).

  52. Sholom Glouberman (9:18-19).

  53. Dr. Scott Evans (9:37).

  54. CIHI, National Health Expenditure – Trends, Ottawa, 15 December 1999 (1975-1999) and 11 December 2000 (1975-2000); and OECD, OECD Health Data, CD-ROM, Paris, 1999 and 2000.

  55. More precisely, total health care spending grew at an average annual rate of 11.1% over the period 1975 to 1991. Then, growth fell substantially to an average annual rate of 2.6% between 1991 and 1996. The average annual rate of growth is expected to have risen to some 6.0% between 1996 to 2000.

  56. Abby Hoffman (13:8).

  57. Data are usually adjusted for inflation by using a GDP implicit price index (the 1992 index equals 100).

  58. Real rates of growth averaged 3.8% between 1975 and 1991, 1.0% between 1991 and 1996 and 4.6% between 1996 and 2000.

  59. As explained in Chapter 1, the GDP measures the value of all goods, services and investments in a country during a year.

  60. The public sector refers to the various levels of government. Private sector spending primarily consists of direct out-of-pocket costs by individuals and expenditures covered by third-party insurers. Expenditures by Workers’ Compensation Boards are included in public spending on health care.

  61. Abby Hoffman (13:8).

  62. PPP is an international price index calculated by comparing the prices of identical goods in various countries. It indicates the rate at which one currency must be converted into another currency to be able to purchase an equivalent basket of goods and services in other countries. Dollars adjusted by the PPP make it possible to compare the prices of identical products in various countries. PPP is not, therefore, simply a monetary conversion but an equivalence which takes into consideration a real value assigned to a basket of goods and services.

  63. Conference Board of Canada, Performance and Potential 2000-2001 – Seeking "Made in Canada" Solutions, 2000, p. 115.

  64. CIHI, Health Care in Canada – A First Annual Report, 2000, p. 21.

  65. This review of the development of population health approach in Canada was based on a document entitled Population Health Initiatives provided to the Committee by Health Canada.

  66. Marc Lalonde, Minister of National Health and Welfare, A New Perspective on the Health of Canadians – A Working Document, Ottawa, April 1974, p. 31.

  67. Jake Epp, Minister of Health and Welfare, Achieving Health for All: A Framework for Health Promotion, Ottawa, 1986.

  68. Federal/Provincial/Territorial Advisory Committee on Population Health, Strategies for Population Health: Investing in the Health of Canadians, Ottawa, 1994.

  69. Federal/Provincial/Territorial Advisory Committee on Population Health, Intersectoral Action… Towards Population Health, Ottawa, June 1999.

  70. Federal, Provincial and Territorial Advisory Committee on Population Health, Toward a Healthy Future – Second Report on the Health of Canadians, 1999.

  71. Statistics Canada, "Health Status of Children", Health Reports, Catalogue 82-003, Winter 1999, Vol. 11, No. 3.

  72. Advisory Council on Health Infostructure, Paths to Better Health: Final Report, Ottawa, February 1999, p. 4-1.

  73. Sholom Glouberman (9:9).

  74. Hon. Marc Lalonde (15:15).

  75. Dr. Robert McMurtry (8:17).

  76. Howard Oxley and Maitland MacFarlan, Health Care Reform: Controlling Spending and Increasing Efficiency, Economic Department Working Papers No. 149, OECD Paris, 1995.

  77. Dr. John S. Millar (14:49).

  78. Professor Colleen Flood, University of Toronto (14:18-19).

  79. Guillaume Bissonnette (17:6).

  80. Frank Fedyk (13:14).

  81. Frank Fedyk (13:21).

  82. Health Canada, Canada’s Health Care System, 1999, p. 2.

  83. Ibid.

  84. Hon. Monique Bégin (16:8).

  85. Dr. Fraser Mustard, Myths, Beliefs, Values, Facts and Health Care, Brief to the Committee, p. 3.

  86. Mark Stabile (14:12).

  87. Martin Zelder (12:39).

  88. Martin Zelder (12:40).

  89. Robert Evans (12:41-42).

  90. Robert McMurtry (8:25).

  91. Dr. J. Fraser Mustard, Brief to the Committee, 22 March 2000, p. 2.

  92. CIHI, Health Care in Canada: A First Annual Report, p. 6.

  93. Abby Hoffman (13:10).

  94. Federal/Provincial/Territorial Advisory Committee on Population Health, Statistical Report on the Health of Canadians, 1999, pp. 31 and 38.

  95. Colleen Flood (14:19).

  96. Dr. Robert McMurtry (8:21).

  97. First Ministers’ Meeting, Communiqué on Health, 11 September 2000 (available at

  98. Graham W. S. Scott, Brief to the Committee, June 2000, p. 7.

  99. Dr. Mary Ellen Jeans (8:21).

  100. Dr. John S. Millar (14:5).

  101. Dr. Mary Ellen Jeans (8:21).

  102. Stem cell technology is another good example of the potential impact health research can have on health and health care. Recently, medical researchers in Alberta have made remarkable breakthroughs in what is called "stem cell" technology. They have taken the healthy cells from a properly functioning pancreas and implanted them into an insulin-dependent diabetic. Months after the procedure, the patient still does not require insulin. Not only will this person save the cost of insulin during his life, he will also be at a much lower risk of developing the debilitating complications of diabetes, such as blindness and heart failure, later on. This development would not only improve the quality of life for the individual, it could potentially save the cost of care for the primary disease and secondary complications associated with it.

Back to top