Combining the Knowledge of Federalism Researchers, Health Care Researchers, and Policy Practitioners to Understand and Improve Canadian Health Care Federalism

Document Type

Book Chapter

Publication Date



Health Care, Health Reform, Federalism


This book has its origins in the collaboration of most of the authors in presenting a pre-conference workshop on health care federalism at the meeting of the Canadian Association for Health Services and Policy Research that took place in Halifax in May 2011 (Canadian Association for Health Services and Policy Research 2011). At that time, just days after the re-election of the Harper Conservatives with a majority government in a national election, the focus was very much on what were generally thought to be the upcoming federal- provincial-territorial negotiations for a new intergovernmental health deal to replace the 10-Year Plan on Strengthening Health Care (appendix 2) that expires in 2014. Our objective was to under- stand and, we hoped, contribute to this process of negotiation through multidisciplinary analyses that combined the perspectives of individuals who approached the study of health care federalism primarily as scholars of federalism with those of individuals who approached it primarily as scholars of health care, and to supple- ment these perspectives with the perspectives of colleagues experienced in the world of public policy at the interface of federalism and health care. Canada’s health care federalism now seems to be at a very different kind of juncture. Through Finance Minister Jim Flaherty, the federal government has told the provinces that federal health care funding after the expiry of current federal funding commitments based on the 10-year plan will be fixed to the prevailing rate of economic growth and be distributed among the provinces on a per capita basis (Bailey and Curry 2011). The absence of any negotiation – even of advance notice – of this approach to health care financing and the disinterest in any reciprocating provincial (and territorial) commit- ments on health care reform signal unmistakably that the brief age of the federal-provincial-territorial health care accord as we have known it in Canadian health care federalism has come to a close, at least for now.