Letter to provinces and territories on the importance of upholding the Canada Health Act

March 9, 2023

Dear Minister:

Canadians see our publicly funded health care system as a source of pride and consistently count health care among their top priorities for government. We are all acutely aware that our health care systems are experiencing significant strain and facing common challenges across the country, including workforce shortages and issues with access to care. Canadians want and expect their governments to work together to find immediate and longer-term solutions to address these challenges and to meet their health care needs.

Modernization and improvements in health care, including virtual care, telemedicine, and the expansion of the scopes of practice of health workers,have the potential to improve how care is provided to meet the health care needs of Canadians. While there are many benefits to these new approaches in health care delivery, they have also resulted in the emergence of new patient charges to access medically necessary care that would otherwise be covered if provided in-person by a physician. It is critical that access to medically necessary services, whether provided in-person or virtually, remains based on medical need and free of charge.

I am very concerned with the recent increase in reports of patient charges for medically necessary services, which must be examined and addressed. The complexities of modern family health, virtual and surgical care, including its provision across jurisdictions, and expanding scopes of practice of health workers, should not be used to permit these charges.

It is my intention to clarify in a separate Canada Health Act interpretation letter that, no matter where in the country Canadians live or how they receive medically necessary care, they must be able to access these services without having to pay out of pocket. Building on significant collaboration with provinces and territories underway to advance equitable access, including for virtual care and digital health, Canada will further ensure that, as our system evolves, it remains true to the spirit and intent of the Canada Health Act. I have instructed Health Canada officials to reach out to your officials to advance this work.

As we continue to work together to improve our health care system, I want to emphasize that we must do so in a manner that strengthens its public and universal nature. This system is built on a foundation of shared principles enshrined, not only in the Canada Health Act, but also in the legislation that preceded it and interpretation letters that have followed enactment. These principles—public administration, comprehensiveness, universality, portability and accessibility—along with the prohibitions against patient charges, work toward ensuring all Canadians have access to medically necessary care based on their medical needs and not their ability, or willingness, to pay.

The Government of Canada remains steadfast in its commitment to the principles of the Canada Health Act, which, as you are aware, have always been linked to federal payments under the Canada Health Transfer. As our health care system evolves, it must do so while respecting the Canada Health Act,in order to protect and preserve public coverage for all medically necessary health services. Where instances of patient charges for these services are present, I will pursue a reduction in federal health transfers by an equivalent amount, as authorized by the Act. My officials are always ready to work with yours to discuss patient charge issues.

I will fulfill my obligations as Canada's Minister of Health, including my mandate commitment to strengthen our universal health care system by strengthening compliance to the Canada Health Act. Canadians pay for their health care services through their tax dollars, and should not be asked to pay again, by way of patient charges when they need to access those services.

I look forward to our continued joint efforts to ensure Canadians have universal and comprehensive access to the health care they need, when they need it, without financial barriers.

Yours sincerely,

The Honourable Jean-Yves Duclos, P.C., M.P.