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Health Care: Funding a Canadian Priority

Remarks by David Kilgour, MP for Edmonton Southeast

House of Commons, Ottawa

37th Parliament, Third Session

Edited Hansard no. 024

11 March 2004


Hon. David Kilgour (Edmonton Southeast, Lib.):

[...]Let me speak first to the repeated provincial claims that the federal share of health spending is in the 14¢ to 16¢ range. To arrive at this figure the provinces, and I believe the Bloc, divide the cash portion of the Canada health and social transfer, the CHST, by all of their social spending in the social domain, not just their health care spending. They include also social services and primary, secondary and post-secondary education in their calculation.

    It seems to me that it is misleading to use the total amount of provincial social spending to calculate the federal share of provincial health care spending. Total provincial health spending is actually $77 billion compared to $143 billion for social spending.

    It is also misleading for the provinces to ignore the $17 billion in CHST tax points provided by the federal government and the more than $10 billion transferred to provinces through the equalization programs. These amounts are available for health care spending and the choice is up to the provinces.

    The CHST is a block fund which provides flexibility to the provinces to allocate the funding according to their own priorities. In short, they can spend as much of the CHST on health as they choose. Under the CHST there is no share of federal transfers earmarked for health care, none. Provinces have full flexibility to spend all or any part of the CHST and equalization on health care.

    It was by mutual agreement that cost sharing of specific provincial expenditures on health and post-secondary education were changed to block funding. This gave all of the provinces much greater flexibility on how they would allocate federal transfers.

    The provinces have complained that cost sharing distorted provincial spending decisions and favoured better off provinces since they could afford to spend more and so attract more federal dollars than the less well off provinces. Effective April 1 of this year the federal government will create a new Canada health transfer to improve transparency and accountability of federal transfer support for health.

    What exactly is the federal contribution to health spending? We have all asked ourselves that question. The federal government contributes to provincial health spending through the CHST, both cash and tax points, and equalization and makes substantial and direct contributions to health care and health research.

    Let us look for a moment at the CHST, that is, cash and tax points, which amount to almost $38 billion in 2003-04 including the $1 billion CHST supplement. The current CHST supports health, post-secondary education, social assistance, social services including early childhood development and early learning and child care services. I wonder how many members of the House accept this.

    Since health spending represents about 62% of the total that the provinces spend in these attended areas, it is reasonable to assume that they spend 62% of the CHST, on average, on health annually. That is more than $23 billion of the annual CHST transfer. Adding the $1 billion in support from the new health reform fund increases the amount to over $24 billion. This total of over $24 billion is an amount equal to 32% of provincial health care spending of $77 billion.

    What is the additional federal contribution to provincial health spending through equalization? The federal government provides eight of the ten provinces with equalization and they are free to allocate as much of that money as they choose to health. On average, provinces are spending about 38% of their program budgets on health care. I thought it was higher than that, but the finance department insists that it is only 38%.

It is reasonable to assume that 38% of the annual equalization goes to health, which means that more than $3 billion a year for health care. Added to the more than $24 billion in federal support through the CHST, the health reform fund which I mentioned, this brings the federal contribution to approximately $28 billion or 36%. I would suggest that we are getting a long way from 16% of provincial health care funding.

    Finally, what about direct federal contributions to total public health spending? The federal government's direct spending for health care is estimated at approximately $5 billion in 2003-04 and that is for first nations health, veterans health, health protection, disease prevention, health information and health related research. As well, through the tax system, the federal government provides support worth about $1 billion a year. That includes credits for medical expenses, disability caregivers and infirm dependents.

    It is not much of a secret where I am going. When we add the over $6 billion in direct spending and tax credits to the $28 billion in transfers to the provinces, the federal government is currently providing about $34 billion a year, or more than 40% of all national public spending on health care in Canada. We all hope this amount will continue to grow, and of course following recent investments outlined in the budget of 2003.

    In summary, health care makes up 62% on average of what the provinces spend on social programs covered by the CHST. As I have said, that makes it reasonable to infer that probably 62% of the CHST is spent on health. If we add the federal support to the health reform fund, and that came to $24 billion, I do not think I need to repeat what I have just said.

    In short, the federal government's contributions would strongly appear to be more than 40% of all national public spending on health care in our country.

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