An Act to amend the Canada Health Act (accountability)

This bill, introduced as Bill C-239, would amend the Canada Health Act to add a new accountability requirement that provinces must meet in order to receive their full share of federal health funding through the Canada Health Transfer. Right now, provinces must meet certain criteria (like public administration and universal coverage) to receive full funding; this bill adds a new condition on top of those.

Specifically, each province would have to create and put in place an "accountability framework" for its health care system. This framework must set benchmarks for how quickly people can access primary care, non-urgent procedures, and emergency care, and it must include transparent public reporting on whether those benchmarks are being met and how efficiently the province is spending its health care dollars. Provinces would be required to publish their framework and an annual report on a public website, and to periodically review and update their benchmarks based on new evidence and best practices in health care delivery.

If a province fails to create or follow through on this accountability framework, the federal cabinet (Governor in Council) would gain the power to reduce or withhold part of that province's cash health transfer, similar to the penalties that already exist for provinces that violate other rules in the Act, such as allowing extra billing. If the problem continues year after year, the funding reduction would keep being reimposed until the province complies. The changes would not take effect immediately upon passage but on a date or dates set later by federal cabinet order.

This bill amends the Canada Health Act to require provinces to create and publish an accountability framework for health services, and allows the federal government to reduce or withhold health transfer payments from provinces that fail to do so.

• New provincial obligation — each province's government must develop and implement an accountability framework setting standards for reasonable access to health services, including benchmarks for timely access to primary care, elective procedures and emergency care, and requirements to publicly report on those benchmarks and on spending efficiency.
• Reporting duty — provinces must give the federal Minister information on their transparency measures, and must publish the framework and an annual report on benchmark achievement and spending efficiency on a public website "as soon as feasible" after each fiscal year — no fixed deadline is set.
• Review duty, undefined timing — provinces must "periodically" review and update their benchmarks based on emerging evidence, with no schedule or federal check specified.
• Federal financial penalty power — the Governor in Council (Cabinet) may, on referral of the matter, order a reduction or withholding of a province's cash contribution under the Canada Health Transfer if it finds the province has failed to implement the accountability framework.
• Reimposition power — the federal Minister may continue reimposing these funding reductions each subsequent fiscal year for as long as the Minister, after consulting the province's health minister, is satisfied the failure continues; the Minister's satisfaction is discretionary and not otherwise defined.
• Coming into force — the amendments take effect on a day or days set by order of the Governor in Council, meaning the timing of implementation is left to Cabinet's discretion rather than fixed in the bill.