When it comes to anticipating what’s in today’s federal budget and what it might mean for healthcare in Canada, the stage has largely been set by decisions already taken. Surprises are likely to be few or nonexistent.
We already know of two key healthcare budget drivers.
The first driver is the federal government’s decision to enter into multi-year funding agreements with its provincial counterparts under the Canada Health Transfer (CHT). The government has already laid out a ten-year spending plan based on achieving agreements on a pan-Canadian basis.
This should result in an immediate “bump up” of $2B, as well as an increase of 5% each year for the next five years (before returning to a 3% escalator), in the amount budgeted for in the CHT. This funding will be in addition to the continuation of multi-year funding already committed to in previous agreements and budgets related to things such as mental health and addiction services as well as to home and community care across Canada.
The second driver is the government’s Confidence and Supply Agreement with the NDP, intended to keep the minority Liberal government in office until at least 2025. That agreement had two cornerstone pledges on which the NDP support would rest: National Pharmacare and National Dental Care.
However, on both these priorities, the government has already staked out an approach and a multi-year funding plan, which has received tacit acceptance by the NDP, even if the effort might be viewed by some as falling short of the grand ambitions telegraphed by the biggest supporters of these initiatives.
Even ahead of the agreement with the NDP, the Trudeau government had already laid out its plan to introduce “national pharmacare” in the 2018 and 2019 budgets and continue to rest on the same core implementation pillars laid out back then, particularly where it comes to funding rare diseases. Last week’s announcement regarding funding $500M per year for a National Strategy for Drugs for Rare Diseases essentially confirms the spending levels for rare diseases already laid out in the 2019 budget, which provided for “up to $500 million per year ongoing”.
When it comes to funding support for national dental care, last year’s budget outlined a five-year commitment, which included a pledge of $600M for 2023-24. That amount is double the amount committed to last year when program eligibility was limited to children under 12 and intended to cover the expansion of the program to youth and seniors this year. However, last year, the Parliamentary Budget Officer – an independent, not-partisan, office that provides analysis directly to Parliament – estimated that the actual cost of delivering the program next year at $2.7B, presenting the government with a potential $2.1B shortfall in funding. How the government addresses this problem is perhaps the one key area worth watching.
So, while it may not be guaranteed how the pie will look when it comes out of the oven, we are already quite confident of its ingredients, the recipe that was followed, and who the various cooks in the kitchen have been.
But – like with all things budget-related – the proof will most definitely be in the final pudding.