Budget 1999
Strengthening Health Care for Canadians: 2
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Archived - Providing equal per capita support under the CHST

When the CHST was introduced in the 1995 budget, the initial allocation among provinces was based on its predecessors -- Established Program Financing (EPF) for health and post-secondary education and the Canada Assistance Plan (CAP) for social assistance and social services.

EPF provided identical per capita federal support to all provinces. CAP did not -- in large part due to the cost-sharing limits imposed on certain provinces by the previous government. As a result, the initial allocation of CHST among provinces reflected the per capita disparities that were in CAP.

The 1996 budget announced that the per capita disparities in the distribution of the CHST among the provinces would gradually be reduced by half by 2002-03 -- four years from now.

This budget provides for the complete elimination of these disparities three years from now -- by 2001-02 (see chart below). All provinces will then receive identical per capita CHST entitlements, providing equal support for health and social services to all Canadians.

Provincial CHST entitlements

Table 5
1999 budget strategic health investments

	1998-99	1999-00	2000-01	2001-02	Total
	(millions of dollars)
Improving health information systems
Canadian Institute for Health Information	95				95
Other health information initiatives		20	70	100	190
Accountability for federal health programs		8	15	20	43
Subtotal	95	28	85	120	328
Promoting health-related research and innovation
Canadian Institutes for Health Research			65	175	240
Increased health funding for research councils/organizations	35	50	50	50	185
Canada Foundation for Innovation1	100				100
NURSE Fund	25				25
Subtotal	160	50	115	225	550
First Nations health services		20	60	110	190
Preventive and other health initiatives
Prenatal nutrition		10	30	35	75
Food safety		15	20	30	65
Toxic substances		14	14	14	42
Innovations in rural and community health		5	20	25	50
Diabetes		5	20	30	55
Subtotal		49	104	134	287
Total	255	147	364	589	1,355
1 Funding for the CFI will be increased by $200 million. Based on awards in 1998, it is expected that about half this amount will be allocated to support health-related research infrastructure.

Strategic Federal Investments: Health Information, Research and Prevention

An additional $1.4 billion to strengthen the health and the well-being of Canadians

The federal government makes important contributions to the health of Canadians through several means in addition to transferring funds to the provinces. This budget provides close to $1.4 billion over the remainder of this fiscal year and the next three years to strengthen these other important roles.

The quality, timeliness, and availability of health information will be significantly enhanced. Research and innovation in health care will be expanded and integrated. Health services provided to First Nations and Inuit will be improved. Programs designed to prevent health problems from occurring will be expanded or reinforced. And funding will be provided to continue exploring with provinces innovative approaches in rural and community health.

Investing in health information systems

Better health information systems mean better health care services.

This budget allocates $328 million over the remainder of this fiscal year and the next three years to further develop health information systems in Canada.

There is a need to improve public access to health information as well as the quality and availability of health information and to better inform Canadians on the performance of the health care system.

In all of this the government is committed to engaging the provinces, health providers and interested Canadians in a manner consistent with the Social Union Framework.

Better health information systems will improve the delivery of health care services and the health and well-being of Canadians. Reliable and up-to-date health information can also help Canadians make the right decisions on how to maintain and improve their health.

Information can also help Canadians understand how their health care dollars are being spent, by whom, and with what results.

Improving access to health information

Applying information technology means enhanced health care through better access to health information.

This budget provides $190 million over the next three years to improve access to health information by:

• Building a National Health Surveillance Network which will electronically link laboratories and public health officers across the country, enabling them to communicate simultaneously and instantaneously with each other. For example, the network will be able to identify the outbreak of serious illnesses -- from the flu to salmonella -- more quickly and more accurately so that preventive measures can be undertaken faster.

• Establishing a Canada Health Network accessible by computer and telephone, enabling Canadians everywhere to have direct access to objective, reliable, up-to-date information on a range of health issues -- from nutrition to breast cancer, from Alzheimer's to diabetes.

• Developing the application of information technology to actual health care, in consultation with provinces, through such innovations as Telehealth. Telehealth uses communications technologies to deliver health information, services and expertise over short and long distance. For example, it can help health care providers in rural and remote areas to communicate with specialists anywhere in the country. A particular application of Telehealth -- Telehomecare -- will assist patients and caregivers in a home care setting by using communication technology to transfer information needed for diagnosis and treatment.

The new funding in this budget is in addition to the $50 million over three years allocated in the 1997 budget to make initial investments towards creating a national health "info-structure," as recommended by the National Forum on Health.

The Canadian Institute for Health Information

The Canadian Institute for Health Information (CIHI) was established in 1994 to improve the quality and availability of health information. It currently has an annual budget of about $13 million and functions as an arm's-length body governed by a board with private, provincial and federal representation.

This budget provides $95 million to the CIHI to use over the next three to four years to lay the groundwork and report regularly on:

• the health of Canadians -- the state of their health and the major factors that influence health; and

• the health of the health care system itself -- how the system is working, from the length of waiting lists to the distribution of doctors and other health care providers to the use of the most effective treatments.

This investment will foster greater accountability to the public on how the health care system is serving them.

Improving accountability for federal health programs

This budget allocates $43 million over the next three years to Health Canada to better inform Canadians on the performance of federal health programs, consistent with the Social Union Framework.

The federal government delivers health services and programs in several areas, including health protection, health promotion, disease prevention and health services to First Nations and Inuit.

Promoting health-related research and innovation

Research is vital to high quality health care.

This budget provides $550 million over the remainder of this fiscal year and the next three years for health-related research and innovation.

Research is important to a high quality health care system. It is vital to enhancing the health of Canadians through improvements in the prevention and diagnosis of disease; the discovery of new therapies and cures; the development of innovative approaches to health care delivery; and health promotion.

Health research takes place in a number of settings: universities, hospitals, research institutes and centres, industrial laboratories and government facilities. Funding for research comes from the federal government, provincial governments, donations to hospitals and health charities, and the private sector.

At the federal level, medical research is supported through a variety of channels. The Medical Research Council is the main source of funding for biomedical and health research.

The federal government also funds vital research in other health-related areas. Research in health services, for example, is funded by the Canadian Health Services Research Foundation. The Social Sciences and Humanities Research Council funds social and population health research. Life science research is funded by the Natural Sciences and Engineering Research Council and the National Research Council. Health Canada's national health research and development program funds research on a range of national health issues.

Through research we are now able to prevent a wide range of diseases -- from polio to tuberculosis. In the past decade alone, many therapies have been developed and many more are being developed.

Federal Research Dollars at Work Dr. Patrick Lee of the University of Calgary made a discovery that could have major implications for cancer treatment. In laboratory tests, he injected 25 different types of cancer cells with a relatively harmless, naturally-occurring human virus. Of the 25 types of cancer cells, including breast, brain, prostate, and pancreatic cancer, the virus killed 20. It is expected clinical trials will start in a few months to confirm this new approach to cancer treatment. Dr. Patricia Kaufert of the University of Manitoba in Winnipeg is studying the complex ethical and practical dilemmas facing women with family histories of breast cancer and Alzheimer's disease. Dr. Alec MacKenzie and Dr. Robert Korneluk of the Children's Hospital of Eastern Ontario in Ottawa discovered a family of genes that control normal cell death through a process called apoptosis. The ability to control these genes -- turning them on or off -- could help patients suffering from major diseases, including Parkinson's, and stroke victims. Dr. Robyn Tamblyn of McGill University in Montreal studied factors which influence how physicians prescribe drugs for elderly patients. This work will help improve the effectiveness of drug therapy for older patients. Dr. Tom Hudson of Montreal General Hospital applied powerful new techniques of genome (chromosome) analysis to better understand the genetic underpinnings of asthma in an effort to prevent and cure this major disease. Dr. Francois Auger and Dr. Lucie Germain of Centre Hospitalier Affilié Universitaire de Québec in Québec City found ways to grow human tissue such as skin, cartilage and blood vessels. Their work could mean major improvements in the treatment of burn victims. Dr. Christine Poulin of Dalhousie University in Halifax is working with Nova Scotia high school students, teachers, parents and communities to determine the effectiveness of education programs in addressing drug use.

The Canadian Institutes of Health Research

Over the past year, a national task force representing the health research community proposed an innovative approach to health research: a new organization called the Canadian Institutes of Health Research (CIHR).

The goal of the CIHR would be to integrate health research nationally to enhance the health of Canadians.

The objective of the CIHR would be to accelerate the discovery of cures and prevention of diseases; forge an integrated national health research agenda; foster collaboration across the many disciplines of health research; and bring new health products and services to the markets of the world.

The institutes would create networks -- not brick and mortar institutions -- which would draw together scientists across the full spectrum of health research from basic science to clinical research to health services to prevention and social determinants of health. For example, it is envisaged that one institute would focus on aging, one on child and maternal health, one on cancer and developmental biology, and another on women's health.

This government is prepared to support and invest in this proposal. This budget sets aside $65 million to support the CIHR in 2000-01, its initial year of operation. The government is prepared to increase this funding to $175 million in its second year.

Following further consultation, legislation establishing the CIHR could be introduced as early as this fall.

In the meantime, while the proposal to establish the CIHR is being fully developed, this budget provides an increase of $150 million over the next three years to the granting councils, the National Research Council and Health Canada for health-related research.

On an annual basis, the $50-million increase in funding will be distributed as follows: $27.5 million to the Medical Research Council; $7.5 million to the Social Sciences and Humanities Research Council; $7.5 million to the Natural Sciences and Engineering Research Council; $5 million to the National Research Council; and $2.5 million to the Health Canada's National Health Research and Development Program.

This builds on the 1998 budget, which also increased funding for the granting councils.

The increased funding in this budget for existing federal research organizations, together with the funds being set aside for the CIHR, will effectively make $225 million of new resources available for the objectives of the CIHR by the year 2001-02.

This budget provides an additional $35-million endowment in 1998-99 to the Canadian Health Services Research Foundation to support its participation in the CIHR initiative.

The Foundation supports research to identify what works in Canada's health care system, what does not work and what procedures and interventions require further evaluation. The new funding builds on the Foundation's initial endowment of $65 million over five years provided in the 1996 budget.

These initiatives will provide more opportunities for health researchers to carry out advanced research in Canada. The increased funding reflects the multidisciplinary nature of health research.

Canada Foundation for Innovation

This budget provides an additional $200 million to the Canada Foundation for Innovation, which has a mandate to help modernize Canada's research infrastructure in several areas, including health.

This follows an $800-million allocation to the Foundation in the 1997 budget. Disbursements by the Foundation from that allocation are expected to be close to $420 million in 1999. In 1998, about 45 per cent of awards were for health-related research in hospitals and universities.

It is expected that about half of this budget's allocation will be available for health research infrastructure across Canada.

NURSE Fund

The government will provide an endowment of $25 million to create a NURSE Fund -- Nurses Using Research and Service Evaluations.

Health care restructuring has had a significant impact on nurses. The NURSE Fund will support a ten-year research program to find solutions to the challenges facing nursing in the next decade. The objective is to develop a knowledge base to:

• better enable nurses to deliver quality care in an environment of health care restructuring;

• identify approaches to retrain the existing workforce; and

• attract new members to the profession.

The endowment will be made available to the Canadian Health Services Research Foundation for this purpose.

First Nations health services

The federal government is providing $190 million over the next three years to better meet the health care needs of First Nations and Inuit communities.

The funding will be used to strengthen home and community care, as well improve case management and other support services.

As well, health information systems will be developed with First Nations communities, and better links made with provincial systems and public health surveillance programs.

First Nations will also benefit from the diabetes initiative described below.

Preventive and other health initiatives

This budget invests $287 million over the next three years to improve prenatal nutrition, food safety, and toxic substances control, to foster innovations in rural and community health, and to combat diabetes.

Prenatal nutrition

An additional $287 million to do more to prevent health problems from occurring

The budget provides an additional $75 million over the next three years to the Canada Prenatal Nutrition Program to help high-risk pregnant women have healthier babies.

The program, which is currently funded at $23 million a year, provides food supplementation, nutrition counselling, support, referral and lifestyle counselling to pregnant women to help ensure they have healthy babies.

Pregnancies put at risk by alcohol or drug abuse, family violence or inadequate social supports can have serious effects on children's prospects.

The new funding is designed to expand the program to many more pregnant women at high risk. It is expected that this program will now reach a majority of these women.

Food safety

The budget allocates $65 million over the next three years to modernize and strengthen the federal food safety program.

Despite having one of the safest food systems in the world, infectious foodborne illness remains a public health problem in Canada with an estimated 2.2 million cases each year. As new foodborne pathogens (disease-causing agents) emerge, as new products come to market and as processing and packaging technologies change, steps must be taken to ensure that Canada's food system remains safe.

The new funds will be used to enhance surveillance systems, improve scientific capacity and increase regulatory activities.

Toxic substances

Toxic substances in the environment, in food and in drinking water present significant risks to the health of Canadians. Children are especially vulnerable, since exposure to toxins can impair fetal, infant and childhood development.

The government has recently introduced amendments to the Canadian Environmental Protection Act. The new Act would require screening within seven years of all potentially harmful substances currently in the Canadian market and prompt subsequent action on substances found to be toxic.

This budget provides $42 million over the next three years to Environment Canada to meet the government's responsibilities under the new legislation. These funds will serve to accelerate screening and assessment of new and existing substances, improve management and control of toxic substances and track progress.

Innovations in rural and community health

Over the past two years, the federal government has worked in partnership with provinces to develop innovative approaches to health care and health care delivery through a Health Transition Fund.

Building on this, the budget provides $50 million over the next three years to continue exploring with provinces innovative approaches in the area of rural and community health.

Provinces face unique challenges posed by health care delivery in rural and remote areas. For example, access to health services must be maintained over large, sparsely populated areas. Attracting and retaining physicians and other health professionals can also be a challenge.

The increased emphasis on home and community care in all provinces presents an ideal opportunity to evaluate different models of service delivery and build on lessons learned.

Diabetes

This budget provides $55 million over the next three years to combat diabetes. The rate of this disease is particularly high among Aboriginal people -- three times that of the general population.

Surveillance and research will be carried out to find better ways to prevent this disease and enhance treatment and care. This should lead to a better understanding of why it has become such a serious problem in Aboriginal communities and what can be done about it, including an enhancement of services on reserve.

Conclusion

Medicare is one of Canada's most important and cherished national programs. Having restored order to the nation's finances, the government is committed to increasing its investment in health care.

This budget underscores this commitment by investing substantial new resources to that end. The government will consider additional investments in coming years as the financial situation permits.

How can I get more information on the 1999 budget?

Department of Finance information is available on the Internet at: http://www.fin.gc.ca

Department of Health information is available on the Internet at: http://www.hc-sc.gc.ca/budget.

You can also obtain copies of this brochure or other budget documents from:

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