Provincial governments are responsible for providing healthcare

Provincial governments are primarily responsible for funding and delivering healthcare in Canada.

Legislation

Federal

The federal government:

1. Sets and administers national standards for health care
2. Helps fund health care
3. Delivers health care services to specific groups
4. Provides other health-related supports

The Canada Health Act sets the national standards for provincial and territorial health insurance plans that provinces and territories must meet to receive their full payment under the Canada Health Transfer (CHT). They are:

• Public administration: Assign a public authority to administer and operate the services on a non-profit basis
• Universality: Provide coverage for all residents
• Portability:
  • Provide coverage for residents when they travel within Canada
  • Provide limited coverage for travel outside Canada
  • provide coverage for residents who move to another province or territory for up to 3 months until they can register for coverage under the new plan
• Accessibility
  • give all residents reasonable access to medically necessary services
  • give access based on medical need and not on the ability to pay
• Comprehensiveness
  • insure medically necessary services provided by hospitals, doctors and dentists (when dental service must be performed in a hospital)
  • cover the full cost of medically necessary services

If a province violates these principles, the federal government can claw back or withhold funding.

The CHT has been unconditional since 1995. The funds flow into general provincial revenues and as long as they are meeting the principles, they can spend it however they want. There is no requirement to show how they spend the money.

In 2023, all of the provinces and territories, except Newfoundland and Labrador, released a position paper requesting increases to the CHT. In it, they asked the federal government for funding increases of $326 billion, but didn’t plan to spend any of it on healthcare.

That same year, the federal government signed 10-year bilateral agreements with the provinces to increase the Canada Health Transfer, including $46.2 billion in new funding over 10 years. The federal government required that 58% ($26.7 billion) had to be spent on four areas of shared priority:

• Family health services
• Health workers and backlogs
• Mental health and substance use
• Modernizing the health care system with standardized information and digital tools

while the other 42% has no strings attached.

Funding

Provincial (primary)

Provincial and territorial governments are primarily responsible for funding healthcare. In 2021, they funded 78% of the cost, with the federal government providing the rest (22%) through the CHT. In 2022-23, the federal government provided 24.5% ($19.2 billion) of Ontario’s health sector spending.

In 2024-2025, the federal government transferred $52.1 billion to provinces and territories through the Canada Health Transfer, to support them in delivering publicly funded care.

Delivery

Provincial

Healthcare delivery is a provincial responsibility. Ontario decides how many hospital beds, how many nurses, and how care is delivered.

Provincial and territorial governments are responsible for the management, organization and delivery of most of Canada’s health care services, with all provincial and territorial health insurance plans expected to meet national principles set out under the Canada Health Act.

This includes:

• Hospital funding and operations
• OHIP coverage decisions
• Physician and nurse compensation
• Long-term care regulation and oversight
• Nursing staffing levels and ratios
• Mental health and addiction services
• Home care programs

Federal

Provides certain health care services to:

• eligible veterans
• refugee claimants
• inmates in federal penitentiaries
• active members of the Canadian Forces
• Inuit and First Nations people living on reserves

More: Which government is responsible? Municipal vs Provincial vs Federal