Chapter 2:
Investing in Public Health Care and Affordable Dental Care

In recent months, Canada's universal public health system has been unable to deliver the high-quality care that Canadians expect.

Emergency rooms and pediatric hospitals are overwhelmed, Canadians are waiting too long for surgeries, and our health care workers are under enormous strain. Even long before COVID-19 first hit, and despite comparatively high levels of health care spending relative to many of our global peers, Canadians were not always receiving the access and health care outcomes they deserve.

The federal government is committed to supporting provinces and territories in delivering better health care results for Canadians.

Budget 2023 lays out the federal government's plan to provide an additional $195.8 billion over ten years in health transfers to provinces and territories, including $46.2 billion in new funding through new Canada Health Transfer measures, tailored bilateral agreements to meet the needs of each province and territory, personal support worker wage support, and a Territorial Health Investment Fund. This funding is to be used to improve and enhance the health care Canadians receive, and is not to be used by provinces and territories in place of their planned health care spending.

The federal government will also work with Indigenous partners to provide additional support for Indigenous health priorities by providing $2 billion over ten years, which will be distributed on a distinctions basis through the Indigenous Health Equity Fund.

A strong and effective public health care system is essential to the well-being of Canadians—and is an important foundation of a growing, healthy economy. When people are healthy and can get the care they need before complications arise; when people don't have to worry about losing health care when they move jobs, and don't have to miss work and slow down their careers because they can't receive the proper treatment—it makes our economy stronger.

With historic federal health investments and a range of new measures to ensure Canadians receive the care they need, Budget 2023 will help deliver the improvements to health care that Canadians expect and deserve.

An Historic Federal Investment in Public Health Care

GDP-Driven Growth: As the Canada Health Transfer's escalator is based on GDP growth, an additional $141.8 billion is projected to be provided over the next ten years through the Canada Health Transfer, over and above the $45.2 billion provided in 2022-23.

Canada Health Transfer Top-Up: The federal government will provide $2 billion in 2022-23 to address urgent pressures in emergency rooms, operating rooms, and pediatric hospitals, building on $6.5 billion in top-ups provided throughout the pandemic.

Canada Health Transfer Five Per Cent Guarantee: The federal government will provide top-up payments to achieve Canada Health Transfer increases of at least five per cent per year for the next five years. The last top-up payment will be rolled into the Canada Health Transfer base at the end of the five-year period, resulting in a permanent funding increase. This represents an estimated $17.1 billion over ten years in additional funding through the Canada Health Transfer.

Tailored Bilateral Agreements: The federal government will provide $25 billion over ten years through a new set of bilateral agreements to address individual provincial and territorial health system needs, such as expanding access to family health services, supporting health workers and reducing backlogs, increasing mental health and substance use support, and modernizing health systems.

Personal Support Worker Wage Support: The federal government will provide $1.7 billion over five years to support hourly wage increases for personal support workers and related professions.

Territorial Health Investment Fund: The federal government will provide $350 million over ten years in recognition of medical travel and the higher cost of delivering health care in the territories.

Health Care Results and Accountability

More funding isn't enough to deliver better health care outcomes. That is why, in exchange for the new funding, the government has asked provinces and territories to:

• Ensure that new federal investments are used in addition to provincial spending, and that provinces and territories do not divert away health care funding of their own;
• Uphold the Canada Health Act and use new federal spending to strengthen Canada's public health care system;
• Streamline foreign credential recognition for internationally educated health professionals and advance multi-jurisdictional credential recognition so that Canada's well-trained health care professionals can work wherever there is need;
• Improve how health information is collected, shared, used, and reported to Canadians, and adopt common data standards;
• Develop action plans to measure and report progress to Canadians, including: improved access to family health services, mental health and substance use services, supporting health care workers, and reducing backlogs and wait lists; and,
• Commit to reconciliation with Indigenous Peoples, including fair and equitable access to quality and culturally safe health care services. 

What gets measured, gets done. The federal government is prepared to measure and report annual progress on common indicators and is requiring the provincial and territorial governments to do the same.

Investing in Better Health Care Data

In addition to providing funding to provinces and territories, the federal government will also provide $505 million over five years, starting in 2023-24, to the Canadian Institute for Health Information, Canada Health Infoway, and other federal data partners. Together, these organizations will work with provinces and territories to develop new health data indicators, support the creation of a Centre of Excellence on health worker data, advance digital health tools and an interoperability roadmap, and support provincial and territorial efforts to use data to improve the safety and quality of health care.

Many rural and remote communities lack access to primary health care because of a shortage of health professionals. As one way to address this shortage, the federal government introduced student loan forgiveness for doctors and nurses who work in underserved rural or remote communities. While this measure has helped many underserved rural and remote communities across Canada, there are still many who don't qualify under the current loan forgiveness program design.

• Budget 2023 proposes to provide $45.9 million over four years, starting in 2024-25, with $11.7 million ongoing, to Employment and Social Development Canada to expand the reach of the Canada Student Loan Forgiveness program to more rural communities, including all communities with populations of 30,000 or fewer, like Sheet Harbour, Nova Scotia. Currently eligible communities with a population over 30,000 will remain eligible until the 2026 Census.

This complements the Budget 2022 decision to increase the Canada Student Loan Forgiveness amount by 50 per cent for eligible doctors and nurses. The government is continuing to examine eligible occupations for loan forgiveness. Quebec, Nunavut, and the Northwest Territories, which do not participate in the Canada Student Loans program, can receive federal funding to provide their own comparable support.

Personal support workers are the backbone of long-term care for our seniors and for persons with disabilities. Personal support workers perform jobs that are mentally and physically exhausting, but they often do not enjoy the same job protections, compensation, and benefits as their peers in the health care sector.

To complement the investments the federal government has made to improve the state of long-term care facilities, including the working conditions and wages of personal support workers, the government is proposing new investments to support Canada's personal support workers.

• Budget 2023 proposes to provide up to $50 million over five years, starting in 2023-24, to Employment and Social Development Canada to develop and test innovative solutions to strengthen the retirement savings of personal support workers without workplace retirement security coverage.

Too many communities and families have been ravaged by toxic illegal drug supplies.  We must save and rebuild lives and communities. We must end the opioid crisis through increased access to evidence-based services and supports including harm reduction, treatment and recovery, prevention, and by aggressively dismantling criminal drug trafficking organizations. The overdose crisis and toxic illegal drug supplies take the lives of an average of 20 Canadians per day—many of which are experiencing homelessness—resulting in immeasurable strain on our communities, health care systems, and local social services.

In addition to tackling drug trafficking and targeting criminal organizations, since 2017, the federal government has invested more than $800 million through the Canadian Drugs and Substances Strategy, restored harm reduction as an essential pillar of the strategy, and worked to support a compassionate and evidence-based response to the overdose crisis and the stigma associated with it.

Health Canada has authorized safe consumption sites to provide a safe space for tens of thousands of Canadians dealing with substance use issues. Health care workers have been able to treat 42,000 overdoses, without a single death on site. This is saving lives in communities across the country.

Among other improvements to health care services for Canadians, new funding of $46.2 billion for provinces and territories will help provide Canadians with access to timely, equitable mental health and substance use services. To complement these investments:

• Budget 2023 proposes to provide a total of $359.2 million over five years, starting in 2023-24, with $5.7 million ongoing and $1.3 million in remaining amortization, to support a renewed Canadian Drugs and Substances Strategy, which would guide the government's work to save lives and protect the health and safety of Canadians. This includes:

  • $144 million over five years, starting in 2023-24, to Health Canada for the Substance Use and Addictions Program to fund community-based supports, including safer supply, supervised consumption sites, and other evidence-based health interventions;
  • $20.2 million over five years, starting in 2023-24, to the Public Health Agency of Canada for a new community-based program to prevent substance use among young people; 
  • $73.9 million over five years, starting in 2023-24, with $4.6 million ongoing, to Health Canada to streamline authorizations for supervised consumption sites and drug checking services, scale-up access to safer supply, and evaluate innovative approaches;
  • $50.8 million over five years, starting in 2023-24, with $1.1 million ongoing and $1.3 million in remaining amortization, to Health Canada; and $16 million over five years, starting in 2023-24, to the Public Health Agency of Canada to support vital data collection on substance-related harms and lab-based analysis of the illegal drug supply;
  • $4.6 million over five years, starting in 2023-24, to Public Safety Canada to develop an overdose monitoring app for paramedics and other first responders; and,
  • $42 million over five years, starting in 2023-24, to the Royal Canadian Mounted Police; $6.2 million over five years, starting in 2023-24, to Public Services and Procurement Canada; and $1.6 million over five years, starting in 2023-24, sourced from existing resources, to Global Affairs Canada to take further action to work with our partners to tackle drug trafficking and stem the global flow of these devastating substances.

It's important that people know they are not alone, and those suffering from suicidal thoughts need to be able to access timely, urgent support. The federal government is committed to making sure that all Canadians have access to critical mental health resources and suicide prevention services, when they need it, no matter where they live.

As of November 30, 2023, Canadians will be able to call or text 988 at any time to access quality, effective, and immediate suicide prevention and mental health crisis support.

• Budget 2023 proposes to provide $158.4 million over three years, starting in 2023-24, to the Public Health Agency of Canada to support the implementation and operation of 988.

The federal government is undertaking a review to establish a long-term funding mechanism for this service in 2025-26.

Building the Shepody Healing Centre

The federal government is committed to ensuring Canadians have access to the mental health services they need.

• Budget 2023 proposes to accelerate the construction of the Shepody Healing Centre in Dorchester, New Brunswick.

The overturning of Roe v. Wade in the United States served as a reminder that we must continue to do everything we can to protect Canadians' access to the full spectrum of sexual and reproductive health care services, including abortion care.

With a woman's right to choose under threat around the world, the federal government is ensuring that abortion services are accessible across Canada. The federal government is committed to ensuring that no Canadian pays out of pocket to receive an abortion. Abortion is health care, and the federal government will continue to withhold Canada Health Transfer payments to provinces and territories that allow any patient charges for abortion services.

In Budget 2023, the government is continuing to reduce existing barriers to care and ensuring that Canadians have access to accurate, culturally safe information about sexual and reproductive health care.

• Budget 2023 proposes to provide $36 million over three years, starting in 2024-25, to Health Canada to renew the Sexual and Reproductive Health Fund. This fund supports community-based organizations that help make access to abortion, as well as other sexual and reproductive health care information and services, more accessible for vulnerable populations.

Improving Canada's Readiness for Health Emergencies

Vaccines and other cutting-edge life-science innovations have helped us to take control of the COVID-19 pandemic. To support these efforts, the federal government has committed significant funding towards the revitalization of Canada's biomanufacturing sector through a Biomanufacturing and Life Sciences Strategy. To date, the government has invested more than $1.8 billion in 32 vaccine, therapeutic, and biomanufacturing projects across Canada, alongside $127 million for upgrades to specialized labs at universities across the country. Canada is building a life sciences ecosystem that is attracting major investments from leading global companies, including Moderna, AstraZeneca, and Sanofi.

To build upon the progress of the past three years, the government will explore new ways to be more efficient and effective in the development and production of the vaccines, therapies, and diagnostic tools that would be required for future health emergencies. As a first step, the government will further consult Canadian and international experts on how to best organize our readiness efforts for years to come.

The New Canadian Dental Care Plan

It isn't just children who need affordable dental care. Across Canada, millions of Canadians are avoiding the dental care they need because it costs too much—and nobody should have to choose between taking care of their teeth and being able to pay the bills at the end of the month.

In Budget 2023, the federal government is moving forward with a transformative investment to provide dental care to Canadians who need it.

• Budget 2023 proposes to provide $13.0 billion over five years, starting in 2023-24, and $4.4 billion ongoing to Health Canada to implement the Canadian Dental Care Plan. The plan will provide dental coverage for uninsured Canadians with annual family income of less than $90,000, with no co-pays for those with family incomes under $70,000. The plan would begin providing coverage by the end of 2023 and will be administered by Health Canada, with support from a third-party benefits administrator. Details on eligible coverage will be released later this year.

Expanding Access to Dental Care

In addition to cost, other factors may also prevent Canadians from accessing the dental care they need, such as living in a remote community, or requiring specialized care due to a disability.

• Budget 2023 proposes to provide $250 million over three years, starting in 2025-26, and $75 million ongoing to Health Canada to establish an Oral Health Access Fund. The fund will complement the Canadian Dental Care Plan by investing in targeted measures to address oral health gaps among vulnerable populations and reduce barriers to accessing care, including in rural and remote communities.

Investing in Better Dental Care Data

Existing data on oral health in Canada is limited and cannot be disaggregated by region or socio-economic characteristics—restricting the government's ability to support those who need it most.

• Budget 2023 proposes to provide $23.1 million over two years, starting in 2023-24, to Statistics Canada to collect data on oral health and access to dental care in Canada, which will inform the rollout of the Canadian Dental Care Plan.

Of these combined investments, $6 billion over four years, starting in 2024-25, and $1.7 billion ongoing would be sourced from the existing dental care funding provided through Budget 2022.