Analyzing the Canada Health Act Annual Report: 2023/24
The numbers are in. The federal government’s annual progress report on the Canada Health Act (CHA) for the fiscal year of 2023-24 was released this June. This report assesses how well provinces are complying with this important federal legislation.
Passed in 1984, the CHA provides national standards for provincial health care delivery, setting a crucial benchmark meant to guaranteed that all provincial health care systems provide care that is comprehensive, universal, accessible, portable, and publicly administered. While the CHA is the law of the land, it is also voluntary for provinces to follow.
So long as they don’t mind missing out on federal funding for health care, that is.
If provinces do wish to receive that financial support – which is worth billions and funds approximately 25 percent of provincial health care services – they must comply with the principles of the CHA.
Given the stakes, it’s concerning how little attention this report has received outside of health care advocacy circles. All Manitobans deserve to know how well our health care system is meeting these important minimum standards, and how our system could be improved to go beyond them. Yet, many Manitobans may not even know about the CHA, or how our health care systems were built and are currently structured.
Until the mid-20th century, health care in Canada was a patchwork of private and charitable, usually religious-based, delivery. Technically a provincial responsibility, it was a very small portion of government spending and left many people without access to regular, quality health care.
Then came the long fight to introduce universal and public health care across Canada, which was finally established in the 1960s. The Canada Health Act itself was passed in the 1980s to entrench and protect the developing public system. Now, in 2025, provinces rely on federal health transfers to help fund universal health care across Canada. In 2023-24, these federal transfers totaled just under fifty billion dollars.
Deductions for violations of the Act in this same period were far less, but not insignificant, amounting to just under eighty million dollars. That’s the big picture.
How does Manitoba fare? The majority of these deductions, amounting to 72.4 million dollars, were taken from just six provinces – Manitoba, Nova Scotia, Quebec, Saskatchewan, Alberta and British Columbia. These deductions were for violations of the Diagnostic Services Policy specifically, which prohibits patients from being charged for lab work, MRIs, or other diagnostic services performed outside of hospital settings.
The good news? In that time, Manitoba’s deductions were by far the lowest of this list – totalling only 650 dollars. Even better, these deductions were reimbursed as the province came into compliance.
The numbers shows that it pays to comply with the Canada Health Act. Manitobans receive better health care because of it. But we can and must go further.
Under the current system, not everyone receives just, accessible care in Manitoba, despite provincial compliance with the CHA. More must be done to decolonize health care and provide culturally safe and holistic care to all Indigenous peoples in Manitoba. Anti-Black and anti-Indigenous racism, along with other interconnected forms of discrimination, must also be addressed with structural and cultural changes across the health care system. There must be more education and supports for all health care workers to learn about cultural and gender diversity and apply that learning to how care is delivered.
Gaps in available coverage in Manitoba also still exist despite provincial compliance with the CHA. The act narrowly defines what is ‘medically necessary,’ largely limited to hospital and physician care. It also allows for the possibility of private delivery of publicly administered care, opening the door for profit motives to infiltrate public health care. Such privatization hurts patients, and ultimately costs provinces more. Manitobans must work together to expand our definition of medically necessary and publicly covered care, and call on our governments to entrench and adequately fund that expanding definition. Going beyond the basic principles of the CHA is necessary to put people over profit in health care delivery.
To build a system that truly benefits everyone, and supports a healthier and more prosperous Manitoba in the process, what is publicly covered must expand. Our understanding of what is medically necessary must grow to full cover all mental health services, all home care and long-term care services, all dental, pharmaceutical, and eye care. We must continue to expand and decolonize our definition of health care and grow the basket of insured services. We must keep profit and foreign private interests out of health care.
Complying with the Canada Health Act is an important benchmark for our provincial system, but it’s also the bare minimum. Manitobans deserve more than that.