First Ministers’ Meeting


OTTAWA - September 11, 2000.

Nothing in this document shall be construed to derogate from the respective governments' jurisdictions. The Vision, Principles, Action Plan for Health System Renewal, Clear Accountability, and Working Together shall be interpreted in full respect of each government's jurisdiction.


First Ministers' vision of health is that:

Canadians will have publicly funded health services that provide quality health care and that promote the health and well-being of Canadians in a cost-effective and fair manner.

First Ministers believe that the key goals of the health system in Canada are t preserve, protect and improve the health of Canadians; ensure that Canadians have reasonably timely access to an appropriate, integrated, and effective range of health services anywhere in Canada, based on their needs, not their ability to pay; and, ensure its long-term sustainability so that health care services are available when needed by Canadians in future years.

It will, therefore, provide greater integration of hospital, primary, home and community care, more emphasis on health protection and promotion, and more effective information sharing within and across jurisdictions.

First Ministers are committed to strengthening and renewing Canada's publicly funded health care services through partnership and collaboration. Given their constitutional responsibilities, provincial and territorial governments play the primary role in the design, management and funding of the health services within their jurisdictions.


To achieve these goals, First Ministers make the following commitments on health. Their governments will:

  • support the principles of universality, accessibility, comprehensiveness, portability and public administration for insured hospital and medical services;    


  • continue to renew health care services by working with other governments, communities, service providers, and Canadians;    


  • promote those public services, programs and policies which extend beyond care and treatment and which make a critical contribution to the health and wellness of Canadians;    


  • further address key priorities for health care renewal and support innovations to meet the current and emerging needs of Canadians;    


  • expand the sharing of information on best practices and thereby contribute to continuing improvements in the quality and efficiency of their health care services;    


  • report regularly to Canadians on health status, health outcomes, and the performance of publicly funded health services, and the actions taken to improve these services; and,    


  • work in collaboration with Aboriginal people, their organizations and governments, to improve their health and well being.

Action Plan for Health System Renewal

Building on renewal initiatives already underway, First Ministers agree to collaborate on the following specific priorities so that each government can be more effective in relation to its responsibilities for health:

1.    Access to Care

Provincial and Territorial Governments agree to work to improve both the timely access to, and quality of, health services of highest priority to Canadians.

2.    Health Promotion and Wellness

All governments are engaged in health education and strategies to prevent illness. First Ministers are committed to strengthening their investments and commitments in this area, including the development of strategies and policies that recognize the determinants of health, enhance disease prevention and improve public health. This will support the shared priority of early childhood development.

3.    Appropriate Health Care Services - Primary Health Care

All jurisdictions have had success with innovative models of renewed primary health care, resulting in better health outcomes, improved access, more satisfied providers, and the relief of pressures elsewhere in the health system, e.g., emergency rooms. First Ministers agree that improvements to primary health care are crucial to the renewal of health services. Governments are committed to ensuring that Canadians receive the most appropriate care, by the most appropriate providers, in the most appropriate settings.

First Ministers will continue to make primary health care reform a high priority. They agree to accelerate primary health care renewal. In particular, they agree to work towards ensuring timely access to services outside of expensive emergency departments.

Recognizing the need for flexibility and taking into account the particular needs and circumstances within jurisdictions, First Ministers agree to promote the establishment of interdisciplinary primary health care teams that provide Canadians first contact with the health care system. Such teams would also focus on health promotion, the prevention of illness and injury, and improved management of chronic disease. First Ministers agree that their governments will work together, in concert with health professionals, on improving primary health care and its integration with other components of the health care system.

4.    Supply of Doctors, Nurses and other Health Personnel

Provinces and Territories agree on the objective of ensuring that each government or jurisdiction has the people with the skills needed to provide appropriate levels of care and health services. Their governments will coordinate efforts on the supply of doctors, nurses, and other health care personnel so that Canadians, wherever they live, enjoy reasonably timely access to appropriate health care services. Their governments will also work together to identify approaches to improve education, training, recruitment and retention of our future health workforce. First Ministers also direct their Ministers of Health to collaborate on identifying approaches that can improve work life conditions, for example, flexible working arrangements and continuing education.

5.    Home Care and Community Care

Home and continuing care are essential parts of the continuum of health care services. Governments are expanding home care and community care programs which are among the fastest growing health services.

Provinces and Territories are committed to strengthened investment in home care and community care as critical components of a more fully integrated health system.

6.    Pharmaceuticals Management

In order to ensure Canadians continue to have access to new, appropriate and cost-effective drugs, First Ministers agree to work together and mandate their Health Ministers to develop strategies for assessing the cost-effectiveness of prescription drugs. These strategies could include the creation of a common intergovernmental advisory process to assess drugs for potential inclusion in government drug plans. They will be informed by an examination of current best practices and various means of addressing drug purchasing costs. The federal government will strengthen the surveillance of the therapeutic effect of drugs on Canadians after they have been approved for sale in Canada. This would complement ongoing work to ensure the optimal use of pharmaceuticals in health care.

7.    Health Information and Communications Technology

All governments have made major investments in health information technologies in recent years to improve care and health system management. First Ministers agree to work together to strengthen a Canada-wide health infostructure to improve quality, access and timeliness of health care for Canadians. First Ministers also commit to develop electronic health records and to enhance technologies like telehealth over the next few years. Governments will continue to work collaboratively to develop common data standards to ensure compatibility of health information networks. This will lead to more integrated delivery of health care services. They will also ensure the stringent protection of privacy, confidentiality and security of personal health information.

8.    Health Equipment and Infrastructure

Consistent with the needs of Canadians and communities, First Ministers are committed to investing in equipment, new technologies and facilities required for sustaining and renewing health services in order to improve access for Canadians to reasonably timely and appropriate preventive, diagnostic, and treatment services through the publicly funded health system.

Clear Accountability - Reporting to Canadians

Respecting each other's responsibilities, all governments believe in the importance of being accountable to Canadians for the health programs and services which they deliver. Clear public reporting, with appropriate, independent, third party verification will enhance the performance of health services, and is important for achieving the vision and accomplishing the priorities set out above.

The purpose of performance measurement is for all governments to be accountable to their public, not to each other. The amount of federal funding provided to any jurisdiction will not depend on achieving a given level of performance.

Measuring, tracking and reporting on performance:



  • allows Canadians to see how we are doing in attaining our goals and objectives;    


  • assists individuals, governments, and health care providers to make more informed choices;    


  • promotes the identification and sharing of best practices within jurisdictions and across Canada, and thus contributes to continuous service improvement;    


  • increases Canadians' understanding of the utilization and outcomes of health services (e.g., increase in life expectancy, improved quality of life, reduced burden of disease and illness); and,    


  • helps Canadians understand how their publicly funded health services are being delivered.

First Ministers direct Health Ministers t

  • provide comprehensive and regular public reporting by each government on the health programs and services they deliver, on health system performance and on progress towards the priorities set forth above; and    


  • collaborate on the development of a comprehensive framework using jointly agreed comparable indicators such that each government will begin reporting by September, 2002. These comparable indicators will address:    


    • health status (i.e., life expectancy, infant mortality, low birth weight, people reporting their health as excellent);        


    • health outcomes (i.e., change in life expectancy, improved quality of life, reduced burden of disease and illness); and,        


    • quality of service (i.e., waiting times for key diagnostic and treatment services, patient satisfaction, hospital re-admissions, access to 24/7 first contact health services, home and community care services, the adequacy of public health surveillance and health protection and promotion activities).

This reporting will take into account the different starting points and pressures facing jurisdictions.

Governments will consult with subject experts, health care professionals, and Canadians to establish this framework. They will work with appropriate organizations across Canada with expertise in health measurement to develop common methods for measuring and reporting on health status, outcomes and services and to allow each government to determine appropriate third party verification for itself to certify and analyse this health system information for the benefit of Canadians.

Working Together

High-quality health services involve collaboration and consultation with Canadians, communities, service providers and governments. Communities play a key role in promoting health and wellness, and preventing disease. Individuals can make important contributions to Canada's health system through numerous volunteer activities and by making wise choices in the use of health care services and by living healthy lifestyles. Through the sharing of best practices and information on health care systems, health care providers, communities and individuals will have better tools to take action to improve their own health and the health of others.

The principles, objectives, and priorities set out in this document will guide the activities of governments and their partners in the task of renewal. This collaborative work will help improve the health and well-being of Canadians, and ensure that they have access to reasonably timely, high quality health services wherever they live or move, and provide for regular reporting to them on the progress of renewal.

Next Steps

First Ministers direct Health Ministers to meet at the earliest opportunity to begin implementation of the commitments and priorities outlined above.

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