What Ottawa Really Controls in Health Care—And Why It Matters This Election

While Canadians often associate health care with provincial cards and local hospitals, the federal government plays a far more influential role than many realize—especially as the country faces a growing physician shortage and aging population. With the April 28 election looming, health experts say it’s time to hold federal leaders accountable for how they shape, support, and reform the national health-care landscape.

According to medical sociologist Amélie Quesnel-Vallée, Canada Research Chair in Policies and Health Inequalities, Ottawa has the power to align health systems across provinces, provide targeted funding, and influence nationwide reforms, especially as more than 6.5 million Canadians remain without a family doctor. Though provinces and territories oversee health-care delivery, the federal government funds it through the Canada Health Transfer (CHT) and sets national expectations under the Canada Health Act.

The Act itself, created in 1984, rests on five principles: public administration, comprehensiveness, universality, portability, and accessibility. It mandates provinces to cover medically necessary services without user fees—primarily doctors and hospital visits. If provinces fail to comply, the federal government can reduce their funding. However, the Act excludes vital services like mental health care, physiotherapy, nutrition counselling, and home care, all of which are inconsistently funded across the country, especially impacting seniors and those with chronic conditions.

Beyond hospital care, Ottawa directly manages health services for Indigenous communities, veterans, federal inmates, and the military. It also regulates food and drug safety, recently introducing free or low-cost access to diabetes and contraceptive medications under the new Pharmacare Act. As Canada faces its worst measles outbreak in decades, the Public Health Agency of Canada is also tasked with infectious disease surveillance—a role becoming more critical as the U.S. reduces funding for the CDC and FDA, affecting international data-sharing.

One major area of federal potential is physician training and mobility. Provinces control education and licensing, but experts like Dr. Aaron Jattan argue the federal government could facilitate a pan-Canadian license to make it easier for doctors to work where they’re most needed. The Canadian Medical Association supports this, along with streamlining foreign credential recognition and expanding medical training into rural regions. However, Ottawa must ensure reforms don’t pull doctors away from lower-resourced areas toward higher-paying urban centres, Quesnel-Vallée cautions.

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Health law expert Bill Jeffery adds that federal efforts should also focus on prevention—everything from regulating sodium levels in packaged food to addressing toxic chemical exposure and fossil fuel pollution. While these issues are rarely central in political discourse, he believes Canadians would demand more if they fully understood how these environmental factors silently affect public health.

As for party platforms, the Conservatives and Liberals both support pan-Canadian licensing and easing foreign doctor integration, while the NDP and Greens call for team-based, salaried care models and broader roles for nurse practitioners and pharmacists. The Bloc Québécois prefers Ottawa stay out of provincial staffing decisions and instead address funding gaps.

Ultimately, while provincial governments may deliver the services, Ottawa controls the purse strings and policy levers that can shape the future of Canadian health care. As the election nears, voters are being urged to scrutinize how federal leaders plan to address growing health inequities, shortages, and systemic gaps that touch the lives of millions.