Ottawa's use of federal transfers to the provinces discourages health care reform; penalties linked with the Canada Health Act deemed a real impediment to reform

VANCOUVER, BC, Jan. 29, 2026 /CNW/ - The federal government has been increasing its fines on provinces for non-compliance with the Canada Health Act (CHA) in recent years, further discouraging provinces from pursuing much-needed reforms, finds a new study published today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

"The federal government's increasingly interventionist approach to provincial health care delivery is not good for patients, as it sends a chill across the country that certain meaningful reforms are not to be pursued," said Nadeem Esmail, director of health policy at the Fraser Institute and co-author of Ottawa's Enforcement of the Canada Health Act Constrains Provincial Health Care Reform.

The study examines reports by Health Canada documenting deemed violations by the provinces of the Canada Health Act and finds that between 2014 and 2024, Ottawa levied a total of $267 million in penalties for provincial non-compliance of the CHA.

Crucially, the number of violations and penalties Ottawa has levied against the provinces has increased in recent years. In fact, in 2014/15 and again in 2015/16, only British Columbia was penalized for non-compliance. By 2022/23, eight provinces were penalized, and in 2023/24 (the last year of available data), 9-in-10 provinces were penalized, with only Prince Edward Island not found in violation of the CHA.

And whereas in 2014/15, only $241,637 in penalties were levied against BC, by 2023/24, Ottawa levied a total of $79 million in penalties.

"Ottawa's ramp-up of CHA enforcement sends a strong message that despite their health-care systems being in dire need of reform, provinces are not to veer from the dictates of Ottawa with respect to their interpretation of the Canada Health Act," Esmail said.

"Instead, the federal government should be doing the opposite by freeing the provinces to reform their health care systems."

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The Fraser Institute is an independent Canadian public policy research and educational organization with offices in Vancouver, Calgary, Toronto, Montreal and Halifax and ties to a global network of think-tanks in 87 countries. Its mission is to improve the quality of life for Canadians, their families and future generations by studying, measuring and broadly communicating the effects of government policies, entrepreneurship and choice on their well-being. To protect the Institute's independence, it does not accept grants from governments or contracts for research. Visit www.fraserinstitute.org

SOURCE The Fraser Institute

MEDIA CONTACT: Nadeem Esmail, Director, Health Policy Studies, Fraser Institute | To arrange media interviews or for more information, please contact: Drue MacPherson, Fraser Institute, [email protected], 604-688-0221 ext.721 | For more information, please contact: Bryn Weese, Associate Director, Communications, Fraser Institute, 604-688-0221 ext. 589, [email protected]