Provincial and territorial health and finance ministers held an unprecedented working session in Toronto last weekend to craft their own recipe for "health care reform and sustainability." With federal political leaders trumpeting their various election platforms for health care, provincial-territorial leaders are anxious to take control of the agenda.

"We want to develop something on our own. We're closest to the ground. We are the agents of delivery," the Globe and Mail quoted Ontario Premier Dalton McGuinty as saying after the meeting. Mr. McGuinty and B.C. Premier Gordon Campbell chaired the two-day meeting.

Participants heard presentations on best practices, explored issues, and organized seven working groups to work out details of an embryonic provincial-territorial plan. These groups will look into: funding; health human resources; pharmaceuticals; electronic health records; waiting lists; rural and remote health care; and information and telehealth.

Each group will prepare a report on issues and recommendations that will be compiled into a final document for presentation at the provincial-territorial premiers' meeting of the Council of the Federation at the end of July.

PEI Premier Pat Binns, who is also Chair of the Council of the Federation, has written the leaders of the three national parties, as well as the Bloc Quebecois, seeking their commitment to keep Prime Minister's promise to hold a health-care summit with the premiers some time this summer. The premiers are looking for a deal on health-care sustainability at that time, and they do not want to be forced into buying-into the election platform of the winning party.

Speaking to the New Brunswick Telegraph-Journal, New Brunswick Health Minister Elvy Robichaud remarked that the provinces and territories need the flexibility to choose how federal funds are used for their particular needs. "If we don't define it, the feds will define it for us," he said.

Mr. Binns' letter also sought the position of the various parties on the issue of "... the sustainability of our health care systems, including the appropriate levels of the federal government's long term funding for health care." In other words, he and his fellow premiers are looking for each party to make a public declaration of much more cash they would ante up for health care on an ongoing basis. The Globe and Mail reported Monday that the provinces and territories are seeking $4 billion more a year from Ottawa.

The NDP is promising to bring federal support up to the 25 per cent level of provincial-territorial health expenditures, and the Liberals have said their $3 billion injection over two years will also reach this level. However, this offer has failed to generate any excitement among provincial leaders. The Conservatives have yet to make a dollar commitment while promising a long-term investment plan for health care.

Participants at last weekend's meeting apparently expressed concern at how the federal government is packaging the money it gives to the provinces and territories for health care. "There is a tendency of the federal government to increase the financing of health care with targeted and non-recurring funds," Quebec Health Minister Philippe Couillard told Le Soleil. He also said Ottawa is creating problems by cutting back on its support for education and social programs so more money can go to health care. Education and social programs are part of the "determinants of health," he pointed out.

At the same time, there are indications that provincial leaders are prepared to carve out a role for Ottawa in terms of funding specific programs. Mr. Robichaud said the provinces and territories may come up with a basket of services that could be funded by federal money. Conservative Leader Stephen Harper has suggested a federally-funded drug program, and Prime Minister Paul Martin has talked about something similar for home care.