There have been no developments with respect to establishing a health accord beyond the formal exchange of letters indicating that further collaborative work needs to be done. An agreement on the social union was finally reached Feb. 4, 1999. It is a three-year deal subject to review and renewal, and was signed by all the provinces and territories except Quebec. The document explicitly recognizes the federal government's role in determining social policy. All the provinces and territories must opt-in in order to qualify for full federal funding.
Several clauses have implications for the future of health care.
There is agreement that there should be improved accountability and transparency of social programs. The governments have agreed to monitor and measure outcomes of social programs and report the results regularly to their residents and agree to work together to share information and identify priorities for collaborative action. The federal government agreed not to introduce any new initiatives in health care, social assistance or education that are funded through intergovernmental transfers without the agreement of a majority of provincial governments. Interestingly, any government can require a review of a decision or action one year after it takes effect. It will be important to monitor the impact of these negotiations in the area of health care.