Provincial Leadership and Green Shoots: Where to Look for Innovation

The recent federal election highlighted an unfortunate fact: the national political parties were not able or willing to prioritize and champion the needed health reforms to be enacted by provinces. Each of the national parties offered few innovations beyond spending more money in the same way to buy access to family physicians.

There are many serious problems with provincial and territorial healthcare systems beyond accessing a family physician – there is palpable disappointment among healthcare experts with national parties' lack of thought leadership in healthcare.

The federal parties have shown that they are unable to articulate innovative ideas to meaningfully address the complex problems of provincial and territorial health systems. For everyone, this state of affairs should crystallize the idea that the federal government will not be leading solutions to the country's most pressing healthcare problems anytime soon.

Where does this leave Canadians looking for meaningful reform to healthcare delivery? In the short and medium terms, provinces and territories will have to develop and lead with innovative solutions that fit the context of their province or territory.

Provincial Innovation

There are green shoots that suggest some optimism for beleaguered healthcare-consuming Canadians and their families.

The premier of Alberta recently announced an overhaul of Alberta's policies used to fund acute care (Province of Alberta 2025). Alberta's new policies of funding hospitals based on their activities are consistent with how Ontario and many European countries with health systems similar to ours fund their hospitals (European Observatory on Health Systems and Policies 2011), though the devil is in the details.

Transforming the way hospitals are remunerated is a profound shift for the acute care sector, which is unaccustomed to competing for revenue or matching costs with prices (C.D. Howe 2013). The downside risk to Albertans is low, as inefficient hospitals are unlikely to be allowed to fail by the government. The upside risks to Albertans are increasing the volume of hospital care and decreasing the cost per case (Province of Alberta 2025). The Province of Quebec also appears poised to further implement the same policies in its push for better access to hospitals, referred to as “financement axé sur le patient,” or FAP (Province of Quebec 2023).

Large-scale health system innovation is also slowly progressing in Ontario. The Ontario Health Team model is a nascent policy initiative, which has long-term goals that include creating incentives for preventive health, aging at home, longitudinal care coordinated by multidisciplinary teams and reducing congestion of hospitals (Ontario Health 2024). The Ontario Health Team model preserves options for future governments to implement capitation-type payment models for Ontario Health Teams, funding healthcare providers for the health of the population in their region.

Ontario proceeding with these policy objectives may represent the “holy grail” of healthcare funding by creating financial incentives for addressing vertical and horizontal inequities in health. Ontario's experiment with Ontario Health Teams presents a bold vision – there are few international settings where population- and team-based longitudinal healthcare models are successful, and there are many legislative, policy and workflow-related barriers to progress that Ontario will need to overcome to succeed.

There are also provinces bereft of meaningful innovations addressing their healthcare systems' problems. British Columbia, Saskatchewan and Manitoba are examples where voters should reflect on their governments' barely sufficient reform-oriented policies. Without change, these provinces should expect more of the same.

As provinces increasingly claim ownership over healthcare transformation – without the encumbrance of standardization coordinated by Health Canada – it is entirely predictable that provinces' health systems will forge ahead in disparate directions. The new policy initiatives of Alberta, Quebec and Ontario highlight that there are few commonalities between them. While differences between provinces' health systems are not inherently “bad,” it is worthwhile to note that what is recognized as public healthcare services in one province may not be considered public healthcare services in another.

On the whole, provinces and territories are clearly in the driver's seat regarding healthcare transformation. With several provinces' governments pushing forward with innovation-based agendas and some electing to stand pat, it is worth reflecting on the potential impacts of whether there is value in provinces and territories moving in the same direction.

In This Issue

This issue of Healthcare Policy is led by a Discussion and Debate article focused on adolescents' access to abortion care across Canada (Cattapan et al. 2025). The interprovincial policy comparisons reveal instances of unclear or contradictory provincial legislation that result in differences in youth's ability to access abortion care. The editorial concludes with a number of recommendations for reducing barriers to abortion care, including revising legislation and consenting processes.

A rejoinder by Haley and Motamedi (2025) extended the preceding article's focus on access to abortion care. Applying an intersectional framework to the healthcare needs of adolescents, the authors provide different insights into barriers to equitable access to abortion care among marginalized groups. The authors provide clear recommendations for reducing barriers, including creating welcoming spaces, a sense of safety and fostering personhood and autonomy that destigmatizes abortion access.

A second Discussion and Debate article focuses on interactions between health services and policy researchers with senior policy makers (Paprica et al. 2025). Framed as a researcher's balancing act between advice and advocacy, the article highlights the risk that health services and policy researchers bear through their research activities. The authors offer a number of strategies for reducing researchers from being perceived as issue advocates.

A rejoinder to the preceding article provides a different perspective on interactions between health services and policy researchers with senior policy makers (Forest 2025). The article proposes that the impact of health services and policy researchers on government policy is lesser than expressed by Paprica et al. (2025), since researchers are rarely involved in government's core policy tasks led by political leaders and decision making processes that incorporate input from a range of input channels beyond researchers, including public opinion polling, platform commitments and lobbying campaigns.

A Data Matters article by Contandriopoulos and Bertoni (2025) analyses recently released Canadian Institute for Health Information data regarding the proportion of Canadians who report having a regular healthcare provider. Variability in the prevalence of nurse practitioners (NPs) across provinces is highlighted. The article concludes that there is building evidence that NPs are granted more autonomy within their scope of practice only when access to care becomes critically constrained, and that the Canada Health Act (1985) also applies to NP-delivered services, potentially affecting NPs' ability to privately bill patients for their services.

Using a survey-based design, Quelch (2025) reports on themes associated with accessing fertility services, such as at fertility clinics or online support groups. The study summarized women's perceptions and experiences associated with accessing in vitro fertilization (IVF) in British Columbia. The results revealed important barriers to IVF, including regional variation and patient-borne costs. The author concludes that British Columbia's recently announced fertility program should reflect the barriers reported by women seeking IVF services.

In the setting of Alberta, Jajszczok et al. (2025) conducted a retrospective analysis of anonymized homecare costs and homecare utilization. The authors report that increased spending and utilization of home care were associated with decreased acute care utilization. The authors conclude that similar analyses are needed in all provinces to provide new insights into how healthcare resources should be allocated across sectors and how healthcare services are consumed by residents based on where they live.