Canada's provinces are seeking C$47.4 billion ($31.2 billion) in new federal health and social spending grants over the next five years - far more than earlier reported and exceeding Ottawa's willingness to pay.
Provincial officials laid out their requests one day before their premiers were to meet Canadian Prime Minister Jean Chretien to try to thrash out a deal to rescue the universal public health system, faltering under increasing demands.
And in another sign of the difficulty Chretien will have in reaching a deal with the premiers, the provinces said they were unhappy with the idea of being forced to expand public health coverage as a price of taking federal cash.
"Our premiers are pretty well maxed out on what we can spend on health care," one senior provincial official told a news briefing ahead of the meeting.
Like many countries, Canada is grappling with an aging population and medical cost inflation. It prides itself that all residents are eligible for care but faces increasing difficulties managing lengthy waiting lists.
Canadian Health Minister Anne McLellan proposed last month a new Health Reform Fund that would help provide, among other new ideas, medical care at home where needed by 2006 and coverage for catastrophic, or very high-cost, prescription drugs by end-2005.
The idea of home care is to relieve pressure on more expensive hospital care. But it will require extra money at least in the medium term to add such home care to the system, and the expensive drug coverage will also add to costs.
The provinces say they are already paying for 86 per cent of the health care system, and spend 40 per cent of their provincial budgets on health alone. They are therefore worried about commitments to entire new areas.
"The concern that we have is the incremental commitment to a significant expansion of programs and services, where the costs are very significant," the official said.
She added that the provinces were open to having the Reform Fund go to reforms to deliver more effectively the core medical services already being provided rather than new areas.