The federal government is taking a hands-off approach to health care. And according to some veteran observers, we should be concerned.

A decade ago, things appeared to be headed in the opposite direction.In 2004, then-Prime Minister Paul Martin and the first ministers of Canadas provinces and territories came together to sign a 10-year health accord. The agreement boosted federal health funding annually while setting a series of guidelines for improving and expanding health care coverage and delivery across the country. At the time, it promised transformative change in Canadian health care, rising to meet many of the growing challenges in health costs and delivery.

That agreement, however, has now run its course. In March of this year, the accord quietly expired with no comparable federal agreements to take its place. And while the Harper government handed down a 10-year funding formula as its replacement, the message was clear: other than setting aside money for the provinces, Ottawa would not be taking an active role in coordinating health care policy.

Dr. Alex Himelfarb, a former clerk of the Privy Council for three prime ministers, says Canadians should pay close attention to these changes, the implications of which are wide-ranging. The lack of a federal leadership role, he warns, may have serious consequences for the future of Canadian health care.

The most immediate concern, he says, is about funding. While the previous agreement included a 6 per cent annual increase in federal health funding, the new one discontinues it after 2017. Increases after that will be tied to GDP or a minimum of 3 per cent.

The 2004 agreement between the federal government and the first ministers, which expired on March 31, 2014, called on numerous improvements and standards to be set nationally, including:

Source:Health Canada.

But Himelfarb is even more concerned about the new funding formula.

The formula for transferring the money has changed to a strictly per-capita basis with no need component, he says. This means that some provinces will be getting pretty much no increase especially provinces that are losing population.

Aside from money, Himelfarb suggests a greater opportunity was lost here: Ottawa has effectively declined to take a leadership role in coordinating policy across the country. In crafting the new arrangement, he says, There was no attempt to set minimum standards, shared objectives or shared principles.

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As accord expires, Ottawa takes a back seat on health care policy