Conditional social transfers have allowed governments to introduce innovative new social programs such as Medicare and ensure they are available to all Canadians. When the federal government uses such conditional transfers, whether cost-funded or block-funded, it should cooperate to respect provincial and territorial governments and their priorities. The inter-provincial collaboration model was recently proposed as a new model of federalism16. This model suggests that Ottawa return social programs to the provinces through unconditional funding. The provinces would then agree with each other on maintaining standards. There is no guarantee that such agreements will be concluded, but it has been argued that the engagement of Canadians in these programs would ensure the introduction of this aspect of the model.16 There are also concerns about the likelihood of provincial cooperation without federal direction.17 The use of federal purchasing power in accordance with the Constitution was essential to the development of the Canadian Social Union. A significant use of purchasing power by the Government of Canada has been the transfer of funds to provincial and territorial governments. These transfers support the implementation of social programs and services by the provinces and territories to promote equal opportunities and mobility for all Canadians and to pursue goals at the Canadian level. The incorporation of a social union into the Constitution of Canada was discussed in 1992 with a set of amendments ultimately rejected, called the Charlottetown Accord. This social union was proposed by the New Democratic Party of Ontario. The Social Charter highlighted common standards for social programs across Canada.
 Prime Minister Chrétien, who came to power in 1993, was not interested in constitutional reform, but was interested in a social union to repair Canadian federalism after the 1995 referendum on Quebec sovereignty.  For example, one of the few programs directly derived from the social union process was the National Child Benefit Program. It has been criticized across the country for allowing provinces to recoup benefits from the most vulnerable groups they receive, parents on social assistance. While relapse funding is intended to apply to programs that benefit this group, this is not the case in Ontario, where the funds are primarily for labour-related parents. The claim for recovery is the subject of a Charter challenge that was filed shortly because many consider it to be very discriminatory. The Government of Canada will consult with provincial and territorial governments at least one year prior to the extension or significant changes to funding for existing social transfers to the provinces/territories, unless otherwise agreed, and will incorporate the time-limit provisions into all new social transfers to provincial and territorial governments. Under the agreement, new transnational social programs can also be implemented with financial assistance from The Confederation, with the agreement of the federal government and the majority of provincial governments. As scholar Jennifer Smith notes, "there is no additional requirement for a minimum population" of the provinces that support the programs. While in theory, the federal government could easily achieve new programs by targeting "poorer provinces," particularly Atlantic Canada, Smith notes that this view "…… that the poorest provinces are indiscriminate programmers.  A final agreement was signed by all provinces except Quebec on February 4, 1999.
The main elements of this agreement, which will have an impact on health care, are the reaffirmation of the principles of the Canada Health Act, the commitment to consult with the provinces and territories one year before transfer changes, commitments to cooperate with the provinces in the development of new programs and not new initiatives without the agreement of the majority of provinces, and the commitment to a collaborative dispute resolution mechanism.1 The health agreement, the provincial guarantee to respect the principles of the Canada Health Act and the