Health Minister Jane Philpott offered an apology of sorts to her provincial and territorial counterparts Tuesday after some of them pushed back against her argument that federal health dollars need to be earmarked for health spending.

"I apologize if people misunderstood," Philpott said, standing among her fellow health ministers after day-long meetings a downtown Toronto hotel.

"There is certainly no intention to make accusations."

The day before, Philpott spoke frankly and at length about what she called the need for greater accountability on the part of the provinces and territories, as well as more innovative ideas on delivering health services more efficiently.

"There are countries in this world, and there are many of them, developed countries ... that are getting far better value for money than we are," she said.

"I have a responsibility as the health minister for Canada to invest in health, to help improve health systems, but when we are going to my finance minister to ask for more money, I need to be able to tell that finance minister it is going to be used for health."

Health dollars for health care

On Tuesday, Philpott refined her message, saying the federal government wants to see greater accountability for future investments.

"What we are talking about is new investments in health care," she said. "That's just what I talked about, the fact that when we are investing in home care ... people in this day and age, health experts from across the country, believe in measurement."

During that same news conference, Ontario Health Minister Eric Hoskins said he and his fellow ministers felt Philpott was sending a clear message that federal health care funding wasn't being spent on health care.

"That implication certainly was received," Hoskins said. "You've probably had a number of us march up to the microphone and actually assert that."

Hoskins went on to add he can say with "absolute confidence" that every single dollar transferred to his province for health goes towards its intended purpose.

Strings or no strings?

Quebec has openly challenged the idea of strings being attached to funding, but Alberta Health Minister Sarah Hoffman said she is open to the idea if it helps to deliver results and defend Canada's health care system.

The tensions that have permeated the talks come from provincial resistance to a federal plan to proceed with a reduction in the rate by which federal transfers increase each year: three per cent, down from the six per cent escalator established in 2004.

Those transfer payments currently flow into the provinces' general revenue pool; Philpott said Tuesday that further investment will require additional detail so the federal government can know what to "expect."

The provinces are involved in the day-to-day delivery of health care but the federal government has an important role to play in a range of areas, she noted, adding it would like to share its ideas and work together.

We take a look back at the 12 years since the federal government hashed out a health-care deal with the provinces. 2:29

The provinces say a three per cent increase in Canada Health Transfer payments will mean $1 billion less the provinces would otherwise have received in 2017-18, and $60 billion over the next decade.

Quebec Health Minister Gaetan Barrette, one of the most outspoken voices on the three-per-cent reduction, said Tuesday he is hopeful the premiers and Prime Minister Justin Trudeau will be able to sit down and reach a compromise.

"We are in a situation where today and tomorrow, obviously we will not be able to provide enough (service)," he said. "That's why the three-per-cent is not enough."

Barrette said it will take time — and money — to address current needs at the provincial level before improved results can be achieved through health innovation.

Trudeau is set to meet with the premiers on Dec. 8 and 9 to discuss climate change — another irritant in the federal-provincial relationship, but an issue that the federal Liberals have made a cornerstone policy.