The federal health minister says Ottawa will keep money reserved for Manitoba if the province doesn't take steps to keep people from paying out-of-pocket to get quicker access to services.

In the latest Canada Health Act annual report, Health Minister Patty Hajdu singled out Manitoba as a province where some citizens have paid to receive diagnostic services faster than other people.

Ottawa has asked all provinces to eliminate this practice by April 1. If that's not done, the federal government warns it will deduct some portion of the health transfers the province receives.

"We have a public health-care system that is designed to make sure that, no matter what jurisdiction you live in, that you have equal access to services that are covered through the act," Hajdu told reporters in Ottawa on Wednesday.

Access shouldn't depend on pay: feds

The report also flagged the practice of nurse practitioners who are working privately and charging patients for services that would normally be covered under the provincial health plan, if performed by a physician.

Health Canada brought its concerns about that practice to Manitoba Health last May.

"In particular, Health Canada expressed concern about the migration of services from a setting where access is universal and based on medical need to one where access depends on the ability, and willingness, of the patient to pay," the report said.

Manitoba said it is "examining the scope of practice of nurse practitioners in private and public practice," according to the report, as well as possible overlap with physician services covered under the provincial health plan.

In a written statement, Manitoba Health Minister Cameron Friesen did not delve into the federal concerns, but said the province "remains committed to the principal of universality as enshrined under the Canada Health Act."

"Our government continues to co-operate with our federal counterparts on a variety of files evidenced by our bilateral agreement on mental health and home care, the Emergency Treatment Fund and other initiatives."

If any deductions from the federal health transfer are necessary, the amount will be calculated at the end of March, a federal government spokesperson said in an email.