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Promises on public health care improvements have been flying thick and fast in this federal election campaign -- billions of dollars in promises.

In 2004, the Liberal government led by Paul Martin negotiated an agreement with the provinces and territories for more than $41 billion in assistance for health care spending over 10 years, with a six per cent per year increase. That deal expires in 2014 – just three years from now.

Health care is the biggest expenditure for provinces and the party that wins on May 2 will likely have to negotiate the next federal-provincial-territories health funding deal – and this has made health care a huge issue on the campaign.

What do they have in mind?

For example, NDP Leader Jack Layton has said he plans to improve health services available to Canadian families, and a first step will be hiring 1,200 doctors, and 6,000 nurses, starting in the first 100 days of an NDP government.

Liberal leader Michael Ignatieff has talked of a First Ministers summit on health care with the federal government, the provinces and territories within 60 days of taking office. The aim would be to renew and improve the current 10-year deal.

Prime Minister Stephen Harper has boasted that his government negotiated with the provinces for the improvement in the long waiting times for health care, not the Paul Martin Liberal government which in 2004 struck the initial agreement.

But how will Canadians stop the promises from being hollow and the plans from falling apart after one of the three front running parties has been voted into power?

Will minds change, promises be forgotten, and excuses be given? How will Canada keep its renowned universal health care on track and constantly improving, as the politicians have said it will?

Pamela Fralick, president and chief executive officer of the Canadian Health Care Association, says it is the responsibility of the taxpayer to make sure the promises are not forgotten or reneged upon by the politicians.

"We have to be the ones who are holding their feet to the fire," she said.

Fralick said the federal government has made little effort to hold the provinces and territories accountable for spending of the health care funding. They have not asked the provinces if they "have covered all the areas that were identified for improvements."

The federal government has not played a role in "pan-Canadian leadership."

"All they are saying is that we will continue the six per cent increases in funding and saying that by putting money into the system, ‘we have done our part'."

The Canadian taxpayer should be "appalled and alarmed by the process" and should be asking what the federal and provincial governments are going to be doing to monitor the improvements needed by the system.

"We have to tell them: Be specific. Don't say you are going to throw money at the problem. Show us how you are going to show leadership of this."

The Canadian Medical Association (CMA) represents 74,000 doctors in Canada, and is holding a series of town hall meetings across the country aimed at gathering the input of Canadians on what should be in the new agreement between the governments that is to be negotiated in 2014.

CMA President Dr. Jeffrey Turnbull said people at the meetings having been asking for the government to show leadership.

"It is very nice to promise money, but money will not do it, the system needs to be fixed. It has to be transformed into a health system that truly aids Canadians."

All the parties are committed to the six per cent increase in transfers each year until the deal is renegotiated. "But they must commit to using that six per cent in a way that makes Canadians proud," Turnbull said.

The public, doctors and other healthcare providers are going to have to see that this is kept on the agenda and must hold the politicians accountable, he said.

"Any new government must be held to account … 2014 is coming very quickly and we have to begin discussions. We are all partners in this and must build in strong national standards on health care.

"This process begins with strong evidence-based discussions and all Canadians have to be at the table."

Ontario's Minister of Health and Long Term Care Deb Matthews said universal health care was a "Canadian core value" and was a gift from the past generation that had to be this generation's gift to the next.

"The ones who don't live up to (expectations) won't get elected again," she added.