ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS
ACKNOWLEDGEMENTS
Health Canada would like to acknowledge the work and effort that went into producing this Annual Report.
It is through the dedication and timely commitment of the following departments of health and their staff
that we are able to bring you this report on the administration and operation of the Canada Health Act:
Newfoundland and Labrador Department of Health and Community Services
Prince Edward Island Department of Health
Nova Scotia Department of Health
New Brunswick Department of Health
Quebec Department of Health and Social Services
Ontario Ministry of Health and Long-Term Care
Manitoba Health
Saskatchewan Health
Alberta Health and Wellness
British Columbia Ministry of Health Services
Yukon Health and Social Services
Northwest Territories Department of Health and Social Services
Nunavut Department of Health and Social Services
We also greatly appreciate the extensive work effort that was put into this report by our production team:
the desktop publishing unit, the translators, editors and concordance experts, and staff of the Regions and
Programs Branch, Health Canada.
Canada Health Act — Annual Report 2008–2009
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Canada Health Act — Annual Report 2008–2009
TABLE OF CONTENTS
Acknowledgements_ __________________________________________________________________________________ i
Introduction__________________________________________________________________________________________ 1
Chapter 1 — Canada Health Act Overview_______________________________________________________________ 3
Chapter 2 — Administration and Compliance____________________________________________________________ 9
Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2008–2009__________________________ 13
Newfoundland and Labrador__________________________________________________________________________ 15
Prince Edward Island_________________________________________________________________________________ 29
Nova Scotia_________________________________________________________________________________________ 41
New Brunswick______________________________________________________________________________________ 59
Quebec_____________________________________________________________________________________________ 75
Ontario______________________________________________________________________________________________ 81
Manitoba____________________________________________________________________________________________ 97
Saskatchewan_______________________________________________________________________________________ 119
Alberta_____________________________________________________________________________________________ 135
British Columbia____________________________________________________________________________________ 147
Yukon_____________________________________________________________________________________________ 167
Northwest Territories________________________________________________________________________________ 183
Nunavut____________________________________________________________________________________________ 191
Annex A — Canada Health Act and Extra-Billing and User Charges Information Regulations_ ______________ 203
Annex B — Policy Interpretation Letters_______________________________________________________________ 223
Annex C — Dispute Avoidance and Resolution Process under the Canada Health Act______________________ 233
Provincial and Territorial Departments of Health Contact Information_______________________ inside back cover
Canada Health Act — Annual Report 2008–2009
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Canada Health Act — Annual Report 2008–2009
Introduction
Introduction
Canada has a predominantly publicly financed and
administered health care system. The Canadian health
insurance system is achieved through 13 interlocking
provincial and territorial health insurance plans, and is
designed to ensure that all eligible residents of Canada
have reasonable access to medically necessary hospital and physician services on a prepaid basis, without
direct charges at the point of service.
The Canadian health insurance system evolved
into its present form over more than five decades.
Saskatchewan was the first province to establish
universal, public hospital insurance in 1947 and,
ten years later, the Government of Canada passed
the Hospital Insurance and Diagnostic Services Act
(1957) to share in the cost of these services with
the provinces and territories. By 1961, all the provinces and territories had public insurance plans
that provided universal access to hospital services.
Saskatchewan again pioneered in providing insurance for physician services, beginning in 1962. The
Government of Canada adopted the Medical Care
Act in 1966 to cost share the provision of insured
physician services with the provinces and territories.
By 1972, all provincial and territorial plans had been
extended to include physician services.
In 1979, at the request of the federal government,
Justice Emmett Hall undertook a review of the state
of health services in Canada. In his report, he affirmed
that health care services in Canada ranked among the
best in the world, but warned that extra-billing by
doctors and user fees levied by hospitals were creating
a two-tiered system that threatened the accessibility
of care. This report, and the national debate it generated, led to the enactment of the Canada Health Act
in 1984.
The Canada Health Act, Canada’s federal health
insurance legislation, defines the national principles
that govern the Canadian health insurance system,
namely, public administration, comprehensiveness,
universality, portability and accessibility. These
principles are symbols of the underlying Canadian
values of equity and solidarity.
Canada Health Act — Annual Report 2008–2009
The roles and responsibilities for Canada’s health care
system are shared between the federal and provincial/
territorial governments. The provincial and territorial
governments have primary jurisdiction in the administration and delivery of health care services. This
includes setting their own priorities, administering
their health care budgets and managing their own
resources. The federal government, under the Canada
Health Act, sets out the criteria and conditions that
must be satisfied by the provincial and territorial
health insurance plans for them to qualify for their
full share of the cash contribution available under
the federal Canada Health Transfer.
On an annual basis, the federal Minister of Health is
required to report to Parliament on the administration
and operations of the Canada Health Act, as set out
in section 23 of the Act. The vehicle for so doing is the
Canada Health Act Annual Report. While the principal
and intended audience for the report is parliamentarians,
it is a readily accessible public document that offers a
comprehensive report on insured services in each of the
provinces and territories. The annual report is structured to address the mandated reporting requirements
of the Act—its scope does not extend to commenting on
the status of the Canadian health care system as a whole.
Health Canada’s approach to the administration of
the Act emphasizes transparency, consultation and
dialogue with provincial and territorial health care
ministries. The application of financial penalties
through deductions under the Canada Health Transfer
is considered only as a last resort when all options to
resolve an issue collaboratively have been exhausted.
Pursuant to the commitment made by premiers under
the 1999 Social Union Framework Agreement, federal,
provincial and territorial governments agreed through
an exchange of letters, in April 2002, to a Canada
Health Act Dispute Avoidance and Resolution (DAR)
process. The DAR process was formalized in the First
Ministers’ 2004 Accord. Although the DAR process
includes dispute resolution provisions, the federal
Minister of Health retains the final authority to interpret and enforce the Canada Health Act.
For the most part, provincial and territorial health
care insurance plans not only meet the criteria and
conditions of the Canada Health Act, in many cases,
provincial and territorial laws and regulations restate
the principles of the Act.
In 2008–2009, the most prominent concerns with
respect to compliance under the Canada Health
Act remained patient charges and queue jumping
for medically necessary health services at private
clinics. Health Canada has made these concerns
known to the provinces that allow these charges.
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Canada Health Act — Annual Report 2008–2009
Chapter 1: Canada Health Act Overview
Persons excluded under the Act include serving
members of the Canadian Forces or Royal Canadian
Mounted Police and inmates of federal penitentiaries.
CHAPTER 1
Canada Health
Act Overview
This section describes the Canada Health Act, its
requirements and key definitions under the Act.
Also described are the regulations and regulatory
provisions of the Act and the interpretation letters
by former federal Ministers of Health Jake Epp and
Diane Marleau to their provincial and territorial
counterparts that are used in the interpretation
and application of the Act.
What is the Canada Health Act?
The Canada Health Act is Canada’s federal legislation
for publicly funded health care insurance. The Act
sets out the primary objective of Canadian health care
policy, which is “to protect, promote and restore the
physical and mental well-being of residents of Canada
and to facilitate reasonable access to health services
without financial or other barriers.”
The Act establishes criteria and conditions related
to insured health services and extended health care
services that the provinces and territories must fulfill
to receive the full federal cash contribution under the
Canada Health Transfer (CHT).
The aim of the Act is to ensure that all eligible residents of Canada have reasonable access to medically
necessary services on a prepaid basis, without direct
charges at the point of service for such services.
Key Definitions Under the
Canada Health Act
Insured persons are eligible residents of a province
or territory. A resident of a province is defined in the
Act as “a person lawfully entitled to be or to remain
in Canada who makes his home and is ordinarily
present in the province, but does not include a tourist,
a transient or a visitor to the province.”
Canada Health Act — Annual Report 2008–2009
Insured health services are medically necessary
hospital, physician and surgical-dental services
(performed by a dentist in a hospital, where a hospital is required for the proper performance of the
procedure) provided to insured persons.
Insured hospital services are defined under the Act and
include medically necessary in- and out-patient services
such as accommodation and meals at the standard
or public ward level and preferred accommodation if
medically required; nursing service; laboratory, radiological and other diagnostic procedures, together with
the necessary interpretations; drugs, biologicals and
related preparations when administered in the hospital; use of operating room, case room and anaesthetic
facilities, including necessary equipment and supplies;
medical and surgical equipment and supplies; use of
radiotherapy facilities; use of physiotherapy facilities; and services provided by persons who receive
remuneration therefore from the hospital, but does not
include services that are excluded by the regulations.
Insured physician services are defined under the Act
as “medically required services rendered by medical
practitioners.” Medically required physician services
are generally determined by physicians in conjunction
with their provincial and territorial health insurance
plans.
Insured surgical-dental services are services provided
by a dentist in a hospital, where a hospital setting is
required to properly perform the procedure.
Extended health care services as defined in the Act
are certain aspects of long-term residential care
(nursing home intermediate care and adult residential care services), and the health aspects of home
care and ambulatory care services.
Requirements of the
Canada Health Act
The Canada Health Act contains nine requirements
that the provinces and territories must fulfill in order
to qualify for the full amount of their cash entitlement under the CHT. They are:
• five program criteria that apply only to insured
health services;
• two conditions that apply to insured health
services and extended health care services; and
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Chapter 1: Canada Health Act Overview
• extra-billing and user charges provisions that
apply only to insured health services.
The Criteria
1. Public Administration (section 8)
The public administration criterion, set out in section
8 of the Canada Health Act, applies to provincial and
territorial health care insurance plans. The intent of
the public administration criterion is that the provincial and territorial health care insurance plans be
administered and operated on a non-profit basis by a
public authority, which is accountable to the provincial or territorial government for decision-making on
benefit levels and services, and whose records and
accounts are publicly audited. However, the criterion
does not prevent the public authority from contracting out the administrative services necessary for
the administration of the provincial and territorial
health care insurance plans.
The public administration criterion pertains only to
the administration of provincial and territorial health
insurance plans and does not preclude private facilities
or providers from supplying insured health services
as long as no eligible resident is charged in relation to
these services.
2. Comprehensiveness (section 9)
The comprehensiveness criterion of the Act requires
that the health care insurance plan of a province
or territory must cover all insured health services
provided by hospitals, physicians or dentists (i.e.,
surgical-dental services that require a hospital setting) and, where the law of the province so permits,
similar or additional services rendered by other
health care practitioners.
3. Universality (section 10)
Under the universality criterion, all insured residents
of a province or territory must be entitled to the insured
health services provided by the provincial or territorial health care insurance plan on uniform terms and
conditions. Provinces and territories generally require
that residents register with the plans to establish
entitlement.
Newcomers to Canada, such as landed immigrants
or Canadians returning from other countries to live in
Canada, may be subject to a waiting period by a province or territory, not to exceed three months, before
they are entitled to receive insured health services.
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4. Portability (section 11)
Residents moving from one province or territory
to another must continue to be covered for insured
health services by the “home” jurisdiction during
any waiting period imposed by the new province
or territory of residence. The waiting period for
eligibility to a provincial or territorial health care
insurance plan must not exceed three months. After
the waiting period, the new province or territory
of residence assumes responsibility for health care
coverage. However, it is the responsibility of residents to inform their province or territory’s health
care insurance plan that they are leaving and to
register with the health care insurance plan of their
new province or territory.
Residents who are temporarily absent from their
home province or territory or from Canada, must
continue to be covered for insured health services
during their absence. This allows individuals to
travel or be absent from their home province or
territory, within a prescribed duration, while
retaining their health insurance coverage.
The portability criterion does not entitle a person to
seek services in another province, territory or country,
but is intended to permit a person to receive necessary
services in relation to an urgent or emergent need when
absent on a temporary basis, such as on business
or vacation.
If insured persons are temporarily absent in another
province or territory, the portability criterion requires
that insured services be paid at the host province’s
rate. If insured persons are temporarily out of the
country, insured services are to be paid at the home
province’s rate.
Prior approval by the health care insurance plan
in a person’s home province or territory may also
be required before coverage is extended for elective
(non-emergency) services to a resident while temporarily absent from his/her province or territory.
5. Accessibility (section 12)
The intent of the accessibility criterion is to ensure
that insured persons in a province or territory have
reasonable access to insured hospital, medical and
surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or
indirectly, by charges (user charges or extra-billing)
or other means (e.g., discrimination on the basis of
age, health status or financial circumstances).
Canada Health Act — Annual Report 2008–2009
Chapter 1: Canada Health Act Overview
In addition, the health care insurance plans of the
province or territory must provide:
• reasonable compensation to physicians and
dentists for all the insured health services they
provide; and
• payment to hospitals to cover the cost of insured
health services.
Reasonable access in terms of physical availability
of medically necessary services has been interpreted
under the Canada Health Act using the “where and
as available” rule. Thus, residents of a province or
territory are entitled to have access on uniform terms
and conditions to insured health services at the setting “where” the services are provided and “as” the
services are available in that setting.
The Conditions
1. Information (section 13(a))
The provincial and territorial governments shall
provide information to the Minister of Health as
may be reasonably required, in relation to insured
health services and extended health care services,
for the purposes of the Act.
2. Recognition (section 13(b))
Extra-billing (section 18)
Under the Act, extra-billing is defined as the billing
for an insured health service rendered to an insured
person by a medical practitioner or a dentist (i.e., a
dentist providing insured surgical-dental services
in a hospital setting) in an amount in addition to
any amount paid or to be paid for that service by the
health care insurance plan of a province or territory.
For example, if a physician was to charge a patient
any amount for an office visit that is insured by
the provincial or territorial health insurance plan,
the amount charged would constitute extra-billing.
Extra-billing is seen as a barrier or impediment for
people seeking medical care, and is therefore contrary to the accessibility criterion.
User Charges (section 19)
The Act defines user charges as any charge for an
insured health service other than extra-billing that
is permitted by a provincial or territorial health care
insurance plan and is not payable by the plan. For
example, if patients were charged a facility fee for
receiving an insured service at a hospital or clinic,
that fee would be considered a user charge. User
charges are not permitted under the Act because,
as is the case with extra-billing, they constitute
a barrier or impediment to access.
The provincial and territorial governments shall
recognize the federal financial contributions toward
both insured and extended health care services.
Other Elements of the Act
Extra-billing and User Charges
Section 22 of the Canada Health Act enables the federal government to make regulations for administering
the Act in the following areas:
The provisions of the Canada Health Act, which
discourage extra-billing and user charges for insured
health services in a province or territory, are outlined
in sections 18 to 21. If it can be confirmed that either
extra-billing or user charges exist in a province or
territory, a mandatory deduction from the federal cash
transfer to that province or territory is required under
the Act. The amount of such a deduction for a fiscal
year is determined by the federal Minister of Health
based on information provided by the province or
territory in accordance with the Extra-billing and
User Charges Information Regulations (described
below).
Regulations (section 22)
• defining the services included in the Act’s
definition of “extended health care services”;
• prescribing which services to exclude from
hospital services;
• prescribing the types of information that the
federal Minister of Health may reasonably require,
and the times at which and the manner in which
that information may be provided; and
• prescribing how provinces and territories are
required to recognize the CHT in their documents, advertising or promotional materials.
To date, the only regulations in force under the Act
are the Extra-billing and User Charges Information
Canada Health Act — Annual Report 2008–2009
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Chapter 1: Canada Health Act Overview
Regulations. These regulations require the provinces
and territories to provide estimates of extra-billing
and user charges before the beginning of a fiscal year
so that appropriate penalties can be levied. They
must also provide financial statements showing the
amounts actually charged so that reconciliations
with any estimated charges can be made. (A copy
of these regulations is provided in Annex A.)
Penalty Provisions of the Canada
Health Act
Mandatory Penalty Provisions
Under the Act, provinces and territories that allow
extra-billing and user charges are subject to mandatory dollar-for-dollar deductions from the federal
transfer payments under the CHT. In plain terms,
this means that when it has been determined that a
province or territory has allowed $500,000 in extrabilling by physicians, the federal cash contribution
to that province or territory will be reduced by that
same amount.
Discretionary Penalty Provisions
Non-compliance with one of the five criteria or two
conditions of the Act is subject to a discretionary
penalty. The amount of any deduction from federal
transfer payments under the CHT is based on the
gravity of the default.
The Canada Health Act sets out a consultation process that must be undertaken with the province or
territory before discretionary penalties can be levied.
To date, the discretionary penalty provisions of the
Act have not been applied.
Excluded Services and Persons
Although the Canada Health Act requires that
insured health services be provided to insured
persons in a manner that is consistent with the
criteria and conditions set out in the Act, not all
Canadian residents or health services fall under
the scope of the Act. There are two categories of
exclusion for insured services:
• services that fall outside the definition of
insured health services; and
• certain services and groups of persons are
excluded from the definitions of insured
services and insured persons.
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These exclusions are discussed below.
Non-insured Health Services
In addition to the medically necessary hospital and
physician services covered by the Canada Health
Act, provinces and territories also provide a range of
programs and services outside the scope of the Act.
These are provided at provincial and territorial discretion, on their own terms and conditions, and vary
from one province or territory to another. Additional
services that may be provided include pharmacare,
ambulance services and optometric services.
The additional services provided by provinces and
territories are often targeted to specific population
groups (e.g., children, seniors or social assistance
recipients), and may be partially or fully covered by
provincial and territorial health insurance plans.
A number of services provided by hospitals and physicians are not considered medically necessary, and thus
are not insured under provincial and territorial health
insurance legislation. Uninsured hospital services for
which patients may be charged include preferred hospital accommodation unless prescribed by a physician,
private duty nursing services and the provision of telephones and televisions. Uninsured physician services
for which patients may be charged include telephone
advice, the provision of medical certificates required
for work, school, insurance purposes and fitness clubs,
testimony in court and cosmetic services.
Excluded Persons
The Canada Health Act definition of “insured person”
excludes members of the Canadian Forces, persons
appointed to a position of rank within the Royal
Canadian Mounted Police and persons serving a term
of imprisonment within a federal penitentiary. The
Government of Canada provides coverage to these
groups through separate federal programs.
As well, other categories of residents such as landed
immigrants and Canadians returning to live from
other countries may be subject to a waiting period
by a province or territory. The Act stipulates that the
waiting period cannot exceed three months.
In addition, the definition of “insured health services” excludes services to persons provided under
any other Act of Parliament (e.g., refugees) or under
the workers’ compensation legislation of a province
or territory.
Canada Health Act — Annual Report 2008–2009
Chapter 1: Canada Health Act Overview
The exclusion of these persons from insured health
service coverage predates the adoption of the Act and
is not intended to constitute differences in access to
publicly insured health care.
Policy Interpretation Letters
There are two key policy statements that clarify the
federal position on the Canada Health Act. These
statements were made in the form of ministerial
letters from former federal ministers of health to
their provincial and territorial counterparts. Both
letters are reproduced in Annex B of this report.
Epp Letter
In June 1985, approximately one year following the
passage of the Canada Health Act in Parliament, thenfederal Minister of Health and Welfare Jake Epp wrote
to his provincial and territorial counterparts to set out
and confirm the federal position on the interpretation
and implementation of the Act.
Minister Epp’s letter followed several months of
consultation with his provincial and territorial
counterparts. The letter sets forth statements of
federal policy intent that clarify the Act’s criteria,
conditions and regulatory provisions. These clarifications have been used by the federal government
in assessing and interpreting compliance with the
Act. The Epp letter remains an important reference
for interpreting the Act.
Marleau Letter — Federal Policy
on Private Clinics
Between February 1994 and December 1994, a series
of seven federal/provincial/territorial meetings dealing wholly or in part with private clinics took place.
At issue was the growth of private clinics providing
medically necessary services funded partially by the
public system and partially by patients and their
impact on Canada’s universal, publicly funded
health care system.
At the September 1994 federal/provincial/territorial
meeting of health ministers in Halifax, all ministers
of health present, with the exception of Alberta’s
health minister, agreed to “take whatever steps are
required to regulate the development of private
clinics in Canada.”
Canada Health Act — Annual Report 2008–2009
Diane Marleau, the federal Minister of Health at the
time, wrote to all provincial and territorial ministers of
health on January 6, 1995, to announce the new Federal
Policy on Private Clinics. The Minister’s letter provided the federal interpretation of the Canada Health
Act as it relates to the issue of facility fees charged
directly to patients receiving medically necessary
services at private clinics. The letter stated that the
definition of “hospital” contained in the Act includes
any facility that provides acute, rehabilitative or
chronic care. Thus, when a provincial/territorial health
insurance plan pays the physician fee for a medically
necessary service delivered at a private clinic, it must
also pay the facility fee or face a deduction from federal
transfer payments.
Dispute Avoidance and
Resolution Process
In April 2002, then-federal Minister of Health A. Anne
McLellan outlined in a letter to her provincial and
territorial counterparts a Canada Health Act Dispute
Avoidance and Resolution process, which was agreed
to by provinces and territories, except Quebec. The
process meets federal and provincial/territorial interests of avoiding disputes related to the interpretation
of the principles of the Act and, when this is not
possible, resolving disputes in a fair, transparent
and timely manner.
The process includes the dispute avoidance activities
of government-to-government information exchange;
discussions and clarification of issues as they arise;
active participation of governments in ad hoc federal/
provincial/territorial committees on Act-related
issues; and Canada Health Act advance assessments,
upon request.
Where dispute avoidance activities prove unsuccessful,
dispute resolution activities may be initiated, beginning with government-to-government fact-finding and
negotiations. If these are unsuccessful, either minister
of health involved may refer the issues to a third-party
panel to undertake fact-finding and provide advice and
recommendations.
The federal Minister of Health has the final authority
to interpret and enforce the Canada Health Act.
In deciding whether to invoke the non-compliance
provisions of the Act, the Minister will take the
panel’s report into consideration.
A copy of Minister McLellan’s letter is included
in Annex C of this report.
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Canada Health Act — Annual Report 2008–2009
Chapter 2: Administration and Compliance
provincial and territorial governments for information sharing;
CHAPTER 2
Administration
and Compliance
Administration
In administering the Canada Health Act, the federal
Minister of Health is assisted by Health Canada staff
in the Regions and Programs Branch and by the
Department of Justice.
Health Canada works with the provinces and
territories to ensure that the principles of the
Act are respected and always strives to resolve
issues through consultation, collaboration and
cooperation.
The Canada Health Act Division
The Canada Health Act Division at Health Canada is
responsible for administering the Act. Members of
the Division located in Ottawa and their colleagues
in regional Health Canada offices fulfill the following
ongoing functions:
• monitoring and analysing provincial and territorial health insurance plans for compliance with
the criteria, conditions and extra-billing and
user charges provisions of the Act;
• disseminating information on the Act and on
publicly funded health care insurance programs
in Canada;
• responding to inquiries about the Act and
health insurance issues received by telephone,
mail and the Internet, from the public, members
of Parliament, government departments, stakeholder organizations and the media;
• developing and maintaining formal and informal
contacts and partnerships with health officials in
Canada Health Act — Annual Report 2008–2009
• developing and producing the Canada Health
Act Annual Report on the administration and
operation of the Act;
• conducting issue analysis and policy research
to provide policy advice;
• collaborating with provincial and territorial
health department representatives through the
Interprovincial Health Insurance Agreements
Coordinating Committee (see below);
• working in partnership with the provinces and
territories to investigate and resolve compliance
issues and pursue activities that encourage compliance with the Act; and
• informing the Minister of possible non-compliance and recommending appropriate action to
resolve the issue.
Interprovincial Health Insurance
Agreements Coordinating Committee
(IHIACC)
The Canada Health Act Division chairs the
Interprovincial Health Insurance Agreements
Coordinating Committee and provides a secretariat
for the Committee. The Committee was formed in
1991 to address issues affecting the interprovincial
billing of hospital and medical services as well as
issues related to registration and eligibility for health
insurance coverage. It oversees the application of
interprovincial health insurance agreements in
accordance with the Canada Health Act.
The within-Canada portability provisions of the
Act are implemented through a series of bilateral
reciprocal billing agreements between provinces
and territories for hospital and physician services.
This generally means that a patient’s health card will
be accepted, in lieu of payment, when the patient
receives hospital or physician services in another
province or territory. The province or territory providing the service will then directly bill the patient’s
home province. All provinces and territories participate in reciprocal hospital agreements and all, with
the exception of Quebec, participate in reciprocal
medical agreements. The intent of these agreements
is to ensure that Canadian residents do not face
point-of-service charges for medically required
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Chapter 2: Administration and Compliance
hospital and physician services when they travel
in Canada. However, these agreements are interprovincial/territorial and signing them is not a
requirement of the Act.
Compliance
Health Canada’s approach to resolving possible
compliance issues emphasizes transparency, consultation and dialogue with provincial and territorial
health ministry officials. In most instances, issues
are successfully resolved through consultation and
discussion based on a thorough examination of the
facts. Deductions have only been applied when all
options to resolve an issue have been exhausted. To
date, most disputes and issues related to administering and interpreting the Canada Health Act have
been addressed and resolved without resorting to
deductions.
The Canada Health Act Division and regional office
staff monitor the operations of provincial and territorial health care insurance plans in order to provide
advice to the Minister on possible non-compliance
with the Act. Sources for this information include:
provincial and territorial government officials and
publications; media reports; and correspondence
received from the public and other non-government
organizations. Staff in the Compliance and Interpretation Unit, Canada Health Act Division, assess
issues of concern and complaints on a case-by-case
basis. The assessment process involves compiling all
facts and information related to the issue and taking
appropriate action. Verifying the facts with provincial and territorial health officials may reveal issues
that are not directly related to the Act, while others
may pertain to the Act but are a result of misunderstanding or mis-communication, and are resolved
quickly with provincial/ territorial assistance, such
as eligibility for health insurance coverage and portability of health services within and outside Canada.
In instances where a Canada Health Act issue has
been identified and remains after initial enquiries,
Division officials ask the jurisdiction in question to
investigate the matter and report back. Division staff
discuss the issue and its possible resolution with
provincial officials. Only if the issue is not resolved
to the satisfaction of the Division after following the
aforementioned steps, is it brought to the attention of
the federal Minister of Health.
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Compliance Issues
For the most part, provincial and territorial health
care insurance plans meet the criteria and conditions
of the Canada Health Act. However, some issues and
concerns remain. The most prominent of these relate
to patient charges and queue jumping for medically
necessary health services at private clinics.
The Act requires that all medically necessary
physician and hospital services be covered by the
provincial and territorial health insurance plans,
whether the services are provided in a hospital
or in a facility providing hospital care. There are
concerns about queue jumping and charges to
insured persons at private surgical clinics in British
Columbia, for services that are covered under its
provincial health insurance plan. Patient charges
and queue jumping at private diagnostic clinics also
remains an issue in some provinces where private
clinics are charging patients for medically necessary
services and allowing them to jump the queue for
insured health services.
During 2008–2009, the outstanding concern
under the Canada Health Act of patient charges
for medical supplies, or “tray fees,” in Manitoba
was resolved when Manitoba Health and Doctors
Manitoba agreed to the incorporation of tray fee
tariffs into the Manitoba Physician’s Manual
effective April 1, 2009.
History of Deductions and
Refunds Under the Canada
Health Act
The Canada Health Act, which came into force
April 1, 1984, reaffirmed the national commitment
to the original principles of the Canadian health
care system, as embodied in the previous legislation,
the Medical Care Act and the Hospital Insurance
and Diagnostic Services Act. By putting into place
mandatory dollar-for-dollar penalties for extrabilling and user charges, the federal government
took steps to eliminate the proliferation of direct
charges for hospital and physician services, judged
to be restricting the access of many Canadians to
health care services due to financial considerations.
During the period 1984 to 1987, subsection 20(5) of
the Act provided for deductions in respect of these
charges to be refunded to the province if the charges
Canada Health Act — Annual Report 2008–2009
Chapter 2: Administration and Compliance
were eliminated before April 1, 1987. By March 31,
1987, it was determined that all provinces, which had
extra-billing and user charges, had taken appropriate
steps to eliminate them. Accordingly, by June 1987,
a total of $244,732,000 in deductions were refunded
to New Brunswick ($6,886,000), Quebec ($14,032,000),
Ontario ($106,656,000), Manitoba ($1,270,000),
Saskatchewan ($2,107,000), Alberta ($29,032,000)
and British Columbia ($84,749,000).
Following the Canada Health Act’s initial three-year
transition period, under which refunds to provinces
and territories for deductions were possible, penalties under the Act did not reoccur until fiscal year
1994–1995. As a result of a dispute between the
British Columbia Medical Association and the
British Columbia government over compensation,
several doctors opted out of the provincial health
insurance plan and began billing their patients
directly. Some of these doctors billed their patients
at a rate greater than the amount the patients could
recover from the provincial health insurance plan.
This higher amount constituted extra-billing under
the Act. Including deduction adjustments for prior
years, dating back to fiscal year 1992–1993, deductions
began in May 1994 and continued until extra-billing
by physicians was banned when changes to British
Columbia’s Medicare Protection Act came into effect
in September 1995. In total, $2,025,000 was deducted
from British Columbia’s cash contribution for extrabilling that occurred in the province between
1992–1993 and 1995–1996. These deductions were
non-refundable, as were all subsequent deductions.
In January 1995, then federal Minister of Health,
Diane Marleau, expressed concerns to her provincial
and territorial colleagues about the development of
two-tiered health care and the emergence of private
clinics charging facility fees for medically necessary services. As part of her communication with
the provinces and territories, Minister Marleau
announced that the provinces and territories would
be given more than nine months to eliminate these
user charges, but that any province that did not,
would face financial penalties under the Canada
Health Act. Accordingly, beginning in November
1995, deductions were applied to the cash contributions to Alberta, Manitoba, Nova Scotia and
Newfoundland and Labrador for non-compliance
with the Federal Policy on Private Clinics.
From November 1995 to June 1996, total deductions of
$3,585,000 were taken from Alberta’s cash contribution
in respect of facility fees charged at clinics providing
Canada Health Act — Annual Report 2008–2009
surgical, ophthalmological and abortion services. On
October 1, 1996, Alberta prohibited private surgical
clinics from charging patients a facility fee for medically necessary services for which the physician fee
was billed to the provincial health insurance plan.
Similarly, due to facility fees allowed at an abortion clinic, a total of $284,430 was deducted from
Newfoundland and Labrador’s cash contribution before
these fees were eliminated, effective January 1, 1998.
From November 1995 to December 1998, deductions
from Manitoba’s CHST cash contribution amounted
to $2,055,000, ending with the confirmed elimination
of user charges at surgical and ophthalmology clinics,
effective January 1, 1999. However, during fiscal year
2001–2002, a monthly deduction (from October 2001
to March 2002 inclusive) in the amount of $50,033
was levied against Manitoba’s CHST cash contribution
on the basis of a financial statement provided by the
province showing that actual amounts charged with
respect to user charges for insured services in fiscal
years 1997–1998 and 1998–1999 were greater than
the deductions levied on the basis of estimates. This
brought total deductions levied against Manitoba to
$2,355,201.
With the closure of a private clinic in Halifax effective November 27, 2003, Nova Scotia was deemed to
be in compliance with the Federal Policy on Private
Clinics. Before it closed, total deductions of $372,135
were taken from Nova Scotia’s CHST cash contribution
for its failure to cover facility charges to patients while
paying the physician fee.
In January 2003, British Columbia provided a financial
statement in accordance with the Canada Health Act
Extra-billing and User Charges Information Regulations, indicating aggregate amounts actually charged
with respect to extra-billing and user charges during
fiscal year 2000–2001, totalling $4,610. Accordingly,
a deduction of $4,610 was taken from the March 2003
CHST cash contribution.
In 2004, British Columbia did not report to Health
Canada the amounts of extra-billing and user charges
actually charged during fiscal year 2001–2002, in
accordance with the requirements of the Extra-billing
and User Charges Information Regulations. As a
result of reports that British Columbia was investigating cases of user charges, a $126,775 deduction was
taken from British Columbia’s March 2004 CHST payment, based on the amount Health Canada estimated
to have been charged during fiscal year 2001–2002.
11
Chapter 2: Administration and Compliance
Deductions were taken from the March 2005 CHT
payments1 to three provinces as a result of charges
to patients which occurred during 2002–2003. A
deduction of $72,464 was taken from British Columbia
on the basis of charges reported by the province for
extra-billing and patient charges at surgical clinics.
A deduction of $1,100 was taken from Newfoundland
and Labrador as a result of patient charges for a
magnetic resonance imaging scan in a hospital, and
a deduction of $5,463 was taken from Nova Scotia
as a reconciliation of deductions that had already
been made to Nova Scotia for patient charges at a
private clinic.
On the basis of charges reported by the province
to Health Canada, deductions were taken from the
March 2006 CHT payments to British Columbia in
respect of extra-billing and user charges at surgical
clinics that occurred during fiscal year 2003–2004,
in the amount of $29,019. A one-time positive adjustment in the amount of $8,121 was made to Nova
Scotia’s March 2006 CHT payment to reconcile
amounts actually charged in respect of extra-billing
and user charges at a private clinic, with the penalties that had already been levied based on estimates
reported for fiscal 2003–2004.
In March 2007, a deduction was taken from the CHT
payment to British Columbia in respect of extrabilling and user charges at surgical clinics that
occurred during fiscal year 2004–2005, in the amount
of $114,850, on the basis of charges reported by the
province to Health Canada. A deduction was also
taken from the March 2007 CHT payment to Nova
Scotia in respect of extra-billing during fiscal year
2004–2005 in the amount of $9,460, on the basis of
charges reported by the province to Health Canada.
A $42,113 deduction was taken from the March
2008 CHT payment to British Columbia in respect of
extra-billing and user charges that occurred during
the fiscal year 2005–2006, on the basis of charges
reported by the province to Health Canada, and in
March 2009, a $66,195 deduction was taken from
the CHT payment to British Columbia in respect of
extra-billing and user charges that occurred during
the fiscal year 2006–2007, on the basis of charges
reported by the province to Health Canada.
Since the passage of the Canada Health Act, from
April 1984 to March 2009, deductions totalling
$9,085,694 have been applied against provincial cash
contributions in respect of the extra-billing and user
charges provisions of the Act. This amount excludes
deductions totalling $244,732,000 between 1984 and
1987 and subsequently refunded to the provinces
when extra-billing and user charges were eliminated.
1. The CHT resulted from the division of the Canada Health and Social Transfer (CHST) into two transfers, the Canada Health Transfer (CHT) and the Canada Social Transfer (CST),
which became effective April 1, 2004.
12
Canada Health Act — Annual Report 2008–2009
Chapter 3: Provincial and Territorial Health Care Insurance Plans in 2008–2009
CHAPTER 3
Provincial and
Territorial Health
Care Insurance
Plans in 2008–2009
The following chapter presents the 13 provincial and
territorial health insurance plans that make up the
Canadian publicly funded health insurance system.
The purpose of this chapter is to demonstrate clearly
and consistently the extent to which provincial and
territorial plans fulfilled the requirements of the
Canada Health Act program criteria and conditions
in 2008–2009.
Officials in the provincial, territorial and federal governments have collaborated to produce the detailed
plan overviews contained in Chapter 3. While all
provinces and territories have submitted detailed
descriptive information on their health insurance
plans, Quebec chose not to submit supplemental statistical information which is contained in the tables
in this year’s report. The information that Health
Canada requested from the provincial and territorial
departments of health for the report consists of two
components:
• a narrative description of the provincial or
territorial health care system relating to the
criteria and conditions of the Act, which can
be found following this chapter; and
• statistical information related to insured
health services.
The narrative component is used to help with the
monitoring and compliance of provincial and territorial
health care plans with respect to the requirements of
the Canada Health Act, while statistics help to identify
current and future trends in the Canadian health care
system.
Canada Health Act — Annual Report 2008–2009
To help provinces and territories prepare their
submissions to the annual report, Health Canada
provided them with the document Canada Health
Act Annual Report 2008–2009: A Guide for Updating
Submissions (User’s Guide). This guide is designed
to help provinces and territories meet the reporting
requirements of Health Canada. Annual revisions
to the guide are based on Health Canada’s analysis
of health plan descriptions from previous annual
reports and its assessment of emerging issues
relating to insured health services.
The process for the Canada Health Act Annual Report
2008–2009 was launched late spring 2009 with bilateral
teleconferences with each jurisdiction. An updated
User’s Guide was also sent to the provinces and territories at that time.
Insurance Plan Descriptions
For the following chapter, provincial and territorial
officials were asked to provide a narrative description
of their health insurance plan. The descriptions follow
the program criteria areas of the Canada Health Act in
order to illustrate how the plans satisfy these criteria.
This narrative format also allows each jurisdiction to
indicate how it met the Canada Health Act requirement for the recognition of federal contributions that
support insured and extended health care services,
as well as outline the range of extended health care
services in their jurisdiction.
Provincial and Territorial Health Care
Insurance Plan Statistics
In 2003–2004, the section of the annual report containing the statistical information submitted from the
provinces and territories was simplified and streamlined following feedback received from provincial
and territorial officials, and based on a review of data
quality and availability. The format was further streamlined for the 2006–2007 report and that format has
been retained since. The supplemental statistical
information can be found at the end of each provincial or territorial narrative, except for Quebec.
The purpose of the statistical tables is to place the
administration and operation of the Canada Health
Act in context and to provide a national perspective
on trends in the delivery and funding of insured
health services in Canada that are within the scope
of the federal Act.
13
Chapter 3: Provincial and Territorial Health Care Insurance Plans in 2008–2009
The statistical tables contain resource and cost data
for insured hospital, physician and surgical-dental
by province and territory for five consecutive years
ending on March 31, 2009. All information was provided by provincial and territorial officials.
Insured Hospital Services Provided Outside Canada:
Hospital services provided out of country represent
residents’ hospital costs incurred while travelling
outside of Canada that are paid for by their home
province or territory.
Although efforts are made to capture data on a consistent basis, differences exist in the reporting on
health care programs and services between provincial
and territorial governments. Therefore, comparisons
between jurisdictions are not made. Provincial and
territorial governments are responsible for the quality
and completeness of the data they provide.
Insured Physician Services Within Own Province
or Territory: Statistics in this sub-section relate
to the provision of insured physician services to
residents in each province or territory, as well as
to visitors from other regions of Canada.
Organization of the Information
Information in the tables is grouped according to the
nine subcategories described below.
Registered Persons: Registered persons are the
number of residents registered with the health
care insurance plans of each province or territory.
Insured Hospital Services within Own Province or
Territory: Statistics in this sub-section relate to the
provision of insured hospital services to residents in
each province or territory, as well as to visitors from
other regions of Canada.
Insured Physician Services Provided to Residents
in Another Province or Territory: This sub-section
reports on physician services that are paid by a
jurisdiction to other provinces or territories for their
visiting residents.
Insured Physician Services Provided Outside Canada:
Physician services provided out of country represent
residents’ medical costs incurred while travelling outside of Canada that are paid by their home province
or territory.
Insured Surgical-Dental Services Within Own
Province or Territory: The information in this
subsection describes insured surgical-dental
services provided in each province or territory.
Insured Hospital Services Provided to Residents
in Another Province or Territory: This sub-section
presents out-of-province or out-of-territory insured
hospital services that are paid for by a person’s home
jurisdiction when they travel to other parts of Canada.
14
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
Newfoundland
and Labrador
Introduction
The majority of publicly funded health services in
Newfoundland and Labrador are delivered through
four regional health authorities. They focus on the
full continuum of care including health promotion
and protection, public health, community services,
acute and long-term care services.
The provincial government appoints Boards of
Trustees to the regional health authorities who
serve in a voluntary capacity. These authorities
are responsible for delivering health and community services to their regions, and in some cases,
to the province as a whole. Regional authorities
interact with the public and community partners
to determine health needs. The regional authorities
receive their funding from the Department of Health
& Community Services and are accountable to the
Minister. The Department of Health and Community
Services provides the regional authorities with policy
direction, financial resources and monitors programs
and services.
In Newfoundland and Labrador, approximately
20,000 health care providers and administrators
provide health services to 505,000 residents (based
on 2006 census).
In March 2009, the Government of Newfoundland
& Labrador released the report of the Commission of
Inquiry on Hormone Receptor Testing and appointed
a team to review the recommendations. Significant
steps have been, and will be taken to address issues
related to this testing issue including enhanced data
management and planning for an accreditation system for laboratories and diagnostic imaging services.
As well, a comprehensive report from a task force on
adverse health impacts will assist in looking at necessary actions in this area.
Canada Health Act — Annual Report 2008–2009
Budget 2008–2009 included significant investment
in health care and continues to commit significant
financial resources to the operation of the health
care sector. A total capital investment in the health
sector of $133.5 million for fiscal 2008/09 included
$79 million for new and redeveloped infrastructure
projects including planning and site selection for a
new hospital in Corner Brook and renovations and
redevelopment of several facilities in the province.
Investments of $52 million for new health equipment
include funding of $10.9 million for 12 new digital
mammography units throughout the province.
Two important new Acts were passed in June 2008.
The Personal Health Information Act establishes
rules to govern the collection, use and disclosure
of personal health information and will provide individuals with the right to access their own information.
It is targeted for proclamation in 2010. The Registered
Nurses Act (2008) provides new governance structures and disciplinary procedures for nurses and
nurse practitioners. It will increase public protection
and place greater accountability on these two professions through the Association of Registered Nurses
of Newfoundland and Labrador.
In Budget 2008–09, government also made investments in several health workforce planning initiatives
including $6 million in new and enhanced measures
to support pathologists and oncologists, $4 million to
expand the number of spaces for NL medical students
at Memorial University’s Faculty of Medicine and
$2.1 million to promote the recruitment and retention
of nurses. A $3.3 million investment by the government added seven new prescription medications
to the provincial formulary of the Newfoundland
and Labrador Prescription Drug Program (NLPDP)
and easier access for three additional groups of
medications.
In February 2009 the government unveiled a new air
ambulance for the province at a cost of $7.8 million.
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
Health care insurance plans managed by the
Department include the Hospital Insurance Plan
and the Medical Care Plan (MCP). Both plans are
non-profit and publicly administered.
15
Chapter 3: Newfoundland and Labrador
The Hospital Insurance Agreement Act is the legislation that enables the Hospital Insurance Plan. The
Act gives the Minister of Health and Community
Services the authority to make Regulations for
providing insured services on uniform terms and
conditions to residents of the province under the
conditions specified in the Canada Health Act and
Regulations.
The Medical Care Insurance Act (1999) empowers
the Minister to administer a plan of medical care
insurance for residents of the province. It provides
for the development of regulations to ensure that the
provisions of the statute meet the requirements of the
Canada Health Act as it relates to administering the
Medical Care Plan.
The Medical Care Plan facilitates the delivery of
comprehensive medical care to all residents of the
province by implementing policies, procedures and
systems that permit appropriate compensation to
providers for rendering insured professional services.
The Medical Care Plan operates in accordance with
the provisions of the Medical Care Insurance Act
(1999) and Regulations, and in compliance with
the Canada Health Act.
There were no legislative amendments to the Medical
Care Insurance Act (1999) or the Hospital Insurance
Agreement Act in 2008–09.
1.2 Reporting Relationship
The Department is mandated with administering
the Hospital Insurance and Medical Care Plans. The
Department reports on these plans through the regular legislative processes; e.g., Public Accounts and
the Estimates Committee of the House of Assembly.
The Department will be tabling its 2008–2009
Annual Report in the House of Assembly in Fall
2009 as well as those of the four regional health
authorities.
The Department’s Annual Report highlights the
accomplishments of 2008–2009 and provides an
overview of the initiatives and programs that will
continue to be developed in 2009–2010. The report is
a public document and is circulated to stakeholders.
It is available on the department’s website at:
www.health.gov.nl.ca/health.
16
1.3 Audit of Accounts
Each year, the Province’s Auditor General independently examines provincial public accounts. MCP
expenditures are now considered a part of the
public accounts. The Auditor General has full
and unrestricted access to MCP records.
The four regional health authorities are subject to
Financial Statement Audits, Reviews and Compliance
Audits. Financial Statement Audits are performed
by independent auditing firms that are selected by
the health authorities under the terms of the Public
Tendering Act. Review engagements, compliance
audits and physician audits were carried out by
personnel from the Department under the authority
of the Newfoundland Medical Care Insurance Act
(1999). Physician records and professional medical
corporation records were reviewed to ensure that the
records supported the services billed and that the
services are insured under the MCP.
Beneficiary audits were performed by personnel from
the Department under the Medical Care Insurance
Act (1999). Individual providers are randomly
selected on a bi-weekly basis for audit.
2.0 Comprehensiveness
2.1
Insured Hospital Services
The Hospital Insurance Agreement Act and the
Hospital Insurance Regulations 742/96 (1996) provide
for insured hospital services in Newfoundland and
Labrador.
Insured hospital services are provided for in and
out-patients in 15 hospitals, 22 community health
centres and 14 community clinics. Insured services
include: accommodations and meals at the standard
ward level; nursing services; laboratory, radiology
and other diagnostic procedures; drugs, biological and related preparations; medical and surgical
supplies, operating room, case room and anaesthetic
facilities; rehabilitative services (e.g., physiotherapy,
occupational therapy, speech language pathology and
audiology); outpatient and emergency visits; and day
surgery.
The coverage policy for insured hospital services is
linked to the coverage policy for insured medical
services. The Department of Health and Community
Services manages the process of adding or de-listing
a hospital service from the list of insured services
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
based on direction from the Minister. There were no
services added or de-listed in 2008–2009.
(1) Where a physician providing insured services is
not a participating physician, and the physician
provides an insured service to a beneficiary, the
physician is not subject to this Act or the regulations relating to the provision of insured services
to beneficiaries or the payment to be made for the
services except that he or she shall:
2.2 Insured Physician Services
The enabling legislation for insured physician services is the Medical Care Insurance Act (1999).
(a) before providing the insured service, if he
or she wishes to reserve the right to charge
the beneficiary for the service an amount in
excess of that payable by the Minister under
this Act, inform the beneficiary that he or she
is not a participating physician and that the
physician may so charge the beneficiary; and
Other governing legislation under the Medical Care
Insurance Act includes:
• the Medical Care Insurance Insured Services
Regulations;
• the Medical Care Insurance Beneficiaries and
Inquiries Regulations; and
(b) provide the beneficiary to whom the physician has provided the insured service with
the information required by the minister
to enable payment to be made under this
Act to the beneficiary in respect of the
insured service.
• the Medical Care Insurance Physician and Fees
Regulations.
Licensed medical practitioners are allowed to provide insured physician services under the insurance
plan. A physician must be licensed by the College
of Physicians and Surgeons of Newfoundland and
Labrador to practice in the province. In 2008–2009,
there were 1,037 physicians registered in the province.
(2) Where a physician who is not a participating
physician provides insured services through
a professional medical corporation, the professional medical corporation is not, in relation to
those services, subject to this Act or the regulations relating to the provision of insured services
to beneficiaries or the payment to be made for the
services and the professional medical corporation
and the physician providing the insured services
shall comply with subsection (1).
An insured service is defined as one that is: listed
in section 3 of the Medical Care Insurance Insured
Services Regulations; medically necessary; and/
or recommended by the Department of Health and
Community Services. There are no limitations on
the services covered, subject to these criteria.
For purposes of the Act, the following services are
covered:
• all services properly and adequately provided
by physicians to beneficiaries suffering from an
illness requiring medical treatment or advice;
• group immunizations or inoculations carried
out by physicians at the request of the appropriate authority; and
• diagnostic and therapeutic x-ray and laboratory
services in facilities approved by the appropriate authority that are not provided under
the Hospital Insurance Agreement Act and
Regulations made under the Act.
Physicians can choose not to participate in the health
care insurance plan as outlined in subsection 12(1) of
the Medical Care Insurance Act (1999), namely:
As of March 31, 2009, there were no physicians who
had opted out of the MCP.
Ministerial direction is required to add to or to deinsure a physician service from the list of insured
services. This process is managed by the Department
in consultation with various stakeholders, including
the provincial medical association and the public.
There were no services added or deleted during the
2008–2009 fiscal year to the list of insured physician
services.
2.3 Insured Surgical-Dental Services
The provincial Surgical-Dental Program is a component of the Medical Care Plan (MCP). Surgical-dental
treatments provided to a beneficiary and carried out
in a hospital by a licensed oral surgeon or dentist are
covered by MCP if the treatment is specified in the
Surgical-Dental Services Schedule.
Canada Health Act — Annual Report 2008–2009
17
Chapter 3: Newfoundland and Labrador
All oral surgeons or dentists licensed to practice
in Newfoundland and Labrador and who have
hospital privileges are allowed to provide surgicaldental services. The dentist’s license is issued by
the Newfoundland and Labrador Dental Board.
In 2008–09, there were 25 dentists with hospital
privileges registered in the province.
Dentists may opt out of the Medical Care Plan. These
dentists must advise the patient of their opted-out
status, stating the fees expected, and provide the
patient with a written record of services and fees
charged. There is currently one opted out dentist.
Because the Surgical-Dental Program is a component
of the MCP, management of the Program is linked
to the MCP process regarding changes to the list of
insured services.
Addition of a surgical-dental service to the list
of insured services must be approved by the
Department.
2.4 Uninsured Hospital, Physician
and Surgical-Dental Services
Hospital services not covered by MCP include:
preferred accommodation at the patient’s request;
cosmetic surgery and other services deemed to be
medically unnecessary; ambulance or other patient
transportation before admission or upon discharge;
private duty nursing arranged by the patient; nonmedically required x-rays or other services for
employment or insurance purposes; drugs (except
anti-rejection and AZT drugs) and appliances
issued for use after discharge from hospital; bedside
telephones, radios or television sets for personal,
non-teaching use; fibreglass splints; services covered
by the Workplace Health, Safety and Compensation
Commission or by other federal or provincial legislation; and services relating to therapeutic abortions
performed in non-accredited facilities or facilities
not approved by the College of Physicians and
Surgeons of Newfoundland and Labrador.
The use of the hospital setting for any services
deemed not insured by the Medicare Plan are also
uninsured under the Hospital Insurance Plan. For
purposes of the Medical Care Insurance Act (1999),
the following is a list of non-insured physician
services:
• any advice given by a physician to a beneficiary
by telephone;
18
• the dispensing by a physician of medicines,
drugs or medical appliances and the giving
or writing of medical prescriptions;
• the preparation by a physician of records,
reports or certificates for, or on behalf of,
or any communication to, or relating to,
a beneficiary;
• any services rendered by a physician to the
spouse and children of the physician;
• any service to which a beneficiary is entitled
under an Act of the Parliament of Canada,
an Act of the Province of Newfoundland and
Labrador, an Act of the legislature of any province of Canada, or any law of a country or part
of a country;
• the time taken or expenses incurred in travelling to consult a beneficiary;
• ambulance service and other forms of patient
transportation;
• acupuncture and all procedures and services
related to acupuncture, excluding an initial
assessment specifically related to diagnosing the
illness proposed to be treated by acupuncture;
• examinations not necessitated by illness or at
the request of a third party except as specified
by the appropriate authority;
• plastic or other surgery for purely cosmetic
purposes, unless medically indicated;
• testimony in a court;
• visits to optometrists, general practitioners and
ophthalmologists solely for determining whether
new or replacement glasses or contact lenses are
required;
• the fees of a dentist, oral surgeon or general
practitioner for routine dental extractions
performed in hospital;
• fluoride dental treatment for children under four
years of age;
• excision of xanthelasma; circumcision of
newborns;
• hypnotherapy;
• medical examination for drivers;
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
• alcohol/drug treatment outside Canada;
• consultation required by hospital regulation;
• therapeutic abortions performed in the province at a facility not approved by the College of
Physicians and Surgeons of Newfoundland and
Labrador;
• sex reassignment surgery, when not recommended by the Clarke Institute of Psychiatry;
• in vitro fertilization and OSST (ovarian stimulation and sperm transfer);
• reversal of previous sterilization procedure;
• surgical, diagnostic or therapeutic procedures not
provided in facilities other than those listed in the
Schedule to the Hospitals Act or approved by the
appropriate authority under paragraph 3(d); and
• other services not within the ambit of section 3
of the Act.
The majority of diagnostic services (e.g., laboratory
services and x-ray) are performed within public
facilities in the province. Hospital policy concerning
access ensures that third parties are not given priority
access.
Medical goods and services that are implanted and
associated with an insured service are provided
free of charge to the patient and are consistent with
national standards of practice. Patients retain the
right to financially upgrade the standard medical
goods or services. Standards for medical goods are
developed by the hospitals providing those services
in consultation with service providers.
Surgical-dental and other services not covered by
the Surgical-Dental Program include the dentist’s
fee and the oral surgeon’s or general practitioner’s
fees for routine dental extractions in a hospital.
3.0 Universality
3.1
Eligibility
Residents of Newfoundland and Labrador are eligible
for coverage under the Medical Care Insurance Act
(1999) and the Hospital Insurance Agreement Act. The
Medical Care Insurance Act (1999) defines a “resident”
as a person lawfully entitled to be or to remain in
Canada, who makes his or her home and is ordinarily
present in the province, but does not include tourists,
transients or visitors to the province.
Canada Health Act — Annual Report 2008–2009
The Medical Care Insurance Beneficiaries and
Inquiries Regulations (Regulation 20/96) identify
those residents eligible to receive coverage under
the plans. MCP has established rules to ensure that
the Regulations are applied consistently and fairly
in processing applications for coverage. MCP applies
the standard that persons moving to Newfoundland
and Labrador from another province become eligible
on the first day of the third month following the
month of their arrival.
Persons not eligible for coverage under the plans
include: students and their dependants already
covered by another province or territory; dependants
of residents if covered by another province or territory; certified refugees and refugee claimants and
their dependants; foreign workers with Employment
Authorizations and their dependants who do not
meet the established criteria; tourists, transients,
visitors and their dependants; Canadian Forces and
Royal Canadian Mounted Police (RCMP) personnel;
inmates of federal prisons; and armed forces personnel from other countries who are stationed in
the province.
3.2 Registration Requirements
Registration under the MCP and possession of a valid
MCP card is required to access insured services. New
residents are advised to apply for coverage as soon as
possible on arriving in Newfoundland and Labrador.
It is the parent’s responsibility to register a newborn
or adopted child. The parents of a newborn child
will be given a registration application upon discharge from hospital. Applications for newborn
coverage will require, in most instances, a parent’s
valid MCP number. A birth or baptismal certificate
will be required where the child’s surname differs
from either parent’s surname.
Applications for coverage of an adopted child require
a copy of the official adoption documents, the birth
certificate of the child, or a Notice of Adoption
Placement from the department. Applications for
coverage of a child adopted outside Canada require
Permanent Resident documents for the child.
3.3 Other Categories of Individual
Foreign workers, international students, clergy and
dependants of North Atlantic Treaty Organization
(NATO) personnel are eligible for benefits. Holders
of Minister’s permits are also eligible, subject to
MCP approval.
19
Chapter 3: Newfoundland and Labrador
4.0 Portability
4.1
Minimum Waiting Period
Insured persons moving to Newfoundland and
Labrador from other provinces or territories are
entitled to coverage on the first day of the third
month following the month of arrival.
Persons arriving from outside Canada to establish
residence are entitled to coverage on the day of
arrival. The same applies to discharged members
of the Canadian Forces, the RCMP and individuals
released from federal penitentiaries. For coverage
to be effective, however, registration is required
under MCP. Immediate coverage is provided to
persons from outside Canada authorized to work
in the province for one year or more.
4.2 Coverage During Temporary
Absences in Canada
Newfoundland and Labrador is a party to the
Agreement on Eligibility and Portability regarding
matters pertaining to portability of insured services
in Canada.
Sections 12 and 13 of the Hospital Insurance Regulations (1996) define portability of hospital coverage
during temporary absences both within and outside
Canada. Portability of medical coverage during temporary absences both within and outside Canada is
defined in Departmental policy. The eligibility policy
for insured hospital services is linked to the eligibility policy for insured physician services.
Coverage is provided to residents during temporary absences within Canada. The Government has
entered into formal agreements (i.e. the Hospital
Reciprocal Billing Agreement) with other provinces
and territories for the reciprocal billing of insured
hospital services. In-patient costs are paid at standard rates approved by the host province or territory.
In-patient, high-cost procedures and out-patient
services are payable based on national rates agreed
to by provincial and territorial health plans through
the Interprovincial Health Insurance Agreements
Coordinating Committee (IHIACC).
Except for Quebec, medical services incurred in all
provinces or territories are paid through the Medical
Reciprocal Billing Agreement at host province or
territory rates. Claims for medical services received
in Quebec are submitted by the patient to the MCP
for payment at host province rates.
20
In order to qualify for out-of-province coverage, a
beneficiary must comply with the legislation and
MCP rules regarding residency in Newfoundland
and Labrador. A resident must reside in the province
at least four consecutive months in each 12-month
period to qualify as a beneficiary. Generally, the rules
regarding medical and hospital care coverage during
absences include the following:
• Before leaving the province for extended periods, a resident must contact the MCP to obtain
an out-of-province coverage certificate.
• Beneficiaries leaving for vacation purposes
may receive an initial out-of-province coverage certificate of up to 12 months. Upon return,
beneficiaries are required to reside in the province for a minimum four consecutive months.
Thereafter, certificates will only be issued for
up to eight months of coverage.
• Students leaving the province may receive a
certificate, renewable each year, provided they
submit proof of full-time enrolment in a recognized educational institution located outside
the province.
• Persons leaving the province for employment
purposes may receive a certificate for coverage
up to 12 months. Verification of employment
may be required.
• Persons must not establish residence in another
province, territory or country while maintaining
coverage under the Newfoundland MCP.
• For out-of-province trips of 30 days or less,
an out-of-province coverage certificate is not
required, but will be issued upon request.
• For out-of-province trips lasting more than
30 days, a certificate is required as proof of
a resident’s ability to pay for services while
outside the province.
Failure to request out-of-province coverage or failure
to abide by the residency rules may result in the
resident having to pay for medical or hospital costs
incurred outside the province.
Insured residents moving permanently to other parts
of Canada are covered up to and including the last
day of the second month following the month of
departure. Coverage is immediately discontinued
when residents move permanently to other countries.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
In 2008/2009, the total amount paid by MCP for
physician services received by residents in another
province or territory was $6,161,000.
4.3 Coverage During Temporary
Absences Outside Canada
The Province provides coverage to residents during
temporary absences outside Canada. Out-of-country
insured hospital in- and out-patient services are
covered for emergencies, sudden illness and elective
procedures at established rates. Hospital services are
considered under the Plan when the insured services
are provided by a recognized facility (licensed or
approved by the appropriate authority within the
state or country in which the facility is located) outside Canada. The maximum amount payable by the
Government’s hospitalization plan for out-of-country
in-patient hospital care is $350 per day, if the insured
services are provided by a community or regional
hospital. Where insured services are provided by a
tertiary care hospital (a highly specialized facility),
the approved rate is $465 per day. The approved rate
for out-patient services is $62 per visit and hæmodialysis is $330 per treatment. The approved rates are
paid in Canadian funds.
Physician services are covered for emergencies
or sudden illness and are also insured for elective
services not available in the province or within
Canada. Physician services are paid at the same rate
as would be paid in Newfoundland and Labrador for
the same service. If the services are not available in
Newfoundland and Labrador, they are usually paid
at Ontario rates, or at rates that apply in the province
where they are available. The total amount spent by
MCP in 2008/2009 for insured physician services
provided outside Canada was $240,000.
4.4 Prior Approval Requirement
Prior approval is not required for medically necessary insured services provided by accredited
hospitals or licensed physicians in the other
provinces and territories. However, physicians
may seek advice on coverage from the MCP so
that patients may be made aware of any financial
implications.
Prior approval is mandatory in order to receive funding at host country rates if a resident of the province
has to seek specialized hospital care outside the
country because the insured service is not available
in Canada. The referring physicians must contact the
Canada Health Act — Annual Report 2008–2009
Department or the MCP for prior approval. If prior
approval is granted, the provincial health insurance plan will pay the costs of services necessary
for the patient’s care. Prior approval is not granted
for out-of-country treatment of elective services if
the service is available in the province or elsewhere
within Canada. If the services are not available in
Newfoundland and Labrador, they are usually paid
at Ontario rates, or at rates that apply in the province
where they are available.
5.0 Accessibility
5.1
Access to Insured Health Services
Access to insured health services in Newfoundland
and Labrador is provided on uniform terms and
conditions. There are no co-insurance charges for
insured hospital services and no extra-billing by
physicians in the province.
5.2 Access to Insured Hospital Services
As of March 31, 2009, regional health authorities
(RHAs) employed approximately 20,000 people in
Newfoundland and Labrador. This figure is comprised of 7,700 nurses (licensed practical nurses and
registered nurses), 750 social workers, 400 medical laboratory technologists, 300 medical radiation
technologists, a further 500 health service providers of various occupations, nearly 1000 managers,
and approximately 9,000 support staff (housekeeping, laundry, facilities, dietary, etc.). Additionally,
there were about 1,040 practicing physicians in
Newfoundland and Labrador at that time.
The Department of Health and Community Services
works closely with educational institutions within
the province to maintain an appropriate supply of
health professionals. The province also works with
external organizations for health professionals not
trained in this province.
Insured hospital services are provided by 37 hospitals
and health centres across Newfoundland and Labrador.
All facilities provide 24-hour emergency services, outpatient clinics, laboratory and x-ray services. Insured
services are also provided in 14 nursing stations. The
other services vary by facility and range from general
surgery, internal medicine and obstetrics to specialized
services such as cardiology and neurology. Quaternary
care is not offered in Newfoundland and Labrador and
provincial residents travel to other jurisdictions to
access services.
21
Chapter 3: Newfoundland and Labrador
The government continued to improve capacity
through a $52 million investment in 2008 for new
diagnostic and capital equipment including 12 new
digital mammography units for health centres
throughout the province, an MRI machine in
Central Health Region, CT scanners for Clarenville
and St. Anthony and an interventional angiography
suite for Corner Brook. In addition, planning will
begin for the acquisition of a PET scanner in the
province.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2009, Newfoundland and Labrador
was within the national benchmarks for cardiac
care, vision restoration, and cancer care within
84–100% of the time, demonstrating that the four
regional health authorities are providing access to
these services within close proximity to the target
time frames. Both the volume and demand for joint
replacements in NL has steadily increased in recent
years. Subsequently, in regions where demand is
greatest one can anticipate longer waits for surgery.
The proportion of joint replacements performed
within the benchmark target ranges from 56–100%.
The number of physicians practicing in the province
has been relatively stable, with an upward trend
since 2003. The Department is committed to working
with regional health authorities to develop a provincial human resource plan for physicians based on
the principle of access to services.
The government provided $5.8 million in 2008 to
improve access to health services, including the
expansion of orthopaedic services, the consolidation of clinical & business systems in Central Health
Region and the addition of portable oxygen to the
benefits list under the special assistance program.
An additional $26.7 million was allocated to regional
health authorities to offset cost increases from inflation and utilization of current programs.
Targeted recruitment incentives are in place to
attract health professionals. Several programs have
been established to provide targeted sign-on bonuses,
bursaries, opportunities for upgrading, and other
incentives for a wide variety of health occupations.
The provincial Primary Health Care (PHC) framework, Moving Forward Together: Mobilizing Primary
Health Care, continues to provide direction for
remodelling primary health care in Newfoundland
and Labrador through a population-health based
approach to service delivery, and using a voluntary
and incremental approach. PHC services include all
the health services delivered in a geographic area
(minimum population 6,000 to maximum population of 25,000) from primary prevention through to,
and including, acute and episodic illness at the PHC
service delivery level.
22
The Dental Bursary Program was established to
increase the number of dentists practising throughout the province, particularly in rural areas. In
2008–09 the government invested $275,000 for
the program’s two components: the Rural Dental
Bursary Program and Specialist Bursary Program
for a total of 11 bursaries.
As of March 31, 2009, there were 512 general practitioners and 525 specialists in practice, compared
with 480 general practitioners and 509 specialists
as of March 31, 2008.
The Department has initiated several measures to
improve access for insured physician services. Some
of these include:
• funding for the Provincial Office of Recruitment;
• retention bonuses for salaried physicians based
on geography and years of service; and
• an annual bursary program valued at $1,175,000
for medical residents and students (matched to
Family Practice in Canadian Resident Matched
Services (CaRMS) willing to commit to provide
medical services in areas of need within the
province. During fiscal year 2008–2009, 47 bursaries were funded.
5.4 Physician Compensation
The legislation governing payments to physicians
and dentists for insured services is the Medical Care
Insurance Act (1999).
The current methods of remuneration to compensate
physicians for providing insured health services
include fee-for-service, salary, contract and sessional
block funding.
Compensation agreements are negotiated between the
provincial government and the Newfoundland and
Labrador Medical Association (NLMA), on behalf
of all physicians. Representatives from the regional
health authorities play a significant role in this
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
process. The current agreement with the provincial
association is due to expire in 2009.
5.5 Payments to Hospitals
The Department is responsible for funding regional
health authorities for ongoing operations and capital
acquisitions. Funding for insured services is provided to the regional health authorities as an annual
global budget. Payments are made in accordance
with the Hospital Insurance Agreement Act (1990)
and the Hospitals Act. As part of their accountability to the Government, the health authorities are
required to meet the Department’s annual reporting
requirements, which include audited financial statements and other financial and statistical information.
The global budgeting process devolves the budget
allocation authority, responsibility and accountability to all appointed boards in the discharge of their
mandates.
Throughout the fiscal year, the regional health
authorities forwarded additional funding requests
to the Department for any changes in program areas
or increased workload volume. These requests were
reviewed and, when approved by the Department,
funded at the end of each fiscal year. Any adjustments to the annual funding level, such as for
additional approved positions or program changes,
were funded based on the implementation date of
such increases and the cash flow requirements.
Regional health authorities are continually facing
challenges in addressing increased demands due
to inflation and increased workload. Higher patient
expectations and new technology is creating new
demands for time, resources and funding. Regional
health authorities continue to work with the Department to address these issues and provide effective,
efficient and quality health services.
6.0 Recognition Given to
Federal Transfers
Funding provided by the federal government through
the Canada Health Transfer (CHT) and the Canada
Social Transfer (CST) has been recognized and
reported by the Government of Newfoundland and
Labrador in the annual provincial budget, through
press releases, government websites and various
Canada Health Act — Annual Report 2008–2009
other documents. For fiscal year 2008–2009, these
documents included:
• the 2008–2009 Public Accounts,
• the Estimates 2008–2009, and
• the Budget Speech 2008.
The Public Accounts and Estimates, tabled by the
Government in the House of Assembly, are publicly
available to Newfoundland and Labrador residents
and have been shared with Health Canada for information purposes.
7.0 Extended Health Care
Services
7.1
Long-Term Care, Home
Intermediate Care and
Adult Residential Care
Newfoundland and Labrador has established longterm residential and community-based programs for
persons discharged from hospital, seniors, and persons with disabilities. These programs are provided
by the regional health authorities. Services include
the following:
• Long-term residential accommodations are
provided for residents with high care needs in
21 hospital/health care centres and 19 Long-term
care homes. There are approximately 2,779 beds
located in these facilities. Residents pay a maximum of $2,800 per month based on each client’s
assessed ability to pay, using provincial financial
assessment criteria. The balance of funding
required to operate these facilities is provided
by the Department.
ersons requiring supervised care or minimal
• P
assistance with activities of daily living can avail
themselves of residential services in personal
care homes. There are approximately 3,605 beds
located in 101 homes across the province. These
homes are operated by the private for-profit
sector. Residents are subsidized to a maximum
of $1,644 per month, based on an individual
client assessment using standardized financial
criteria.
23
Chapter 3: Newfoundland and Labrador
7.2
Home Care Services
• Home care services include professional and
non-professional supportive care to enable people to remain in their own homes for as long as
possible. Professional services include nursing
and some rehabilitative programs. These services are publicly funded and delivered by staff
employed by the four regional health authorities.
Non-professional services include personal care,
household management, respite and behavioural
management. These services are delivered by
home support workers through agency or selfmanaged care arrangements.
• Eligibility for non-professional services is determined through a client financial assessment
using provincial criteria. The monthly ceiling
for home support services in fiscal 2008–2009
was $2,707 for seniors and $3,875 for persons
with disabilities.
7.3
Ambulatory Health Care Services
• The Air Ambulance Program provides air transport for patients requiring emergency care who
could not be transported by a commercial airline
or by road ambulance because of urgency or
time, or remoteness of location. It can also be
utilized for routine/non-emergency patients
who cannot be transported by other means.
This program uses two fixed-wing aircraft and
five chartered helicopters. These helicopters are
also used for routine transportation of doctors
and nurses to remote communities for clinics.
A third fixed wing aircraft is used in Labrador
for regional medical services transports, including routine appointments by coastal residents in
Happy Valley/Goose Bay, Labrador.
• Residents who travel by commercial air to access
medically necessary insured services that are
not available within their area of residence or
within the province, may qualify for financial
assistance under the Medical Transportation
Assistance Program. This program is administered by the Department. Kidney donors and
bone marrow/stem-cell donors are eligible for
financial assistance, as administered by Eastern
Health, when the recipient is a Newfoundland
and Labrador resident eligible for coverage under
the provincial Hospital Insurance and Medical
Care Plans.
24
• The Dental Health Plan incorporates a children’s
dental component, an Income Support component and an Access Plan Enhancement. The
children’s program covers the following dental
services for all children up to and including the
age of 12: examinations at six-month intervals;
cleanings at 12-month intervals; fluoride applications at 12-month intervals for children aged
6 to 12; x-rays (some limitations); fillings and
extractions; and some other specific procedures
that require approval before treatment. Services
are available to recipients of Income Support or
eligible families with low incomes who are 13 to
17 years of age: examinations (every 24 months);
x-rays (with some limitations); routine fillings
and extractions; emergency examinations, when
the patient is seen for pain, infection or trauma.
Adults receiving income support are eligible
for emergency care and extractions. There
is no adult component for the Access Plan
Enhancement.
• The Newfoundland and Labrador Prescription
Drug Program (NLPDP) provides prescription
drugs and additional drug benefits approved
by the Department of Health and Community
Services which are listed in the Newfoundland
and Labrador Prescription Drug Program Benefits.
These approved benefits are supplied as part of
the Foundation Plan, 65 Plus Plan, Access Plan
and Assurance Plan for eligible residents.
• The Foundation Plan provides prescription
drug coverage for residents of the province
who qualify for full benefit coverage under the
Department of Human Resources, Labour and
Employment. Coverage is also provided for
residents in Government subsidized Long-Term
Care Facilities, children in care, and youth corrections. The Income Support Component covers
the full cost of benefit prescription items, including a set mark-up amount and dispensing fee.
• The 65 Plus Plan provides prescription drug
coverage for residents who are 65 years of age
or over, who receive Old Age Security (OAS)
benefits and who are in receipt of the federal
Guaranteed Income Supplement (GIS). The
plan covers defined ingredient cost only for
identified benefits. Any additional cost, such
as dispensing fees, is the client’s responsibility.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
• Ostomy Subsidy benefits are available to those
senior citizens who qualify for a drug card
under the 65 Plus Plan or Foundation Plan.
Government will reimburse eligible senior
citizens for 75% of the retail cost of items that
are benefits. Eligible seniors are responsible
for the remaining costs.
• The Select Needs Plan provides universal
coverage for patients with Cystic Fibrosis
and Growth Hormone Deficiency. The Select
Needs Plan covers the full cost for identified
benefits — disease-related prescription drugs,
enzymes, foods, medical supplies, and equipment — supplied through the Health Sciences
Central Supply and Pharmacy.
Canada Health Act — Annual Report 2008–2009
• The Access Plan provides prescription drug
coverage ranging from 30–80% for residents of
Newfoundland and Labrador who are eligible
for and in receipt of a MCP card and whose
income falls within the following thresholds:
• Families with children, including single
parents, with net incomes of $30,000 or less;
• Couples without children with net annual
incomes of $21,000 or less;
• Single individuals with net incomes of
$19,000 or less.
• The Assurance Plan offers protection for individuals and families against the financial
burden of eligible high drug costs, whether
it be from the cost of one extremely high cost
drug or the combined costs of different drugs.
Depending on their income level, individuals
and families will be assured that their annual
out-of-pocket eligible drug costs will be capped
at either 5, 7.5, or 10 percent of their net family
income.
25
Chapter 3: Newfoundland and Labrador
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
569,835
545,160
545,629
506,530
2008–2009
514,470
1
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
36
36
36
36
37
b. chronic care
0
0
0
0
0
c. rehabilitative care
0
0
0
0
d. other
0
0
0
14
2
14
e. total
36
36
36
50
2
51
679,024,717
740,235,437
743,680,905
798,018,159
0
3. Payments for insured health services ($):
a. acute care
b. chronic care
0
0
0
0
c. rehabilitative care
0
0
0
0
d. other
0
0
0
0
e. total
679,024,717
740,235,437
743,680,905
798,018,159
880,628,613
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
880,628,613
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
1
1
1
1
1
b. diagnostic imaging facilities
0
0
0
0
0
c. total
1
1
1
1
1
264,575
285,475
288,800
307,825
389,375
307,825
389,375
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
264,575
285,475
288,800
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
1,711
1,850
1,736
1,910
2008–2009
1,732
12,276,510
15,355,713
15,157,341
16,509,144
15,695,411
27,577
30,762
34,349
34,159
29,758
4,489,143
5,385,716
6,755,412
6,817,250
7,680,172
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
1.
2.
3.
4.
50
54
60
73
90
76,981
112,039
92,683
496,719
368,959
301
261
345
60,159
24,265
934,295
4
404
400
651,841
204,973
Newfoundland and Labrador has just completed the re-registration project that commenced in 2006. Thus, the 2007–2008 number represents re-registered residents only.
Nursing stations/community clinics not included in previous reports.
Lines 6–9 changed to reflect date processing adjustments.
Increase attributable to patients who were granted prior approval to receive insured services outside the country.
26
Canada Health Act — Annual Report 2008–2009
Chapter 3: Newfoundland and Labrador
Insured PHYSICIAN Sevices Within Own Province or TErrITitory
14.Number of participating physicians (#):
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
460
471
481
480
512
5
a. general practitioners
b. specialists
494
500
504
509
525
c. other
not applicable
not applicable
not applicable
not applicable
not applicable
d. total
954
971
985
989
1,037
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
not available
not available
not available
not available
not available
b. total payments ($)
not available
not available
not available
not available
not available
4,019,000
4,234,000
4,295,000
4,361,000
4,467,000
175,910,000
180,263,000
182,730,000
189,169,000
199,127,000
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
113,000
136,000
139,000
168,000
136,000
4,770,000
5,197,000
6,290,000
6,320,000
6,161,000
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
2,400
2,300
2,100
2,300
2,900
136,000
135,000
130,000
300,000
240,000
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
31
26
27
25
25
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
3,022
2,633
2,044
885
2,995
329,000
313,000
123,000
73,000
331,000
5. Newfoundland and Labrador has just completed the re-registration project that commenced in 2006. Thus, the 2007–2008 number represents re-registered residents only.
Canada Health Act — Annual Report 2008–2009
27
28
Canada Health Act — Annual Report 2008–2009
Chapter 3: Prince Edward Island
Departmental Management Committee comprised of
the Deputy Minister, the Assistant Deputy Minister
of Health Operations, and senior directors whose
responsibility it is to direct the overall departmental
management and day-to-day operations. A summary
of the principal roles of divisions is outlined below.
Prince Edward Island
Introduction
The Ministry of Health is a system of integrated services whose aim is to protect, maintain and improve
the health and well-being of Prince Edward Islanders.
Health services in Prince Edward Island are delivered
through a single management model centralized under
the Department of Health.
The Ministry is responsible for providing a variety
of health services to Islanders to promote and help
foster their optimal health, including public health
services, primary care, acute care, community hospital and continuing care services. These services are
delivered by over 4,500 dedicated professional staff
through a large number of facilities and programs
across the province. Included are:
• acute care facilities;
• community hospitals;
• provincial manors;
• an in-patient mental health facility;
• a provincial addictions treatment facility and
community programs;
• family health centres;
• public health, home care, community addictions
programs;
• community mental health;
• the Chief Health Officer; and
• Vital Statistics and regulatory services.
A Minister of the Crown is ultimately accountable
to the rest of government and the citizens of PEI
for the Department of Health and its performance
and results. The Department is managed by a
Canada Health Act — Annual Report 2008–2009
Acute Care: Provides regional and provincial secondary, specialty services, and in-patient mental health
services to residents of PEI. Facilities include Prince
County Hospital (PCH), the Queen Elizabeth Hospital
(QEH) and Hillsborough Hospital. Administratively,
one Executive Director is responsible for PCH and
one Executive Director is responsible for QEH/
Hillsborough Hospital, both of whom are members
of the Departmental Management Committee.
Community Hospitals and Continuing Care:
Provides acute care services to rural communities
and supportive services to adults and seniors in need
of continuing care on PEI. Programs and facilities
include five rural community hospitals, provincial
manors, home care, palliative care, dialysis, and
adult protection. Administratively, the Director
of Community Hospitals and Continuing Care is
responsible for this division and is a member of the
Departmental Management Committee.
Medical Programs: Provides for the delivery of
medical programs and services which include the
provincial Medicare Program, physician services,
physician referrals, physician billing assessment
and payment, Out-of-Province Liaison Program,
emergency medical services, In-Province and Outof-Province medicare claims. Administratively,
the Director of Medical Programs is responsible for
this division and is a member of the Departmental
Management Committee.
Primary Care: Provides primary health services
to citizens of PEI. Programs and facilities include:
seven Family Health Centres, Public Health Nursing,
and Chronic Disease Prevention. Administratively,
the Director of Primary Care is responsible for
this division and is a member of the Departmental
Management Committee.
Chief Health Office: Provides delivery of programs
and services in the areas of Epidemiology and Health
Research, Environmental Health, Vital Statistics
and Reproductive Care. This office is also responsible
for the administration and enforcement of the Public
Health Act, supervision of related public health
programs and disease surveillance and control.
Recruitment and Retention Secretariat: Provides
health human resource planning and undertakes
29
Chapter 3: Prince Edward Island
recruitment and retention efforts to meet the current
and future needs for physicians, nurses and allied
health professionals.
2.0 Comprehensiveness
1.0 Public Administration
Insured hospital services are provided under the
Hospital and Diagnostic Services Insurance Act
(1988). The accompanying Regulations (1996) define
the insured in- and out-patient hospital services
available at no charge to a person who is eligible.
Insured hospital services include: necessary nursing
services; laboratory, radiological and other diagnostic
procedures; accommodations and meals at a standard
ward rate; formulary drugs, biologicals and related
preparations prescribed by an attending physician
and administered in hospital; operating room, case
room and anaesthetic facilities; routine surgical supplies; and radiotherapy and physiotherapy services
performed in hospital.
1.1
Health Care Insurance Plan and
Public Authority
The Hospital Care Insurance Plan, under the authority
of the Minister of Health, is the vehicle for delivering
hospital care insurance in Prince Edward Island. The
enabling legislation is the Hospital and Diagnostic
Services Insurance Act (1988), which insures services
as defined under section 2 of the Canada Health Act.
The role of the Department is to provide sound
leadership in innovation and ongoing improvement,
quality administration and regulatory services, and
delivery of client-centred health services, consistent
with provincial communities’ needs.
The Department of Health is responsible for service
delivery and operates hospitals, health centres, manors and mental health facilities. The Public Service
Commission hires physicians, nurses and other
health related workers.
1.2 Reporting Relationship
An annual report is submitted by the Department
to the Minister responsible who tables it in the
Legislative Assembly. The Report provides information on the operating principles of the Department
and its legislative responsibilities, as well as an
overview and description of the operations of the
departmental divisions and statistical highlights
for the year.
1.3 Audit of Accounts
The provincial Auditor General conducts annual
audits of the Public Accounts of the province of
Prince Edward Island. The Public Accounts of the
province include the financial activities, revenues
and expenditures of the Department of Health.
The provincial Auditor General, through the Audit
Act, has the discretionary authority to conduct further audit reviews on a comprehensive or program
specific basis.
30
2.1
Insured Hospital Services
The process to add a new hospital service to the
list of insured services involves extensive consultation and negotiation between the Department and
key stakeholders. The process involves the development of a business plan which, when approved
by the Minister, would be taken to Treasury Board
for funding approval. The Cabinet has the final
authority in adding new services.
As of March 2009, there were seven acute care facilities participating in the province’s Insurance Plan. In
addition to 432 acute care beds, these facilities house
20 rehabilitative beds as defined under the Hospitals
Act (1988), for a total of 452 beds.
2.2 Insured Physician Services
The enabling legislation that provides for insured
physician services is the Health Services Payment
Act (1988). Amendments were passed in 1996. Changes
were made to include the physician resource planning process.
Insured physician services are provided by medical
practitioners licensed by the College of Physicians
and Surgeons. The total number of practitioners,
including locums, who billed the Insurance Plan
as of March 31, 2009, was 389.
Under section 10 of the Health Services Payment Act,
a physician or practitioner who is not a participant in
the Insurance Plan is not eligible to bill the Plan for
services rendered. When a non-participating physician provides a medically required service, section
10(2) requires that physicians advise patients that
they are not participating physicians or practitioners
Canada Health Act — Annual Report 2008–2009
Chapter 3: Prince Edward Island
and provide the patient with sufficient information
to enable recovery of the cost of services from the
Minister of Health.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Under section 10.1 of the Health Services Payment
Act, a participating physician or practitioner may
determine, subject to and in accordance with the
Regulations and in respect of a particular patient
or a particular basic health service, to collect fees
outside the Plan or selectively opt out of the Plan.
Before the service is rendered, patients must be
informed that they will be billed directly for the
service. Where practitioners have made that determination, they are required to inform the Minister
thereof and the total charge is made to the patient
for the service rendered.
Provincial hospital services not covered by the
Hospital Services Plan include:
As of March 31, 2009, no physicians had opted out
of the Health Care Insurance Plan.
• services that persons are eligible for under
other provincial or federal legislation;
• mileage or travel, unless approved by the
Department;
• advice or prescriptions by telephone, except
anticoagulant therapy supervision;
• telephone consultation except by internists and
orthopedic surgeons, provided the patient was
not seen by that internist or orthopedic surgeon
within 3 days of the telephone consult;
Any basic health services rendered by physicians
that are medically required are covered by the
Health Care Insurance Plan. These include most
physicians’ services in the office, at the hospital or
in the patient’s home; medically necessary surgical services, including the services of anaesthetists
and surgical assistants where necessary; obstetrical
services, including pre- and post-natal care, newborn care or any complications of pregnancy such as
miscarriage or caesarean section; certain oral surgery
procedures performed by an oral surgeon when it is
medically required, with prior approval that they
be performed in a hospital; sterilization procedures,
both female and male; treatment of fractures and
dislocations; and certain insured specialist services,
when properly referred by an attending physician.
• examinations required in connection with
employment, insurance, education, etc.;
The process to add a physician service to the list of
insured services involves negotiation between the
Department and the Medical Society. The process
involves development of a business plan which, when
approved by the Minister, would be taken to Treasury
Board for funding approval. Cabinet has the final
authority in adding new services.
• dental services other than those procedures
included as basic health services;
2.3 Insured Surgical-Dental Services
Dental services are not insured in the Health Care
Insurance Plan. Only oral maxillofacial surgeons are
paid through the Plan. There are currently two surgeons in that category. Surgical-dental procedures
included as basic health services in the Tariff of Fees
are covered only when the patient’s medical condition
requires that they be done in hospital or in an office
with prior approval as confirmed by the attending
physician.
Canada Health Act — Annual Report 2008–2009
• group examinations, immunizations or inoculations, unless prior approval is received from the
Department;
• preparation of records, reports, certificates or
communications, except a certificate of committal to a psychiatric, drug or alcoholism facility;
• testimony in court;
• travel clinic and expenses;
• surgery for cosmetic purposes unless medically
required;
• dressings, drugs, vaccines, biologicals and
related materials;
• eyeglasses and special appliances;
• chiropractic, podiatry, optometry, chiropody,
osteopathy, naturopathy, and similar treatments;
• physiotherapy, psychology, audiology, and
acupuncture except when provided in hospital;
• reversal of sterilization procedures;
• in vitro fertilization;
• services performed by another person when
the supervising physician is not present or not
available;
31
Chapter 3: Prince Edward Island
• services rendered by a physician to members of
the physician’s own household, unless approval
is obtained from the Department; and any other
services that the Department may, upon the recommendation of the negotiation process between
the Department and the Medical Society, declare
non-insured.
Provincial hospital services not covered by the Hospital
Services Plan include private or special duty nursing at
the patient’s or family’s request; preferred accommodation at the patient’s request; hospital services rendered
in connection with surgery purely for cosmetic reasons;
personal conveniences, such as telephones and televisions; drugs, biologicals and prosthetic and orthotic
appliances for use after discharge from hospital; and
dental extractions, except in cases where the patient
must be admitted to hospital for medical reasons with
prior approval of the Department.
The process to de-insure services by the Health Care
Insurance Plan is done in collaboration with the
Medical Society and the Department. No services
were de-insured during the 2008/2009 fiscal year.
All Island residents have equal access to services.
Third parties such as private insurers or the Workers’
Compensation Board of Prince Edward Island do not
receive priority access to services through additional
payment.
Prince Edward Island has no formal process to monitor compliance; however, feedback from physicians,
hospital administrators, medical professionals and
staff allows the Department to monitor usage and
service concerns.
3.0 Universality
3.1
Eligibility
The Health Services Payment Act and Regulations,
section 3, define eligibility for the health care insurance
plans. The plans are designed to provide coverage for
eligible Prince Edward Island residents. A resident is
anyone legally entitled to remain in Canada and who
makes his or her home and is ordinarily present on
an annual basis for at least six months plus a day, in
Prince Edward Island.
All new residents must register with the Department
in order to become eligible. Persons who establish
permanent residence in Prince Edward Island from
32
elsewhere in Canada will become eligible for insured
hospital and medical services on the first day of the
third month following the month of arrival.
Residents who are ineligible for coverage under the
Health Care Insurance Plan in Prince Edward Island
are members of the Canadian Forces, Royal Canadian
Mounted Police (RCMP), inmates of federal penitentiaries and those eligible for certain services under other
government programs, such as Workers’ Compensation
or the Department of Veterans Affairs’ programs.
Ineligible residents may become eligible in certain
circumstances. Members of the Canadian Forces or
RCMP become eligible on discharge or completion
of rehabilitative leave. Penitentiary inmates become
eligible upon release. In such cases, the province where
the individual in question was stationed at the time of
discharge or release, or release from rehabilitative leave,
would provide initial coverage during the customary
waiting period of up to three months. Parolees from
penitentiaries will be treated in the same manner as
discharged parolees.
Foreign students, tourists, transients or visitors to
Prince Edward Island do not qualify as residents
of the province and are, therefore, not eligible for
hospital and medical insurance benefits.
3.2 Registration Requirements
New or returning residents must apply for health
coverage by completing a registration application
from the Department. The application is reviewed
to ensure that all necessary information is provided.
A health card is issued and sent to the resident within
two weeks. Renewal of coverage takes place every
five years and residents are notified by mail six weeks
before renewal.
The number of residents registered for the Health
Care Insurance Plan in Prince Edward Island as of
March 31, 2009, was 142,305.
3.3 Other Categories of Individual
Foreign students, temporary workers, refugees and
Minister’s Permit holders are not eligible for health
and medical coverage. Kosovar refugees are an
exception to this category and are eligible for both
health and medical coverage in Prince Edward
Island.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Prince Edward Island
4.0 Portability
4.1
Minimum Waiting Period
Insured persons who move to Prince Edward Island
are eligible for health insurance on the first day of
the third month following the month of arrival in
the province.
4.2 Coverage During Temporary
Absences in Canada
Persons absent each year for winter vacations and
similar situations involving regular absences must
reside in Prince Edward Island for at least six months
plus a day each year in order to be eligible for sudden
illness and emergency services while absent from
the province, as allowed under section 5.(1)(e) of the
Health Services Payment Act.
The term “temporarily absent” is defined as a period
of absence from the province for up to 182 days in a
12 month period, where the absence is for the purpose
of a vacation, a visit or a business engagement. Persons
leaving the province under the above circumstances
must notify the Registration Department before
leaving.
Prince Edward Island participates in the Hospital
Reciprocal Billing Agreement and the Medical
Reciprocal Billing Agreement. The total amount
paid under these agreements in 2008/2009 was
$31,871,835.
The payment rate currently ranges from $797 at the
community hospitals to $806 at Prince County Hospital
and $1023 at the Queen Elizabeth Hospital per day for
hospital stays. The standard interprovincial outpatient
rate is $232. The methodology used to derive these rates
is as if the patient had the services provided in Prince
Edward Island.
4.3 Coverage During Temporary
Absences Outside Canada
The Health Services Payment Act is the enabling
legislation that defines portability of health insurance during temporary absences outside Canada,
as allowed under section 5.(1)(e) of the Health
Services Payment Act.
Insured residents may be temporarily out of the
country for a 12 month period one time only.
Students attending a recognized learning insti-
Canada Health Act — Annual Report 2008–2009
tution in another country must provide proof of
enrolment from the educational institution on an
annual basis. Students must notify the Registration
Department upon returning from outside the country.
For Prince Edward Island residents leaving the
country for work purposes for longer than one
year, coverage ends the day the person leaves.
For Island residents travelling outside Canada,
coverage for emergency or sudden illness will be
provided at Prince Edward Island rates only, in
Canadian currency. Residents are responsible for
paying the difference between the full amount
charged and the amount paid by the Department.
In 2008–2009, the total amounts paid for in-patient
claims was $113,901 and $33,919 for out-patient
claims.
4.4 Prior Approval Requirement
Prior approval is required from the Department
before receiving non-emergency, out-of-province
medical or hospital services. Island residents seeking such required services may apply for prior
approval through a Prince Edward Island physician.
Full coverage may be provided for (Prince Edward
Island insured) non-emergency or elective services,
provided the physician completes an application to
the Department. Prior approval is required from the
Medical Director of the Department to receive out-ofcountry hospital or medical services not available in
Canada.
5.0 Accessibility
5.1
Access to Insured Health Services
Both of Prince Edward Island’s hospital and medical
services insurance plans provide services on uniform
terms and conditions on a basis that does not impede
or preclude reasonable access to those services by
insured persons.
5.2 Access to Insured Hospital Services
Prince Edward Island has a publicly administered
and funded health system that guarantees universal
access to medically necessary hospital and physician
services as required by the Canada Health Act.
Prince Edward Island has two referral hospitals and
five community hospitals, with a combined total
33
Chapter 3: Prince Edward Island
of 452 beds. Along with nine government manors
and one facility for children with disabilities that
house 609 (plus 12 respite) long-term care nursing
beds, Islanders have access to an additional 439 in
nine private nursing homes. The system also operates several addictions and mental health facilities,
including the provincial in-patient psychiatric
Hillsborough Hospital which has 17 acute care
beds and 53 long term care beds.
This past year saw renovations completed to the
Emergency Departments at the Prince County
Hospital and the Kings County Memorial Hospital.
As well, construction has begun on Phase I of a
$52 million multi-phase redevelopment plan to
upgrade the 25+ year-old Queen Elizabeth Hospital.
This multi-phase redevelopment will occur over
the next few years and will ultimately result in a
major redesign of the emergency department and
support services, an addition to the Cancer Treatment Centre, and enhancements to ambulatory
care and day surgery, among other improvements.
The public sector health workforce on PEI has
approximately 4,500 employees. Through the Health
Recruitment and Retention Secretariat, there is ongoing recruitment to address vacancies in the physician
complement in this province. This challenge is being
met in part by continuing to develop a long-term physician resource plan, by providing salary options to new
graduates and existing physicians, and by engaging in
more communication with PEI students and medical
residents through the Medical Education Program.
Prince Edward Island launched the PEI Family
Medicine Residency Program to provide ongoing
training opportunities to medical school graduates
who are training as a family physician. The intent
is to better integrate our medical students so that
they will want to stay and practice in the province.
Five family medicine residents began their twoyear training program on the Island during this
reporting period.
In addition to the aforementioned programs, other
current initiatives include the:
• Nurse Recruitment Strategy,
• Provider Registry,
• Musco-skeletal Injury Prevention Program
(Workplace safety),
• Wait Times Strategy,
• Youth Addictions Strategy,
34
• Clinical Information System interoperable
Electronic Health Record,
• Patient Safety Strategy,
• Rural Physician Stabilization Initiative, and the
• Pandemic Planning.
Other new initiatives announced during this period
include the:
• Critical Care and Emergency Nursing Program,
• Healthy Aging Strategy,
• Accelerated Nursing Program, and the
• Palliative Home Care Drug Program.
This year the province released a consultant’s report
on the comprehensive review of the Prince Edward
Island health care system. The Government’s vision
for health care is One Island Community, One Island
Future, One Island Health System. The single goal for
this review was: To ensure the sustainability of the
health system and provide improved health services
to all Islanders. The Government also announced
the creation of the Island Health Advisory Council
which will consult with Islanders and recommend
an appropriate governance model for the health
system.
Research indicates that our population is aging and
exhibiting a variety of modifiable risk factors relating to physical inactivity, unhealthy eating, alcohol
consumption, smoking and obesity. As in previous
years, the rate of chronic diseases continues to rise.
As the population ages, so too will the number of
people affected by chronic disease. A variety of
initiatives are in place which directly or indirectly
address current and future levels of chronic disease.
Examples include primary care redesign, which
includes the continued establishment of family
health centres; innovations and improvements
in the areas of Pharmacare, home care, wait time
guarantees being developed and implemented; and
the Clinical Information System/Electronic Health
Record to improve health care provider access to
timely and accurate information. This ongoing work
will improve the overall quality of care and health
outcomes for patients. Furthermore, models of service delivery and health care provider roles continue
to evolve. Increased adoption of collaborative/interdisciplinary approaches as well as enhancements in
the areas of ambulatory care (including the multiyear QEH redevelopment project) and primary health
Canada Health Act — Annual Report 2008–2009
Chapter 3: Prince Edward Island
care will contribute to chronic disease prevention,
treatment, and management.
Recruitment to find suitable replacements for the
remaining vacancies is ongoing.
Collaborative strategies focussed on promoting
healthier lifestyles include:
When vacancies exist within the physician complement, locum physicians provide coverage to ensure
continuous service. For highly specialized consultation and treatment services not available on PEI,
residents are referred out-of-province. Examples
include sub-specialties of cardiac and neurotrama
services, oncology, pediatrics, prenatal, orthopedic,
and addiction services. The Department of Health
funds the delivery of such approved medical services provided to PEI residents by out-of-province
physicians.
• the Cancer Control Strategy, which includes
a partnership with the PEI Cancer Control
Committee, which works to reduce the burden of cancer on PEI by identifying priorities,
coordinating efforts, monitoring progress and
communicating results from the strategy;
• the PEI Strategy for Healthy Living, which
focuses on tobacco reduction and promoting
exercise and good nutrition;
• the PEI Active Living Alliance, which promotes
physical activity through a variety of community
initiatives; and
• the Healthy Aging Strategy, which outlines the
future of long-term and continuing care on PEI
and builds supports for Island seniors who wish
to remain independent in their homes and communities as long as desired and possible.
As PEI is primarily a rural province where a large
segment of the population resides outside the main
service centres, local access to health services, including acute services delivered through community
hospitals, is important to small communities. Rural
hospitals have historically played an important role
in health care delivery and serve vital and central
roles in their respective communities. Rural hospitals
and other health services delivered in these areas face
a number of challenges, such as the recruitment and
retention of health care providers and keeping pace
with evolving standards of care and quality.
5.3 Access to Insured Physician and
Surgical-Dental Services
Physician services are provided to PEI residents by
permanent general practitioners and specialists working within the physician complement. As of March
31, 2009 there were the following vacancies in the
complement: Family Medicine, Emergency Medicine,
Addiction Services, Radiology, Pathology, Physical
Medicine, Internal Medicine, Ophthalmology and
Radiation Oncology, overall totaling 12.9 full-time
equivalent vacant positions. Some of these positions are to be filled in the near future by candidates
who have been successfully identified and have
accepted offers of employment to work on the Island.
Canada Health Act — Annual Report 2008–2009
The Government is committed to remaining
competitive in the recruitment and retention
of physicians. In 2006, the Enhanced Physician
Recruitment/Retention and Medical Education
Strategy was announced that built on existing
initiatives and addresses the financial, professional and lifestyle concerns of today’s
physicians. These enhancements are targeted
towards physicians in training, physicians
being recruited to Prince Edward Island, and
physicians currently in practice on PEI.
In December 2007, the Government announced
the development of the PEI Family Medicine
Residency Program. Five first year residents were
announced in March 2009, to begin training in
Prince Edward Island in July 2009, with five more
Residents beginning in July 2010. The program
provides tremendous training opportunities and
is a key component in helping to ensure an adequate
number of family doctors in Prince Edward Island.
5.4 Physician Compensation
A collective bargaining process is used to negotiate physician compensation. Bargaining teams are
appointed by both physicians and the government to
represent their interests in the process. A new threeyear Physician Master Agreement between the PEI
Medical Society, on behalf of Island physicians, and
the provincial government was reached and will be in
effect until March 31, 2010. The government continues
to make additional investments to address areas that
will make the health system more competitive so that
it can maintain services and increase the success of
recruitment and retention efforts for physicians.
The legislation governing payments to physicians
and dentists for insured services is the Health
Services Payment Act.
35
Chapter 3: Prince Edward Island
Many physicians continue to work on a fee-forservice basis. However, alternate payment plans
have been developed and some physicians receive
salary, contract and sessional payments. Alternate
payment modalities are growing and seem to be
the preference for new graduates. Currently, over
65 percent of PEI physicians are compensated under
an alternate payment method (non-fee-for-service)
as their primary means of remuneration.
5.5 Payments to Hospitals
Payments (advances) to provincial hospitals and
community hospitals for hospital services are
approved for disbursement by the Department in
line with cash requirements and are subject to
approved budget levels.
The usual funding method includes using a global
budget adjusted annually to take into consideration
increased costs related to such items as labour
agreements, drugs, medical supplies and facility
operations.
care beds. Nursing home admission is for individuals
who require 24-hour registered nurse (nursing care)
supervision and care management. The standardized
provincial Seniors Assessment Screening Tool is used
to determine service needs of residents for all admissions. The Long-Term Care Subsidization Act provides
the framework for the provision of services. Residents
in manors and private nursing homes are funded by
the Department of Health for basic health-related
costs. Residents are responsible for the accommodation (room and board) cost as well as their personal
expenses. Residents with a net annual income less
than $26,500 may qualify for an accommodation payment subsidy and can apply through the Long-term
Care Subsidization Program.
In 2008, the Province subsidized 77 percent of residents
in nursing homes. The federal government subsidized
approximately 8.2 percent of nursing home residents
through Veterans Affairs Canada. The remaining
14.8 percent financed their own care.
Extended health care services are not insured services,
except for the insured chronic care beds noted in
section 2.1.
In addition to nursing home facilities, the system
operates several addictions and mental health facilities, including the provincial in-patient psychiatric
Hillsborough Hospital which has 18 acute care beds
and 57 long term care beds. There are also 37 licensed
community care facilities in Prince Edward Island. As
of March 31, 2009, the total number of licensed community care facility beds was 1,088. A Community
Care Facility is a privately operated, licensed establishment with five or more residents. These facilities
provide semi-dependent seniors and semi-dependent
physically and mentally challenged adults with
accommodation, housekeeping, supervision of daily
living activities, meals and personal care assistance
for grooming and hygiene. Care needs are assessed
using the Seniors Assessment Screening Tool and are
at Level 1, 2 or 3. Residents are eligible to apply for
financial assistance under the Social Assistance Act
Regulations, Part I. It should be noted that payment
to community care is the responsibility of the individual. Clients lacking adequate financial resources
may apply for financial assistance under the Prince
Edward Island Social Assistance Act.
7.1
7.2
6.0 Recognition Given to
Federal Transfers
The Government of Prince Edward Island acknowledged
the federal contributions provided through the Canada
Health Transfer in its 2008–2009 Annual Budget and
related budget documents and its 2008–2009 Public
Accounts, which were tabled in the Legislative
Assembly and are publicly available to Prince
Edward Island residents.
7.0 Extended Health Care
Services
Nursing Home Intermediate Care
and Adult Residential Care Services
Nursing home services are available on approval from
provincial admission committees for placement into
public manors and licensed private nursing homes.
There are currently 18 long-term care facilities in
the province, 9 public manors and 9 licensed private
nursing homes, with a total of 1,012 long term nursing
36
Home Care Services
Home Care and Support provides assessment and
care planning to medically stable individuals, and
defined groups of individuals with specialized needs,
who, without the support of the formal system, are
at risk of being unable to stay in their own home, or
are unable to return to their own home from a hospital or other care setting. Services provided through
Canada Health Act — Annual Report 2008–2009
Chapter 3: Prince Edward Island
Home Care and Support include nursing, personal
care, respite, occupational and physical therapies,
adult protection, palliative care, home and community-based dialysis, assessment for nursing home
placement and community support. The Senior’s
Assessment Screening Tool is used to determine
the nature and type of service needed. Professional
services in home care are currently provided at no
cost to the client. Visiting homemaker services are
subject to a sliding fee scale based on an individual’s
income assessment, which is generally waived for
palliative care clients.
7.3
Ambulatory Health Care Services
Prince Edward Island has public Adult Day Programs
that provide services such as recreation, education
and socialization for dependent elders. Individuals
who require this service are assessed by regional
Home Care staff. The overall purpose of adult day
programs, is to allow clients to remain in their homes
as long as possible, provide respite for care givers,
monitor client’s health and provide social interaction. There are Adult Day Programs located across
Prince Edward Island.
Canada Health Act — Annual Report 2008–2009
The Prince Edward Island Dialysis Program is a
community-based service that operates under the
medical direction and supervision of the Nephrology
team at the Queen Elizabeth II Health Sciences
Centre in Halifax.
There are five hemo-dialysis clinics in the province.
This is a publicly funded service. Prince Edward
Island also offers a hemo-dialysis service to out-ofprovince/country visitors from the existing clinic
locations. The provision of this service is based on
the capacity within the clinics and the availability
of human resources to provide this treatment at the
time of the request. Cost of the service is covered
through reciprocal billing if from another Canadian
jurisdiction and by the visitor if from out of Canada.
Significant ambulatory care services are also delivered from the two provincial referral hospitals on
an outpatient basis. These services include asthma
education, cardio-pulmonary testing and treatment,
endoscopy, surgery clinics, nursing clinics, nutrition
counselling and oncology.
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Chapter 3: Prince Edward Island
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
143,261
144,159
145,047
146,518
142,305
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
7
7
7
7
7
b. chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c. rehabilitative care
not applicable
not applicable
not applicable
not applicable
not applicable
d. other
not applicable
not applicable
not applicable
not applicable
not applicable
e. total
7
7
7
7
7
125,118,252
129,976,900
137,365,100
143,254,200
147,295,500
3. Payments for insured health services ($):
a. acute care
b. chronic care
not applicable
not applicable
not appliciable
not applicable
not applicable
c. rehabilitative care
not applicable
not applicable
not appliciable
not applicable
not applicable
d. other
not applicable
not applicable
not appliciable
not applicable
e. total
125,118,252
129,976,900
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
1
137,365,100
143,254,200
1
not applicable
1
147,295,500
1
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
b. diagnostic imaging facilities
not applicable
not applicable
not applicable
not applicable
not applicable
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
b. diagnostic imaging facilities
not applicable
not applicable
not applicable
not applicable
not applicable
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
2,163
2,187
2,003
2,253
2008–2009
2,591
15,325,267
16,463,548
17,510,188
19,448,899
20,582,454
14,368
15,547
15,675
17,867
18,488
2,667,968
3,225,803
3,345,624
4,292,114
5,290,630
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
30
25
35
28
34
95,719
69,391
105,268
49,616
113,901
93
91
96
137
122
16,304
17,084
16,179
27,533
33,919
1. Figures are budget estimates, not actuals.
38
Canada Health Act — Annual Report 2008–2009
Chapter 3: Prince Edward Island
Insured PHYSICIAN Sevices Within Own Province or TErrITitory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
98
113
120
111
133
14.Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
96
98
108
110
123
not applicable
not applicable
not applicable
not applicable
not applicable
194
211
228
221
256
2
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
not applicable
not applicable
0
0
0
b. specialists
not applicable
not applicable
0
0
0
c. other
not applicable
not applicable
0
0
0
d. total
not applicable
not applicable
0
0
0
1,387,070
9,795,812
3
14,490,876
3
11,897,457
3
1,312,506
4
1,137,286
4
1,219,712
4
40,027,386
56,063,644
5
61,974,581
5
61,445,780
5
1,197,935
1,052,167
937,707
794,706
749,779
772,057
34,423,393
35,226,215
34,543,095
34,973,359
41,123,808
17.Services provided by physicians paid through all payment methods:
a. number of services (#)
b. number of records
b. total payments ($)
2,504,320
40,012,026
18.Services provided by physicians paid through fee-for-service:
a. number of services (#)
b. number of records
b. total payments ($)
887,967
893,281
Insured Physician Services Provided to Residents in Another Province or Territory
19.Number of services (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
48,928
54,269
73,399
77,992
77,830
58,284
60,044
61,254
5,221,586
6,035,626
5,998,751
Number of Records
20.Total payments ($).
4,122,725
4,674,004
Insured Physician Services Provided Outside Canada
21.Number of services (#).
627
534
Number of Records
22.Total payments ($).
21,849
15,844
746
562
1,053
681
541
751
27,899
23,979
52,601
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2
3
3
3
3
410
303
442
364
424
332
263
381
96,490
115,918
106,708
95,749
149,794
23.Number of participating dentists (#).
24.Number of services provided (#).
Number of records provided
25.Total payments ($).
2. Total does not include locums or visiting specialists.
3. Beginning in 2006–2007 service count reflects the total # of transactions recorded within all records. The service count will always be greater than or equal to the record count.
4. Beginning in 2006–2007 record count reflects total # of individual interactions with insured health services.
5. Reflects payments made through claim submissions and salary allocations.
Canada Health Act — Annual Report 2008–2009
39
40
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
The Department of Health is responsible for setting
the strategic direction and standards for health
services; ensuring availability of quality health care;
monitoring, evaluating and reporting on performance
and outcomes; and funding health services. The
Department of Health is directly responsible for physician and pharmaceutical services, emergency health,
continuing care, and many other insured and publicly
funded health programs and services.
Nova Scotia
Introduction
The Nova Scotia Department of Health’s mission is,
through leadership and collaboration, to ensure an
appropriate, effective, and sustainable health system
that promotes, maintains and improves the health
of Nova Scotians. This requires that health care
services in Nova Scotia are integrated, communitybased and sustainable.
In February 2006, the Government of Nova Scotia
created a new Department of Health Promotion and
Protection that brought together two areas from the
Department of Health, the Office of the Chief Medical
Officer of Health and Public Health branch, with
Nova Scotia Health Promotion.
The Health Authorities Act, Chapter 6 of the Acts of
2000, established the province’s nine District Health
Authorities (DHAs) and their community-based supports, Community Health Boards (CHBs). DHAs are
responsible for governing, planning, managing, delivering and monitoring health services within each
district and for providing planning support to the
CHBs. Services delivered by the DHAs include acute
and tertiary care, mental health, and addictions.
The province’s thirty-seven CHBs develop community
health plans with primary health care and health promotion as their foundation. DHAs draw two thirds of
their board nominations from CHBs. Their community
health plans are part of the DHAs annual business
planning process. In addition to the nine DHAs, the
IWK Health Centre continues to have separate board,
administrative and service delivery structures.
Canada Health Act — Annual Report 2008–2009
Under the Health Authorities Act, the DHAs are
required to provide the Minister of Health with
monthly and quarterly financial statements and
audited year-end financial statements. They are
also required to submit annual reports, which provide updates on implementing DHA business plans.
These provisions ensure greater financial accountability. The sections of the Health Authorities Act
related to financial reporting and business planning
came into effect on April 1, 2001.
In January, 2007, the PHSOR Report was officially
released. 103 recommendations came out of the
report in order to transform Nova Scotia’s health
care system, making it more effective, efficient, and
sustainable for all Nova Scotians now and in the
future. The Government supported all 103 recommendations and released a response document
which outlined the Government’s commitment
to health transformation.
Pursuant to the Provincial Finance Act (2000) and
government policies and guidelines, the Department
of Health is required to release annual accountability
reports outlining outcomes against its business plan
for that fiscal year. The 2007–2008 accountability
report was released in December 2008.
Nova Scotia faces a number of challenges in the
delivery of health care services. Nova Scotia’s population is aging. Approximately 14.1% of the Nova
Scotian population is sixty-five or over and this figure is expected to nearly double by 2026. In response
to the needs of our aging population, Nova Scotia
has expanded its basket of publicly insured services
to include home care, long-term care, and enhanced
pharmaceutical coverage. Nova Scotia also has much
higher than average rates of chronic diseases such as
cancers and diabetes which contribute to the rising
costs of health care delivery in Nova Scotia.
41
Chapter 3: Nova Scotia
In comparison to other provinces, Nova Scotia has the:
• second highest rate of primary site cancer incidence for males (560) and the highest rate for
females (393) per 100,000 population1
• highest prevalence of diabetes (5.7)2
• second highest percentage of the population
reporting their health as only fair or as poor (14) 3
• second highest rate of colorectal cancer mortality for males (33) and the third highest rate for
females (21) per 100,000 population4
• third highest rate of breast cancer mortality (25)
per 100,000 population5
• third highest percentage of the population reporting their mental health as only fair or poor (5.4) 6
Other major cost drivers are a highly competitive
labour market for health human resources, the
increasing costs of pharmaceuticals and aging facility infrastructure. The health care system accounts
for more than 33,900 positions across the province.
Health care is a labour-intensive service and is sensitive to fluctuations and cost pressures associated
with the labour market and health professional workforce. Highly competitive labour markets continue
to drive wage and incentive increases, placing additional demands on health care resources. The lack of
health human resources also affects service delivery,
such as limiting hours for emergency rooms due to
a lack of staff. The distribution of staff to rural areas
presents challenges for providing high-quality care.
As noted in the PHSOR Report7, data from the Nova
Scotia Association of Health Organizations Pension
Plan database shows that of the 11,068 staff in key
professional groups today, 2,158 or 20% will be
eligible for retirement in 2010. By 2015, that number
increases to 4,834 or 44%. Continuing with the same
approach to health workforce planning and system
delivery is not sustainable and a new, more collaborative approach is required.
Despite these ever increasing pressures and challenges, Nova Scotia continues to be committed to the
delivery of medically necessary services consistent
with the principles of the Canada Health Act.
1.
2.
3.
4.
5.
6.
7.
Additional information related to health care in
Nova Scotia may be obtained from the Department
of Health website at:
www.gov.ns.ca/health
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
Two plans cover insured health services in Nova
Scotia: the Hospital Insurance Plan (HSI) and
the Medical Services Insurance Plan (MSI). The
Department of Health administers the HSI Plan,
which operates under the Health Services and
Insurance Act, Chapter 197, Revised Statutes of
Nova Scotia, 1989: sections 3(1), 5, 6, 10, 15, 16,
17(1), 18 and 35.
The MSI is administered and operated by an authority
consisting of the Department of Health and Medavie
Blue Cross (formerly called Atlantic Blue Cross), under
the above-mentioned Act (sections 8, 13, 17(2), 23, 27,
28, 29, 30, 31, 32 and 35).
Section 3 of the Health Services and Insurance Act
states that subject to this Act and the Regulations,
all residents of the province are entitled to receive
insured hospital services from hospitals on uniform terms and conditions. As well, all residents
of the province are insured on uniform terms and
conditions in respect of the payment of insured
professional services to the extent of the established
tariff. Section 8 of the Act gives the Minister of
Health, with approval of the Governor in Council,
the power to enter into agreements and vary, amend
or terminate the same with such person or persons
as the Minister deems necessary to establish, implement and carry out the MSI Plan.
The Department of Health and Medavie Blue Cross
entered into a new service level agreement, effective August 1, 2005. This new ten-year agreement
replaced the 1992 Memorandum of Agreement
between Medavie and the Department of Health.
Under the agreement, Medavie is responsible for
Canadian Cancer Care Statistics 2009 Report
Diabetes in Canada: Highlights from the NDSS Report, Public Health Agency of Canada, 2008 (Note: Nova Scotia tied with New Brunswick for highest prevalence)
Canadian Community Health Survey, 2007
Canadian Cancer Care Statistics, 2009
Canadian Cancer Care Statistics, 2009
Canadian Community Health Survey, 2007
PHSOR Report, 2009
42
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
operating and administering programs contained
under MSI, Pharmacare Programs and Health Card
Registration Services.
1.2 Reporting Relationship
Medavie is obliged to provide reports to the Department
under various Statement of Requirements for each
Business Service Description as listed in the contract.
Section 17(1)(i) of the Health Services and Insurance
Act, and sections 11(1) and 12(1) of the Hospital
Insurance Regulations, under this Act, set out the
terms for reporting by hospitals and hospital boards
to the Minister of Health.
1.3 Audit of Accounts
The Auditor General audits all expenditures of the
Department of Health. The Department of Health has
a service level agreement in place with Medavie Blue
Cross, effective August 1, 2005. An annual audit is
performed on this agreement, including Medicare,
Pharmacare and Health Card Registration, which has
been recommended by the Auditor General’s office.
All long-term care facilities, home care and
home support agencies are required to provide
the Department with annual audited financial
statements.
Under section 34(5) of the Health Authorities Act,
every hospital board is required to submit to the
Minister of Health by July 1st each year, an audited
financial statement for the preceding fiscal year.
1.4 Designated Agency
Medavie Blue Cross Care administers and has
the authority to receive monies to pay physician
accounts under a new service level agreement with
the Department of Health, effective August 1, 2005.
Medavie Blue Cross Care receives written authorization from the Department for the physicians to whom
it may make payments. The rates of pay and specific
amounts depend on the physician contract negotiated
between Doctors Nova Scotia and the Department of
Health.
All Medavie Blue Cross Care system development for
MSI and Pharmacare is controlled through a joint
committee. All MSI and Pharmacare transactions
are subject to a review by the Office of the Auditor
General.
2.0 Comprehensiveness
2.1
Insured Hospital Services
Nine District Health Authorities and the IWK
Health Centre (Women and Children’s Tertiary
Care Hospital) deliver insured hospital services
to both in- and out-patients in Nova Scotia in a
total of 35 facilities.8
Accreditation is not mandatory, but all facilities are
accredited at a facility or district level. The enabling
legislation that provides for insured hospital services
in Nova Scotia is the Health Services and Insurance
Act, Chapter 197, Revised Statutes of Nova Scotia,
1989: sections 3(1), 5, 6, 10, 15, 16, 17(1), 18 and 35,
passed by the Legislature in 1958. Hospital Insurance
Regulations were made pursuant to the Health
Services and Insurance Act.
In-patient services include:
• accommodation and meals at the standard
ward level;
• necessary nursing services;
• laboratory, radiological and other diagnostic
procedures;
• drugs, biologicals and related preparations,
when administered in a hospital;
• routine surgical supplies;
• use of operating room(s), case room(s) and
anaesthetic services;
• use of radiotherapy and physiotherapy services
for inpatients, where available; and
• blood or therapeutic blood fractions.
8. The number of facilities reported in other documents may differ from the 35 facilities reported here as a result of differences in definitions for the term “facility”.
Canada Health Act — Annual Report 2008–2009
43
Chapter 3: Nova Scotia
Out-patient services include:
• laboratory and radiological examinations;
• diagnostic procedures involving the use of
radio-pharmaceuticals;
• electroencephalographic examinations;
• use of occupational and physiotherapy
facilities, where available;
• necessary nursing services;
• drugs, biologicals and related preparations;
• blood or therapeutic blood fractions;
• hospital services in connection with most
minor medical and surgical procedures;
• day-patient diabetic care;
• services provided by the Nova Scotia Hearing
and Speech Clinics, where available;
• ultrasonic diagnostic procedures;
• home parenteral nutrition, where available; and
• haemodialysis and peritoneal dialysis, where
available.
In order to add a new hospital service to the list of
insured hospital services, District Health Authorities
are required to submit a New and/or Expanded Program
Proposal9 to the Department of Health. This process is
carried out annually by request through the business
planning process. A Department-developed process
format is forwarded to the Districts for their guidance.
A Department working group reviews and prioritizes
all requests received. Based on available funding,
a number of top priorities may be approved by the
Minister of Health.
2.2 Insured Physician Services
The legislation covering the provision of insured
physician services in Nova Scotia is the Health
Services and Insurance Act, sections 3(2), 5, 8, 13,
13A, 17(2), 22, 27-31, 35 and the Medical Services
Insurance Regulations.
9.
44
The Health Services and Insurance Act was amended
in 2002–2003 to include section 13B stating that:
“Effective November 1, 2002, any agreement between
a provider and a hospital, or predecessors to a hospital, stipulating compensation for the provision of
insured professional services, for the provider undertaking to be on-call for the provision of such services
or for the provider to relocate or maintain a presence
in proximity to a hospital, excepting agreements to
which the Minister and the Society are a party, is
null and void and no compensation is payable pursuant to the agreement, including compensation
otherwise payable for termination of the agreement.”
Under the Health Services and Insurance Act, persons who can provide insured physician services
include: general practitioners, who are persons who
engage in the general practice of medicine; physicians, who are not specialists within the meaning
of the clause; and specialists, who are physicians
and are recognized as specialists by the appropriate
licensing body of the jurisdiction in which he or she
practises.
Physicians (general practitioner or specialist) must be
licensed by the College of Physicians and Surgeons
in Nova Scotia in order to be eligible to bill the MSI
system. Dentists receiving payment under the MSI
Plan must be registered with the Provincial Dental
Board and be recognized as dentists. In 2008–2009,
2,343 physicians and 29 dentists were paid through
the MSI Plan.
Physicians retain the ability to opt into or out of the
MSI Plan. In order to opt out, a physician notifies
MSI, relinquishing his or her billing number. MSI
reimburses patients who pay the physician directly
due to opting out. As of March 31, 2009, no physicians had opted out.
Insured services are those medically necessary to
diagnose, treat, rehabilitate or otherwise alter a disease pattern. There are no limitations on medically
necessary insured services.
No new large-scale services were added to the list of
insured physician services in 2008–2009. On an as
needed basis, new specific fee codes are approved
that represent enhancements, new technologies or
new ways of delivering a service.
Emergency/unexpected requirements may be considered at any time throughout the fiscal year.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
The addition of new fee codes to the list of insured
physician services is accomplished through a committee structure. Physicians wishing to have a new
fee code recognized or established must first present
their cases to Doctors Nova Scotia, which puts a suggested value on the proposed new fee.
The proposal is then passed to the Fee Schedule
Advisory Committee for review and approval. The
Committee is comprised of equal representation from
Doctors Nova Scotia and the Department of Health.
When approved by the Committee, the approved
proposed new fee is forwarded to the Department
of Health for final approval and Medavie Blue Cross
Care is directed to add the new fee to the schedule of
insured services payable by the MSI Plan.
2.3 Insured Surgical-Dental Services
Under the Nova Scotia Health Services and Insurance
Act, a dentist is defined as a person lawfully entitled
to practice dentistry in a place where such practice is
carried on by that person.
To provide insured surgical-dental services under
the Health Services and Insurance Act, dentists must
be registered members of the Nova Scotia Dental
Association and must also be certified competent in
the practice of dental surgery. The Health Services
and Insurance Act is so written that a dentist may
choose not to participate in the MSI Plan. To participate, a dentist must register with MSI. A participating
dentist who wishes to reverse election to participate
must advise MSI in writing and is then no longer
eligible to submit claims to MSI. As of March 31, 2009,
no dentists had opted out. In 2008–2009, 29 dentists
were paid through the MSI Plan for providing insured
surgical-dental services.
Insured surgical-dental services must be provided in
a health care facility. Insured services are detailed
in the Department of Health MSI Dentist Manual
(Dental Surgical Services Program) and are reviewed
annually through the Acute & Tertiary Care Branch
as required by Insured Dental Services Tariff Regulations. Services under this program are insured
when the conditions of the patient are such that it is
medically necessary for the procedure to be done in
a hospital and the procedure is of a surgical nature.
Generally included as insured surgical-dental services are orthognathic surgery, surgical removal of
impacted teeth and oral and maxillary facial surgery.
Requests for an addition to the list of surgical-dental
Canada Health Act — Annual Report 2008–2009
services are accomplished by first approaching the
Dental Association of Nova Scotia and having them
put forward a proposal to the Department of Health
for the addition of a new procedure. The Department
of Health, in consultation with specific experts in
the field, renders the decision as to whether or not
the new procedure becomes an insured service.
Effective February 15, 2005, “Other extraction
services” (routine extractions) at public expense
were approved for the following groups of patients:
1) cardiac patients, 2) transplant patients, 3) immunocompromised patients, and 4) radiation patients.
Routine extractions for these patients will be provided at public expense when and only when, the
following criteria have been met. These patients must
be undergoing active treatment in a hospital setting
and the attendant medical procedure must require
the removal of teeth that would otherwise be considered routine extractions and not paid at public
expense. It is critical/vital to the claims approval
process that the dental treatment plans include
the name of the Medical Specialist providing the
care and that he/she has indicated in writing in the
patient’s medical treatment plan that the routine
dental extractions are required prior to performing
the medical treatment/procedure.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital services include:
• preferred accommodation at the patient’s request;
• telephones;
• televisions;
• drugs and biologicals ordered after discharge
from hospital;
• cosmetic surgery;
• reversal of sterilization procedures;
• surgery for sex reassignment;
• in-vitro fertilization;
• procedures performed as part of clinical
research trials;
45
Chapter 3: Nova Scotia
• services such as gastric bypass for morbid
obesity, breast reduction/augmentation and
newborn circumcision;10
• services not deemed medically necessary that
are required by third parties, such as insurance
companies.
Uninsured physician services include:
• services eligible for coverage under the Workers’
Compensation Act or under any other federal or
provincial legislation;
• mileage, travel or detention time;
• telephone advice or telephone renewal of
prescriptions;
• examinations required by third parties;
• group immunizations or inoculations unless
approved by the Department;
The Department of Health also carefully reviews all
patient complaints or public concerns that may indicate that the general principles of insured services
are not being followed.
The de-insurance of insured physician services is
accomplished through a negotiation process between
the Doctors Nova Scotia and the Physician Services
Branch of Department of Health, who jointly evaluate
a procedure or process to determine whether the services should remain an insured benefit. If a process
or procedure is deemed not to be medically necessary, it is removed from the physician fee schedule
and will no longer be reimbursed to physicians as an
insured service. Once a service has been de-insured,
all procedures and testing relating to the provision
of that service also become de-insured. The same
process applies to dental and hospital services. The
last time there was any significant de-insurance of
services was in 1997.
• preparation of certificates or reports;
3.0 Universality
• testimony in court;
3.1
• services in connection with an electrocardiogram, electromyogram or electroencephalogram,
unless the physician is a specialist in the appropriate specialty;
• cosmetic surgery;
• acupuncture;
• reversal of sterilization; and
• in-vitro fertilization.
Major third party agencies purchasing medically
necessary health services in Nova Scotia include
Workers’ Compensation, Department of National
Defence, the Royal Canadian Mounted Police.
All residents of the province are entitled to services
covered under the Health Services and Insurance
Act. If enhanced goods and services, such as foldable
intraocular lens or fiber glass casts are offered as an
alternative, the specialist/physician is responsible to
ensure that the patients is aware of their responsibility for the additional cost. Patients are not denied
service based on their inability to pay. The Province
provides alternatives to any of the enhanced goods
and services.
Eligibility
Eligibility for insured health care services in Nova
Scotia is outlined under section 2 of the Hospital
Insurance Regulations made pursuant to section 17
of the Health Services and Insurance Act. All residents of Nova Scotia are eligible. A resident is defined
as anyone who is legally entitled to stay in Canada
and who makes his or her home and is ordinarily
present in Nova Scotia.
A person is considered to be “ordinarily present” in
Nova Scotia if the person:
• makes his or her permanent home in Nova Scotia;
• is physically present in Nova Scotia for at least
183 days in any calendar year (short term absences
under 30 days, within Canada, are not monitored);
and
• is a Canadian citizen or “Permanent Resident” as
defined by Citizenship and Immigration Canada.
Persons moving to Nova Scotia from another Canadian
province will normally be eligible for MSI on the first
day of the third month following the month of their
arrival. Persons moving permanently to Nova Scotia
from another country are eligible on the date of their
arrival in the province, provided they are Canadian
10.These services may be insured when approved as special consideration for medical reasons only.
46
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
citizens or hold “Permanent Resident” status as
defined by Citizenship and Immigration Canada.
Members of the RCMP, members of the Canadian Forces
and federal inmates are ineligible for MSI coverage.
When their status changes, they immediately become
eligible for provincial Medicare.
There were no changes to eligibility requirements in
2008–2009.
3.2 Registration Requirements
To obtain a health card in Nova Scotia, residents
must register with MSI. Once eligibility has been
determined, an application form is generated. The
applicant (and spouse if applicable) must sign the
form before it can be processed. The applicant must
indicate on the application the name and mailing
address of a witness. The witness must be a Nova
Scotia resident who can confirm the information on
the application. The applicant must include proof of
Canadian citizenship or provide a copy of an acceptable immigration document.
When the application has been approved, health
cards will be issued to each family member listed.
MSI registration information is maintained as a family unit. Each health card number is unique and is
issued for the lifetime of the applicant. Health cards
expire every four years. The health card number
also acts as the primary health record identifier for
all health service encounters in Nova Scotia for the
life of the recipient. Proof of eligibility for insured
services is required before residents are eligible to
receive insured services. Renewal notices are sent to
most cardholders three months before the expiry date
of the current health card. Upon return of a signed
renewal notice, MSI will issue a new health card.
There is no legislation in Nova Scotia forcing residents of the province to apply for MSI. There may
be residents of Nova Scotia who, therefore, are not
members of the health insurance plan.
In 2008–2009, the total number of residents registered with the health insurance plan was 975,206.
3.3 Other Categories of Individual
The following persons may also be eligible for
insured health care services in Nova Scotia, once
they meet the specific eligibility criteria for their
situations:
Canada Health Act — Annual Report 2008–2009
Immigrants: Persons moving from another country
to live permanently in Nova Scotia, are eligible for
health care on the date of arrival. They must possess
a landed immigrant document. These individuals, formerly called “landed immigrants”, are now referred
to as “Permanent Residents”.
Convention Refugees and Non-Canadians married
to Canadian Citizens/Permanent Residents (copy of
Marriage Certificate required), who possess any other
document and who have applied within Canada for
Permanent Resident status, will be eligible on the
date of application for Permanent Resident status —
provided they possess a letter or documentation from
Citizenship and Immigration Canada stating that
they have applied for Permanent Residence.
Non-Canadians married to Canadian Citizens/
Permanent Residents (copy of Marriage Certificate
required), who possess any other document and who
have applied outside Canada for Permanent Resident
status, will be eligible on the date of arrival — provided they possess a letter or documentation from
Citizenship and Immigration Canada stating that
they have applied for Permanent Residence.
In 2008–2009, there were 27,770 Permanent Residents
registered with the health care insurance plan.
Work Permits: Persons moving to Nova Scotia from
outside the country who possess a work permit can
apply for coverage on the date of arrival in Nova
Scotia, providing they will be remaining in Nova
Scotia for at least one full year. A declaration must
be signed to confirm that the worker will not be outside Nova Scotia for more than 31 consecutive days,
except in the course of employment. MSI coverage
is extended for a maximum of 12 months at a time.
Each year a copy of their renewed immigration document must be presented and a declaration signed.
Dependants of such persons, who are legally entitled
to remain in Canada, are granted coverage on the
same basis.
Once coverage has terminated, the person is to be
treated as never having qualified for health services
coverage as herein provided and must comply with
the above requirements before coverage will be
extended to him/her—or their dependents.
In 2008–2009, there were 2,130 individuals with
Employment Authorizations covered under the
health care insurance plan.
Study Permits: Persons moving to Nova Scotia from
another country, who possess a Study Permit will
be eligible for MSI on the first day of the thirteenth
47
Chapter 3: Nova Scotia
month following the month of their arrival, provided they have not been absent from Nova Scotia
for more than 31 consecutive days, except in the
course of their studies. MSI coverage is extended
for a maximum of 12 months at a time and only for
services received within Nova Scotia. Each year, a
copy of their renewed immigration document must
be presented and a declaration signed. Dependants
of such persons, who are legally entitled to remain in
Canada, will be granted coverage on the same basis,
once the student has gained entitlement.
In 2008–2009, there were 882 individuals with
Student Authorizations covered under the health
care insurance plan.
Refugees: Refugees are eligible for MSI if they possess either a work permit or study permit.
4.0 Portability
4.1
Nova Scotia pays the host province rates for insured
services in all reciprocal-billing situations.
There were no changes made in Nova Scotia in
2008–2009 regarding in-Canada portability.
Minimum Waiting Period
Persons moving to Nova Scotia from another
Canadian province or territory will normally
be eligible for MSI on the first day of the third
month following the month of their arrival.
4.2 Coverage During Temporary
Absences in Canada
The Interprovincial Agreement on Eligibility and
Portability is followed in all matters pertaining to
portability of insured services.
Generally, the Nova Scotia MSI Plan provides coverage
for residents of Nova Scotia who move to other provinces or territories for a period of three months, per
the Eligibility and Portability Agreement. Students,
and their dependants, who are temporarily absent
from Nova Scotia and in full-time attendance at an
educational institution, may remain eligible for MSI
on a yearly basis. To qualify for MSI, the student must
provide, to MSI, a letter directly from the educational
institution, which states that they are registered as
full-time students. MSI coverage will be extended on
a yearly basis pending receipt of this letter.
Workers who leave Nova Scotia to seek employment elsewhere will still be covered by MSI for
up to 12 months, provided they do not establish
residence in another province, territory or country.
Services provided to Nova Scotia residents in other
48
provinces or territories are covered by reciprocal
agreements. Nova Scotia participates in the ‘Hospital
Reciprocal Billing Agreement’ and the ‘Medical
Reciprocal Billing Agreement’. Quebec is the only
province that does not participate in the medical
reciprocal agreement. Nova Scotia pays for services
provided by Quebec physicians to Nova Scotia residents at Quebec rates if the services are insured in
Nova Scotia. The majority of such claims are received
directly from Quebec physicians. In-patient hospital
services are paid through the interprovincial reciprocal billing arrangement at the standard ward rate of
the hospital providing the service. The total amounts
paid by the plan in 2008–2009, for in- and out-patient
hospital services received in other provinces and territories was $27,482,997.
4.3 Coverage During Temporary
Absences Outside Canada
Nova Scotia adheres to the Agreement on Eligibility
and Portability for dealing with insured services for
residents temporarily outside Canada. Provided a
Nova Scotia resident meets eligibility requirements,
out-of-country services will be paid, at a minimum,
on the basis of the amount that would have been paid
by Nova Scotia for similar services rendered in this
province. Ordinarily, to be eligible for coverage, residents must not be outside the country for more than
six months in a calendar year. In order to be covered,
procedures of a non-emergency nature must have
prior approval before they will be covered by MSI.
Students and their dependants who are temporarily
absent from Nova Scotia and in full-time attendance
at an educational institution outside Canada may
remain eligible for MSI on a yearly basis. To qualify
for MSI, the student must provide to MSI, a letter
obtained from the educational institution that verifies the student’s attendance there in each year for
which MSI coverage is requested.
Persons who engage in employment (including volunteer/missionary work/research) outside Canada,
which does not exceed 24 months, are still covered
by MSI; providing the person has already met the
residency requirements.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
Emergency out-of-country services are paid at a
minimum on the basis of the amount that would
have been paid by Nova Scotia for similar services
rendered in this province. The total amount spent in
2008–2009 for insured in-patient services provided
outside Canada was $1,190,016.
There were no changes made in Nova Scotia in
2008–2009 regarding out-of-Canada portability.
4.4 Prior Approval Requirement
Prior approval must be obtained for elective services
outside the country. Application for prior approval
is made to the Medical Director of the MSI Plan by
a specialist in Nova Scotia on behalf of an insured
resident. The medical consultant reviews the terms
and conditions and determines whether or not the
service is available in the province, or if it can be
provided in another province or only out-of-country.
The decision of the Medical Consultant is relayed to
the patient’s referring specialist. If approval is given
to obtain service outside the country, the full cost of
that service will be covered under MSI.
5.0 Accessibility
5.1
Access to Insured Health Services
Insured services are provided to Nova Scotia residents under uniform terms and conditions. There
are no user charges or extra charges allowed under
the plan.
Nova Scotia continually reviews access situations
across Canada to ensure equitability of access. In
areas where improvement is deemed necessary,
depending on the Province’s financial situation,
extra funding is generally allocated to that need.
Based on the previous acceptance of the recommendations of the Provincial Osteoporosis Committee
report, which included placing new bone density
units in Sydney and Yarmouth and operating the
Truro unit at full capacity, an additional five units
have been operationalized across the province.
In Fiscal 2007/08, the provision of bilateral cochlear implants was approved for both children and
adults who meet the requirements. To address the
issue of ever increasing orthopaedic wait lists the
Department of Health approved a contract with a
private surgical facility to carry out minor orthopae-
dic surgeries. The procedures are done by Capital
District surgeons and anaesthetists. The patients
are taken from the current public wait lists, there
is no queue-jumping and there is no charge for
the patients. The facility operates as an extension
of the Capital Health Department of Surgery. This
is a one year demonstration project that is undergoing a strict evaluation. It is anticipated that in excess
of 500 patients will be seen at this facility with the
added benefit of freeing up space at Capital Health
for more joint replacements.
A Logic Model Evaluation of this pilot project
was completed in February 2009. The key findings
showed that of the 500 procedures completed the
cost per procedure, including the hourly facility fee
of $500 was 20–30% lower than the cost in our public facilities. Patient satisfaction rates were above 99%.
An additional 235 arthroplasties were completed at
the QEll Health Sciences Centre because of the space
and financial saving associated with completing the
minor surgeries at SSI.11
In addition to this project the Department of Health
and Capital Health are embarking on the establishment of an Orthopaedic Assessment Clinic with the
involvement of Bone & Joint Decade. This is being
undertaken to address the long orthopaedic wait list
in the Halifax area. This ongoing project has reduced
the wait time from GP referral to Specialist consultation from up to 18 months to 8–12 weeks.12
In addition to the latest diffusion of the four MRIs
located in four rural areas (Antigonish, New Glasgow,
Kentville, and Yarmouth) to increase rural access
and reduce provincial wait times and the replacement of two MRIs at the Capital District Health
Authority in Halifax, four new 64-slice computed
tomography units have been installed/replaced in
Halifax (2) and two rural sites. Further, the Truro
Regional Hospital replacement which is expected to
open in the 3rd quarter 2010/2011 will be equipped
with an MRI suite.
The previously approved Positron Emission Tomography Program (PET/CT) became operational on
June 13, 2008. Initially, approval funding is to provide a maximum of 1500 scans per year. In addition
to the PET/CT project, the province has approved
funding for a cyclotron to provide local access to the
required isotopes. It is expected that the cyclotron
will be operational in the third quarter of fiscal year
2009/2010.
11.As a result of the evaluation and the patient satisfaction combined with the financial savings, the project has been continued until March 31, 2010.
12.With DoH support the CDHA has committed to providing an additional 430 arthroplasties on a yearly basis commencing in part in November 2009.
Canada Health Act — Annual Report 2008–2009
49
Chapter 3: Nova Scotia
5.2 Access to Insured Hospital Services 5.3 Access to Insured Physician and
Surgical-Dental Services
The Government of Nova Scotia continues to emphasize the provision of sustainable, quality health care
services to its citizens.
In 2008–2009, a total of $11.0 million in funding was
provided to train, recruit and retain nurses. Since the
start of the nursing strategy, at least 80% new graduates
have renewed their license to practice in Nova Scotia.
Table 1 provides a breakdown of key health professions that are licensed to practice in Nova Scotia.
Not all of these health professionals were actively
involved in delivering insured health services.
In 2008–2009, 2,343 physicians and 29 dentists actively
provided insured services under the Canada Health
Act or provincial legislation. Innovative funding solutions such as block funding and personal services
contracts have enhanced recruitment.
The Province has increased the capacity for medical
education for both Canadian medical students and
internationally educated physicians, coordinates
ongoing recruitment activities and has provided
funding to create a re-entry program for general
practitioners wishing to enter specialty training after
completing two years of general practice service in
the province.
Table 1: Health Personnel in Nova Scotia13
Health Occupation
Physicians
Dentists14
Registered/Licensed to Practice
2,343
528
Registered Nurses
9,655
Licensed Practical Nurses
3,588
Medical Radiation Technologists
551
Respiratory Therapists
252
Pharmacists
1,178
Occupational Therapists
384
Speech-Language Pathologists
190
Chiropractors
112
Opticians
199
Optomotrists
101
Denturists
44
Dieticians
450
Psychologists
495
Physiotherapists
532
13.Not all professionals licensed to practice actually work.
14.A limited number of licensed dentists are approved for insured dental services.
50
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
5.4 Physician Compensation
The Health Services and Insurance Act, RS Chapter
197 governs payment to physicians and dentists for
insured services. Physician payments are made in
accordance with a negotiated agreement between
Doctors Nova Scotia and the Nova Scotia Department
of Health. Doctors Nova Scotia is recognized as the
sole bargaining agent in support of physicians in the
province. When negotiations take place, representatives from Doctors Nova Scotia and the Department
of Health negotiate the total funding and other terms
and conditions. The agreement lays out what the
medical services unit value will be for physician
services and addresses other issues such as Canadian
Medical Protective Association, membership benefits,
emergency department payments, on-call funding,
specific fee adjustments, dispute resolution processes, and other process or consultation issues.
Fee-for-service is still the most prevalent method of
payment for physician services. However, there has
been significant growth in the number of alternative
payment arrangements in place in Nova Scotia.
Over the past number of years, we have seen a
significant shift toward alternative payment. In the
1997–1998 fiscal year, about 9 percent of our doctors were paid solely through alternative funding.
In 2008–2009, 27 percent of physicians were remunerated exclusively through alternative funding.
Approximately 66 percent of physicians receive some
portion of their remuneration through alternative
funding. They can be broken down into three groups:
1) Academic Funding Plan — (these physicians are
mainly located in Halifax at the QEII and the
IWK centres). Most of the Academic Specialist
groups are on alternate funding arrangements
with the exception of Urology, Adult Radiology
and Ophthalmology.
2) Currently there are regional specialist contracts
for anaesthesiology, geriatrics, neonatology, paediatrics, obstetrics/gynaecology, and palliative
care.
3) There are also contract arrangements available to
general practitioners in certain rural areas and
General Practitioner/Nurse Practitioner contracts
that support collaborative practice teams in designated areas.
Canada Health Act — Annual Report 2008–2009
Alternative funding mechanisms include Sessional,
Psychiatry, Remote Practice, Facility On-Call and
Emergency Room funding. In total, over 65 percent
of physicians in Nova Scotia receive all or a portion
of their remuneration through alternative funding
mechanisms.
In 2008–2009, total payments to physicians for
insured services in Nova Scotia were $598,546,450.
The Department paid an additional $7,671,840 for
insured physician services provided to Nova Scotia
residents outside the province, but within Canada.
Payment rates for dental services in the province are
negotiated between the Department of Health and the
Nova Scotia Dental Association and follow a process
similar to physician negotiations. Dentists are paid
on a fee-for-service basis. The current agreement took
effect April 1, 2008 and will expire on March 31, 2013.
5.5 Payments to Hospitals
The Department of Health establishes budget targets
for health care services. It does this by receiving business plans from the nine (9) District Health Authorities
(DHAs), the IWK Health Centre and other non-DHA
organizations. Approved provincial estimates form the
basis on which payments are made to these organizations for service delivery.
The Health Authorities Act was given Royal Assent
on June 8, 2000. The Act instituted the nine DHAs
& the IWK that replaced the former regional health
boards. This change came into effect in January
2001, under the District Health Authorities General
Regulations. The implementation of community
health boards under the Community Health Boards
Member Selection Regulations was effective as of
April 2001. The DHAs/IWK are responsible (section
20 of the Act) for overseeing the delivery of health
services in their districts and are fully accountable
for explaining their decisions on the community
health plans through their business plan submissions
to the Department of Health.
Section 10 of the Health Services and Insurance Act
and sections 9 through 13 of the Hospital Insurance
Regulations define the terms for payments by the
Minister of Health to hospitals for insured hospital
services.
In 2008–2009, there were 3,034 hospital beds in Nova
Scotia (3.0 beds per 1,000 population). Department of
51
Chapter 3: Nova Scotia
Health direct expenditures for insured hospital services operating costs were increased to $1.4 billion.
6.0 Recognition Given to
Federal Transfers
In Nova Scotia, the Health Services and Insurance
Act acknowledges the federal contribution regarding the cost of insured hospital services and insured
health services provided to provincial residents. The
residents of Nova Scotia are aware of ongoing federal
contributions to Nova Scotia health care through the
Canada Health Transfer (CHT) as well as other federal
funds through press releases and media coverage.
The Government of Nova Scotia also recognized
the federal contribution under the CHT in various
published documents including the following
documents released in 2008–2009:
to individuals who require ongoing access to professional nursing services; Residential Care Facilities
which provide accommodation, personal care and/
or supervisory care to four or more individuals in a
residential setting; and Community Based Options
which provide accommodation, personal care and/or
supervisory care for three or less residents. Residents
who live in nursing homes, residential care facilities
and community-based options under the Department
of Health’s mandate have the costs of their health
care services covered by the provincial government.
Residents pay the accommodation cost portion of the
long-term care services they receive. There is a daily
Standard Accommodation Charge for each long-term
care facility type. Subject to an income test, some
residents may have accommodation costs subsidized
through a reduction in the Standard Accommodation
Charge. For more information please see:
www.gov.ns.ca/health/ccs/ltc.htm
• Public Accounts 2008–2009; and
7.2
• Budget Estimates 2008–2009.
Broad-based, provincially funded home care services
are available to Nova Scotians of all ages and help
individuals to reach and maintain their maximum
level of health and to support independent living
in the community. Both chronic care services over
the longer term and short-term acute services are
provided through home care. Home care services
can be provided to people who are chronically ill,
convalescent, palliative, disabled or to individuals with an acute illness. The services available to
individuals through home care include professional
nursing care, assistance with personal care, nutritional care, aid with home making activities, home
oxygen services and respite care. The program also
provides referrals to and linkages with other services such as adult day programs, community based
equipment loan programs, volunteer services, meals
on wheels and community rehabilitation services.
The Department of Health also offers a Self-managed
Care service component to assist physically disabled
Nova Scotians to increase control over their lives.
The Self-managed Care program provides funds to
eligible individuals so that they may directly employ
caregivers to meet their home support and personal
care needs.
7.0 Extended Health Care
Services
The Nova Scotia Department of Health’s Continuing
Care branch offers home care and long-term care
services. These services promote independence, fairness, equity, and choice for people with care needs.
The Department of Health provides a Single Entry
Access to its continuing care services. Nova Scotians
can connect with Continuing Care through a single
toll-free number.
In 2006, the Department of Health released a broad
based, multi-year Continuing Care strategy that will
see the addition of long-term care beds and the expansion and enhancement of community and home based
services over the ensuing five to ten years.
7.1 Nursing Home Intermediate
Care and Adult Residential
Care Services
The Department of Health provides residentially-based
long-term care services in the following facility types:
Nursing Homes & Homes for the Aged which provide
a range of personal care and/or skilled nursing care
52
Home Care Services
In addition to the services outlined above, the
following services and programs are provided to
Nova Scotians outside the requirements of the
Canada Health Act.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
Nova Scotia Seniors’ Pharmacare Program — This
provincial drug insurance plan helps seniors manage their prescription drug costs. Eligible persons
include all residents aged 65 years or older and who
do not have prescription drug coverage through
Veterans Affairs Canada, First Nations and Inuit
Health, or a private drug plan. The program provides access to prescription drugs, and diabetic and
ostomy supplies listed as benefits in the Nova Scotia
Formulary. Persons using this program are responsible for co-payments of 33 percent of the prescription
cost with an annual maximum of $382. General
information regarding Pharmacare can be found at:
www.nspharmacare.ca
Special Funding for Drugs for Specific Disease
States — The Province provides special funding
for drug therapies for a few specific disease states
including cystic fibrosis, diabetes insipidus, cancer
and growth hormone deficiency. There are no user
charges for this coverage. General information regarding Drug Programs and Funding can be found at:
www.nspharmacare.ca
Nova Scotia Family Pharmacare Program — This
provincial drug insurance plan began in March 2008
and is designed provide prescription drug coverage to
Nova Scotians who are at risk of having unmet drug
needs because they are uninsured or underinsured.
The program is available to all residents of Nova
Scotia; however people cannot receive benefits from
the Family Pharmacare and Senior’s Pharmacare
or Diabetes Assistance or Community Services
Income Assistance Pharmacare at the same time.
There are no premiums to join Family Pharmacare,
and the program’s co-payment and deductible have
yearly maximums that are set depending on a family’s annual income. General information regarding
Pharmacare can be found at:
www.nspharmacare.ca
Diabetes Assistance Program — In 2005–2006,
$2.5 million was allocated to design and start this
program. This program helps cover the cost of most
diabetes medications and supplies and is available
to Nova Scotians under 65 years of age who have no
other drug coverage. General information on this
program is available at:
www.nspharmacare.ca
Canada Health Act — Annual Report 2008–2009
Emergency Health Services
Pre-hospital and Out of Hospital Emergency Care —
Emergency Health Services Nova Scotia (EHS) is
responsible for the continual development, implementation, monitoring and evaluation of pre-hospital
and out of hospital emergency health services in
Nova Scotia. EHS integrates various pre-hospital
and out of hospital services and programs into one
system to meet the needs of Nova Scotians. These
services include: EHS ground ambulance system,
EHS LifeFlight (the provincial air medical transport
system), the EHS Medical Communications Centre,
Medical Oversight (Management and Direction),
the EHS NS Trauma Program, EHS Atlantic Health
Training and Simulation Centre and the EHS Medical
First Response program. This integrated provincewide system has been rated in the top 10 percent
of systems in North America. Nova Scotia residents
are typically levied a user charge of $130.60, to be
transported to hospital by ambulance (regardless
of distance). There is no charge to the patient for
transport from hospital to hospital.
Children’s Oral Health Program (COHP)
This program has two components: 1) the Insured
Services Treatment component provides diagnostic,
preventative and restorative services; and 2) the
Public Health Services component provides prevention-oriented activities through the application of
public health initiatives. Children are eligible for
services up to the end of the month in which they
turn 10 years of age.
Special Dental Plans
This covers all dental services required, including
prosthetics and orthodontics required by persons
diagnosed as having a cleft palate cranofacial disorder; as well as in-hospital and office delivered dental
services provided to those diagnosed as being severely
mentally challenged. Maxillofacial prosthodontic services are also included within this group of services.
Diagnostic, preventive and restorative procedures to
residents of the Nova Scotia School for the Blind are
provided by the Paediatric Dentistry Program of the
IWK Health Centre.
Beneficiaries covered are: patients registered with
the Cleft Palate Cranofacial Clinic at the IWK Health
Centre; registered students at the School for the
Blind; patients with a signed statement to the effect
53
Chapter 3: Nova Scotia
that they are severely mentally challenged and
require hospitalization for dental treatment; and
those residents requiring the services of a maxillofacial prosthodontist.
Specific services include:
• Prevention and community education;
• Community Based Services, including:
Mental Health Services
• Adolescent Services;
The IWK Heath Centre and the District Health
Authorities (DHAs), provide mental health services
to Nova Scotians of all ages. A continuum of services is available across five core program areas:
promotion, prevention and advocacy, outpatient
and outreach services, community mental health
supports, inpatient services and specialty services.
These specialty services include: eating disorders,
forensic mental health, seniors mental health, early
psychosis, concurrent mental health and substance
abuse disorders and neuro-developmental disorders
for children and youth. Specialty services are located
in the more heavily populated areas of the province
and are accessible through all DHAs. This continuum
of services is publicly funded.
• Driving While Impaired and Ignition Interlock;
Nova Scotia Addiction Services
In Nova Scotia, the provision of Addiction Services is
regionalized. Addiction services are provided through
nine DHAs and the IWK Health Centre. These organizations are responsible for coordinating prevention
and treatment services related to drugs, alcohol and
gambling. In some cases service delivery is provided
via a shared service arrangement between two or three
DHAs. The provincial Department of Health and the
Department of Health Promotion and Protection are
jointly responsible for setting provincial directions in
substance abuse prevention and treatment, establishing and monitoring provincial standards for addiction
services, monitoring the quality of prevention and
treatment services across the system, supporting a
provincial client data base, and maintaining provincial alcohol and other drug use monitoring and
surveillance system. The Departments work to ensure
that there is provincial coordination around addiction prevention and treatment issues and support
knowledge development and exchange opportunities
throughout the province.
Programs and services are offered on out-patient, day
or residential basis.
54
• Nicotine Treatment;
• Problem Gambling Services;
• Women’s Services;
• Withdrawal Management;
• Structured Treatment Program; and
• Methadone Maintenance Treatment.
Client needs are viewed holistically and services
are tailored to meet individual needs. Treatment
plans are based on a comprehensive assessment and
may include a combination of individual, family
and group therapy. Addiction services staff work in
partnership with many other community services
to ensure that clients are able to access the ranges
of services necessary for recovery.
Optometric Benefit
This benefit provides insurance for visual analysis carried out by optometrists. Vision analysis is
defined as: “... an examination that includes the
determination of: 1) the refractive status of the eye;
2) the presence of any observed abnormality in the
visual system, and all necessary tests and prescriptions connected with such determination.” Coverage
is limited to one routine vision analysis every two
years for those under 10 years of age and those 65
and over. Those between 10 and 65 are not covered
for routine analyses, but are covered where medical
need is indicated.
Prosthetic Services
All insured residents of the province are eligible
for financial assistance in acquiring and replacing
standard arm and leg prostheses prescribed by a
qualified physician and repairs on such prostheses
as required. Patients are responsible for all costs over
and above stated coverage.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
Interpreter Service Program
Out of Province Travel and Accommodation:
This program guarantees equal access to government
services, offered to the general public, to eligible deaf
and hard of hearing residents of Nova Scotia.
Nova Scotians can face health challenges that require
medically insured services that are not available in
the province. In 2009/10 the Department will develop
a new out-of-province travel and accommodation
policy to help support individuals needing access
to care outside of Nova Scotia.
Speech and Language Pathology Program
The service options of this program include:
1) one-to-one therapy; 2) small-group therapy;
and 3) consultations (e.g. classroom, day-cares,
developmental preschools, and residential facilities for individuals with special needs). The
Nova Scotia Hearing and Speech Centres provide
specialized services such as dysphagia (swallowing)
programs and pervasive developmental delay programs at limited locations in the province. There
are no user charges. Eligible persons include children from birth to school age and individuals when
they leave school through their adult lifespan.
Provincial school boards service children in the
public school system.
Canada Health Act — Annual Report 2008–2009
French Language Services Plan:
Through the creation of the French Language
Services Act and the development of the French
Language Services Regulations, The Department of
Health has committed to increasing access to health
services for French speaking minority communities.
This includes addressing the needs of the Acadian
and Francophone communities of Nova Scotia
through the development of a French Language
Services Plan.
55
Chapter 3: Nova Scotia
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
961,089
963,993
965,044
970,450
975,206
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
35
35
35
35
35
b. chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c. rehabilitative care
not applicable
not applicable
not applicable
not applicable
not applicable
d. other
not applicable
not applicable
not applicable
not applicable
not applicable
e. total
35
35
35
35
35
3. Payments for insured health services ($):
15
a. acute care
1,133,215,533
1,230,549,093
1,301,306,116
1,367,828,540
1,406,145,241
b. chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c. rehabilitative care
not applicable
not applicable
not applicable
not applicable
not applicable
d. other
not applicable
not applicable
not applicable
not applicable
not applicable
e. total
1,133,215,533
1,230,549,093
1,301,306,116
1,367,828,540
1,406,145,241
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
0
0
0
0
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
b. diagnostic imaging facilities
not available
not available
not available
not applicable
not applicable
c. total
not available
not available
not available
not applicable
not applicable
0
16
16
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
2,335
2,252
2,154
2,257
2008–2009
2,310
15,795,451
16,285,032
14,502,141
16,726,553
15,924,363
34,166
37,811
41,729
42,569
42,089
6,107,316
7,345,702
8,269,002
8,946,688
11,558,634
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
not available
not available
not available
not available
not available
678,205
1,495,313
727,586
1,257,620
1,190,016
12.Total number of claims, out-patient (#).
not applicable
not available
not available
not available
not available
13.Total payments, out-patient ($).
not applicable
not available
not available
not available
not available
11.Total payments, in-patient ($).
15.$’s are paid to acute care facilities/DHAs only.
16.$’s paid to physicians working out of private for profit facilities are included in indicator #18 — total fee for service payments.
56
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nova Scotia
Insured Physician Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
905
948
944
943
964
14.Number of participating physicians (#):
a. general practitioners
b. specialists
1,235
1,270
1,333
1,341
1,372
c. other
27
2
5
6
7
d. total
2,167
2,220
2,282
2,290
2,343
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
not applicable
not applicable
b. specialists
0
0
0
not applicable
not applicable
c. other
0
0
0
not applicable
not applicable
d. total
0
0
0
not applicable
not applicable
9,290,207
9,599,128
9,569,146
9,591,989
9,806,908
464,685,571
540,495,196
581,817,423
555,659,788
598,546,450
6,353,382
6,553,774
6,357,622
6,223,067
6,284,680
246,724,107
254,621,655
255,007,711
258,751,069
266,174,648
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
188,118
198,262
205,237
212,404
215,490
5,866,887
6,619,938
7,091,572
7,606,977
7,671,840
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
3,111
2,981
2,931
2,701
3,051
151,175
151,414
153,937
134,729
161,555
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
25
33
29
27
29
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
17
18
4,343
5,169
5,321
5,831
6,254
995,966
1,060,006
1,122,126
1,215,333
1,374,645
17.Total services includes block funded dentists.
18.Total payments does not include block funded dentists.
Canada Health Act — Annual Report 2008–2009
57
58
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
• Miramichi-based RHA B replaced RHA1
South East (Moncton), RHA 2 (Saint John),
RHA 3 (Fredericton), and RHA 7 (Miramichi).
New Brunswick
Introduction
New Brunswick remains committed to the five
fundamental principles of the Canada Health Act
(CHA), a commitment which is evident both in the
day to day functioning of the various elements of
New Brunswick’s health system, and in new initiatives announced or implemented in 2008–2009.
April 1, 2008, witnessed the introduction of a new
provincial health plan: Advancing Health Care
by Putting Patients First. This plan will guide the
provincial health system through 2012, focusing
on six pillars:
• achieving a better balance between the need
to promote good health and provide health
care for those who are ill;
• enhancing access to health services when,
where and how they are needed;
• improving the overall efficiency of the
health-care system;
• harnessing innovation to improve safety,
effectiveness, quality and efficiency;
• making quality count in the planning,
implementation and delivery of all
health-care services; and
• engaging partners in all aspects of
health-care delivery.
In concert with the new Plan, work began to renew
the health system’s governance structure. The number
of Regional Health Authorities (RHA) was reduced
to two:
• Bathurst-based RHA A replaced RHA 1
Beauséjour (Moncton), RHA 4 (Edmundston),
RHA 5 (Campbellton) and RHA 6 (Bathurst).
Canada Health Act — Annual Report 2008–2009
Intended to better ensure standardized care throughout the province, the action also replaced the existing
RHA boards with new 17-member boards of directors,
appointed by the Lieutenant Governor in Council based
on demonstrated competencies. In addition, two further
agencies were created as of the same date, to assume
specific roles:
• Facilicorp NB was established to assume the
provision of a number of non-clinical services
on behalf of the RHAs. Currently responsible to
provide Materials Management and Information
Technology services to the RHAs, Facilicorp’s
role will expand over time to include accounts
payable/receivable and payroll, clinical engineering, energy retrofitting, and laundry services.
• The New Brunswick Health Council was established to measure, monitor and evaluate New
Brunswick’s health system performance through a
dual mandate of public engagement and evaluating
population health and health service quality.
Both the RHAs and these two new agencies assumed
full operational responsibilities on September 1, 2008.
These actions, and a number of associated investments in services in some ways mirror the Canada
Health Act’s principles (e.g. Enhancing Access),
while in other ways reflect CHA principles implicitly.
The transformed governance structure expresses New
Brunswick’s ongoing commitment to health care’s public administration, while exploring options to improve
integration, efficiency, quality, and accessibility.
As these initiatives and others become fully implemented, their workings and refinement will continue
within the context of the CHA principles, and New
Brunswick’s obligations to its citizens.
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
In New Brunswick, the health care insurance plan
is known as the Medical Services Plan. The public
authority responsible for operating and administering the plan is the Minister of Health (“Minister”),
whose authority rests under the Medical Services
Payment Act and its Regulations.
59
Chapter 3: New Brunswick
The Medical Services Payment Act and Regulations
specify eligibility criteria, the rights of the beneficiary
and the responsibilities of the provincial authority,
including the establishment of a medical service plan,
the insured and the uninsured services. The legislation
also stipulates the type of agreements the provincial
authority may enter into with provinces and territories
and with the New Brunswick Medical Society. As well,
it specifies the rights of a medical practitioner; how the
amounts to be paid for entitled services will be determined; how assessment of accounts for entitled services
may be made; and confidentiality and privacy issues
as they relate to the administration of the Medical
Services Payment Act.
1.2 Reporting Relationship
The Medicare — Insured Services Branch and the
Medicare — Eligibility and Claims Branch of the
Department of Health (the “Department”) are mandated to administer the Medical Services Plan. The
Minister reports to the Legislative Assembly through
the Department’s annual report and through regular
legislative processes.
The Regional Health Authorities Act establishes the
RHAs and sets forth the powers, duties and responsibilities of same. The Minister is responsible for the
administration of the Act, provides direction to the
RHAs and may delegate additional powers, duties or
functions to an RHA.
1.3 Audit of Accounts
Three groups have a mandate to audit the Medical
Services Plan.
1) The Office of the Auditor General: In accordance
with the Auditor General Act, the Office of the
Auditor General conducts the external audit of
the accounts of the Province of New Brunswick,
which includes the financial records of the
Department. For 2008–2009, all financial transactions of the Department were subject to audit.
These procedures are completed on a routine
basis each year. Following the audit, the Auditor
General issues a management letter or report
to identify errors and control weaknesses. The
Auditor General also conducts management
reviews on programs as he or she sees fit and
follows up on prior years’ audits. For 2008–2009,
the Auditor General also reported on the Fee for
Service Physicians’ Retention Fund, and followed
up on prior recommendations regarding the
Prescription Drug Program and the Health Levy.
60
2) The Office of the Comptroller: The Comptroller is
the chief internal auditor for the Province of New
Brunswick and provides accounting, audit and
consulting services in accordance with responsibilities and authority set out in the Financial
Administration Act. The Comptroller’s internal
audit objectives cover Appropriations Audits,
Information Systems Audits, Statutory Audits
and Value-For-Money Audits. The audit work
performed by the Office varies, depending on
the nature of the entity audited and the audit
objectives. During 2008–2009, the Office of the
Comptroller performed audits of payments made
by the Department of Health.
3) Department of Health Internal Audit Branch:
(1) The Department’s Internal Audit Branch
was established to independently review and
evaluate departmental activities as a service to
all levels of management. This group is responsible for providing departmental management
with information about the adequacy and the
effectiveness of its system of internal controls and
adherence to legislation and stated policy. The
Branch also performs program audits to report
on the efficiency, effectiveness and economy of
programs in meeting departmental objectives.
During 2008–09, the Branch continued work on
a review of Medicare card usage. (2) In accordance with the Medical Services Payment Act,
the Audit section of Medicare — Eligibility and
Claims is responsible for auditing physician
payments to ensure they are made in accordance
with the Medical Service Plan. When appropriate, funds are recovered from physicians.
2.0 Comprehensiveness
2.1
Insured Hospital Services
Legislation providing for insured hospital services
includes the Hospital Services Act, section 9 of
Regulation 84-167 and the Hospital Act. At the
beginning of fiscal 2008–09 there were eight RHAs
established under the authority of the Regional
Health Authorities Act; the number was reduced
to two RHAs effective September 1, 2008. Each
RHA includes regional hospital facilities and a
number of smaller facilities, all of which provide
insured services for both in- and out-patients.
Each RHA has health facilities and health centres
without designated beds that provide a range of
services to entitled persons.
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
Under Regulation 84-167 of the Hospital Services
Act, New Brunswick residents are entitled to the
following in-patient and out-patient insured hospital
services.
In-patient services include:
• accommodation and meals at the standard
ward level;
• necessary nursing service;
• laboratory, radiological and other diagnostic
procedures, together with the necessary interpretations for maintaining health, preventing
disease and helping diagnose and treat any
injury, illness or disability;
• drugs, biological and related preparations;
• use of operating room, case room and anaesthetic facilities, including necessary equipment
and supplies, and routine surgical supplies;
• use of radiotherapy facilities, where available;
• use of physiotherapy facilities, where available;
and
• services rendered by persons who receive remuneration therefore from the RHA.
Out-patient services in a hospital facility operated by
an approved RHA are as follows:
• laboratory and diagnostic procedures, together
with the necessary interpretations when referred
by a medical practitioner or nurse practitioner,
when approved facilities are available;
• laboratory and diagnostic procedures, together
with the necessary interpretations, where
approved facilities are available, when performed for the purpose of a mammography
screening service that has been approved by
the Minister of Health;
• the hospital component of available outpatient
services when prescribed by a medical practitioner or nurse practitioner and provided in
an out-patient facility of an approved RHA, for
maintaining health, preventing disease and
helping diagnose and treat any injury, illness
or disability, excluding the following services:
• the provision of any proprietary medicines;
• diagnostic services performed to satisfy
the requirements of third parties, such
as employers and insurance companies;
• visits solely for the administration of drugs,
vaccines, sera or biological products; and
• any out-patient service that is an entitled service under the Medical Services Payment Act.
The process for adding a hospital service to the list of
insured services involves the Department receiving a
proposal from a RHA or other stakeholder, who is then
screened for eligibility against the criteria for insured
hospital services described under the Hospital Services
Act and its Regulations.
On March 31, 2009, 53 facilities existed in New
Brunswick which delivered insured hospital services to in-patients or out-patients. Many of these
provided more than one type of care (e.g. both acute
and chronic care), but the breakdown of facilities
by their primary function was:
• 22 provided acute care,
• 0 provided chronic care,
• 1 provided rehabilitative care, and
• 30 provided other (e.g., Community Health Centre).
2.2 Insured Physician Services
The enabling legislation providing for insured physician services is the Medical Services Payment Act and
corresponding Regulations.
No changes pertaining to physician services were
introduced to this Act and regulations during fiscal
2008–2009.
The New Brunswick Medical Services Plan covers
physicians who provide medically required services.
The conditions that a physician must meet to participate in the New Brunswick Medical Services Plan are:
• maintain current licensure with the New
Brunswick College of Physicians and Surgeons;
• maintain membership in the New Brunswick
Medical Society;
• hold privileges in a RHA; and
• signing of the Participating Physicians Agreement.
• the provision of medications for the patient
to take home;
Canada Health Act — Annual Report 2008–2009
61
Chapter 3: New Brunswick
The number of physicians with an active status as
of March 31, 2009, was 1,500, of which 730 were
general practitioners, and 770 specialists.
Physicians in New Brunswick have the option
to opt out totally or for selected services. Totally
opted-out practitioners are not paid directly by
Medicare for the services they render and must
bill patients directly in all cases. Patients are
not entitled to reimbursement from Medicare for
services rendered by totally opted-out physicians.
The selective opting-out provision may not be invoked
in the case of an emergency or for continuation of care
commenced on an opted-in basis. Opted-in physicians
wishing to opt out for a service must first obtain the
patient’s agreement to be treated on an opted-out basis,
after which they may bill the patient directly for the
service. In these instances the following procedures
must be adhered to.
The physician must advise the patient in advance and:
• the charges must not exceed the Medicare tariff.
The practitioner must complete the specified
Medicare claim forms and indicate the exact
total amount charged to the patient. The beneficiary seeks reimbursement by certifying on the
claim form that the services have been received
and forwarding the claim form to Medicare;
• if the charges will be in excess of the Medicare
tariff, the practitioner must inform the beneficiary
before rendering the service that:
• they are opting out and charging fees above
the Medicare tariff;
• in accepting service under these conditions,
the beneficiary waives all rights to Medicare
reimbursement; and
• the patient is entitled to seek services from
another practitioner who participates in the
Medical Services Plan.
• the physician must obtain a signed waiver from
the patient on the specified form and forward
such form to Medicare.
As of March 31, 2009, no physicians rendering health
care services had elected to completely opt out of the
New Brunswick Medical Services Plan.
The range of entitled services under Medicare includes
the medical portion of all services rendered by medical practitioners that are medically required. It also
62
includes certain surgical-dental procedures when
performed by a physician or a dental surgeon in a
hospital facility. The range of non-entitled services is
set out under Schedule 2, Regulation 84-20 and the
Medical Services Payment Act.
An individual, a physician or the Department may
request the addition of a new service. All requests
are considered by the New Service Items Committee,
which is jointly managed by the New Brunswick
Medical Society and the Department. The decision
to add a new service is usually based on conformity
to “medically necessary” and whether the service
is considered generally acceptable practice (not
experimental) within New Brunswick and Canada.
Considerations under the term “medically necessary”
include services required for maintaining health,
preventing disease and/or diagnosing or treating an
injury, illness or disability. No public consultation
process is used.
No physician services were added or deleted during
fiscal 2008–2009.
2.3 Insured Surgical-Dental Services
Schedule 4 of Regulation 84-20 under the Medical
Services Payment Act, identifies the insured surgicaldental services that can be provided by a qualified
dental practitioner in a hospital, providing the condition of the patient requires services to be rendered in
a hospital. In addition, a general dental practitioner
may be paid to assist another dentist for medically
required services under some conditions.
In addition to Schedule 4 of Regulation 84-20, Oral
Maxillofacial Surgeons (OMS) have added access to
approximately 300 service codes in the Physician
Manual and can admit and discharge patients in
addition to performing physical examinations.
The array of services includes those performed
in an outpatient setting.
The conditions that an OMS and a dental practitioner
must meet to participate in the medical plan are:
• maintaining current registration with the
New Brunswick Dental Society; and
• completing the Participating Physician’s
Agreement (included in the New Brunswick
Medicare Dental registration form).
As of March 31, 2009, there were 94 OMSs and
dentists registered with the Plan.
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
OMSs and Dentists have the same opting out provision as physicians (see section 2.2) and must follow
the same guidelines. The Department has no data for
the number of non-enrolled dental practitioners in
New Brunswick.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital services include the following:
patent medicines; take-home drugs; third-party
requests for diagnostic services; visits to administer
drugs, vaccines, sera or biological products; televisions and telephones; preferred accommodation at the
patient’s request; and hospital services directly related
to services listed under Schedule 2 of the Regulation
under the Medical Services Payment Act.
• vaccines, serums, drugs and biological products
listed in sections 106 and 108 of New Brunswick
Regulation 88-200 under the Health Act;
• advice or prescription renewal by telephone
which is not specifically provided for in the
Schedule of Fees;
• examinations of medical records or certificates
at the request of a third party, or other services
required by hospital regulations or medical
by-laws;
• dental service provided by a medical practitioner
or an OMS;
• services that are generally accepted within
New Brunswick as experimental or that are
provided as applied research;
Services are not insured if provided to those entitled
under other statutes.
• services that are provided in conjunction with,
or in relation to, the services referred to above;
The services listed in Schedule 2 of New Brunswick
Regulation 84–20 under the Medical Services Payment
Act are specifically excluded from the range of
entitled medical services under Medicare, namely:
• testimony in a court or before any other tribunal;
• elective surgery or other services for cosmetic
purposes;
• correction of inverted nipple;
• breast augmentation;
• immunization, examinations or certificates
for travel, employment, emigration, insurance
purposes, or at the request of any third party;
• services provided by medical practitioners or
OMS to members of their immediate family;
• psychoanalysis;
• otoplasty for persons over the age of 18;
• electrocardiogram (ECG) where not performed by
a specialist in internal medicine or paediatrics;
• removal of minor skin lesions, except where the
lesions are, or are suspected to be, pre-cancerous;
• laboratory procedures not intended as part of an
examination or consultation fee;
• abortion, unless the abortion is performed by
a specialist in the field of obstetrics and gynaecology in a hospital facility approved by the
jurisdiction in which the hospital facility is
located and two medical practitioners certify
in writing that the abortion was medically
required;
• refractions;
• surgical assistance for cataract surgery unless
such assistance is required because of risk of
procedural failure, other than the risk inherent
in removing the cataract itself, due to the
existence of an illness or other complication;
• medicines, drugs, materials, surgical supplies
or prosthetic devices;
Canada Health Act — Annual Report 2008–2009
• services provided within the province by medical practitioners, OMS or dental practitioners
for which the fee exceeds the amount payable
under this Regulation;
• the fitting and supplying of eyeglasses or contact
lenses;
• transsexual surgery;
• radiology services provided in the province by
a private radiology clinic;
• acupuncture;
• complete medical examinations when performed
for a periodic check-up and not for medically
necessary purposes;
63
Chapter 3: New Brunswick
• circumcision of the newborn;
• reversal of vasectomies;
• second and subsequent injections for impotence;
• reversal of tubal ligation;
• intrauterine insemination;
• bariatric surgery unless the person (i) has a body
mass index of 40 or greater, (ii) has obesity-related
co-morbid conditions, and (iii) has, under the
supervision of a medical practitioner, commenced
and failed an exercise and diet program to reduce
the person’s weight to a more acceptable level; and
• venipuncture for the purpose of taking blood
when performed as a stand-alone procedure in a
facility that is not an approved hospital facility.
Dental services not specifically listed in Schedule 4
of the Dental Schedule are not covered by the Plan.
Those listed in Schedule 2 are considered the only
non-insured medical services. There are no specific policies or guidelines, other than the Act and
Regulations, to ensure that charges for uninsured
medical goods and services (i.e., enhanced medical
goods and services such as intraocular lenses, fibreglass casts, etc.), provided in conjunction with an
insured health service, do not compromise reasonable
access to insured services. Intraocular lenses are now
provided by the hospitals.
The decision to de-insure physician or surgical-dental
services is based on the conformity of the service to the
definition of “medically necessary,” a review of medical
service plans across the country and the previous use
of the particular service. Once a decision to de-insure
is reached, the Medical Services Payment Act dictates
that the government may not make any changes to the
Regulation until the advice and recommendations
of the New Brunswick Medical Society are received
or until the period within which the Society was
requested by the Minister to furnish advice and make
recommendations has expired. Subsequent to receiving
their input and resolution of any issues, a regulatory
change is completed. Physicians are informed in writing following notification of approval. The public is
usually informed through a media release. No public
consultation process is used.
In 2008–2009 no services were removed from
the insured service list.
64
3.0 Universality
3.1
Eligibility
Sections 3 and 4 of the Medical Services Payment
Act and its Regulation 84-20, define eligibility for
the health care insurance plan in New Brunswick.
Residents are required to complete a Medicare application and to provide proof of Canadian citizenship,
Native status or valid Canadian immigration document. A resident is defined as a person lawfully
entitled to be, or to remain, in Canada, who makes
his or her home and is ordinarily present in New
Brunswick, but does not include a tourist, transient,
or visitor to the province.
All persons entering or returning to New Brunswick
(excluding children adopted from outside Canada)
have a waiting period before becoming eligible for
Medicare coverage. Coverage commences on the
first day of the third month following the month
of arrival.
Residents who are ineligible for Medicare coverage
include:
• regular members of the Canadian Armed Forces;
• members of the Royal Canadian Mounted Police
(RCMP);
• inmates of federal prisons;
• persons moving to New Brunswick as temporary
residents;
• a family member who moves from another
province to New Brunswick before other
family members move;
• persons who have entered New Brunswick from
another province to further their education and
who are eligible to receive coverage under the
medical services plan of that province; and
• non-Canadians who are issued certain types of
Canadian authorization permits (e.g., a Student
Authorization).
Provisions to become eligible for Medicare coverage
include:
• non-Canadians who are issued an immigration
permit that would not normally entitle them to
coverage are eligible if legally married to, or in
a common-law relationship with, an eligible
New Brunswick resident.
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
Provisions when status changes include:
• persons who have been discharged or released
from the Canadian Armed Forces, the RCMP or
a federal penitentiary. Provided they are residing
in New Brunswick at the time, these persons are
eligible for coverage on the date of their release.
They must complete an application, provide
the official date of release and provide proof
of citizenship.
3.2 Registration Requirements
A beneficiary who wishes to become eligible to
receive entitled services shall register, together
with any dependants under the age of 19, on a
form provided by Medicare for this purpose, or be
registered by a person acting on his or her behalf.
Upon approval of the application, the beneficiary
and dependants are registered and a Medicare card
with an expiry date is issued to the beneficiary and
each dependent.
A Notice of Expiry form providing all family information currently existing on the Medicare files is issued to
the beneficiary two or three months before the expiry
date of the Medicare card or cards. A beneficiary who
wishes to remain eligible to receive entitled services is
required to confirm the information on the Notice of
Expiry, to make any changes as appropriate and return
the form to Medicare. Upon receiving the completed
form, the file is updated and new card(s) are issued
bearing a revised expiry date.
Currently in New Brunswick, only those individuals
deemed eligible are registered; the total number of
persons registered as of March 31, 2009 was 742,974.
All family members (the beneficiary, spouse and
dependents under the age of 19) are required to register as a family unit. Residents who are cohabiting,
but not legally married, are eligible to register as a
family unit if they so request.
Residents may opt out of Medicare coverage if they
choose. They are asked to provide written confirmation of their intention. This information is added to
their files and benefits are terminated.
3.3 Other Categories of Individual
Non-Canadians who may be issued an immigration permit that would not normally entitle them to
Medicare coverage are eligible, provided that they
Canada Health Act — Annual Report 2008–2009
are legally married to, or living in a common-law
relationship with, an eligible New Brunswick resident and still possess a valid immigration permit.
At the time of renewal, they are required to provide
an updated immigration document.
4.0 Portability
4.1
Minimum Waiting Period
A person is eligible for New Brunswick Medicare
coverage on the first day of the third month following
the month permanent residence has been established
in New Brunswick. The three month waiting period
is legislated under New Brunswick’s Medical Services
Payment Act and no exemptions can be made.
4.2 Coverage During Temporary
Absences in Canada
The legislation that defines portability of health insurance during temporary absences in Canada is
the Medical Services Payment Act, Regulation 84-20,
sub-sections 3(4) and 3(5).
Students in full-time attendance at a university or
other approved educational institution who leave
New Brunswick to further their education in another
province are granted coverage for a 12-month period
that is renewable provided they comply with the
following:
• provide proof of enrolment;
• contact Medicare once every 12-month period
to retain their eligibility;
• do not establish residence outside New
Brunswick; and
• do not receive health coverage in another
province.
Residents temporarily employed in another province
or territory, are granted coverage for up to 12 months
provided the following terms are adhered to:
• residents do not establish residence in another
province;
• residents do not receive coverage in another
province; and
• residents plan on returning to New Brunswick.
65
Chapter 3: New Brunswick
If absent longer than 12 months, residents should
apply for coverage in the province or territory where
they are employed and should be entitled to receive
coverage on the first day of the thirteenth month.
New Brunswick has formal agreements with all
Canadian provinces and territories for reciprocal
billing of insured hospital services. In addition,
New Brunswick has reciprocal agreements with all
provinces except Quebec for the provision of insured
physicians’ services. Services provided by Quebec
physicians to New Brunswick residents are paid at
Quebec rates, if the service delivered is insured in
New Brunswick. The majority of such claims are
received directly from Quebec physicians. Any paid
claims submitted by the patient are reimbursed to the
patient, according to New Brunswick regulations.
Payments made for insured services provided to New
Brunswick residents in other provinces and territories during 2008–2009 were $37,772,992 (in-patient),
and $12,858,195 (out-patient).
4.3 Coverage During Temporary
Absences Outside Canada
The legislation that defines portability of health
insurance during temporary absences outside Canada
is the Medical Services Payment Act, Regulation 84-20,
sub-sections 3(4) and 3(5).
Eligibility for “temporarily absent” New Brunswick
residents is determined in accordance with the
Medical Services Payment Act and Regulations
and the Inter-Provincial Agreement on Eligibility
and Portability.
Residents temporarily employed outside the country
are granted coverage for up to 12 months, regardless
if it is known beforehand that they will be absent
beyond the 12-month period, provided they do not
establish residence outside Canada.
Any absence over 182 days, whether it is for work
purposes or vacation, would require the Director’s
approval. This approval can only be up to 12 months
in duration and will only be granted once every three
years. Families of workers temporarily employed outside Canada will continue to be covered, provided
that they reside in New Brunswick.
New Brunswick residents who exceed the 12 month
extension have to reapply for New Brunswick Medicare
upon their return to New Brunswick, and be subject
to the legislated three month waiting period. However,
66
a “grace period” of up to 14 days could be extended to
those New Brunswick residents who have been “temporarily absent” slightly beyond the 12 month absence.
In some cases this would alleviate having to reapply
as a returning resident with the legislated three month
waiting period.
Mobile Workers
Mobile Workers are residents whose employment
requires them to travel outside the province (e.g.,
pilots, truck drivers, etc.). Certain guidelines must
be met to receive Mobile Worker designation. These
are as follows:
• applications must be submitted in writing;
• documentation is required as proof of Mobile
Worker status (e.g., letter from employer confirming that frequent travel is required outside
New Brunswick; letter from New Brunswick
resident confirming that their permanent residence is New Brunswick and how often they
return to New Brunswick; copy of resident’s
New Brunswick drivers license; if working
outside Canada, copy of resident’s Immigration
document that allows them to work outside the
country);
• the worker’s permanent residence must remain
in New Brunswick; and
• the worker must return to New Brunswick
during their off-time.
Mobile Worker status is assigned for a maximum of
two years, after which the New Brunswick resident
must reapply and resubmit documentation to confirm
continuing Mobile Worker status.
Contract Workers
Any New Brunswick resident accepting a contract
out-of-country must supply the following information and documentation:
• letter of request from the New Brunswick resident with their signature, detailing their absence
including Medicare number, New Brunswick
address, date of departure, destination and forwarding address, reason for absence and date
of return; and
• copy of contractual agreement between employee
and employer which defines a start date and end
date of employment.
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
“Contract Worker” status is assigned for up to a maximum of two years. Any further requests for contract
worker status must be forwarded to the Director of
Medicare Eligibility and Claims for approval on an
individual basis.
Students
Those in full-time attendance at a university or other
approved educational institution, who leave New
Brunswick to further their education in another
country, will be granted coverage for a 12-month
period that is renewable, provided that they do
the following:
• provide proof of enrolment;
• contact Medicare, once every 12-month period
to retain their eligibility;
• do not establish permanent residence outside
New Brunswick; and
• do not receive health coverage elsewhere.
Insured residents who receive insured emergency
services out of country are eligible to be reimbursed
$100 per day for in-patient stay and $50 per outpatient visit. The insured resident is reimbursed for
physician services associated with the emergency
treatment at NB rates. The difference in rates is the
patient’s responsibility (private insurance).
• In 2008–2009, New Brunswick funded the following insured services for insured residents
temporarily outside Canada:
• $753,104 for in-patient services;
• $561,855 for out-patient services;
• $341,618 for physician services.
4.4 Prior Approval Requirement
Medicare will cover out-of-country services that are
not available in Canada on a prior approval basis
only. Residents may opt to seek non-emergency outof-country services; however, those who receive such
services will assume responsibility for the total cost.
New Brunswick residents may be eligible for reimbursement if they receive elective medical services
outside the country, provided they fulfill the following requirements:
Canada Health Act — Annual Report 2008–2009
• the required service, or equivalent or alternate
service, must be unavailable in Canada;
• it must be rendered in a hospital listed in
the current edition of the American Hospital
Association Guide to the Health Care Field
(guide to United States hospitals, health care
systems, networks, alliances, health organizations, agencies and providers);
• the service must be rendered by a medical
doctor; and
• the service must be an accepted method of
treatment recognized by the medical community and be regarded as scientifically proven
in Canada. Experimental procedures are not
covered.
If the above requirements are met, it is mandatory
to request prior approval from Medicare in order
to receive coverage. A physician, patient or family
member may request prior approval to receive these
services outside the country, accompanied by supporting documentation from a Canadian specialist
or specialists.
Out-of-country insured services that are not available
in Canada, are non-experimental, and receive prior
approval are paid in full. Often the amount payable
is negotiated with the provider by the Canadian
Medical Network on the province’s behalf.
The following are considered exemptions under the
out-of-country coverage policy:
• haemodialysis: patients will be required to
obtain prior approval and Medicare will reimburse the resident at a rate equivalent to the
inter-provincial rate of $220 per session; and
• allergy testing for environmental sensitivity: all
tests outside the country will be paid at a maximum rate of $50 per day, an amount equivalent
to an out-patient visit.
Prior approval is also required to refer patients to
psychiatric hospitals and addiction centres outside the province because they are excluded from
the Interprovincial Reciprocal Billing Agreement.
A request for prior approval must be received by
Medicare from the Addiction Services or Mental
Health branches of the Department of Health.
67
Chapter 3: New Brunswick
5.0 Accessibility
5.1
Access to Insured Health Services
New Brunswick charges no user fees for insured
health services as defined by the Canada Health Act.
Therefore, all residents of New Brunswick have equal
access to these services.
5.2 Access to Insured Hospital Services
People representing many different health professions
work in New Brunswick’s health care facilities, providing insured hospital services. As of March 31, 2009, a
summary of some of the most prominent professions
includes:
• 5,947 nurses providing general care,
• 118 community health nurses,
• 44 nurse practitioners,
• 239 nurse supervisors,
• 1,611 licensed practical nurses,
• 775 other nursing resource workers,
• 845 diagnostic imaging technicians or
technologists,
• 545 medical laboratory technicians or
technologists,
• 338 occupational therapists or occupational
therapy assistants,
• 69 audiologists or audiology assistants,
• 107 psychologists,
• 177 dieticians,
• 155 speech language pathologists,
• 137 pharmacists,
• 276 physiotherapists, and
• 369 social workers.
New Brunswick has well-established recruitment
and retention initiatives for nurses and allied health
professionals, which are aimed at addressing health
human resources labour market planning and management at the Provincial level. Regional Health
68
Authorities are responsible for human resources
management within the facilities they operate.
The following measures were taken in 2008–2009
to improve access to hospital services:
• Significant investments were made towards the
purchase of a variety of pieces of diagnostic
imaging equipment:
• digital mammography units in Miramichi,
Bathurst, Moncton, and Saint John will
promote faster diagnosis, and improve
the probability of treating breast cancer
successfully;
• a new CT scanner and an upgrade of an existing
CT scanner at the Dr. Everett Chalmers Regional
Hospital will enhance the quality of diagnostic images, and the speed at which they are
obtained; and
• digital radiographic/fluoroscopic imaging
equipment in Caraquet, Edmundston, and
Saint John will upgrade image quality, increase diagnostic viewing and diagnosis,
improving workload capacity for such
imaging in some regions by up to 50%.
• Digital echocardiography ultrasound units in
Miramichi and Saint John replace outdated
equipment. In addition to improved diagnostic
capacity, digital imaging promotes faster cardiac
care access especially in the regions, through
allowing immediate image viewing by cardiac
specialists in other areas of the province.
• Construction began for an addition for a new
emergency department at the Saint John Regional
Hospital, reflecting the hospital’s designation as
a Level 1 trauma facility.
• The number of dialysis treatment units in
Miramichi doubled, with the intent that
all medically stable dialysis patients in the
Miramichi area could receive services in
their own region. This is an expansion of
a pioneering satellite dialysis program,
operating in conjunction with RHA A’s
nephrology centre in Moncton.
• Linear accelerators were purchased to replace
two existing units in Moncton, one in Saint
John, and to add an additional unit in Saint
John. Construction was also initiated in Saint
John for the bunkers to house this equipment.
The accelerators provide radiation therapy to
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
cancer patients; the purchases (made pursuant
to an agreement with the Government of Canada)
will help ensure that all patients requiring the
therapy begin to receive it within an 8 week
benchmark timeline.
• Renovations at the Campbellton Regional Hospital
were completed, allowing permanent housing
of an oncology clinic. A satellite of an oncology
centre in Moncton, the Campbellton clinic is part
of an initiative to provide better patient access to
chemotherapy in northern New Brunswick. Under
the initiative, similar clincs were established in
Bathurst and Caraquet, and the Miramichi clinic
was upgraded. It is estimated that each regional
oncology centre will serve approx. 40,000 New
Brunswickers.
• The Midwifery Act was introduced, describing
how midwifery will be regulated and publicly
funded in New Brunswick. The Act prepares the
way for midwives to be hired in future years,
improving access to (insured) obstetrical and
maternity care.
• Plans were unveiled to offer retinal surgery in
Saint John, with the actual service slated to begin
in 2009–2010. The service will provide care to up
to 150 New Brunswickers annually, who previously would have had to travel outside the
province for the procedures.
more effectively respond to potential recruitment
opportunities, including the provision of location
grants for $25,000 and $50,000 for family practitioners and $40,000 for specialists willing to practice in
under-serviced areas of the province. The recruitment
and retention strategy also provides for increased
government involvement in post-graduate training
of family physicians, the maintenance of 350 weeks
in summer rural preceptorship training for medical
students, and moving physician remuneration toward
relative parity with other Atlantic provinces.
5.4 Physician Compensation
Payments to physicians and dentists are governed under
the Medical Services Payment Act, Regulations 84-20,
93-143 and 96-113.
During fiscal 2008–2009, negotiations were underway
with the New Brunswick Medical Society to develop a
new agreement in relation to fee-for-service physicians;
the previous agreement expired on March 31, 2008. A
tentative agreement was announced in December 2008,
although details were not released pending ratification
by all parties, which was not achieved by the end of the
2008–2009 fiscal year.
There is no formal negotiation process for dental
practitioners in New Brunswick.
• A new palliative care program was established
in the Campbellton region. This includes a new
4-bed palliative care unit in the Dalhousie
Community Health Centre.
The methods used to compensate physicians for providing insured health services in New Brunswick are
fee-for-service, salary and sessional or alternate payment mechanisms that may also include a blended
system.
• A new obstetrical and post-natal ambulatory clinic
is now in operation in the Acadian Peninsula.
5.5 Payments to Hospitals
• A 4-bed palliative care unit was opened at the
Hôpital de l’Enfant-Jésus de Caraquet.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2009, there were 730 general practitioners, 770 specialists, and 94 OMSs and dentists
registered with the plan.
In fiscal 2008–2009, the Department continued to
operate its successful recruitment and retention
strategy, aimed at attracting newly licensed family
practitioners and specialists. This strategy includes
a contingency fund to allow the Department to
Canada Health Act — Annual Report 2008–2009
The legislative authorities governing payments
to hospital facilities in New Brunswick are the
Hospital Act, which governs the administration
of hospitals, and the Hospital Services Act, which
governs the financing of hospitals. The Regional
Health Authorities Act provides for the delivery
and administration of health services in defined
geographic areas within the province.
The Department uses two components to distribute
available funding to New Brunswick’s RHAs. The
main component is a “Current Service Level” (CSL)
base. This component addresses five patient-care
delivered services:
69
Chapter 3: New Brunswick
• tertiary services (cardiac, dialysis, neurosurgery,
radiation oncology);
• psychiatric services (psychiatric units and
facilities);
• dedicated programs (e.g., addictions services);
• community-based services (Extra-Mural
Program; health service centres); and
• general patient care.
The mechanism and the authority under which
these CSL funds are distributed did not change
in 2008–2009, except in regards to the reduction
of the number of Regional Health Authorities
effective September 1, 2008, as discussed above.
Added to this are non-patient care support services
(e.g., general administration, laundry, food services,
energy). Funding for these services continues to flow
to the Regional Health Authorities, which now use it
to engage some non-clinical services from Facilicorp
NB under purchase of service agreements.
The current budget process may extend over more
than one fiscal year and includes several steps.
By March of each year, RHAs are to provide the
Department with their utilization data and revenue
projections for the following fiscal year, as well as
their actual utilization data and revenue figures for
the first nine months of the current fiscal year. This
information, along with the audited financial statements from the previous two fiscal years, is used to
evaluate the expected funding level for each RHA.
Budget amendments are provided during the year
to allow for adjustments to applicable programs and
services on either recurring or non-recurring bases.
The “year-end settlement process” reconciles the
total annual approved budget for each RHA to its
audited financial statements and reconciles budgeted revenues and expenses to actual revenues
and expenses.
Any requests of funding for new programs are
submitted to the branch responsible for the new
program. An evaluation of the request is performed
by Department of Health officials in collaboration
with the RHA staff.
70
6.0 Recognition Given to
Federal Transfers
New Brunswick routinely recognizes the federal role
regarding its contributions under the Canada Health
Transfer (CHT) in public documentation presented
through legislative and administrative processes.
These include the following:
• the Budget Papers presented by the Minister of
Finance on March 17, 2009;
• the 2007–2008 Public Accounts presented by the
Minister of Finance on September 26, 2008; and
• the Main Estimates presented by the Minister of
Finance on March 17, 2009.
New Brunswick does not produce promotional
documentation on its insured medical and hospital
benefits.
7.0 Extended Health Care
Services
7.1
Nursing Home Intermediate
Care and Adult Residential
Care Services
The New Brunswick Long-Term Care program, a noninsured service, was transferred to the Department
of Family and Community Services on April 1, 2000.
Nursing home care, also a non-insured service, is
offered through the Nursing Home Services program
of the Department of Family and Community Services,
now called the Department of Social Development
(since December 2007). Other adult residential care
services and facilities are available through a variety
of agencies and funding sources within the province.
Nursing homes are private, not-for-profit organizations. In order to be admitted to a nursing home,
clients go through an evaluation process, based on
specific health condition criteria.
Adult Residential Facilities are, for the most part,
private and not-for-profit organizations. The number of
available beds fluctuates as private entrepreneurs open
and close residential facilities. Clients are admitted
after going through the same evaluation process used
for nursing home admissions.
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
Public housing units are available for low-income
elderly persons. Admission criteria are based on age
and the applicant’s financial situation. The Victorian
Order of Nurses offers support services to some units.
7.2
Home Care Services
The New Brunswick Extra-Mural Program provides
comprehensive home healthcare services throughout the province. Services include acute, palliative,
chronic care, rehabilitation services provided in
community settings (an individual’s home, a nursing
home or public school) and a home oxygen program.
Since 1996, this program has been delivered by New
Brunswick’s RHAs according to provincial policies
and standards. Service providers include registered
Canada Health Act — Annual Report 2008–2009
nurses, licensed practical nurses, social workers,
dieticians, respiratory therapists, physiotherapists,
occupational therapists, speech language pathologists,
pharmacists and rehabilitation support personnel,
where funded.
7.3
Ambulatory Health Care Services
Ambulatory health care services were delivered
by New Brunswick’s RHAs according to provincial
policies and standards, and included services provided in hospital emergency rooms, day or night
care in hospitals and in clinics if available in
hospitals, health centres and Community Health
Centres. This is considered an insured service
under the provincial Hospital Services Plan.
71
Chapter 3: New Brunswick
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
741,726
740,759
738,651
740,845
742,974
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
27
23
23
22
22
0
0
0
0
0
2. Number (#):
a. acute care
b. chronic care
c. rehabilitative care
1
1
1
1
1
d. other
22
26
26
27
30
e. total
50
50
50
50
53
3. Payments for insured health services ($):
a. acute care
not available
not available
not available
not available
not available
b. chronic care
not available
not available
not available
not available
not available
c. rehabilitative care
not available
not available
not available
not available
not available
d. other
not available
not available
not available
not available
not available
e. total
1,118,701,200
1,205,197,000
1,290,887,880
1,372,911,800
1,449,216,237
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): 1
a. surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
b. diagnostic imaging facilities
not applicable
not applicable
not applicable
not applicable
not applicable
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
5. Payments to private for-profit facilities for
insured health services($): 1
a. surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
b. diagnostic imaging facilities
not applicable
not applicable
not applicable
not applicable
not applicable
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
Insured Hospital Services Provided to residents in another province or territory
2004–2005
2005–2006
2006–2007
2007–2008
5,464
5,418
3,740
4,363
3,919
$33,743,005
$38,017,578
$32,494,834
$42,267,067
$37,772,992
34,422
45,911
44,941
51,406
46,824
$5,887,128
$9,561,558
$10,022,287
$11,316,103
$12,858,195
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2008–2009
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
191
215
211
209
196
$587,632
$374,035
$741,599
$726,650
$753,104
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
1,170
1,453
1,122
1,073
1,430
$337,337
$321,202
$358,594
$441,575
$561,855
1. There are no private for-profit facilities operating in New Brunswick.
72
Canada Health Act — Annual Report 2008–2009
Chapter 3: New Brunswick
Insured Physician Services Within Own Province or Territory
Public Facilities
14.Number of participating physicians (#):
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2
a. general practitioners
658
667
693
708
730
b. specialists
707
714
706
745
770
c. other
0
0
0
0
0
d. total
1,365
1,381
1,399
1,453
1,500
15.Number of opted-out physicians (#):
a. general practitioners
not available
not available
not available
not available
not available
b. specialists
not available
not available
not available
not available
not available
c. other
not available
not available
not available
not available
not available
d. total
not available
not available
not available
not available
not available
16.Number of not participating physicians (#):
a. general practitioners
not available
not available
not available
not available
not available
b. specialists
not available
not available
not available
not available
not available
c. other
not available
not available
not available
not available
not available
d. total
not available
not available
not available
not available
not available
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
not available
not available
not available
not available
not available
b. total payments ($)
$351,888,988
$373,500,994
$400,481,139
$421,547,901
$441,197,899
5,540,170
5,721,352
5,746,248
5,711,742
5,875,756
$229,403,104
$240,841,117
$244,907,268
$254,454,602
$260,939,796
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
175,528
202,555
192,544
213,710
197,023
$9,789,304
$11,353,739
$11,125,487
$11,998,933
$11,607,119
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
5,339
6,707
6,047
5,990
4,175
$409,132
$449,689
$417,942
$487,679
$341,618
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
22
21
25
21
26
23.Number of participating dentists (#). 2
24.Number of services provided (#).
25.Total payments ($).
3
2,422
2,890
2,472
2,962
3,323
$537,679
$621,491
$502,913
$598,383
$571,175
2. These are the number of physicians with an active physician status on March 31st of each year.
3. These are the number of Dentists and Oral Maxillofacial Surgeons participating in New Bruswick’s Medical Services Plan during each fiscal year.
Canada Health Act — Annual Report 2008–2009
73
74
Canada Health Act — Annual Report 2008–2009
Chapter 3: Quebec
2.0 Comprehensiveness
2.1
Quebec
1.0 Public Administration
1.1
Health Insurance Plan and
Public Authority
Quebec’s hospital insurance plan, the Régime
d’assurance hospitalisation du Québec, is
administered by the ministère de la Santé
et des Services sociaux (MSSS) (the Quebec
Department of Health and Social Services).
Quebec’s health insurance plan, the Régime
d’assurance maladie du Québec, is administered
by the Régie de l’assurance maladie du Québec
(RAMQ) (the Quebec Health Insurance Board),
a public body established by the provincial
government and reporting to the Minister of
Health and Social Services.
1.2 Reporting Relationship
The Public Administration Act (R.S.Q., c. A-6.01) sets
out the government criteria for preparing reports on
the planning and performance of public authorities,
including the ministère de la Santé et des Services
sociaux and the Régie de l’assurance maladie du
Québec.
1.3 Audit of Accounts
Both plans (the Quebec hospital insurance plan and
the Quebec health insurance plan) are operated on a
non-profit basis. All books and accounts are audited
by the Auditor General of the province.
Canada Health Act — Annual Report 2008–2009
Insured Hospital Services
Insured in-patient services include the following:
standard ward accommodation and meals; necessary
nursing services; routine surgical supplies; diagnostic
services; use of operating rooms, delivery rooms and
anesthetic facilities; medications, prosthetics and
orthotic devices that can be integrated with the
human body; biologicals and related preparations;
use of radiotherapy, radiology and physiotherapy
facilities; and services rendered by hospital staff.
Outpatient services include the following: clinical
services for psychiatric care; electroshock, insulin and
behaviour therapies; emergency care; minor surgery
(day surgery); radiotherapy; diagnostic services; physiotherapy; occupational therapy; inhalation therapy,
audiology, speech therapy and orthoptic services; and
other services or examinations required under Quebec
legislation.
Other services covered by insurance are the following: mechanical, hormonal or chemical contraception
services; surgical sterilization services (including tubal
ligation or vasectomy); reanastomosis of the fallopian
tubes or vas deferens; and extraction of a tooth or root
when the patient’s health status makes hospital services
necessary.
The MSSS administers an ambulance transportation
program that is free of charge to persons aged 65
or older.
In addition to basic insured health services, the Régie
also covers the following, with some limitations, for
certain inhabitants of Quebec, as defined by the Health
Insurance Act, and for employment assistance recipients: optometric services; dental care for children and
employment assistance recipients, and acrylic dental
prostheses for employment assistance recipients;
prostheses, orthopedic appliances, locomotion and
postural aids, and other equipment that helps with a
physical disability; external breast prostheses; ocular
prostheses; hearing aids, assistive listening devices
and visual aids for people with a visual or auditory
disability; and permanent ostomy appliances.
With regard to drug insurance, since January 1, 1997,
the Régie has covered, in addition to its regular clientele (employment assistance recipients and persons
65 years of age or older), individuals who would not
otherwise have access to a private drug insurance
plan. Currently (as of 2008), the drug insurance plan
covers 3.18 million insured persons.
75
Chapter 3: Quebec
2.2 Insured Physician Services
The services insured under this plan include medical
and surgical services that are provided by physicians
and that are medically necessary.
2.3 Insured Surgical-Dental Services
Services insured under this plan include oral surgery
performed by dental surgeons and specialists in oral
and maxillo-facial surgery, in a hospital centre or
university institution determined by regulation.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital services include: plastic surgery;
in vitro fertilization; a private or semi-private room
at the patient’s request; televisions; telephones; drugs
and biologics ordered after discharge from hospital;
and services for which the patient is covered under
the Act respecting industrial accidents and occupational diseases or other federal or provincial legislation.
The following services are not insured: any examination or service not related to a process of cure or
prevention of illness; psychoanalysis of any kind,
unless such service is rendered in a facility maintained by an institution authorized for such purpose
by the Minister of Health and Social Services; any
service provided solely for aesthetic purposes; any
refractive surgery where there is documented failure in
respect of corrective lenses and contact lenses, with
the exception of astigmatism of more than 3 diopters
or anisometropia of more than 5 diopters measured
from the cornea; any consultation by telecommunication or by correspondence; any service rendered by
a professional to his or her spouse or children; any
examination, expert appraisal, testimony, certificate
or other formality required for legal purposes or by
a person other than one who has received an insured
service, except in certain cases; any visit made for the
sole purpose of obtaining the renewal of a prescription;
any examinations, vaccinations, immunizations or
injections, where the service is provided to a group
or for certain purposes; any service rendered by a
professional on the basis of an agreement or contract
with an employer, association or body; any adjustment of spectacles or contact lenses; any surgical
extraction of a tooth or dental fragment performed
by a physician, unless such a service is provided in
a hospital centre in certain cases; all acupuncture
procedures; injection of sclerosing substances and
76
the examination performed at that time; mammography used for detection purposes, unless this service
is rendered on medical prescription in a place designated by the Minister to a recipient 35 years of age or
older, provided that the person has not been so examined for one year; thermography, tomodensitometry,
magnetic resonance imaging and use of radionuclides
in vivo in humans, unless these services are rendered
in a hospital centre; ultrasonography, unless this service is rendered in a hospital centre or, for obstetrical
purposes, in a local community service centre (CLSC)
recognized for that purpose; any radiological or anesthetic service provided by a physician if required with
a view to providing an uninsured service, with the
exception of a dental service provided in a hospital
centre or, in the case of radiology, if required by a person
other than a physician or dentist; any sex-reassignment
surgery, unless it is provided on the recommendation of
a physician specializing in psychiatry and is provided
in a hospital centre recognized for this purpose; and
any services that are not related to a pathology and
that are rendered by a physician to a patient between
18 and 65 years of age, unless that individual is the
holder of a claim booklet, for colour blindness or a
refractive error, in order to provide or renew a prescription for spectacles or contact lenses.
3.0 Universality
3.1
Eligibility
Registration with the hospital insurance plan is not
required. Registration with the Régie de l’assurance
maladie du Québec or proof of residence is sufficient
to establish eligibility. All persons who reside or
stay in Quebec must be registered with the Régie
de l’assurance maladie du Québec to be eligible for
coverage under the health insurance plan.
3.2 Registration Requirements
Registration with the hospital insurance plan is not
required. Registration with the Régie or proof of residence is sufficient to establish eligibility.
3.3 Other Categories of Individual
Services received by regular members of the Canadian
Forces, members of the Royal Canadian Mounted Police
(RCMP) and inmates of federal penitentiaries are not
covered by the plan. There are no health premium
charges.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Quebec
Certain categories of residents, notably permanent
residents under the Immigration Act and persons
returning to live in Canada, become eligible under
the plan following a waiting period of up to three
months. Persons receiving last resort financial assistance are eligible upon registration. Members of the
Canadian Forces and RCMP who have not acquired
the status of inhabitant of Quebec become eligible the
day they are discharged, and inmates of federal penitentiaries become eligible the day they are released.
Immediate coverage is provided for certain seasonal
workers, repatriated Canadians, persons from outside
Canada who are living in Quebec under an official
bursary or internship program of the ministère de
l’Éducation (the Quebec Department of Education),
and refugees. Persons from outside Canada who have
work permits and are living in Quebec for the purpose of holding an office or employment for a period
of more than six months become eligible for the plan
following a waiting period.
4.0 Portability
4.1
Minimum Waiting Period
Persons settling in Quebec after moving from another
province of Canada are entitled to coverage under the
Quebec health insurance plan when they cease to be
entitled to benefits from their province of origin, provided they register with the Régie.
4.2 Coverage During Temporary
Absences Outside Quebec
(in Canada)
If living outside Quebec in another province or territory for 183 days or more, students and full time
unpaid trainees may retain their status as residents
of Quebec: students for a maximum of four calendar
years, and full-time unpaid trainees for a maximum
of two consecutive calendar years.
federal government and posted outside Quebec, also
retain their status as an inhabitant of the province,
provided their families remain in Quebec or they
retain a dwelling there.
Status as an inhabitant of the province is also maintained by persons who remain outside the province
for 183 days or more, but less than 12 months within
a calendar year, provided such absence occurs only
once every seven years and provided they notify the
Régie of their absence.
The costs of medical services received in another
province or territory of Canada are reimbursed at
the amount actually paid or the rate that would have
been paid by the Régie for such services in Quebec,
whichever is less. However, Quebec has negotiated a
permanent arrangement with Ontario to pay Ottawa
doctors at the Ontario fee rate for emergency care
and when the specialized services provided are
not offered in the Outaouais region. This agreement
came into effect on November 1, 1989. A similar
agreement was signed in December 1991 between
the Centre de santé Témiscaming (Témiscaming
Health Centre) and North Bay.
Costs of hospital services with which a recipient is
provided in another province or territory of Canada
are paid in accordance with the terms and conditions
of the interprovincial agreement on reciprocal billing
regarding hospital insurance agreed on by the provinces and territories of Canada. In-patient costs are paid
at standard ward rates approved by the host province or
territory, and out-patient costs or the costs of expensive
procedures are paid at approved interprovincial rates.
However, as of November 1, 1995, when patients are
hospitalized in a hospital centre in another province
for non-urgent care or services available in their region,
the Government of Quebec reimburses a maximum of
$450 per day of hospitalization.
Insured persons who leave Quebec to settle in another
province or territory of Canada are covered for up to
three months after leaving the province.
This is also the case for persons living in another
province or territory who are temporarily employed
or working on contract there. Their resident status
can be maintained for no more than two consecutive
calendar years.
4.3 Coverage During Temporary
Absences Outside Quebec
(Outside Canada)
Persons directly employed or working on contract
outside Quebec in another province or territory, for a
company or corporate body having its headquarters
or a place of business in Quebec, or employed by the
Students, unpaid trainees, Quebec government officials
posted abroad and employees of non-profit organizations working in international aid or cooperation
programs recognized by the Minister of Health and
Social Services must contact the Régie to determine
Canada Health Act — Annual Report 2008–2009
77
Chapter 3: Quebec
their eligibility. If the Régie grants them special status, they receive full reimbursement of hospital costs
in case of emergency or sudden illness, and 75 percent
reimbursement in other cases.
5.0 Accessibility
Persons directly employed or working on contract
outside Canada, for a company or corporate body
having its headquarters or a place of business in
Quebec, or employed by the federal government and
posted outside Quebec, also retain their status as an
inhabitant of the province, provided their families
remain in Quebec or they retain a dwelling there.
Everyone has the right to receive adequate health
care services without any kind of discrimination.
There is no extra-billing by Quebec physicians.
As of September 1, 1996, hospital services provided
outside Canada in case of emergency or sudden illness
are reimbursed by the Régie, usually in Canadian
funds, to a maximum of CAN$100 per day if the
patient was hospitalized (including in the case of
day surgery) or to a maximum of CAN$50 per day
for out-patient services.
However, hemodialysis treatments are covered to
a maximum of CAN$220 per treatment, including
drugs, whether the patient is hospitalized or not. In
such cases, the Régie provides reimbursement for the
associated professional services. The services must
be rendered in a hospital or hospital centre recognized and accredited by the appropriate authorities.
No reimbursements are made for nursing homes,
spas or similar establishments.
Costs for insured services provided by physicians,
dentists, oral surgeons and optometrists are reimbursed at the rate that would have been paid by the
Régie to a health professional recognized in Quebec,
up to the amount of the expenses actually incurred.
The cost of all services insured in the province is
reimbursed at the Quebec rate, usually in Canadian
funds, when they are incurred abroad.
An insured person who moves permanently from
Quebec to another country ceases to be a recipient
as of the day of departure.
4.4 Prior Approval Requirement
Insured persons requiring medical services in
hospitals abroad, in cases where those services are
not available in Quebec or elsewhere in Canada, are
reimbursed 100 percent if prior consent has been
given for medical and hospital services that meet
certain conditions. Consent is not given by the
Plan’s officials if the medical service in question
is available in Quebec or elsewhere in Canada.
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5.1
Access to Insured Health Services
5.2 Access to Insured Hospital Services
On March 31, 2009, Quebec had 117 institutions
operating as hospital centres for a clientele suffering
from acute illnesses. There were 20,440 beds for
persons requiring care for acute physicial or psychiatric ailments allotted to these institutions. From
April 1, 2007, to March 31, 2008, Quebec hospital
institutions had 716,191 admissions for short stays
(including newborns) and 307,246 registrations for
day surgeries. These hospitalizations accounted for
5,124,049 patient days.
Restructuring of the health network: In November
2003, Quebec announced the implementation of local
service networks covering all of Quebec. At the heart of
each local network is a new local authority, the Centre
de santé et de services sociaux (CSSS; the health and
social services centre). These centres are the result of
the merger of the public institutions whose mission
it was to provide CLSC (local community service centre) services, CHSLD (residential and long-term care)
services, and, in most cases, neighbourhood hospital
services. The CSSSs also provide the people in their
territory with access to other medical services, general
and specialized hospital services, and social services.
To do so, they will have to enter into service agreements
with other health sector organizations. The linking
of services within a territory forms the local services
network. Thus, the aim of integrated local health and
social services networks is to make all the stakeholders in a given territory collectively responsible for the
health and well-being of the people in that territory.
5.3 Access to Insured Physician and
Surgical-Dental Services
Primary care: In 2003–2004, family medicine groups
(FMGs) were established. These groups work closely
with the CSSSs and other network resources to provide
services such as health assessment, case management
and follow-up, diagnosis, treatment of acute and
chronic problems, and disease prevention. Their
services are available 24 hours a day, seven days
a week. In April 2009, there were 193 accredited
FMGs in Quebec.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Quebec
The Conseil médical du Québec (Quebec medical
board) has established a committee to develop the
concept of the physician/population ratio because
interprovincial comparisons suggest that Quebec
has an adequate number of physicians.
5.4 Physician Compensation
Physicians are remunerated in accordance with
the negotiated fee schedule. Physicians who have
withdrawn from the health insurance plan are paid
directly by the patient according to the fee schedule
after the patient has collected from the Régie. Nonparticipating physicians are paid directly by their
patients according to the amount charged.
Provision is made in law for reasonable compensation for all insured health services rendered by
health professionals. The Minister may enter into
an agreement with the organizations representing
any class of health professional. This agreement
may prescribe a different rate of compensation for
medical services in a territory where the number
of professionals is considered insufficient. The
Minister may also provide for a different rate of
compensation for general practitioners and medical
specialists during the first years of practice, depending on the territory or the activity involved. These
provisions are preceded by consultation with the
organizations representing the professional groups.
While the majority of physicians practise within the
provincial plan, Quebec allows two other options:
professionals who have withdrawn from the plan and
practise outside the plan, but agree to remuneration
according to the provincial fee schedule; and nonparticipating professionals who practise outside the
plan, with no reimbursement from the Régie going
to either them or their patients.
Canada Health Act — Annual Report 2008–2009
In 2008–2009, the Régie paid an estimated $4,094,500
to doctors in the province, while the amount for medical services outside the province reached an estimated
$10.5 million.
5.5 Payments to Hospitals
The Minister of Health and Social Services funds
hospitals through payments directly related to the
cost of insured services provided.
The payments made in 2007–2008 to institutions
operating as hospital centres for insured health
services provided to inhabitants of Quebec were
more than $9 billion. Payments to hospital centres
outside Quebec were approximately $128.8 million.
7.0 Extended Health Care
Services
Intermediate care, adult residential care and home
care services are available. Admission is coordinated
on a local or regional level and based on a single
assessment tool. The health and social services centres
receive individuals, evaluate their care requirements,
and either arrange for provision of services such as
day care centre programs or home care, or refer them
to the appropriate agencies.
The MSSS offers some home care services, including
nursing care and assistance, homemaker services and
medical supervision.
The province ensures that residential facilities and
long-term care units in acute-care hospitals focus on
maintaining their clients’ autonomy and functional
abilities by providing them with a variety of programs and services, including health care services.
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Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
1.2 Reporting Relationship
The Health Insurance Act stipulates that the Minister of Health and Long-Term Care is responsible
for the administration and operation of OHIP, and
is Ontario’s public authority for the purposes of the
Canada Health Act.
1.3 Audit of Accounts
Ontario
Introduction
Ontario has one of the largest and most complex
publicly funded health care systems in the world.
Administered by the province’s Ministry of Health
and Long-Term Care (MOHLTC), Ontario’s health care
system was supported by over $40 billion (including
capital) in spending for 2008–2009.
MOHLTC is audited annually by the Office of the
Auditor General of Ontario. The Auditor General’s 2008
Annual Report was released on December 8, 2008.
MOHLTC’s accounts and transactions are published
annually in the Public Accounts of Ontario. The
2008–2009 Public Accounts of Ontario were released
on September 25, 2009.
1.4 Designated Agency
The Ministry provides services to the public
through such programs as health insurance, drug
benefits, assistive devices, forensic mental health
and supportive housing, long-term care, home care,
community and public health, and health promotion
and disease prevention. It also regulates hospitals
and nursing homes, operates medical laboratories
and coordinates emergency health services.
LHINs were established under the Local Health
System Integration Act, 2006 to improve Ontarians’
health through better access to high-quality health
services, coordinated health care, and effective and
efficient management of the health system at the
local level. On April 1, 2007, the LHINs assumed
full responsibilities for funding, planning, and
integrating health care services at the local level.
Fourteen Local Health Integration Networks (LHINs)
plan, fund and integrate local health care services.
With the LHINs responsible for local health care
management, the Ministry assumes a stewardship
role establishing overall strategic direction and
priorities for the provincial health care system.
LHINs are not-for-profit Crown Agencies that plan,
fund and integrate local health care services that
are delivered by hospitals, Community Care Access
Centres, long-term care homes, community health
centres, community support services, and mental health agencies. The Act requires each LHIN
to prepare an Annual Report for the Minister who
is required to table the reports in the Legislative
Assembly of Ontario.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The Ontario Health Insurance Plan (OHIP) is administered on a non-profit basis by MOHLTC. OHIP was
established under the Health Insurance Act, Revised
Statutes of Ontario, 1990, c. H-6, to provide insurance
in respect of the cost of insured services provided in
hospitals and health facilities, and by physicians and
other health care practitioners.
Canada Health Act — Annual Report 2008–2009
MOHLTC has accountability agreements with each
LHIN that include performance goals and objectives
for the networks. The agreements also include the
allocations for health service providers. The legislation also provides the LHINs with the authority to
fund health service providers and to enter into service accountability agreements with each provider.
The Act also reaffirms the principles of the French
Languages Services Act to ensure equitable access to
services in French for French-speaking Ontarians.
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Chapter 3: Ontario
2.0 Comprehensiveness
2.1 Insured Hospital Services
Insured in-patient and out-patient hospital services
in Ontario are prescribed under the Health Insurance
Act, and Regulation 552 under that Act.
Insured in-patient hospital services1 include medically
required: use of operating rooms, obstetrical delivery
rooms and anaesthetic facilities; necessary nursing
services; laboratory, radiological and other diagnostic
procedures together with the necessary interpretations
for the purpose of maintaining health, preventing
disease and assisting in the diagnosis and treatment
of any injury, illness or disability e.g. dialysis related
equipment and supplies; drugs, biologicals and related
preparations; and, accommodation and meals at the
standard ward level.
Insured out-patient services include medically
required: laboratory, radiological and other diagnostic procedures; use of radiotherapy, occupational
therapy, physiotherapy and speech therapy facilities,
where available; use of diet counselling services; use
of the operating room, anaesthetic facilities, surgical
supplies, necessary nursing service, and supplying of
drugs, biologicals, and related preparations (subject
to some exceptions), including vaccines, anti-cancer
drugs, biologicals and related preparations (subject
to some exceptions); provision of equipment, supplies and medication to haemophiliac patients for
use at home; and the following drugs for take-home
use: cyclosporine to transplant patients; zidovudine,
didanosine, zalcitabine and pentamidine to patients
with HIV infection; biosynthetic human growth
hormone to patients with endogenous growth hormone deficiency; drugs for treating cystic fibrosis
and thalassemia; erythropoieitins to patients with
anaemia of end-stage renal disease; alglucerase to
patients with Gaucher disease; clozapine to patients
with treatment-resistant schizophrenia; verteporfin
to treat patients with predominantly classic subfoveal choroidal neovascularisation secondary to either
age-related macular degeneration, presumed ocular
histoplasmosis syndrome or pathologic myopia.
In 2008–2009, there were 150 public hospital corporations (excluding specialty mental health hospitals,
private hospitals) staffed and in operation in Ontario.
This includes 130 acute care hospital corporations,
15 chronic care hospitals, and four general and special rehabilitation units. Though they provide a mix
of services, hospitals are categorized by major activity.
For example, many acute care hospitals offer chronic
care services. A number of designated chronic care
facilities also offer rehabilitation.
When insured physician services are provided in
licensed independent health facilities outside hospitals and where the total cost paid for these insured
services is not included in the physician fees paid
under the Health Insurance Act, MOHLTC provides
funding through the payment of facility fees under
the Independent Health Facilities Act. Facility fees
(fees for services/costs that support, assist or are a
necessary adjunct to insured services) are payable
in order to cover the cost of the premises, equipment,
supplies, and personnel related to an insured service.
Under the Independent Health Facilities Act, charges
to patients for facility fees are prohibited.
Facility fees are charged to the provincial government only by facilities that are licensed under the
Independent Health Facilities Act. Examples of
facilities that are licensed under this Act include:
surgical/treatment facilities (e.g., those providing
abortions, cataract surgery, dialysis and non-cosmetic
plastic surgery) and diagnostic facilities (e.g., those
providing x-ray, ultrasound, nuclear medicine, sleep
studies and pulmonary function studies). New facilities are ordinarily established through a Request for
Proposals process based on an assessment of need for
the service.
2.2 Insured Physician Services
Insured physician services are prescribed under the
Health Insurance Act and regulations under that Act.
Under subsection 37.1(1) of Regulation 552 of the
Health Insurance Act, a service provided by a physician in Ontario is an insured service if it is medically
necessary; contained in the Schedule of Benefits for
Physician Services; and rendered in such circumstances or under such conditions as outlined in the
Schedule of Benefits. Physicians provide medical,
surgical and diagnostic services, including primary
health care services. Services are provided in a variety of settings, including: private physician offices,
community health centres, hospitals, mental health
facilities, licensed independent health facilities, and
long-term care homes.
In general terms, insured physician services include:
diagnosis and treatment of medical disabilities and
conditions; medical examinations and tests; surgical
procedures; maternity care; anaesthesia; radiology
1. A complete list of hospital services is available under the Health Insurance Act, Reg. 552, s.7-11.
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Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
and laboratory services in approved facilities; and,
immunizations, injections and tests.
The Schedule of Benefits is regularly reviewed and
revised to reflect current medical practice and new
technologies. New services may be added, existing
services revised or obsolete services removed through
regulatory amendment. This process involves consultation with the Ontario Medical Association.
During 2008–2009, physicians could submit claims
for all insured services rendered to insured persons
directly to the OHIP office, in accordance with section
15 of the Health Insurance Act, or a limited number
could bill the insured person, as permitted by section
15.2 of the Act (see also Part II of the Commitment to
the Future of Medicare Act). Physicians who do not
bill OHIP directly are commonly referred to as having “opted-out”. When a physician has opted out, the
physician bills the patient (not exceeding the amount
payable for the service under the Schedule of Benefits),
and the patient is then entitled to reimbursement by
OHIP. However, the number of physicians who may
opt out was fixed (on a “grandparented” basis) following proclamation of the Commitment to the Future of
Medicare Act on September 23, 2004.
Physicians must be registered to practice medicine in
Ontario by the College of Physicians and Surgeons of
Ontario.
There were approximately 24,500 physicians who
submitted claims to OHIP in 2008–2009. This figure
includes physicians submitting both fee-for-service
claims and physicians included in an alternative
payment plan who submitted tracking or shadowbilled claims.
2.3 Insured Surgical-Dental Services
Certain surgical-dental services are prescribed as
insured services in section 16 of Regulation 552 in
the Health Insurance Act and the Dental Schedule
of Benefits. The Health Insurance Act authorizes
OHIP to cover a limited number of procedures when
the insured services are medically necessary and
are performed in a public hospital graded under the
Public Hospitals Act as Group A, B, C or D by a dental
surgeon who has been appointed to the dental staff
of the public hospital.
Approximately 291 dentists and dental/oral surgeons
provided insured surgical-dental services in Ontario
in 2008–2009.
Canada Health Act — Annual Report 2008–2009
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Services prescribed by and rendered in accordance
with the Health Insurance Act and regulations under
that Act are insured.
Uninsured hospital services include: additional
charges for preferred accommodation unless prescribed by a physician, oral-maxillofacial surgeon
or midwife; telephones and televisions; charges for
private-duty nursing; provision of medications for
patients to take home from hospital, with certain
exceptions; and in-province, out-patient hospital
visits solely for administering drugs, subject to
certain exceptions.
Section 24 of Regulation 552 details those physician
and supporting services that are specifically prescribed
as uninsured.
Uninsured physician services include: services that
are not medically necessary; toll charges for longdistance telephone calls; the preparation or provision
of a drug, antigen, antiserum or other substance, unless
the drug, antigen or antiserum is used to facilitate a
procedure; advice given by telephone at the request
of the insured person or the person’s representative;
an interview or case conference (in limited circumstances); the preparation and transfer of records at
the insured person’s request; a service that is received
wholly or partly for producing or completing a document or transmitting information to a “third party” in
prescribed circumstances; the production or completion of a document or transmitting information to any
person other than the insured person in prescribed
circumstances; provision of a prescription when no
concomitant insured service is rendered; acupuncture
procedures; psychological testing; research and survey programs; and experimental treatment.
3.0 Universality
3.1 Eligibility
Regulation 552 of the Health Insurance Act specifies
the eligibility criteria for OHIP coverage.
On April 1, 2009, the Ministry of Health and LongTerm Care amended the eligibility provisions of
Regulation 552. Part of the purpose of these changes
was to align the ministry’s administration of OHIP
eligibility with the Immigration and Refugee Protection
Act and related federal government processing changes.
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Chapter 3: Ontario
The changes to Regulation 552 also formalized existing policies and government commitments, including
the addition of the eligibility and portability provisions
of the Interprovincial Agreement on Eligibility and
Portability to ensure adherence to this agreement and
to facilitate compliance with the Canada Health Act.
To be considered a resident of Ontario for the purpose
of obtaining Ontario health insurance coverage generally speaking, a person must:
• hold Canadian citizenship or an immigration
status as prescribed in Regulation 552 of the
Health Insurance Act;
• make his or her primary place of residence
in Ontario;
• subject to some limited exceptions, be physically
present in Ontario for at least 153 days in any
12-month period; and
• for most new and returning residents, be physically
present in Ontario for 153 of the first 183 days following the date residence is established in Ontario
(i.e., a person cannot be away from the province
for more than 30 days in the first six months of
residency).
With certain prescribed exceptions in which there is
an exemption from the waiting period, residents of
Ontario, as defined in Regulation 552 of the Health
Insurance Act, are eligible for Ontario health insurance coverage subject to a three-month waiting
period. Assessment of whether or not an individual
is subject to the three-month waiting period occurs
at the time of their application for health insurance
coverage. Examples of those who are exempt from the
three-month waiting period include newborn babies,
eligible military family members, and insured residents from another province or territory who move
to Ontario and immediately become residents of an
approved long-term care facility in Ontario.
Individuals who are not eligible for OHIP coverage
are those who do not meet the definition of a resident,
including those who do not hold an immigration
status that is set out in Regulation 552, such as tourists, transients, and visitors to the province. Other
individuals such as federal penitentiary inmates,
Canadian Forces members and ranked Royal Canadian
Mounted Police personnel do not require Ontario
health insurance coverage as their health services
are covered under a federal health care plan.
84
Persons who were previously ineligible for Ontario
health insurance coverage but whose status and/
or residency situation has changed (e.g., change in
immigration status) may be eligible, upon application, subject to the requirements of Regulation 552.
When it is determined that a person is not eligible or
is no longer eligible for OHIP coverage, a request may
be made to MOHLTC to review the decision. Anyone
may request that the Ministry review the denial of
their OHIP eligibility by making a request in writing
to the OHIP Eligibility Review Committee.
3.2 Registration Requirements
Every resident of Ontario (or their legally authorized
substitute decision maker), who seeks Ontario health
insurance coverage, is required to apply to obtain
coverage.
A health card is issued to eligible residents upon
application provided they meet the eligibility
requirements as set out under Regulation 552.
Eligible persons should apply for coverage upon
establishing their primary place of residence in
the province.
As of April 21, 2008, MOHLTC, in partnership with
the Ministry of Government Services, transferred
the delivery of health card registration services to
Service Ontario. Service Ontario now manages the
province-wide network for health card registration
services. MOHLTC continues to be responsible for
the policy and programs related to health insurance,
including the policy and program management of
health card registration.
Health Card Registration services are provided
through local Service Ontario Centres. Applicants
for Ontario health insurance coverage must complete
and sign a Registration for Ontario Health Insurance
Coverage form and provide original documents to
prove their Canadian citizenship or eligible immigration status, their residence in Ontario and their
identity. Eligible applicants over the age of fifteen
and one half years are generally required to have
their photographs and signatures captured for their
photo health cards.
Each photo health card has a renewal/expiry date in
the bottom right-hand corner of the card. Renewal
notices are sent to registrants several weeks before
the card’s renewal date.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
MOHLTC is the sole payer for OHIP insured physician, hospital, and dental-surgical services. An
eligible Ontario resident may not register with or
obtain any benefits from another insurance plan for
the cost of any insured service that is covered by
OHIP (with the exception of during a waiting period).
hold a permit with a case type of 86, 87, 88, 89, 90,
91, 92, 93, 94, 95 or 80 (if for adoption) are eligible for
Ontario health insurance coverage. Individuals who
hold a permit with a case type of 80 (except adoption),
81, 84, 85 and 96 are not eligible for Ontario health
insurance coverage.
Approximately 12.8 million Ontario residents were
registered with OHIP and held valid and active
health cards as of April 1, 2009.
Clergy, Foreign Workers and their Accompanying
Family Members: An eligible foreign clergy is a person who is sponsored by a religious organization or
denomination if the member has finalized an agreement to minister to a religious congregation or group
in Ontario for at least six months, as long as the
member is legally entitled to stay in Canada.
3.3 Other Categories of Individual
MOHLTC provides health insurance coverage to
residents of Ontario other than Canadian citizens
and Permanent Residents/Landed Immigrants.
These residents are required to provide acceptable
documentation to support their eligible immigration status, their residence in Ontario, and their
identity in the same manner as Canadian citizen or
Permanent Resident/Landed Immigrant applicants.
The individuals listed below, who are resident in
Ontario, may be eligible for Ontario health insurance
coverage in accordance with Regulation 552 of the
Health Insurance Act. Clients applying for coverage
under any of these categories should contact their
local Service Ontario Centre for further details.
Applicants for Permanent Residence/Applicants
for Landing: These are persons who have submitted an application for Permanent Resident/Landed
Immigrant status to Citizenship and Immigration
Canada (CIC), even if the application has not yet been
approved, provided that CIC has confirmed that the
person meets the eligibility requirements to apply for
permanent residency in Canada and that the application has not yet been denied.
Protected Persons: These are persons who are
determined to be Protected Persons under the
terms of the Immigration and Refugee Protection
Act. Members of this group are exempt from the
three-month waiting period.
Holders of Temporary Resident Permits/Minister’s
Permits: A Temporary Resident Permit/Minister’s
Permit is issued to an individual by Citizenship
and Immigration Canada when there are compelling reasons to admit an individual into Canada
who would otherwise be inadmissible under the
federal Immigration and Refugee Protection Act.
Each Temporary Resident Permit/Minister’s Permit
has a case type or numerical designation on the
permit that indicates the circumstances allowing
the individual entry into Canada. Individuals who
Canada Health Act — Annual Report 2008–2009
A foreign worker is eligible for Ontario health insurance coverage if the individual has been issued a Work
Permit/Employment Authorization or other document
by CIC that permits the person to work in Canada if the
person also has a formal agreement in place to work
full-time for an employer in Ontario. The work permit/
other document issued by CIC or a letter provided by
the employer must set out the employer’s name, state
the person’s occupation with the employer and state
that the person will be working for the employer for
no less than six consecutive months.
A spouse and/or dependant child (under 22 years of
age; or 22 years of age or older, if dependent due to
a mental or physical disability) of an eligible foreign
member of the clergy or an eligible foreign worker is
also eligible for Ontario health insurance coverage as
long as the spouse or dependant is legally entitled to
stay in Canada.
Live-in Caregivers: Eligible Live-in Caregivers are
persons who hold a valid Work Permit/Employment
Authorization under the Live-in Caregiver Program
(LCP) administered by CIC. The Work Permit/Employment Authorization for LCP workers does not have
to list the three specific employment conditions
required by all other foreign workers.
Applicants for Citizenship: These individuals are
eligible for Ontario health coverage if they have
submitted an application for Canadian citizenship
under Section 5.1 of the federal Citizenship Act,
even if the application has not yet been approved,
provided that CIC has confirmed that the person
meets the eligibility requirements to apply for citizenship under that section and the application
has not yet been denied.
Migrant Farm Workers: Migrant farm workers
are persons who have been issued a Work Permit/
Employment Authorization under the Seasonal
Agricultural Worker Program administered by CIC.
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Chapter 3: Ontario
Due to the special nature of their employment,
migrant farm workers are deemed resident (may
be resident for less than the required five month
period and not have a primary place of residence in
Ontario) and are not required to complete the threemonth waiting period and still qualify for OHIP.
4.2 Coverage During Temporary
Absences in Canada
Children born out-of-country: A child born to an
OHIP-eligible woman who left Ontario to receive
insured services that were pre-approved for payment
by OHIP is eligible for immediate OHIP coverage
provided the mother was pregnant at the time of
departure from Ontario.
Ontario adheres to the terms of the Interprovincial
Agreement on Eligibility and Portability; therefore,
insured residents who are temporarily outside
of Ontario can use their Ontario health cards to
obtain insured physician (except in Quebec) and
hospital services.
Internationally Adopted Children: Children under
16 who are adopted by Ontario residents are eligible
for Ontario health insurance coverage, provided the
child has an OHIP-eligible citizenship/immigration
status and meets the other residency requirements as
set out in Regulation 552 of the Health Insurance Act.
Additionally, these children may be exempt from the
three-month waiting period if the adoption meets the
requirements set out in Regulation 552.
An insured person who leaves Ontario temporarily to
travel within Canada, without establishing residency
in another province or territory, may continue to be
covered by OHIP for a period of up to 12 months.
3.4 Premiums
There are no premiums payable as a condition
of obtaining Ontario health insurance coverage.
The Ontario Health Premium is collected through
the provincial income tax system and is not connected to OHIP registration or eligibility in any way.
Responsibility for the administration of the Ontario
Health Premium lies with the Ontario Ministry
of Finance.
4.0 Portability
4.1 Minimum Waiting Period
In accordance with section 5 of Regulation 552 under
the Health Insurance Act, individuals who move to
Ontario are typically entitled to OHIP coverage, three
months after establishing residency in the province,
unless listed as an exception in section 6.
In accordance with section 5 of Regulation 552
under the Health Insurance Act and as provided for
in the Interprovincial Agreement on Eligibility and
Portability, persons moving permanently to Ontario
from another Canadian province or territory will
typically be eligible for OHIP coverage after the last
day of the second full month following the date
residency is established.
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Insured out-of-province services are prescribed under
sections 28, 28.0.1, 29 to 32 of Regulation 552 of the
Health Insurance Act.
An insured person who seeks or accepts employment
in another province or territory may continue to be
covered by OHIP for a period of up to 12 months.
If the individual plans to remain outside Ontario
beyond the 12-month maximum, he or she should
apply for coverage in the province or territory where
that person has been working or seeking work.
Insured students who are temporarily absent from
Ontario, but remain within Canada, may be eligible
for continuous health insurance coverage for the
duration of their full-time studies, provided they do
not establish permanent residency elsewhere during
this period. To ensure that they maintain continuous
OHIP eligibility, a student should provide MOHLTC
with documentation from their educational institution confirming registration as a full-time student.
Family members (spouses and dependent children)
of students who are studying in another province or
territory are also eligible for continuous OHIP eligibility while accompanying students for the duration
of their studies.
In accordance with Regulation 552 of the Health
Insurance Act, most insured residents who want to
travel, work or study outside Ontario, but within
Canada, and maintain OHIP coverage, must have
resided in Ontario for at least 153 days in the last
12-month period immediately prior to departure
from Ontario.
Ontario participates in Reciprocal Hospital Billing
agreements with all other provinces and territories
for insured in-patient and out-patient hospital services. Payment is at the in-patient rate of the plan
in the province or territory where hospitalization
Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
occurs. Ontario pays the standard out-patient charges
authorized by the Interprovincial Health Insurance
Agreements Coordinating Committee.
Ontario also participates in the Physicians’ Reciprocal
Billing agreements with all other provinces and territories, except Québec (which has not signed a reciprocal
agreement with any other province or territory), for
insured physician services. Ontario residents who
may be required to pay for physician services received
in Québec can submit their receipts to MOHLTC for
payment as an insured service at Ontario rates.
Certain family members may also qualify for
continuous Ontario health insurance coverage
while accompanying the primary applicant on
an extended absence outside Canada.
Out-of-country services are covered under sections
28.1 to 28.6 inclusive, and sections 29 and 31 of
Regulation 552 of the Health Insurance Act.
Effective September 1, 1995, out-of-country emergency hospital costs are reimbursed at Ontario fixed
per diem rates of:
• a maximum $400 (CAD) for in-patient services;
4.3 Coverage During Temporary
Absences Outside Canada
Health insurance coverage for insured Ontario residents during extended absences outside Canada is
governed by sections 1.7 through 1.14 (inclusive) of
Regulation 552 of the Health Insurance Act.
In accordance with the above noted sections of
Regulation 552 of the Health Insurance Act, MOHLTC
provides insured Ontario residents with continuous
Ontario health insurance coverage during absences
outside Canada of longer than 212 days (seven months)
in a 12-month period.
The Ministry requests that residents apply to
MOHLTC for this coverage before their departure
and provide documents explaining the reason for
their absence outside Canada. In accordance with
the regulations and MOHLTC policy, most applicants
must also have been resident in Ontario for at least
153 days in each of the two consecutive 12-month
periods before their expected date of departure.
The length of time that MOHLTC will provide a
person with continuous Ontario health insurance
coverage during an extended absence outside Canada
varies depending on the reason for the absence. Please
refer to the information below for further details:
Reason
OHIP Coverage
Study
Duration of a full-time academic
program in an educational institution
(unlimited)
Work
For a term of up to 5 continuous years
Charitable Worker
For a term of up to 5 continuous years
Vacation/Other
For a term of up to 5 continuous years
Canada Health Act — Annual Report 2008–2009
• a maximum $50 (CAD) for out-patient services
(except dialysis); and
• the actual cost incurred by the patient per
dialysis treatment.
During 2008–2009, emergency medically-necessary
out-of-country physician services were reimbursed
at the Ontario rates detailed in regulation under the
Health Insurance Act or the amount billed, whichever
is less. Charges for medically-necessary emergency or
out-of-country in-patient and out-patient services are
reimbursed only when rendered in an eligible hospital
or health facility. Medically necessary out-of-country
laboratory services when done on an emergency basis
by a physician are reimbursed in accordance with the
formula set out in section 29(1)(b) of the Regulation
or the amount billed, whichever is less, and when
done on an emergency basis by a laboratory, in accordance with the formula set out in section 31 of the
Regulation. 2008-2009 figures reflecting Ontario’s
payments for out-of-country emergency in-patient and
outpatient insured hospital and medical services are
not available.
4.4 Prior Approval Requirement
As set out in section 28.4 of Regulation 552 of the
Health Insurance Act, written approval from MOHLTC
is required for payment for non-emergency health services provided outside of Canada prior to the medical
services being rendered. Where identical or equivalent
treatment is not performed in Ontario, or in those
instances where the patient faces a delay in accessing
treatment in Ontario that would threaten the patient’s
life or cause medically-significant irreversible tissue
damage, the patient may be entitled to full funding
for out-of-country insured health services.
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Chapter 3: Ontario
Funding requirements for non-emergency laboratory tests performed outside Canada are described
in section 28.5 of Regulation 552 of the Health
Insurance Act.
Generally speaking, Ministry funding may be provided if the prior approval application establishes
that the services or tests are:
• not performed in Ontario (or the identical or
equivalent service is performed in Ontario but
it is necessary that the insured person travel out
of Canada to avoid a delay that would result in
death or medically significant irreversible tissue
damage);
• generally accepted by the medical profession in
Ontario as appropriate for a person in the same
circumstances as the insured person;
• not experimental;
• not performed for research purposes or
survey; and,
• performed at a hospital or health facility
(as defined in the regulation).
In 2008–2009, Ontario’s total payments for
prior-approved treatment outside Canada were
$127.9 million.
There is no formal prior-approval process required
for services provided to eligible Ontario residents
outside the province, but within Canada, if the
insured service is covered under the Reciprocal
Hospital Billing Agreements. Costs associated with
all uninsured or approved for clinical usage (experimental) devices and drugs are the responsibility of
the patient or must have prior approval from their
home province. As detailed above in section 4.2,
Regulation 552 and the Interprovincial Agreement
on Eligibility and Portability ensures that Ontario
residents who are temporarily travelling, working
or studying in another province continue to be eligible for Ontario health coverage.
5.0 Accessibility
5.1
Access to Insured Health Services
All insured hospital, physician and surgical-dental
services are available to Ontario residents on uniform
terms and conditions.
88
All insured persons are entitled to all insured physician, surgical-dental and hospital services, as defined
in the Health Insurance Act and Regulations.
Access to insured services is protected under Part II
of the Commitment to the Future of Medicare Act
(CFMA), “Health Services Accessibility”. This Act
prohibits any person or any entity from charging or
accepting payment or other benefit for rendering an
insured service to an insured person except as permitted in the Act. In addition, the CFMA prohibits
physicians, practitioners and hospitals from refusing
to provide an insured service if an insured person
chooses not to pay a “block” fee for an uninsured service. The Act further prohibits any person or entity
from paying, conferring or receiving a payment or
other benefit in exchange for preferred access to an
insured service.
MOHLTC investigates all possible contraventions of
Part II of the CFMA that come to its attention. For situations in which it is found that a patient has made
an unauthorized payment, the Ministry ensures that
the amount is repaid to that patient.
MOHLTC implemented Health Number/Card
Validation to aid health care providers and patients
with access to the information requested for OHIP
and claims payment. Providers may subscribe for
validation privileges to verify their patient eligibility
and health number/version code status (card status).
If patients require access to insured services and
do not have a health card in their possession, the
provider may obtain the necessary information by
submitting to MOHLTC a Health Number Release
Form signed by the patient. An accelerated process
for obtaining health numbers for patients who are
unable to provide a health number and require
emergency treatment is available to emergency
room facilities through the Health Number Look
Up service.
5.2 Access to Insured Hospital Services
Public hospitals in Ontario are not permitted to
refuse the admission of a patient if by refusal of
admission the patient’s life would be endangered.
In 2008–2009, there were 150 public hospital corporations staffed and in operation in Ontario, which
included chronic, general and special rehabilitation units. There were 7,692,770 acute patient days,
1,914,309 chronic patient days and 763,326 rehabilitation patient days delivered by public hospitals.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
Acute care priority services are designated highly
specialized hospital-based services that deal with
life-threatening conditions. These services are often
high-cost and are rapidly growing, which has made
access a concern. Generally, these services are managed provincially, on a time-limited basis.
Acute care priority services include:
• selected cardiovascular services;
• selected cancer services;
• chronic kidney disease;
• critical care services; and
• organ and tissue donation and organ
transplantation.
5.3 Access to Insured Physician Services
During 2008–2009, MOHLTC implemented the
following initiatives in order to improve access
to health care services:
Underserviced Area Program (UAP): UAP is one of
a number of initiatives/supports that MOHLTC provides to help communities across the province access
needed health care services. UAP provides a variety of
integrated initiatives aimed at attracting and retaining health care providers. To be eligible for the UAP’s
recruitment and retention support, a community must
be designated as under-serviced. UAP works closely
with under-serviced communities to identify their
need for health human resources. It provides financial
incentives and practice supports, and enables community access to primary care services in smaller, rural
areas unable to support full-time family physicians
by providing funding to operate 21 nursing stations,
as well as access to physician services by funding
locums and outreach clinics in northern communities
experiencing physician shortages. Currently, there are
134 communities in Ontario designated as underserviced for general/family practitioners and 13 northern
Ontario communities designated as under-serviced for
medical specialists.
Northern Physician Retention Initiative (NPRI):
The NPRI provides eligible family practitioners and
specialists who maintain practices and full active
hospital privileges in northern Ontario for at least
four years with a retention incentive as well as access
to funding for continuing medical education.
Canada Health Act — Annual Report 2008–2009
Northern Health Travel Grant (NHTG) Program: The
NHTG helps defray travel-related costs for residents
of northern Ontario who must travel long distances
to access insured hospital procedures and specialist
medical services that are not locally available, and
also promotes using specialist services located in
northern Ontario, which encourages more specialists
to practice and remain in the north.
Primary Health Care: During 2008–2009, Ontario
continued to align its new and existing primary care
delivery models to help improve and expand access
to primary health care for all Ontarians by continuing to include elements such as after-hours access
to telephone triage, health information, and on-call
physicians (as required) through the Telephone
Health Advisory Service (THAS), increased afterhours coverage and preventive care initiatives that
enhance health promotion, disease prevention,
and chronic disease management. As of March 31,
2009, there were approximately 8.8 million patients
rostered to 7,278 physicians in the various models, which include the Comprehensive Care Model
(CCM), Family Health Groups (FHGs), Family Health
Networks (FHNs), Family Health Organizations (FHOs),
Rural and Northern Physician Group Agreement
(RNPGA), and Community Health Centres (CHCs).
Negotiated agreements are in place to address other
special needs populations such as: the homeless,
remote First Nations communities, palliative care
patients, and maternity centre patients.
General Practitioner (GP) Focused Practice Alternative
Funding Plans (AFPs) have been developed to recognize and compensate physicians practicing within
speciality areas such as HIV and palliative care. In
addition, work is underway to develop alternative
funding plans for physicians with focused practices
in oncology and care of the elderly.
As part of transforming its health care system, Ontario
has reached its goal of creating 150 Family Health
Teams (FHTs), which are in various stages of development and implementation. When fully operational
it is expected that these 150 teams will improve access
to primary care for more than 2.5 million Ontarians
in 112 communities.
5.4 Physician Compensation and
Dental-Surgical Services
Physicians are paid for the services they provide
through a number of mechanisms. Some physician
payments are provided through fee-for-service
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Chapter 3: Ontario
arrangements. Remuneration is based on the
Schedule of Benefits under the Health Insurance
Act. Other physician payment models include
Primary Care Models (such as blended capitation
models), Alternate Payment Plans and new funding
arrangements for physicians in Academic Health
Science Centres.
General practitioners paid solely on a fee-for-service
basis represent 33 per cent of Ontario’s registered
general practitioners. The remaining family physicians in Ontario receive funding through one of
the primary care initiatives such as Family Health
Organizations, Family Health Networks, Family
Health Groups, Comprehensive Care Models, and
Blended Salary Model — Family Health Team.
Family Health Teams build upon existing primary
care physician funded models by providing funding
for inter-disciplinary health care professionals, who
work as integral members of the team. Physicians
participating in Family Health Teams are funded
by one of three compensation options that include:
Blended Capitation (such as FHN or FHO), Complement Based Models (RNPGA or other specialized
model agreements) and Blended Salary Model (for
community-sponsored FHTs).
MOHLTC negotiates physician funding with the
Ontario Medical Association (OMA). A new fouryear Physician Services Agreement, from April 2008
to March 31, 2012 was reached in October 2008.
The 2008 Physician Services Agreement centers
on delivering on two key Government priorities —
access to family health care and reducing congestion
in emergency departments. The Agreement does
not provide for any across-the-board fee increases.
Increases in specific fee codes will be implemented
to address Ministry priorities and income relativity between OMA sections. The fee code revisions
will be achieved through annual investment in the
Schedule of Benefits,with 5% in the second year,
3% in the third year and 4.25% in the fourth year.
The Agreement also includes investments in recruitment and retention initiatives and in northern/rural
programs to support stabilizing physician human
resources as well as investments in other ministry
priority areas, such as mental health, diagnostic services and care of the elderly. Additionally, through
this Agreement, $100 million in performance based
funding is provided for a new Local Health Integration Network (LHIN)-Physician Collaboration
Incentive Fund. This Fund will recognize and
reward the local efforts of physician groups who
work together and in collaboration with other service
providers to support the needs of patients in four
90
key areas — Most Responsible Physician, Emergency
Department, Unattached Patients and Hospital
On-Call Coverage.
With respect to insured surgical-dental services,
MOHLTC negotiates changes to the Schedule of
Benefits for Dental Services with the Ontario Dental
Association. In 2002–2003, MOHLTC and the Ontario
Dental Association agreed on a new multi-year funding agreement for dental services, which became
effective on April 1, 2003, and expired on March 31,
2007. The terms of the agreement continue until a
new contract is negotiated by the parties.
5.5 Payments to Hospitals
The Ontario budget system is a prospective
reimbursement system that reflects the effects
of workload increases, costs related to provincial
priority services, wait time strategies, and cost
increases in respect of above-average growth
in the volume of service in specific geographic
locations. Payments are made to hospitals on a
semi-monthly basis.
On April 1, 2007, LHINs assumed funding authority
for hospitals in Ontario. The LHINs negotiated twoyear Hospital Service Accountability Agreements
(HSAAs) with the hospitals and are the lead for the
Hospital Annual Planning Submissions (HAPS)
which are the precursors to the HSAAs. Payments to
hospitals are based on historical global allocations
and multi-year incremental increases that incorporate
population growth and anticipated service demands
within the available provincial budget.
Public hospitals submit HAPS to the LHINs that are
the result of broad consultations within the facilities
(e.g., all levels of staff, unions, physicians and board)
and within the community and region. HAPS are based
on a multi-year budget and provide a corresponding
multi-year planning forecast. The data submitted in
the HAPS are used to populate schedules for service
volumes and performance targets that form the contractual basis for the HSAA.
In an HSAA between the LHIN and the hospital,
hospital performance is measured through five key
performance indicators: total margin, current ratio,
percentage of full-time nurses, relative risk of readmission and chronic care patient quality indicators.
A review of the targets in each of the schedules and
a discussion of corresponding corridors for performance indicators in the HSAA is conducted between
the LHIN and the hospital.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
The Interprovincial Hospitals’ Reciprocal Billing
agreements are a convenient administrative arrangement in which provincial/territorial governments
reimburse hospitals in their jurisdictions for insured
services provided to patients from other provinces/
territories.
safeguarding resident rights, improving the quality
of care and improving the accountability framework
of LTC homes for the care, treatment and well-being
of more than 75,000 residents. Regulation development
is currently underway to support the requirements
in the Act.
MOHLTC reviews chronic care co-payment regulations and rates annually, accounting for changes in the
Consumer Price Index, Old Age Security each year, and
determines whether revisions to the regulations and
rates are appropriate.
As of March 31, 2009 there were approximately
622 Long Term Care (LTC) homes with over
76,000 beds in operation. Of the 622 LTC homes,
354 were for-profit and 268 were not-for-profit.
6.0 Recognition Given to
Federal Transfers
The Government of Ontario publicly acknowledged
the federal contributions provided through the Canada
Health Transfer in its 2008–2009 publications.
7.0 Extended Health Care
Services
7.1
Nursing Home Intermediate
Care and Adult Residential
Care Services
Long-Term Care (LTC) homes provide care and personal support services and accommodation for people
who are no longer able to live independently. Nursing
care is available on-site 24-hours a day. Residents
may also require on-site supervision, personal care
and monitoring to ensure their safety and well-being.
The home-like environment is intended to foster the
best possible quality of life. MOHLTC, via the LHINs,
currently funds all LTC homes licensed or approved
under three different Acts: the Homes for the Aged
and Rest Homes Act, the Nursing Homes Act, and the
Charitable Institutions Act. MOHLTC retains responsibility for compliance, inspections and enforcement
under the various Acts.
The Long-Term Care Homes Act, 2007 (LTCHA), which
received Royal Assent on June 4, 2007, is the cornerstone of the government’s strategy to improve care for
residents in Ontario’s long-term care (LTC) homes and
to strengthen the LTC home sector. Once proclaimed
into force, this legislation would replace the three
existing pieces of legislation governing LTC homes
which would be repealed. Once proclaimed into force,
the LTCHA would be the legislative authority for
Canada Health Act — Annual Report 2008–2009
LTC homes offer higher levels of nursing and personal care support services than those offered by
either retirement homes or supportive housing.
Residents in LTC homes must qualify for placement
in the homes. Placement is solely coordinated by
Community Care Access Centres (CCACs).
MOHLTC regulates the LTC home sector through its
Compliance Management Program which is designed
to safeguard residents’ rights, safety, security, quality
of care and quality of life. Through the Compliance
Management Program, MOHLTC monitors and inspects
LTC homes for compliance with legislation, regulation, standards and criteria, service agreements
and, where necessary, uses enforcement measures
to achieve compliance.
A public ministry web site provides information on
all LTC homes in Ontario, including reports on home
profiles, the outcomes of compliance inspections and
verified complaint inspections for a 12-month period.
The Ontario Health Quality Council (OHQC) is currently developing quality indicators which will be
used to publicly report on residents’ quality of life
and quality of care outcomes, resident and family
satisfaction, and staff satisfaction and engagement.
By January 2010, OHQC will begin publicly reporting
on quality indicators for the LTC homes sector.
The Ministry engaged Ms. Shirlee Sharkey in August
2007 to provide independent advice regarding staffing and care standards for LTC homes in Ontario. Ms.
Sharkey completed her review and submitted her final
report, People Caring for People: Impacting the Quality
of Life and Care of Residents of Long-Term Care Homes.
Ms. Sharkey’s report, released publicly on June 17, 2008,
includes 11 recommendations relating to strengthening
staff capacity and accountability for better outcomes in
the LTC homes sector.
Ms. Sharkey led a team of stakeholders (including
residents, staff and LTC home operators) that was
tasked to facilitate implementation of her recommendations. The team developed staffing plan guidelines
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Chapter 3: Ontario
for implementation in the LTC homes sector. Once
implemented, LTC homes will consult with residents,
families and staff to develop staffing plans to better
match staffing resources to the anticipated needs of
residents. The team also provided feedback to the
OHQC and advised on key resident care areas which
require regulations under the Long-Term Care Homes
Act, 2007.
7.2 Home Care Services
Ontario home and community care programs provide
a range of services that support people living in their
homes or other community care settings. These services are available through CCACs and Community
Service agencies.
CCACs provide simplified access for eligible Ontario
residents, of all ages, to home and community care;
make arrangements for the provision of home care
services to people in their homes, schools and communities; and determine eligibility, manage the waiting
lists, and authorize admission to publicly-funded
LTC homes. There is no charge for services provided
by CCACs.
The CCAC is responsible for the following:
• providing or purchasing a range of community
services on behalf of eligible clients. Services
include: nursing, personal support, homemaking, physiotherapy, occupational therapy,
respiratory therapy, pharmacy services, speech
language pathology, social work, social service
work, dietetics, medical supplies, dressings and
treatment equipment, laboratory and diagnostic
services, and transportation services;
• assessing an individual’s requirements and
determining their eligibility for professional
health services, homemaking, and personal
support services provided in people’s homes
and in the community. CCACs assess and determine eligibility for professional health services
for children/youth in public and private schools
and children/youth receiving home schooling,
and for personal support services for children/
youth in private schools and children/youth
receiving home schooling;
• developing plans of service;
• re-assessing the individual’s needs and revising
the plan of service when the individual’s needs
have changed;
92
• providing information and referral services for
the public to home and community care related
services; and
• managing the Requests for Proposal process for
purchased client services.
Legislation most relevant to CCACs includes:
the Long-Term Care Act, 1994; Community Care
Access Corporations Act, 2001; Nursing Homes Act;
Charitable Institutions Act; Homes for the Aged and
Rest Homes Act; Local Health System Integration
Act, 2006; and French Language Services Act. Each
CCAC must also be familiar with all other relevant
laws, including, but not limited to, the Health Care
Consent Act, 1996; Substitute Decisions Act, 1992;
Personal Health Information Protection Act, 2004;
and the Ministry of Health Appeal and Review
Boards Act, 1998.
Community Support Service agencies provide support
services that include: adult day programs, caregiver
support, meal services, home maintenance and repair,
friendly visiting, security checks or reassurance, social
or recreational services and transportation. Some
of these community services are also provided to
clients through assisted living services in supportive
housing and there are services specifically for clients
with acquired brain injury. Community services are
regulated under the Long-Term Care Act, 1994 and are
delivered by community-based, not-for-profit agencies
that rely heavily on volunteers, and are funded by the
Local Health Integration Networks (LHINs).
The provincial End-of-Life Care Strategy helps
replace hospitalizations, where appropriate, with
home care services made possible through advances
in treatment practices and collaborative planning
between all health care sectors. The objectives of the
strategy are to shift care of the dying from the acute
setting to an appropriate alternate setting based on
individual preference; to enhance/develop a clientcentred and interdisciplinary end-of-life care service
capacity; and to improve access to, and coordination/
consistency of comprehensive end-of-life care services. End-of-life care services are provided in home
or the community by CCACs, Community Support
Service agencies and residential hospices.
7.3
Ambulatory Health Care Services
Community Health Centres
Community Health Centres are transfer payment
agencies governed by incorporated non-profit community boards of directors that include members
Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
of the community served by the centre. The name
“Community Health Centre” reflects the fact that the
agency is established by the community and provides
programs and services in response to needs identified
in that community. Community Health Centres
deliver services through inter-disciplinary teams
including physicians, nurse practitioners, nurses,
counsellors, dieticians, therapists, community health
workers and health promoters. Services include
comprehensive primary care as well as group and
community programs, such as diabetes education,
parent/child programs, community kitchens, and
youth outreach services. Community Health Centres
work within a population health framework that
places an equal emphasis on providing comprehensive primary care, preventing illness, and health
promotion.
Community Health Centres identify the priority
populations that they will serve — traditionally
people have experienced barriers to access based on
culture, language, literacy, age, geographic isolation,
socio-economic status, disability, mental health status
and homelessness. Community Health Centres also
develop partnerships with other service providers to
improve access to care, promote effective service integration and build community capacity to address the
social determinants of health in their communities.
Service is provided through 54 Community Health
Centres operating from more than 80 full-service
sites across Ontario. Of these, 27 are in large urban
centres, 14 are in smaller urban centres, and 13 are
in either northern or rural communities. There is no
legislation specific to Community Health Centres.
Historically, Community Health Centres were developed based on expressions of interest from sponsoring
groups. This resulted in an uneven distribution and
some significant gaps in coverage across the province.
In 2004 and 2005 the government announced an expansion of the network of Community Health Centres by
adding 21 new Community Health Centres and 28 new
Community Health Satellite Centres. This expansion
was targeted to communities with at-risk populations
facing barriers to access. The new Community Health
Centres and Community Health Satellite Centres are in
Canada Health Act — Annual Report 2008–2009
various stages of development with a goal of addressing
the most critical gaps in coverage across the province.
Family Health Teams
Family Health Teams build upon existing primary care physician funded models by providing
funding for inter-disciplinary health care professionals, who work as integral members of the team.
Physicians participating in Family Health Teams are
funded by one of three compensation options that
include: Blended Capitation (such as FHN or FHO),
Complement Based Models (RNPGA or other specialized model agreements) and Blended Salary Model
(for community-sponsored FHTs).
Family Health Teams are located across the province, in both urban and rural settings, with half being
located in under serviced communities. Family Health
Teams range in size, structure, scope and governance
and reflect varying degrees of community integration.
The teams include an interdisciplinary team of physicians and other providers such as nurse practitioners,
nurses, social workers and dietitians all working
together to see more patients and keep them healthy.
As of March 31, 2009, the 150 teams, which are in
various stages of development and implementation, are
currently providing care to over 1.9 million Ontarians
and are serving over 270,000 new unattached patients.
Of these, 149 teams have commenced operation and
have hired over 1,193 new allied health professionals.
These numbers will continue to grow as the teams
continue to develop and become more operational.
The ministry has made impressive progress during the past four years toward its goal of increasing
access to family health care for Ontarians. A central goal has been reducing the number people in
Ontario who do not have regular access to a family
health care provider. A commitment has been made
to implement 50 new Family Health Teams over the
next four years. The implementation of the 50 new
Teams is part of the government’s Family Care for
All Strategy which will improve access to comprehensive family health care for all Ontarians.
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Chapter 3: Ontario
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
12,400,000
12,500,000
2006–2007
2
12,600,000
2007–2008
12,700,000
2
2008–2009
2
12,800,000
2
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
135
134
132
132
130
13
14
14
14
15
4
2. Number (#):
a. acute care
b. chronic care
c. rehabilitative care
4
4
4
4
d. other
3
4
4
4
e. total
155
3
156
3
154
3
154
3
154
3
5
3. Payments for insured health services ($):
a. acute care
not available
4
not available
4
not available
4
not available
4
not available
4
b. chronic care
not available
4
not available
4
not available
4
not available
4
not available
4
c. rehabilitative care
not available
4
not available
4
not available
4
not available
4
not available
4
d. other
not available
4
not available
4
not available
4
not available
4
not available
4
e. total
12,300,000,000
12,700,000,000
13,500,000,000
14,032,000,000
14,700,000,000
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
not available
5
not available
5
not available
5
not available
5
not available
5
b. diagnostic imaging facilities
not available
5
not available
5
not available
5
not available
5
not available
5
c. total
not available
5
not available
5
not available
5
not available
5
not available
5
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
not available
5
not available
5
not available
5
not available
5
not available
5
b. diagnostic imaging facilities
not available
5
not available
5
not available
5
not available
5
not available
5
c. total
not available
5
not available
5
not available
5
not available
5
not available
5
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
8,184
8,374
8,037
7,130
2008–2009
9,457
52,000,000
54,000,000
49,870,000
45,712,000
65,183,888
154,460
174,848
139,036
166,373
161,193
23,000,000
29,100,000
25,576,000
31,052,000
38,030,901
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
21,710
23,845
20,800
24,327
21,869
42,466,826
66,916,271
76,828,432
113,663,332
136,036,532
12.Total number of claims, out-patient (#).
not available
6
not available
6
not available
6
not available
6
not available
6
13.Total payments, out-patient ($).
not available
7
not available
7
not available
7
not available
7
not available
7
2. These estimates represent the number of Valid and Active Health Cards (have current eligibility and resident has incurred a claims in the last 7 years).
3. Provincial Psychiatric Hospitals are excluded and Specialty Mental Health Hospitals are reported under 2(d) — Other.
4. Facilities in Ontario tend to be mixed (acute/chronic, chronic/rehabilitative beds) with only a minority having one type of bed. Separating by facility type gives a small sample size
and significantly understates the amount actually spent on chronic and rehabilitative beds.
5. Data are not collected in a single system in MOHLTC. Further, the MOHLTC is unable to categorize providers/facilities as “for-profit” as MOHLTC does not have financial statements
detailing service providers’ disbursement of revenues from the Ministry.
6. Included in #10.
7. Included in #11.
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Canada Health Act — Annual Report 2008–2009
Chapter 3: Ontario
Insured PHYSICIAN Sevices Within Own Province or TErrITitory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
10,660
10,774
11,114
11,288
11,511
14.Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
not applicable
d. total
21,676
22,234
23,201
23,859
24,411
14
12
13
10
9
11,016
11,460
8
not applicable
12,087
8
not applicable
12,571
8
not applicable
12,900
8
not available
8
15.Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
not applicable
d. total
76
62
39
8
not applicable
36
8
51
not applicable
31
8
not applicable
49
30
8
not available
40
8
39
16.Number of not participating physicians (#):
a. general practitioners
not applicable
9
not applicable
9
not applicable
9
not applicable
9
not available
9
b. specialists
not applicable
9
not applicable
9
not applicable
9
not applicable
9
not available
9
c. other
not applicable
9
not applicable
9
not applicable
9
not applicable
9
not available
9
d. total
not applicable
9
not applicable
9
not applicable
9
not applicable
9
not available
9
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
200,825,265
10
215,980,656
10
222,632,480
10
230,383,956
10
238,551,791
10
6,424,329,400
10
7,072,813,000
10
7,791,581,966
10
8,410,478,000
10
9,324,794,000
10
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
191,451,200
203,656,000
204,545,656
206,136,644
209,528,058
4,973,000,000
5,312,085,618
5,642,049,000
5,962,775,787
6,528,353,572
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
534,179
573,830
627,375
759,570
683,377
20,300,000
21,164,600
23,754,500
25,180,900
26,471,536
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
179,410
200,723
182,693
211,323
247,741
11,635,998
13,211,381
19,351,944
37,901,297
54,780,594
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
335
330
316
317
291
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
86,000
87,111
92,264
91,540
99,212
11,786,600
12,546,397
14,229,896
13,423,384
13,916,464
8. All physicians are categorized as general practitioner or specialist.
9. Ontario has no non-participating physicians, only opted-out physicians who are reported under item #8.
10.Number of services includes services provided by Ontario physicians through Fee-for-Service, Primary Care, Alternate Payment Programs, and Academic Health Science Centres.
Total Payments includes payments made to Ontario physicians through Fee-for-Service, Primary Care, Alternate Payment Programs, and Academic Health Science Centres and the
Hospital On Call Program. Services and payments related to Other Practitioner Programs, Out-of-Country/Out-of-Province Programs, and Community Labs are excluded.
Canada Health Act — Annual Report 2008–2009
95
96
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
Manitoba
Introduction
Manitoba Health and Healthy Living provides leadership and support to protect, promote and preserve
the health of all Manitobans. The Department is organized into six distinct but related functional areas:
Corporate and Provincial Program Support; Primary
Care & Healthy Living; Health Workforce; Regional
Affairs; Administration, Finance and Accountability
and Public Health. Their mandates are derived from
established legislation and policy pertaining to
health and wellness issues. The roles and responsibilities of the Department include policy, program
and standards development, fiscal and program
accountability and evaluation. In addition, specific
direct services continue to be provided in the areas
of mental health, diagnostics/laboratory, tuberculosis
prevention and control and public health inspection.
Manitoba Health and Healthy Living remains committed to the principles of Medicare and improving
the health status of all Manitobans. In support of
these commitments, a number of activities were
initiated in 2008/09:
• Manitoba Health has been advancing public
health through initiatives to reduce disparities in health status and decrease preventable
diseases and injuries, improving surveillance
and analysis of public health threats, updating
the legislative/regulatory framework required to
protect the health of the public, addressing and
responding to existing and emerging diseases,
reviewing preparedness plans for public health
emergencies, responding to environmental
health issues, and working collaboratively with
partners to improve data collection, information
sharing, and research related to public health
best practice.
• We have been further developing our Health
Human Resources across a range of health professions through a number of recruitment and
retention strategies. Net gains in the number of
physicians and nurses in the province continued
to be seen in fiscal 2008/09. The Northern Remote
Physician Practice Initiative was established to
address the retention of graduates in northern/
remote settings. As of March 31, 2009, 384 rural
and northern nursing vacancies were filled
through the Conditional Grant Program. There
has also been progress in other disciplines, such
as an increase in midwifery positions (from 34.0
to 41.5) and the introduction of 18 new nurse
practitioner positions (from 58 to 76).
• Continued focus on healthy living was advanced
in the department’s seven priority areas of healthy
living — active living, healthy eating, mental
health promotion and substance abuse reduction,
chronic disease prevention, tobacco reduction,
injury prevention, and healthy sexuality. Highlights include:
• Manitoba continues to make progress in improving patient access through the reduction of wait
lists and wait times in priority areas. Access
targets to address national benchmarks have been
developed for cardiac surgery, cataract surgery,
radiation therapy, and hip and knee joint replacement. The provincial patient access registry
has instituted a standardized way of collecting
wait time data to improve reporting and support
ongoing efforts to ensure a timely and seamless
journey for patients through the system.
• Received the 2008 Canada in motion Russ
Kisby Physical Activity Leadership Award
in recognition of excellence in physical activity leadership for Manitoba in motion; this
initiative includes Healthy Schools in motion,
Communities in motion and Workplaces
in motion.
• Manitoba provides disaster management through
intense operational support and guidance in
emergencies such as the summer 2008 forest fires,
the spring 2009 flood, and the February 2009
ice storm.
• With various partners, Manitoba Health
engaged in promotion of the Northern
Healthy Foods Initiative, the Manitoba
Food Charter, a Food in Schools website,
the School Fruit and Vegetable Snack pilot
program, and the Dial-A-Dietician service.
Canada Health Act — Annual Report 2008–2009
Active Living:
Healthy Eating:
97
Chapter 3: Manitoba
Mental Health Promotion and Substance
Abuse Reduction:
• The Youth Suicide Prevention Strategy was
developed with a focus on aboriginal youth;
enhancement of community-based eating
disorders; and improved access to addiction
services in the province.
Chronic Disease Prevention:
• A Healthy Living guide and Healthy Together
Now were distributed as resources; 83 communities were supported to implement Chronic
Disease Prevention Initiative action plans; and
over 700 health care providers were trained as
part of the Regional Diabetes Program.
Tobacco Reduction:
• Developed a website to support the Review
& Rate V teen smoking prevention program;
completed a renewed strategy for tobacco
control and disease prevention; continued
to support Not on Tobacco, a teen smoking
cessation program, and Students Working
Against Tobacco.
Injury Prevention:
• With various partners, Manitoba Health continued to promote such successful initiatives
as the Low-Cost Bike Helmet campaign, the
Personal Flotation Device Loaner Program, the
Community Water Safety Grant program, Falls
Prevention and Vision Screen project, and the
Safe Play Areas on Farms grant program.
Healthy Sexuality:
• Manitoba Health continued implementation of
a healthy sexuality plan to address the needs
of five priority populations.
• We committed funding and began implementation of thirteen Maternal and Child Healthcare
Services (MACHS) Initiatives that focus on
supporting access to service closer to home,
addressing service gaps, and supporting promising (best) practice.
• Manitoba Health continued to work with interdepartmental and community partners on the
children’s therapy initiative, action planning
for children and adults with Autism Spectrum
Disorders, and healthy living resources for persons with disabilities.
98
• In partnership with the Prairie Women’s Health
Centre of Excellence, Manitoba Health introduced the Women’s Health Profile by conducting
a gender-based analysis of provincial and federal
data to identify over 140 indicators of women’s
and teen girls’ health.
• Manitoba Health supported the falls prevention
component of the SafetyAid Program for seniors
in conjunction with Manitoba Justice, Seniors
and Healthy Aging Secretariat and community
partners.
• We worked with the Winnipeg Regional Health
Authority to provide the Clinic for Alcohol
and Drug Exposed Children (CADEC) with
additional funding to stabilize services, and
to expand diagnostic services for children and
youth with fetal alcohol spectrum disorder.
Manitoba promotes and encourages major provincial quality improvement endeavours including the
provision of guidance and support for regions as they
continue to operationalize legislative requirements
for critical incident reporting and management. This
mandatory reporting and learning process is aimed at
enhancing patient safety by reducing the potential for
recurrence of critical incidents. In June 2007, Health
Minister Theresa Oswald announced the province
and its partners will invest $3.6 million to construct a
clinical learning and simulation facility (CLSF). This
facility opened in 2008. The state-of-the-art facility
will bring medical, nursing and allied health-care students and professionals together to practice medical
and surgical procedures prior to contact with patients.
The Manitoba Institute for Patient Safety (MIPS),
established in 2004, continues to implement a variety of activities to promote, coordinate and stimulate
research and initiatives that enhance patient safety
and quality care. These include planned expansion
of their health literacy initiative, It’s Safe to Ask, to
include education and awareness relative to medication safety. This initiative will consist of practical
tools for both patients and health care providers. The
aim of this initiative is to enhance clear communication and help reduce health care errors and critical
incidents. MPIS sponsors the Western Node of Safer
Healthcare Now. MIPS continues to organize education events for the public and healthcare providers
on various patient safety topics. MIPS is working on
another important initiative to address medication
safety relative to the use of abbreviations.
Manitoba Health and Healthy Living restructured
provincial drug programs to establish three functional units (Operational Program Management,
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
Professional Services and Drug Management Policy) to
facilitate comprehensive, coordinated and proactive
drug benefit program management for the publiclyfunded drug programs in Manitoba. The Operational
Program Management Unit is responsible for operational issues. The Professional Services Unit focuses
on formulary management and implementation of
drug management intervention strategies. The Drug
Management Policy Unit provides for focused policy
and planning capacity on emerging drug management and utilization issues. In 2008/09, Manitoba
Health and Healthy Living extended the Utilization
Management Agreement (UMA) strategy implemented
in 2007 for brand-name drugs, to generic products.
In Manitoba, UMAs are now requisite for listing
new products on the formulary. As part of the UMA
process, drug companies are required to develop a
business case to demonstrate the proposed utilization
of the drug product and how that particular product’s
value proposition compared to other products in the
class. On the basis of the proposal, Manitoba Health
and Healthy Living modifies the formulary listing
of the existing and new products, and ensures, as
part of the legal contract, that the most cost-effective
product is appropriately promoted.
Aging in Place is the central principle in the planning of all provincial government housing and
long-term care initiatives. By increasing the opportunity to remain in one’s community, or age in place,
Manitobans will be provided options to continue to
contribute to the social, civic and economic life of
the community. Aging in Place is a matter of preserving the ability of Manitobans from every culture to
remain safely in their own community, to enjoy the
familiar social, cultural and spiritual interactions
that enrich their lives even though their health may
be compromised. Aging in Place supports an individual’s identity and sense of self within the larger
community, whether it is in rural or urban areas, in
northern or aboriginal communities. The principles
of Aging in Place address the need for affordable
options for housing with supports, as alternatives to
premature personal care home placement. The strategy addresses the elements between an individual
living in their home and Personal Care Homes.
Aging in Place is a lifestyle that supports the following inherent values:
• Safety and security — living with reduced
risks in the home
• Flexibility — adjusting services to meet
changing needs
Canada Health Act — Annual Report 2008–2009
• Choice — freedom to choose among options
• Equity — equal access for all seniors
• Dignity — Ability to maintain sense of self
worth, self esteem and humanness
It is anticipated that supporting individuals to
remain in their community and age in place will
not only promote independence in daily living, but
will also maximize overall well-being and health.
Based on the Aging in Place principle, Manitoba’s Long
Term Care strategy was launched in 2006. Creating
increased community options with supports provides
alternatives to premature or inappropriate placement
in personal care homes. This enables Manitobans to
remain in their communities to enjoy the social, cultural and spiritual interactions that enrich their lives
even though their health may be compromised. The
strategy currently supports more than 3,300 community living units in the province.
Considerable health capital investments in acute care
facilities have been made: the Pediatric Opthalmology
Clinic Redevelopment at the Health Sciences Centre,
the Community Cancer Program at the Deloraine
Health Centre, Hemodialysis Expansion at Thompson
General Hospital, renovations to St. Anthony’s Hospital
(The Pas Health Complex), Emergency/Special Care
Unit and Dialysis Units, Outpatient Chemotherapy
Program and Obstetric Facilities at Bethesda Hospital in
Steinbach are projects that were completed in 2008/09.
Further, planning was initiated for the redevelopment
of the Women’s Hospital at Health Sciences Centre in
Winnipeg. The new hospital will replace the existing
facility as a provincial centre of excellence in women’s
health services offering state-of-the-art maternity, newborn and women’s medical and surgical care. Capital
investments in long-term care facilities included a new
100-bed personal care home in Neepawa.
Further provincial program capital investments
included: providing significant tenant improvements,
expansions, renovations or redevelopments to the
Swan Valley Health Centre, the St. Anne, Bethesda,
St. Anthony’s and Flin Flon Hospitals, a new health
care centre in Wabowden, continued enhancement of
rehabilitation services with planning for the second
stage of the WRHA Rehabilitation Re-configuration
Project, the community health services building in
Dauphin, the Lourdeon Wellness Centre in Notre
dame de Lourdes, replacement of the Ilford Nursing
Station with a new 5-bed freestanding residence in
Thompson for persons with acquired brain injuries.
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Chapter 3: Manitoba
In addition, significant capital investments include
the following ongoing projects in construction during 2008/09: Emergency Department Renovations at
Concordia General Hospital, Emergency Department
Redevelopment at Seven Oaks General Hospital,
phase 1 of the Emergency Department and Oncology
Redevelopment at Victoria General Hospital, Cardiac
Sciences Centre at St. Boniface General Hospital,
Sleep Lab at the Misericordia Health Centre, North
End Wellness Centre — Primary Health Care Office,
Emergency Room Redevelopment at the Portage
District General Hospital, Redevelopment of the
Selkirk Mental Health Centre, a 24-bed residential addictions treatment facility — Thompson
Residential Care and Outreach Facility.
In January, 2007 the Colorectal Cancer (CRC)
Screening Program was launched. Phase 1 started
on April 1, 2007 and was completed in October 2008.
This phase targeted a population of select individuals
aged 50–74 years in the Assiniboine and Winnipeg
Regional Health Authorities, including both rural
and urban populations. As of December 31, 2008, a
total of 24,174 people had been invited to participate
and there has been a 17.5% return rate. Phase 2
funding was announced in September 2008; this
will enable the program to expand province-wide.
The program will be inviting eligible people from all
regions to participate in colorectal cancer screening.
Other CRC screening activities include a Colorectal
Cancer awareness campaign and further education
of primary care providers.
creativity, compassion, confidence, trust and respect,
and plays a leadership role in promoting prevention
and positive health practices.
It is the mission of Manitoba Health and Healthy
Living “to meet the health needs of individuals,
families and their communities by leading a sustainable, publicly administered health system that
promotes well-being and provides the right care, in
the right place, at the right time.” This mission is
accomplished by providing strategic direction and
leadership to the provincial health system. This
includes defining provincial goals, setting priorities, establishing standards and policies based on
evidence and best practices, promoting quality and
safety, encouraging innovation, allocating resources
within the framework of provincial legislation, and
assuring accountability while balancing health service needs with fiscal responsibility.
In addition, Manitoba Health and Healthy Living plays
a leadership role in promoting and co-ordinating
strategies across departments that reflect the determinants of health which lie outside the traditional health
care system. Manitoba Health and Healthy Living also
manages the insured benefits claims payments for
residents of Manitoba related to the cost of medical,
hospital, personal care, Pharmacare and other health
services. Most direct services are delivered through
regional health authorities, and other health care
organizations; however, the department manages the
direct operations of Selkirk Mental Health Centre and
Cadham Provincial Laboratory.
The Role and Mission of Manitoba 1.0 Public Administration
Health and Healthy Living
Manitoba Health and Healthy Living is a line department within the government structure and operates
under the provisions of statutes and responsibilities
charged to the Minister of Health and the Minister
of Healthy Living. The formal mandates contained in
legislation, combined with mandates resulting from
responses to emerging health and health care issues,
establish a framework for planning and delivering
services.
The stated vision of Manitoba Health and Health Living
is “Healthy Manitobans through an appropriate balance
of prevention and care.” Manitoba Health and Healthy
Living leads the way to quality health care built with
1.1
Health Care Insurance Plan and
Public Authority
The Manitoba Health Services Insurance Plan
(MHSIP) is administered by the Department of
Health under the Health Services Insurance Act,
R.S.M. 1987, c. H35. The Act1 was significantly
amended in 1992, dissolving the Manitoba Health
Services Commission and transferring all assets
and responsibilities to Manitoba Health and
Healthy Living. The dissolution took effect on
March 31, 1993.
The MHSIP is administered under this Act for insurance in respect of the costs of hospital, personal care
1. Where reference is made to “the Act” in the text, this refers to the Health Services Insurance Act as consolidated to March 31, 2007.
100
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
and medical and other health services referred to
in acts of the Legislature or regulations thereunder.
The Act was amended on January 1, 1999, to provide
insurance for out-patient services relating to insured
medical services provided in surgical facilities.
The Minister of Health is responsible for administering and operating the Plan. Under section 3(2), the
Minister has the power:
• to provide insurance for residents of the province
in respect of the costs of hospital services, medical
services and other health services, and personal
care; to plan, organize and develop throughout
the province a balanced and integrated system of
hospitals, personal care homes and related health
facilities and services commensurate with the
needs of the residents of the province;
• to ensure that adequate standards are maintained in hospitals, personal care homes and
related health facilities, including standards
respecting supervision, licensing, equipment
and inspection, or to make such arrangements
that the Minister considers necessary to ensure
that adequate standards are maintained;
• to provide a consulting service, exclusive of
individual patient care, to hospitals and personal care homes in the province or to make
such arrangements as the Minister considers
necessary to ensure that such a consulting
service is provided;
• to require that the records of hospitals, personal
care homes and related health facilities are audited
annually and that the returns in respect of hospitals, which are required by the Government of
Canada, are submitted; and
• in cases where residents do not have available
medical services and other health services, to
take such measures that are necessary to plan,
organize and develop medical services and other
health services commensurate with the needs of
the residents.
The Minister may also enter into contracts and
agreements with any person or group that he or she
considers necessary for the purposes of the Act.
The Minister may also make grants to any person
or group for the purposes of the Act on such terms
and conditions that are considered advisable. Also,
the Minister may, in writing, delegate to any person
any power, authority, duty or function conferred or
Canada Health Act — Annual Report 2008–2009
imposed upon the Minister under the Act or under
the regulations.
There were no legislative amendments to the Act
or the regulations in the 2008/2009 fiscal year that
affected the public administration of the Plan.
1.2 Reporting Relationship
Section 6 of the Act requires the Minister to have
audited financial statements of the Plan showing
separately the expenditures for hospital services,
medical services and other health services. The
Minister is required to prepare an annual report,
which must include the audited financial statements, and to table the report before the Legislative
Assembly within 15 days of receiving it, if the
Assembly is in session. If the Assembly is not in
session, the report must be tabled within 15 days
of the beginning of the next session.
1.3 Audit of Accounts
Section 7 of the Act requires that the Office of the
Auditor General of Manitoba (or another auditor
designated by the Office of the Auditor General of
Manitoba) audit the accounts of the Plan annually
and prepare a report on that audit for the Minister.
The most recent audit reported to the Minister and
available to the public is for the 2008/2009 fiscal year
and is contained in the Manitoba Health and Healthy
Living Annual Report, 2008/2009. It will also be available on the Province’s website in late October 2009.
2.0 Comprehensiveness
2.1
Insured Hospital Services
Sections 46 and 47 of the Act, as well as the Hospital
Services Insurance and Administration Regulation
(M.R. 48/93), provide for insured hospital services.
As of March 31, 2009, there were 96 facilities providing insured hospital services to both in- and
out-patients. Hospitals are designated by the
Hospitals Designation Regulation (M.R. 47/93)
under the Act.
Services specified by the Regulation as insured
in- and out-patient hospital services include: accommodation and meals at the standard ward level;
101
Chapter 3: Manitoba
necessary nursing services; laboratory, radiological
and other diagnostic procedures; drugs, biologics
and related preparations; routine medical and surgical supplies; use of operating room, case room and
anaesthetic facilities; and use of radiotherapy, physiotherapy, occupational and speech therapy facilities,
where available.
All hospital services are added to the list of available hospital services through the health planning
process. Manitoba residents maintain high expectations for quality health care and insist that the best
available medical knowledge and service be applied
to their personal health situations. Manitoba Health
and Healthy Living is sensitive to new developments
in the health sciences.
2.2 Insured Physician Services
The enabling legislation that provides for insured
physician services is the Medical Services Insurance
Regulation (M.R. 49/93) made under the Act.
Physicians providing insured services in Manitoba
must be lawfully entitled to practise medicine in
Manitoba, and be registered and licensed under
the Medical Act. As of March 31, 2009, there were
2,370 physicians on the Manitoba Health and Healthy
Living Registry.
A physician, by giving notice to the Minister in
writing, may elect to collect the fees for medical
services rendered to insured persons other than from
the Minister, in accordance with section 91 of the
Act and section 5 of the Medical Services Insurance
Regulation. The election to opt out of the health
insurance plan takes effect on the first day of the
month following a 90-day period from the date the
Minister receives the notice.
Before rendering a medical service to an insured
person, physicians must give the patient reasonable
notice that they propose to collect any fee for the
medical service from them or any other person
except the Minister. The physician is responsible
for submitting a claim to the Minister on the patient’s
behalf and cannot collect fees in excess of the benefits
payable for the service under the Act or regulations.
To date, no physicians have opted out of the medical
plan in Manitoba.
for Insured Medical Services Regulation (M.R.
95/96). Coverage is provided for all medically
required personal health care services that are
not excluded under the Excluded Services Regulation (M.R. 46/93) of the Act, rendered to an
insured person by a physician.
During fiscal year 2008/2009, a number of new
insured services were added to a revised fee schedule. The Physician’s Manual can be viewed on-line at:
http://www.gov.mb.ca/health/manual/index.html
In order for a physician’s service to be added to the
list of those covered by Manitoba Health and Healthy
Living, physicians must put forward a proposal
to their specific section of the Manitoba Medical
Association (MMA). The MMA will negotiate the
item, including the fee, with Manitoba Health and
Healthy Living. Manitoba Health and Healthy Living
may also initiate this process.
2.3 Insured Surgical-Dental Services
Insured surgical and dental services are listed in
the Hospital Services Insurance and Administration
Regulation (M.R. 48/93) under the Act. Surgical
services are insured when performed by a certified
oral and maxillofacial surgeon or a licensed dentist in a hospital, when hospitalization is required
for the proper performance of the procedure. This
Regulation also provides benefits relating to the cost
of insured orthodontic services in cases of cleft lip
and/or palate for persons registered under the program by their 18th birthday, when provided by
a registered orthodontist. As of March 31, 2009,
609 dentists were registered with Manitoba Health
and Healthy Living.
Providers of dental services may elect to collect their
fees directly from the patient in the same manner as
physicians and may not charge to or collect from an
insured person a fee in excess of the benefits payable
under the Act or regulations. No providers of dental
services had opted out as of March 31, 2009.
In order for a dental service to be added to the list
of insured services, a dentist must put forward a
proposal to the Manitoba Dental Association (MDA).
The MDA will negotiate the fee with Manitoba
Health and Healthy Living.
The range of physician services insured by Manitoba
Health and Healthy Living is listed in the Payment
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Chapter 3: Manitoba
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
The Excluded Services Regulation (M.R. 46/93) made
under the Act sets out those services that are not
insured. These include: examinations and reports for
reasons of employment, insurance, attendance at university or camp, or performed at the request of third
parties; group immunization or other group services
except where authorized by Manitoba Health and
Healthy Living; services provided by a physician,
dentist, chiropractor or optometrist to him or herself
or any dependants; preparation of records, reports,
certificates, communications and testimony in court;
mileage or travelling time; services provided by psychologists, chiropodists and other practitioners not
provided for in the legislation; in vitro fertilization;
tattoo removal; contact lens fitting; reversal of sterilization procedures; and psychoanalysis.
The Hospital Services Insurance and Administration
Regulation states that hospital in-patient services
include routine medical and surgical supplies,
thereby ensuring reasonable access for all residents.
The regional health authorities and Manitoba Health
monitor compliance.
Manitoba Health and Healthy Living has addressed
the issue of patient charges for medical supplies, or
“tray fees,” by including tray fees in the listing of
insured medical benefits.
All Manitoba residents have equal access to services.
Third parties such as private insurers or the Workers
Compensation Board do not receive priority access
to services through additional payment. Manitoba
has no formalized process to monitor compliance;
however, feedback from physicians, hospital administrators, medical professionals and staff allows
regional health authorities and Manitoba Health
and Healthy Living to monitor usage and service
concerns.
To de-insure services covered by Manitoba Health
and Healthy Living, the Ministry prepares a submission for approval by Cabinet. The need for public
consultation is determined on an individual basis
depending on the subject.
No services were removed from the list of those
insured by Manitoba Health and Healthy Living in
2008/2009.
Canada Health Act — Annual Report 2008–2009
3.0 Universality
3.1
Eligibility
The Health Services Insurance Act defines the eligibility of Manitoba residents for coverage under the
provincial health care insurance plan. Section 2(1) of
the Act states that a resident is a person who is legally
entitled to be in Canada, makes his or her home in
Manitoba, is physically present in Manitoba for at least
six months in a calendar year, and includes any other
person classified as a resident in the Regulations,
but does not include a person who holds a temporary
resident permit under the Immigration and Refugee
Protection Act (Canada), unless the Minister determines otherwise, or is a visitor, transient or tourist.
The Residency and Registration Regulation (M.R.
54/93) extends the definition of residency. The extensions are found in sections 7(1) and 8(1). Section
7(1) allows missionaries, individuals with out-ofcountry employment and individuals undertaking
sabbatical leave to be outside Manitoba for up to two
years while still remaining residents of Manitoba.
Students are deemed to be Manitoba residents while
in full-time attendance at an accredited educational
institution. Section 8(1) extends residency to individuals who are legally entitled to work in Manitoba and
have a work permit of 12 months or more.
The Residency and Registration Regulation, section 6,
defines Manitoba’s waiting period as follows:
“A resident who was a resident of another
Canadian province or territory immediately
before his or her arrival in Manitoba is not
entitled to benefits until the first day of the
third month following the month of arrival.”
There are currently no other waiting periods in
Manitoba.
The MHSIP excludes residents covered under
the following federal statutes: Aeronautics Act;
Civilian War-related Benefits Act; Government
Employees Compensation Act; Merchant Seaman
Compensation Act; National Defence Act; Pension
Act; Royal Canadian Mounted Police Act; Veteran’s
Rehabilitation Act; or under legislation of any other
jurisdiction (Excluded Services Regulations subsection 2(2)). The excluded are residents who are
members of the Canadian Forces, the Royal Canadian
Mounted Police (RCMP) and federal inmates. These
residents become eligible for Manitoba Health and
Healthy Living coverage upon discharge from the
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Canadian Forces, the RCMP, or if an inmate of a
penitentiary has no resident dependants. Upon
change of status, these persons have one month to
register with Manitoba Health and Healthy Living
(Residency and Registration Regulation (M.R. 54/93,
subsection 2(3)).
3.2 Registration Requirements
The process of issuing health insurance cards
requires that individuals inform and provide documentation to Manitoba Health and Healthy Living
that they are legally entitled to be in Canada, and
that they intend to be physically present in Manitoba
for six consecutive months. They must also provide
a primary residence address in Manitoba. Upon
receiving this information, Manitoba Health and
Healthy Living will provide a registration card for
the individual and all qualifying dependants.
Manitoba has two health-related numbers. The
registration number is a six-digit number assigned
to an individual 18 years of age or older who is not
classified as a dependant. This number is used by
Manitoba Health and Healthy Living to pay for all
medical service claims for that individual and all
designated dependants. A nine-digit Personal Health
Identification Number (PHIN) is used for payment
of all hospital services and for the provincial drug
program.
As of March 31, 2009, there were 1,209,401 residents
registered with the health care insurance plan.
There is no provision for a resident to opt out of the
Manitoba Health and Healthy Living Plan.
3.3 Other Categories of Individual
The Residency and Registration Regulation (M.R.
54/93, sub-section 8(1)) requires that temporary
workers possess a work permit issued by Citizenship
and Immigration Canada (CIC) for at least 12 consecutive months, be physically present in Manitoba and
be legally entitled to be in Canada before receiving
Manitoba Health and Healthy Living coverage. As of
March 31, 2009, there were 6,514 individuals on work
permits covered under the MHSIP. The definition of
“resident” under the Health Services Insurance Act
allows the Minister of Health or the Minister’s designated representative to provide coverage for holders
of a Minister’s permit under the Immigration Act
(Canada). No legislative amendments to the Act or
the regulations in the 2008/2009 fiscal year affected
universality.
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4.0 Portability
4.1
Minimum Waiting Period
The Residency and Registration Regulation (M.R.
54/93, section 6) identifies the waiting period for
insured persons from another province or territory.
A resident who lived in another Canadian province
or territory immediately before arriving in Manitoba
is entitled to benefits on the first day of the third
month following the month of arrival.
4.2 Coverage During Temporary
Absences in Canada
The Residency and Registration Regulation (M.R.
54/93 section 7(1)) defines the rules for portability
of health insurance during temporary absences in
Canada.
Students are considered residents and will continue
to receive health coverage for the duration of their
full-time enrolment at any accredited educational
institution. The additional requirement is that
they intend to return and reside in Manitoba after
completing their studies. Manitoba has formal agreements with all Canadian provinces and territories
for the reciprocal billing of insured hospital services.
Manitoba has a bilateral agreement with the Province
of Saskatchewan for Saskatchewan residents who
receive care in Manitoba border communities.
In-patient costs are paid at standard rates approved
by the host province or territory. Payments for inpatient, high-cost procedures and out-patient services
are based on national rates agreed to by provincial or
territorial health plans. These include all medically
necessary services as well as costs for emergency care.
Except for Quebec, medical services incurred in all
provinces or territories are paid through a reciprocal
billing agreement at host province or territory rates.
Claims for medical services received in Quebec are
submitted by the patient or physician to Manitoba
Health and Healthy Living for payment at host province rates.
In 2008/2009, Manitoba Health and Healthy Living
made payments of approximately $38.6 million for
hospital services and $9.7 million for medical services provided in Canada.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
4.3 Coverage During Temporary
Absences Outside Canada
The Residency and Registration Regulation (M.R.
54/93, sub-section 7(1)) defines the rules for portability of health insurance during temporary absences
from Canada.
Residents on full-time employment contracts outside
Canada will receive Manitoba Health and Healthy
Living coverage for up to 24 consecutive months.
Individuals must return and reside in Manitoba after
completing their employment terms. Clergy serving
as missionaries on behalf of a religious organization
approved as a registered charity under the Income
Tax Act (Canada) will be covered by Manitoba Health
and Healthy Living for up to 24 consecutive months.
Students are considered residents and will continue
to receive health coverage for the duration of their
full-time enrollment at an accredited educational
institution. The additional requirement is that
they intend to return and reside in Manitoba after
completing their studies. Residents on sabbatical
or educational leave from employment will be covered by Manitoba Health and Healthy Living for up
to 24 consecutive months. These individuals also
must return and reside in Manitoba after completing
their leave.
Coverage for all these categories is subject to amounts
detailed in the Hospital Services Insurance and Administration Regulation (M.R. 48/93). Hospital services
received outside Canada due to an emergency or a
sudden illness, while temporarily absent, are paid
as follows:
In-patient services are paid based on a per-diem rate
according to hospital size:
• 1–100 beds: $280
• 101–500 beds: $365
• over 500 beds: $570
Out-patient services are paid at a flat rate of $100 per
visit or $215 for haemodialysis.
The calculation of these rates is complex due to the
diversity of hospitals in both rural and urban areas.
Manitobans requiring medically necessary hospital services unavailable in Manitoba or elsewhere
in Canada may be eligible for costs incurred in the
United States by providing Manitoba Health and
Healthy Living with a recommendation from a
specialist stating that the patient requires a specific,
medically necessary service. Physician services
received in the United States are paid at the equivalent Manitoba rate for similar services. Hospital
services are paid at a minimum of 75 percent of the
hospital’s charges for insured services. Payment for
hospital services is made in U.S. funds (the Hospital
Services Insurance and Administration Regulation,
sections 15–23).
Manitoba Health and Healthy Living made payments of
approximately $6,701,1802 for hospital care provided in
hospitals outside Canada in the 2008–2009 fiscal year.
In addition, Manitoba Health and Healthy Living made
payments of approximately $725,382 for medical care
outside Canada.
In instances where Manitoba Health and Healthy
Living has given prior approval for services provided
outside Canada and payment is less than 100 percent
of the amount billed for insured services, Manitoba
Health and Healthy Living will consider additional
funding based on financial need.
4.4 Prior Approval Requirement
Prior approval by Manitoba Health and Healthy
Living is not required for services provided in other
provinces or territories or for emergency care provided outside Canada. Prior approval is required for
elective hospital and medical care provided outside
Canada. An appropriate medical specialist must
apply to Manitoba Health and Healthy Living to
receive approval for coverage.
No legislative amendments to the Act or the regulations in the 2008/2009 fiscal year had an effect on
portability.
5.0 Accessibility
5.1 Access to Insured Health Services
Manitoba Health and Healthy Living ensures that
medical services are equitable and reasonably available to all Manitobans. Effective January 1, 1999, the
Surgical Facilities Regulation (M.R. 222/98) under
the Health Services Insurance Act came into force
to prevent private surgical facilities from charging
additional fees for insured medical services.
2. Please note that the above totals are actual payments in 2008/09 and do not include any adjustments for accruals (current or prior year).
Canada Health Act — Annual Report 2008–2009
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Chapter 3: Manitoba
In July 2001, the Health Services Insurance Act, the
Private Hospitals Act and the Hospitals Act were
amended to strengthen and protect public access to
the health care system. The amendments include:
• changes to definitions and other provisions to
ensure that no charges can be made to individuals who receive insured surgical services
or to anyone else on that person’s behalf; and
• ensuring that a surgical facility cannot perform
procedures requiring overnight stays and thereby function as a private hospital.
Manitoba Health and Healthy Living has developed
a number of initiatives to increase clients’ access to
insured services such as Advanced Access, Health
Links-Info Sante congestive heart failure initiative,
collaborative practice and Bridging Generalist and
Specialist Care.
5.2 Access to Insured Hospital Services
All Manitobans have access to hospital services
including acute care, psychiatric extended treatment, mental health, palliative, chronic, long-term
assessment/rehabilitation and to personal care facilities. There has been a shift in focus from hospital
beds to community services, out-patients and day
surgeries, which are also insured services.
Manitoba continues to have growth in the number
of active practicing nurses through expansions to
the nursing education programs and strategies of the
Nurses Recruitment and Retention Fund (NRRF).
According to the registration data received from the
Colleges of Registered Nurses, Registered Psychiatric
Nurses and Licensed Practical Nurses, there were
16,126 active practicing nurses in Manitoba in 2008.
This is a net gain of 245 more nurses than in 2007.
There remain, however, ongoing nursing resource
challenges in some rural and northern regions, and
in specialty care areas in Winnipeg. Manitoba has
increased nursing education seats throughout the
province resulting in a more than doubling of enrolments in the last 10 years. The Winnipeg Regional
Health Authority’s (WRHA) strategy, the Winnipeg
Critical Care Nursing Education Program (WCNEO),
was aimed at increasing the number of Intensive
Care Nurses in the province, thus reducing nursing
overtime costs, decreasing surgery cancellations and
bed closures. The first class commenced in 2008. The
NRRF also contributes significantly to improving
the nursing supply in Manitoba through initiatives
such as relocation assistance, the Conditional Grant
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Program to encourage new graduates to work in
rural and northern regions (outside Winnipeg and
Brandon), the personal care home grant, and funding
for continuing education, and specialty education
programs. The Extended Practice Regulation came to
effect in June 2005, allowing nurses on the register
to independently prescribe drugs, order screening
and diagnostic tests, and perform minor surgical
and invasive procedures as set out in regulation.
The number of nurses on the register has grown
from 4 in June 2005 to 73 as of March 31, 2009.
In addition, Manitoba has a wide range of other health
care professionals. There are shortages in midwifery;
the development of human resources for maternal/
newborn health services is being addressed by expansion of the Bachelor of Aboriginal Midwifery program
delivered by the University College of the North, as
well as development of bridging opportunities for
internationally educated midwives. Shortages in some
of the technology fields persist, primarily in rural and
northern areas of the province. Shortages in some of
the technology fields such as medical radiology technology, medical laboratory technology and sonography
continue to be an issue; however recent expansions of
training opportunities are expected to have positive
impacts in the near future.
Manitoba currently has access to eight Magnetic
Resonance Imaging (MRI) machines for clinical
testing. The first unit was installed in 1990 by the
St. Boniface Research Foundation. In Winnipeg,
there are three MRI machines located at St. Boniface
General Hospital, two located at the Health Sciences
Centre and one at Pan Am Clinic. One of the MRIs at
the Health Science Centre was a joint initiative with
the National Research Council (NRC). The first MRI
in Manitoba to be located outside of Winnipeg was
opened at Brandon Regional Health Centre in June
2004. The eighth and newest MRI was installed at
the Boundary Trails Health Centre in south central
Manitoba and became operational November 2007.
Manitoba has 20 Computerized Tomography (CT)
scanners, 11 in Winnipeg, 8 in rural Manitoba and
one in CancerCare Manitoba. In Winnipeg there
are three (one for paediatric patients) at the Health
Sciences Centre, two at the St. Boniface General
Hospital, one each at Victoria General Hospital,
Misericordia Health Centre, Seven Oaks, Grace
and Concordia Hospitals. The rural CT scanners
are located throughout the province, in Dauphin
Regional Health Centre, Thompson General Hospital,
Brandon Regional Health Centre, Boundary Trails
Health Centre, Bethesda Hospital, The Pas Hospital,
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
Selkirk Regional Health Centre and Portage District
General Hospital.
There are a total of 101 diagnostic ultrasound scanners in Manitoba. Seventy-four are in Winnipeg health
facilities and 27 are in the rural and northern regional
health authorities. The 101st scanner, added in June
2008, is a mobile unit that serves both Eriksdale and
Arborg in Manitoba’s Interlake region.
Wait Times funding supported the purchase and installation of an additional echo cardiography scanner in
Brandon in August 2007, which supported enhanced
echo services and lower wait times for echo scans.
In February 2008, Deloraine opened the 16th
Community Cancer Program (CCP) site within
Manitoba’s Community Cancer Program Network
(CCPN). The CCPN is a shared-care model in which
CancerCare Manitoba (CCMB) and Regional Health
Authority health care staff partner to provide residents with chemotherapy and other cancer services
closer to home. The CCPN program delivers care
across the cancer spectrum for most cancer diagnoses.
In early 2007, the Health Sciences Centre received
a new Gamma Knife which replaced the Gamma
Knife acquired in 2003. Winnipeg is the first site
in North America and only second in the world to
have this next generation of Gamma Knife, allowing
Manitoba to maintain leadership in safe and high
quality patient care. This upgraded version of the
Knife expands its capability to allow for treatment
of cancers in the lower head and neck, therefore
avoiding highly disfiguring surgical procedures on
many patients. This acquisition fits well with the
government’s announcement earlier this year of the
acquisition of the Artiste. The Artiste is expected to
be functional in early January 2010 housed within
the Siemens Institute for Advanced Medicine.
Wait time funding has been continued for additional hip and knee joint replacements at several
sites in Winnipeg, as well as the Brandon Regional
Health Centre and Boundary Trails Health Centre.
Prehabilitation clinics have also been established
in Winnipeg, Brandon and Boundary Trails to optimize patient health prior to their joint replacement
surgery, resulting in better health outcomes.
The Hip and Knee Institute (HKI) is located in a
newly developed multi-story building. This building
will be the location of a group of orthopaedic surgeons
currently known as the Concordia Joint Replacement
Group (CJRG). These doctors currently provide and
will continue to provide over 1,400 joint replacements
per year at the Concordia Hospital (1,491 over 2007)
Canada Health Act — Annual Report 2008–2009
which accounts for 40% of the joint replacement surgeries conducted in Manitoba. The HKI also includes
a private x-ray clinic and the Regional Prehab Program. This provides a one stop centre for patients
who require hip and knee joint replacements.
The HKI will provide researchers with the facilities
needed to recreate the conditions within the body
that lead to implant failure. Hip and knee implant
simulators will allow investigators to evaluate new
implant technology as well as those that have been
unsuccessful. This is being done through efforts
such as a joint replacement registry and an implant
retrieval and analysis program. There are currently
over 25 studies underway.
Additional cataract procedures to reduce wait lists
at Pan Am Clinic in Winnipeg, Brandon Regional
Health Centre, Minnedosa and Portage la Prairie
have been maintained.
The Cardiac Sciences Program continues to develop
with the opening of the Bergen Centre at St. Boniface
Hospital and the construction within the Asper
Research Centre to house a new intensive care unit
and other cardiac care clinics.
In response to the ongoing challenges with the delivery
of emergency departments and the recognition that
system-based solutions would most effectively address
these challenges, Manitoba Health and Healthy Living,
in conjunction with the regional health authorities and
emergency department physicians, conducted a review
of emergency department service across the province.
The review was completed in November 2006 and as
a result, short and medium to long-term strategies to
enact system changes were developed. Psychiatric
nurse positions were added in 2008/09 in a number of
emergency departments across the province, to better
support individuals presenting with an exacerbation
of a mental illness. Additional nursing resources for a
number of the province’s busy emergency departments
were funded in the year 2009.
The Wait Times Task Force was established in 2006 to
oversee the implementation of the Manitoba Wait Time
Strategy to improve access to quality care and reduce
wait times. The Wait-Time Reduction Strategy targets
the five priority areas identified by First Ministers in
their 10-year plan to strengthen health care: cancer,
cardiac, diagnostic imaging, joint replacement and
sight restoration. In addition, Manitoba is targeting
four other priority areas: children’s dental surgeries,
mental health programs, pain management and treatment for sleep disorders. A plan was developed in
consultation with practitioners and stakeholders,
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which will increase the number of surgeries and
procedures, invest in human resources, technology
and capital, and provide regional health authorities
with new wait-list management tools and resources.
This work has now been fully implemented. In late
2007, the Patient Access Registry Tool (PART), an
information system to capture data on all patients
waiting for hospital-based medical consultation and/or
surgical services within Manitoba, was implemented.
Roll-out and clinician engagement in data submission
is still underway.
The Wait Time Task Force established the Manitoba
Patient Access Network (MPAN) in 2006 which is
charged with developing new approaches to patient
navigation, improved patient flow, better system
integration and coordination, and improved patient
access to services. To date, the MPAN has supported
12 projects focused on achieving the above aims at
facilities throughout the province.
Federal funding was announced in March 2008,
for the Bridging General and Specialist Care Project,
which will create more seamless and timely transitions between general and specialist care by designing
and implementing a criteria based interactive referral
system, which includes the development of a specialists’ catalogue.
5.3 Access to Insured Physician and
Surgical-Dental Services
The Physician’s Manual, a billing and fee guide, provides Manitoba physicians with a listing of medical
services that are insured by Manitoba Health and
Healthy Living. Five main system data checks and
processes within the Manitoba Health and Healthy
Living mainframe ensure that claims for insured
services are processed in accordance with the Rules
of Application in the Physician’s Manual under the
Health Services Insurance Act. Appeals under the
Physician’s Manual are heard by the Medical Review
Committee. In addition, The Manitoba Health Appeal
Board, a quasi-judicial tribunal hears appeals if
a person is not satisfied with certain decisions of
Manitoba Health and Healthy Living or is denied
entitlement to a benefit under the Health Services
Insurance Act.
Manitoba Health and Healthy Living continued to
support initiatives to improve access to physicians
in rural and northern areas of the province. One of
the supported initiatives, implemented in the fall of
2005, was a co-ordinated process to assist regional
108
health authorities with the logistics of recruiting
foreign-trained physicians. The co-ordinated process, administered through the Physician Resource
Coordination Office (PRCO), is aimed at avoiding
duplication of effort, while introducing future
physician candidates to opportunities available
in Manitoba.
The province has recently announced comprehensive physician recruitment and retention initiatives
which have been informed, in part, by the PRCO
and provincial stakeholders. There are initiatives
that improve the flexibility in the health-care system to meet short, medium and long-term needs for
physicians, focus on repatriation of Manitoban and
Canadian graduates, and continue to improve the
processes leading to licensure of international medical graduates.
Manitoba continues to experience increases in
the number of new physicians registering with the
licensing body. To encourage retention of Manitoba
graduates, the province continued to provide a financial assistance grant, introduced in 2001, for students
and residents. In return for financial assistance during
their training, the student or resident agrees to work
in Manitoba for a specific period after graduating. In
2005, the Practice Assistance Option of the Medical
Student/Resident Financial Assistance Program
(MSRFAP) was enhanced to provide two grants
of $50,000 each to physicians re-entering training
in an area of critical need in the province, such as
emergency medicine or anaesthesia. In addition,
five grants of $15,000 each have been made available to family physicians who have been working
in an urban area and five grants of $25,000 each to
family physicians working in a rural/northern area
of the Province, subject to certain eligibility criteria. In one notable example, Manitoba has recently
introduced greater funding flexibility to the return of
service for students (for example, fourth year grants
of $25,000 in return for service in a community
designated by the Province) by allowing return by
locum (maximum 3 months per year over 4 years).
The province also provides a provincial specialist fund to specialists recruited to Manitoba in the
amount of $15,000, to those candidates who have not
received funds through MSRFAP. Recent announcements that further support physicians include the
Physician Resettlement Fund and Physician Relief
Fund. Eligibility criteria are being finalized in
consultation with regional stakeholders at this time.
Since 2001, Manitoba has supported an expansion in
medical school class sizes, which continues in 2008
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
with the first year enrolment reaching 110 students.
In 2008, the Province introduced the Northern
Remote Physician Practice Initiative. The initiative
is a two-year family medicine residency training
stream-specific to the rural/north, after which applicants must return service of 2+ years in rural/remote
Manitoba, and upon completion of return of service
are guaranteed a specialty residency position in
Manitoba. The program began with one student
with a further ten joining this year. The recent
announcement of a coordinator to assist in the
repatriation of Manitoban and Canadian students
training abroad will facilitate service to the Province.
Through the current assessment and training programs,
foreign-trained physicians can achieve conditional
licensure to practice medicine in return for agreeing to
work in a sponsoring rural regional health authority.
Eligible applicants for the Medical Licensure Program
for International Medical Graduates may enter one
year of residency training similar to family medicine
residency training and upon successful completion
of that training may be granted conditional licensure for primary care practice in a rural or northern
community of Manitoba. Eligible applicants for the
family practice assessment process leading to licensure will complete an orientation, a three day Family
Practice Assessment and a three month Clinical
Field Assessment. Upon successful completion of the
assessments, candidates may be recommended for
conditional licensure and upon commencement of
practice are linked with a physician mentor for a minimum of 12 months. The Non-Registered Specialist
Assessment Program initiative assists in facilitating
the assessment of physicians whose practice will be
limited to a specialty field of training. Through this
program clinical assessments are organized and facilitated in order for foreign-trained physicians to meet
the College of Physicians and Surgeons of Manitoba
(CPSM) criteria for licensure.
By the end of 2008/09, the Manitoba Telehealth
Network had grown to 65 Telehealth sites across the
province, with 17 in Winnipeg and 48 in rural and
northern Manitoba. This modern telecommunications link means patients can be seen by specialists
and medical staff can consult with each other without having to endure the expense and inconvenience
of travelling from rural or northern Manitoba to
Winnipeg or a regional centre. Current information
on Manitoba Telehealth, including location of sites,
is available at:
http://www.mbtelehealth.ca/index.php.
Canada Health Act — Annual Report 2008–2009
5.4 Physician Compensation
Manitoba continues to employ the following methods
of payment for physicians: fee-for-service, salaried,
sessional and blended.
The Health Services Insurance Act governs payment
to physicians for insured services. There were no
amendments to the Health Services Insurance Act
(HSIA) related to physician compensation during the
2008/2009 fiscal year.
Fee-for-service remains the dominant method of
payment for physician services. Notwithstanding,
alternate payment arrangements constitute a significant portion of the total compensation to physicians
in Manitoba. Alternate-funded physicians are those
who receive either a salary (employer-employee
relationship) or those who work on an independent
contract basis. Manitoba also uses blended payment
methods to “top-up” the wages of physicians whose
fee-for-service income may not be competitive, yet
whose services remain vital to the province. As
well, physicians may receive sessional payments
for providing medical services, as well as stipends
for on-call responsibilities.
Manitoba Health and Healthy Living (MHHL) represents the government in negotiations with Manitoba
physicians. The physicians are typically represented
by Doctors Manitoba (DMB) with some notable exceptions, such as oncologists.
The August 15, 2008 settlement, effective April 1,
2008 to March 31, 2011, maintained some terms of
the June 27, 2005, Agreement including:
• the continuation of a Physician Retention Fund
($5 million in the first year of the agreement,
increasing to $6 million annually in subsequent
years as well as $6 million per annum in any
subsequent agreement);
• the continuation of the Professional Liability
Insurance Fund ($5 million per annum until
2011, and subject to renegotiation in the next
agreement);
• the continuation of the Continuing Medical
Education Fund ($2 million per annum until
2011, and subject to renegotiation in the next
agreement);
• the continuation of a Maternity/Parental Benefits
Fund ($1 million per annum until 2011, and subject to renegotiation in the next agreement);
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• a mechanism to initiate arbitration proceedings
with respect to a subsequent agreement, if notice
is given by either party by January 1, 2011; and
• increase to Personal Care Home (PCHs) tariff
rates to encourage GPs to provide on-going
medical care to PCH patients;
• that physicians covered by the Agreement shall
refrain from stopping work or curtailing services
and will continue to provide services without
interruption.
• new 65–69 and 70+ categories for some
fee-for-service tariffs in order to better compensate physicians and thereby encourage
them to treat older, often more complex
patients;
Other highlights of the August 15, 2008 negotiated
settlement include:
• a three-year term from April 1, 2008 to
March 31, 2011;
• the establishment of a tripartite relationship
between MHHL, DMB and the Regional Health
Authorities (and certain other health system
stakeholders) to enable the parties to work
together to implement change within the health
care system and develop strategies and models of
care to provide better health care for Manitobans;
• an overall increase of a 7.5 percent (noncompounded) to the Fee-For-Service
Schedule of Benefits, as well as 7.5%
increase (non-compounded) for alternatefunding agreements and arrangements
as follows:
• 2.5 percent effective April 1, 2008
• 2.5 percent effective April 1, 2009
• 2.5 percent effective April 1, 2010
• an additional $15.41 million in 2008/09 devoted
to increasing compensation for all fee-for-service
blocks for market adjustment purposes;
• an additional $9.17 million over the duration of
the agreement allocated to improving existing
fee-for-service programs as well as initiating
new programs geared towards effecting health
system change including;
• expansion of eligibility to bill telemedicine
tariffs by General Practitioners in order to
improve access to care for patients in rural
and northern Manitoba;
• increase to the northern differential from
10% to 25%;
• expansion of billing of telephone tariffs to GPs
and previously excluded specialists in order
to expedite and enhance the effectiveness of
patient referrals and consults;
110
• an additional $29.0 million devoted to new
remuneration schemes for alternately funded
contracts with the aim of achieving health
system change including;
• compensation review of all general practitioners
and specialists alternately funded remuneration;
• statistics to ensure comparison and equity,
based on geographic location, qualification
and years of service.;
• increase in compensation for more frequent,
onerous on-call through a new specialist oncall premium;
• increase to the northern geographic differential for alternate funding contracts from 10%
to 25%;
• new hospital care models for better treatment
of unassigned patients;
• new PCH on-call program in order to ensure
afters hours coverage for PCHs; and
• significant increase in compensation for
Government Employed Doctors (GEDs) in
order to build greater capacity for strategic
planning within the Ministry.
5.5 Payments to Hospitals
Division 3.1 of Part 4 of the Regional Health
Authorities Act sets out the requirements for
operational agreements between regional health
authorities and the operators of hospitals and
personal care homes, defined as “health corporations” under the Act.
Pursuant to the provisions of this division, Regional
Health Authorities are prohibited from providing funding to a health corporation for operational purposes
unless the parties have entered into a written agreement for this purpose that enables the health services
to be provided by the health corporation, the funding
to be provided by the Regional Health Authority for
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
the health services, the term of the agreement, and a
dispute resolution process and remedies for breaches. If
the parties cannot reach an agreement, the Act enables
them to request that the Minister of Health appoint a
mediator to help them resolve outstanding issues. If
the mediation is unsuccessful, the Minister is empowered to resolve the matter or matters in dispute. The
Minister’s resolution is binding on the parties.
There are three regional health authorities which
have hospitals operated by health corporations in
their health regions. The regional health authorities have concluded the required agreements with
health corporations. The operating agreements
enable the Regional Health Authority to determine
funding based on objective evidence, best practices
and criteria that are commonly applied to comparable facilities. In all other regions, the hospitals
are operated by the Regional Health Authorities Act.
Section 23 of the Act requires that Regional Health
Authorities allocate their resources in accordance
with the approved regional health plan.
The allocation of resources by regional health authorities for providing hospital services is approved by
Manitoba Health and Healthy Living through the
approval of the Regional Health Authorities regional
health plans, which the Regional Health Authorities are
required to submit for approval pursuant to section 24
of the Regional Health Authorities Act. Section 23 of the
Act requires that Authorities allocate their resources in
accordance with the approved regional health plan.
Pursuant to subsection 50(2.1) of the Health Services
Insurance Act, payments from the MHSIP for insured
hospital services are to be paid to the regional health
authorities. In relation to those hospitals that are not
owned and operated by a Regional Health Authority,
the Regional Health Authority is required to pay each
hospital in accordance with any agreement reached
between the Regional Health Authority and the hospital operator.
No legislative amendments to the Act or the regulations
in 2008/2009 had an effect on payments to hospitals.
6.0 Recognition Given to
Federal Transfers
Manitoba routinely recognizes the federal role
regarding the contributions provided under the
Canada Health Transfer (CHT) in public documents.
Federal transfers are identified in the Estimates of
Canada Health Act — Annual Report 2008–2009
Expenditures and Revenue (Manitoba Budget) document and in the Public Accounts of Manitoba. Both
documents are published annually by the Manitoba
government. In addition, Manitoba Health and
Healthy Living cites the federal contribution from
the First Ministers Ten Year Plan to Strengthen
Health Care (the 2004 Health Accord—Wait Time
Reduction Fund) in funding letters to the regional
health authorities and other organizations who are
implementing programs using this funding.
7.0 Extended Health Care
Services
Manitoba has established community-based service
programs as appropriate alternatives to hospital
services. These service programs are funded by
Manitoba Health and Healthy Living through the
regional health authorities. The services include
the following:
Diabetes and Chronic Disease Services: Preventable
chronic health conditions can be minimized by
addressing three common modifiable risk factors —
physical inactivity, poor eating habits and smoking
— through sustained programs and supportive policies. Regional health authorities provide a number of
programs and services to promote the prevention and
management of chronic disease. Manitoba instituted
a Chronic Disease Prevention Initiative led by the
community, coordinated by regional health authorities and supported by the provincial and federal
governments. As well, multidisciplinary teams
throughout the province deliver a comprehensive
Regional Diabetes Program. A screening pilot was
completed in partnership with the Brandon Regional
Health Authority and is being initiated in partnership with the Winnipeg Regional Health Authority
to identify prediabetes/undiagnosed type 2 diabetes
and validate a national screening tool. An innovative Manitoba Retinal Screening Vision Program was
implemented to reduce wait times and improve access
to ophthalmology services for northern residents.
Regional health authorities are developing healthy
living community teams and regional programming
for chronic disease prevention and healthy living.
Personal Care Home Services: Insured personal care
services are provided pursuant to the Personal Care
Services Insurance and Administration Regulation
under the Health Services Insurance Act. In 2005,
the Personal Care Homes Standards Regulation and
Personal Care Homes Licensing Regulation were
111
Chapter 3: Manitoba
enacted under the same Act, linking licensing to
compliance with a range of standards designed to
ensure safe, quality care. Both proprietary and nonproprietary homes are licensed by Manitoba Health
and Healthy Living. Personal care homes are visited
every two years to review progress in meeting personal care home standards. Residents of personal
care homes pay a residential charge towards accommodation costs, with the cost of care funded by
Manitoba Health and Healthy Living through the
regional health authorities.
Personal care services assist Manitobans who can no
longer remain safely at home because of a disability
or their health care needs. Personal care services
include:
• meals (including meals for special diets);
• assistance with daily living activities like bathing, getting dressed and using the bathroom;
• necessary nursing care;
• routine medical and surgical supplies;
• prescription drugs eligible under Manitoba’s
Personal Care Home Program;
• physiotherapy and occupational therapy, if the
facility is approved to provide these services;
and
• routine laundry and linen services.
The cost of these services is shared by the provincial
government (Manitoba Health and Healthy Living) and
the client who needs the services. Manitoba Health and
Healthy Living pays the majority of the cost through the
regional health authorities. The personal care service
client pays the other portion of the cost. This cost is
a daily charge calculated for each individual resident
based on their net income minus taxes payable (as per
their most recent year’s Notice of Assessment from the
Canada Revenue Agency). For 2008, the minimum daily
charge was $29.70 and the maximum was $69.70. There
is an application process for requesting a reduction
in charges.
Funding in 2008/09 supported the delivery of insured
personal care services for 9,683 licensed personal care
home beds and 150 unlicensed interim (temporary)
personal care beds plus a total of 179 chronic care
beds, and 149 rehabilitation beds.
New construction projects during 2008/09 included
the Neepawa PCH 100-bed facility which replaced
the 124-bed Eastview Lodge in Neepawa. As well, in
112
Winnipeg the two Sharon Personal Care homes, total
229 beds, were amalgamated as a 200 bed facility
renamed The Saul and Claribell Simkin Centre of
the Sharon Home in September 2008.
In April 2008, MHHL committed $3 million over
three years to support residents at six First Nations
personal care homes. The $3 million in provincial
funding will be provided in a phased in approach
over three years. Funding for residents assessed
at care levels 1-3 and for capital upgrades to these
facilities will continue to be provided by Indian and
Northern Affairs Canada.
Home Care Services: The Manitoba Home Care
Program is the oldest comprehensive, province-wide,
universal home care program in Canada. Manitoba
Home Care provides effective, reliable and responsive
community health care services to support independent living; to develop appropriate care options to
support continued community living; and to facilitate admission to institutional care when community
living is no longer a viable alternative. Home Care
services are delivered through the local offices of the
regional health authorities and include a broad range
of services based on a multi-disciplinary assessment
of individual needs. Home Care case co-coordinators
conduct assessments and develop individual care
plans, which may include Self or Family Managed
Care, personal care assistance, household maintenance, professional health care, in-home family
relief, facility-based respite care, some supplies and
equipment, access to adult day programs, and/or
access to support services to seniors’ programs that
coordinate volunteers, congregate meal programs,
transportation, emergency response systems and
other activities that support continued independent
community living.
MHHL partnered with Manitoba Finance in the
establishment of the Primary Caregiver Tax Credit
(PCGTC) which benefits caregivers of Manitoba’s
residents assessed at Care Level 2 and higher.
Mental Health, Addictions and Spiritual Health
Care Services: Manitoba Health and Healthy Living
(MHHL) funds a comprehensive system of mental
health services and supports across the province.
Regional health authorities are funded by MHHL to
provide the majority of services and MHHL directly
funds some organizations to deliver services and
programs, e.g., provincial mental health self-help.
The mental health system in Manitoba includes:
in-patient and out-patient services in acute care
hospitals; case management including specialized
case management programs; inpatient and commu-
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
nity forensic mental health; crisis stabilization units
and mobile crisis teams; proctor services; phone and
online support; safe houses; self-help and family support; vocational and employment supports; housing
and community living programs; social and recreational programs; suicide prevention activities; early
intervention in mental illness; and, mental health
education, prevention, and promotion.
Selkirk Mental Health Centre (SMHC) is a 252-bed,
direct-operating unit of Manitoba Health and Healthy
Living and is the designated facility for the provision
of long-term mental health inpatient treatment and
rehabilitation services. Its four mental health program
areas include acute, forensic, psychosocial rehabilitation, and geriatric services. SMHC also provides
post-acute treatment and rehabilitation to medicallystable individuals impacted by a brain injury.
A key initiative undertaken in 2008/09 was MHHL’s
Youth Suicide Prevention Strategy. With the goal of
preventing youth suicide, the strategy’s identified
objectives include improving access to mental health
services, enhancing protective factors, and reducing
modifiable risk factors. Notable initiatives include:
building northern youth crisis stabilization and
treatment capacity; enhancing access to child and
adolescent psychiatric services in remote, northern,
and First Nations communities through regular
consultation via Telehealth; supporting communitybased, youth services that increase opportunities
for Aboriginal children and youth to become more
physically active and to develop skills and leadership
abilities that promote community development; and,
enhancing existing community-based education and
peer support programs.
Addictions agencies are funded to provide a comprehensive range of residential and community-based
services across the province. These agencies work to
reduce the harm associated with alcohol and other
drugs and are directed to both adults and youth.
Programs include education, prevention, rehabilitation
and follow-up supports such as second-stage housing.
Also, one regional health authority funds two detox
programs while another funds a residential treatment
agency for adults. Manitoba’s five-point addictions
strategic plan was announced in June 2008. Its objectives are to: Build a Better System; Improve Service
Access; Increase Residential Treatment Capacity;
Build Community-based Treatment Capacity; and,
Enhance Addictions Research.
Spiritual health care has become integrated into
the former Mental Health and Addictions Branch.
Through the addition of a Provincial Spiritual
Canada Health Act — Annual Report 2008–2009
Health Care Coordinator, there is recognition of the
ever-growing awareness that health is made up of
the physical, mental, social and spiritual aspects of
being. The primary focus of this position is to support
comprehensive spiritual health care through strategic planning, analytical study, consensus building,
resource sharing and education. Each regional health
authority has either a designated and specifically
trained Spiritual Health Care Coordinator or a staff
person who is responsible for the service. Two provincial committees facilitate the coordination of this
aspect of health service: the Spiritual Health Care
Management Network and the Provincial Spiritual
Care Advisory Committee. These groups ensure
communication, connection, and future planning for
the province. The management network represents
all the regional health authorities in the province.
The community-based, advisory committee seeks
includes members from a wide range of interfaith,
religious, and spiritual groups.
Primary Health Care
The Primary Health Care’s Strategic Plan addresses:
• improved access to primary care services,
• development of comprehensive multi-disciplinary
collaborative teams,
• establishment of improved linkages amongst
the different levels of care,
• skill building in the areas of quality
improvement/leadership,
• access to and use of information systems,
• improved working environment for all primary
care providers, and
• demonstration of high quality care with a specific
focus on chronic disease management.
Key initiatives to meet these objectives include:
the implementation of Advanced Access, CareLink
demonstration projects, sponsorship of Physician
Management Institutes, support for the use of
Electronic Medical Records, the development of
a Peer to Peer Network, the introduction of Nurse
Practitioners (NP), the expansion of the Physician
Integrated Network, hosting customer care workshops, expansion of Midwifery Services, and
establishing a provincial Maternal and Child
HealthCare Services Task Force (MACHS).
Phase 1 of a provincial initiative to introduce
Advanced Access has concluded with 16 clinics
113
Chapter 3: Manitoba
trained to implement it. In April 2009, the Minister
of Health announced funding to sustain and
expand Advanced Access.
Phase 2 will commence in November 2009 with the
formal training and education of self-selected clinics.
Additional sessions for future trainers will be incorporated into phase 2.
CareLink, supported by Canada Health Infoway,
involves two demonstration projects focused on
“Improving Patient Access to Quality Primary Care”
in Manitoba. Both projects focus on the use of technology and system integration to enhance after-hours
access to primary care and province-wide access
to chronic disease self-management services particularly in rural, remote and northern regions of
Manitoba.
The Primary Health Care Branch has sponsored
several Canadian Medical Association Physician
Management Institutes for physicians wishing to
develop their leadership skills. The first advanced
level institute, strategic planning is scheduled for
October 2009.
As part of the Primary Care Information System
Strategy, Manitoba conducted competitive process
to qualify four vendors for the Electronic Medical
Record (EMR) systems. Use of EMRs by physicians
and other primary care providers is a key requirement to achieve the benefits of the Electronic Health
Record (EHR) and to reform the healthcare system
through a focus on quality. Manitoba physicians
cited uncertainty about what products to buy, and
the time and complexity involved in evaluating
products, as inhibitors to their adoption of EMRs,
and they encouraged Manitoba Health and Healthy
Living (MHHL) to show more leadership in this area.
The objective of the resulting qualification process
is to select a small number of products which satisfy the requirements of Manitoba stakeholders and
whose vendors will commit to periodic updates to
their product in order to meet emerging requirements
to support primary care renewal, to connect to the
Electronic Health Record and to meet new functional
requirements.
The Physician Peer to Peer Network is an initiative
sponsored by Canada Health Infoway and operated
by Manitoba eHealth to encourage increased adoption
and effective use of electronic medical record (EMR)
systems by community physicians. The premise is
that physicians are more likely to listen to advice
from other physicians in considering, selecting and
implementing systems to assist in running their
practice and providing quality care to patients.
114
Manitoba has recruited ten physicians with significant experience in implementing technology
such as EMRs. The Physician Peer to Peer Network
initiative provides a vehicle to reimburse these
physicians for spending time with other physicians
who are interested in acquiring systems — guiding
their investigations, answering specific questions,
pointing them to other sources of information and
possibly demonstrating how they use their own
EMRs within their practice. This program is
underway but will gear up in a more proactive
manner once Manitoba has selected its Approved
EMR Vendor List in October 2008.
Nurse Practitioners and midwives provide primary
care services as employees of the regional health
authorities. The integration of nurse practitioners
(NPs) into primary care supports primary care
renewal and interdisciplinary practice. The Registered
Nurse (Extended Practice) Regulation was enacted
in 2005, and 65 nurse practitioners were registered
as of December 31, 2008. Most work in primary care
settings. An NP is a registered nurse with additional
education in health assessment, diagnosis and management of illnesses and injuries. In addition to the
services a registered nurse can already provide, an
NP can prescribe medications, order and manage the
results of diagnostic and screening tests and perform
minor surgical and invasive procedures. Manitoba
Health and Healthy Living is working with the
regional health authorities to successfully integrate
30 newly funded NP positions across the province.
Manitoba has 76 nurse practitioner positions.
Significant human resource needs in midwifery
are being addressed by a Bachelor of Midwifery
(Aboriginal Midwifery) program through University
College of the North, and participation with other
jurisdictions in development of bridging programs
for internationally educated midwives. Manitoba
Health and Healthy Living continues to work
with the regional health authorities to develop
new positions and provide supports for successful
growth of this newly regulated profession.
Another key strategy includes the development of
the Physician Integrated Network (PIN) Initiative.
PIN focuses on the engagement of fee-for-service
physician groups. The objectives of this initiative
are: 1) to improve access to primary care, 2) to improve
primary care providers’ access to and use of information systems, 3) to improve the work life for all primary
care providers, and 4) to demonstrate high quality care
with a specific focus on chronic disease management.
PIN will complete its Phase 1 demonstration period
and move to its second phase in September 2008.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
All four Phase 1 demonstration sites had an electronic
medical record in place at the outset of the initiative.
However, many changes to the software and the staff
use of the systems were necessary in order to capture
relevant indicators, extract useful information, and
support the development of a blended funding model
which included Quality Based Incentive Funding
(QBIF). QBIF provides financial incentives based on
selected clinical process indicators (derived from the
Canadian Institute for Health Information primary
care indicator list (April 2006)).
Phase 2 of the PIN initiative has been planned to not
only increase the number of engaged family physicians in Manitoba, but also further develop:
• a blended funding and remuneration model
• a provincial indicator development framework
• information management and information technology in primary care; and
• data collection and analysis mechanisms.
Manitoba Health and Healthy Living is working with
the Regional Health Authorities to support the development of collaborative, multi-disciplinary maternity
care teams and to increase access to maternal/newborn
health services and birth services closer to home. The
development of Midwifery services is a key component of this work. Manitoba introduced, regulated and
funded midwifery services as part of primary care in
2000. Midwives provide comprehensive, communitybased maternal and newborn health services, and may
provide well-woman care in underserved communities.
Midwives prescribe medications, order and manage
the results of diagnostic and screening tests, perform
minor surgical and invasive procedures, admit to hospital and attend births in hospitals and homes. There
are now 45.5 funded midwifery positions across the
province; 25.5 outside the Winnipeg region including
Canada Health Act — Annual Report 2008–2009
in rural, northern and remote communities. Midwives
attend approximately 8% of provincial births; in some
communities, midwives attend up to 30% of births.
Midwifery services focus on priority populations and
on closing the gap in services for Aboriginal people.
A Midwifery Database, initiated in 2001, shows lower
rates of pre-term birth, high and low birth weight and
birth interventions for clients of midwifery services;
while over 65% of clients are from priority populations.
In September 2008, Manitoba announced the support
of the recommendations of the Maternal and Child
Healthcare Services (MACHS) Task Force. The Task
Force identified 25 initiatives that focus on supporting
access to service closer to home, addressing service
gaps, and supporting promising (best) practices.
Examples of the initiatives include:
• a 24-hour, seven-day-a-week access to allow
physicians from across the province to quickly
connect with obstetric/gynecologic/pediatric
experts to consult;
• a referral system to help expectant women, who
have to relocate from First Nations, Inuit and
Métis communities or rural/remote communities
for extended periods of time to give birth, access
coordinated prenatal and social supports;
• training for peer support workers to offer preand post-natal social support as well as labour
support for delivery in a culturally appropriate
manner including services in First Nations, Inuit
and Métis languages; and,
• a new program to reduce Vitamin D deficiencies and rickets in women and their infants.
Preparations for the implementation of the
13 initiatives, as well as the developmental
work required for the other 12 initiatives, are
currently underway.
115
Chapter 3: Manitoba
Registered Persons
1. Number as of June 1st (#). 3
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
1,169,667
1,173,815
1,178,457
1,186,386
1,209,401
4
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
b. chronic care
98
5
98
5
95
5
95
5
95
5
3
6
3
6
2
6
2
6
2
6
not available
2
6
2
6
c. rehabilitative care
not available
2
6
not available
not available
1
7
1
7
d. other
1
7
e. total
98
98
97
97
97
1,400,448,441
1,488,094,835
1,515,237,203
1,605,095,309
1,673,473,520
96,364,992
71,117,677
75,250,507
76,373,042
71,993,446
3. Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
not available
not available
not available
not available
not available
d. other
not available
not available
not available
not available
not available
e. total
not available
not available
not available
not available
not available
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
1
1
1
1
1
b. diagnostic imaging facilities
0
0
0
0
0
c. total
1
1
1
1
1
1,290,989
1,305,132
1,292,830
1,289,964
1,553,438
0
0
0
0
0
1,290,989
1,305,132
1,292,830
1,289,964
1,553,438
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
b. diagnostic imaging facilities
c. total
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
3,036
2,995
2,806
2,823
2008–2009
3,280
15,393,378
19,153,208
19,431,036
18,731,739
24,489,298
24,057
29,685
30,357
31,329
35, 957
3,896,789
5,670,133
6,306,240
6,933,920
9,662,718
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
540
569
589
549
658
1,085,650
1,455,908
1,294,963
1,791,864
3,252,651
6,170
6,690
7,673
8,796
10,121
1,112,466
1,325,062
1,695,844
2,692,096
2,650,500
3.
4.
5.
6.
The population data is based on records of residents registered with Manitoba Health as of June 1.
As of March 31, 2009.
95 submitting Acute facilities includes 22 Nursing Stations and 2 Federal Hospitals
One Acute facility has been given a rehab institution submitting number: Riverview Health Centre. Deer Lodge is no longer a submitting acute care facility, and therefore only
counted as rehab and chronic.
7. Manitoba Adolescent Treatment Centre
116
Canada Health Act — Annual Report 2008–2009
Chapter 3: Manitoba
Insured Physician Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
979
981
971
1,041
1,061
14.Number of participating physicians (#):
a. general practitioners
b. specialists
1,008
1,035
997
1,009
1,012
c. other
not applicable
not applicable
not applicable
not applicable
not applicable
d. total
1,987
2,016
1,968
2,050
2,073
15.Number of opted-out physicians (#):
a. general practitioners
not applicable
not applicable
not applicable
0
0
b. specialists
not applicable
not applicable
not applicable
0
0
c. other
not applicable
not applicable
not applicable
0
0
d. total
not applicable
not applicable
not applicable
0
0
16.Number of not participating physicians (#):
a. general practitioners
not applicable
not applicable
not applicable
not applicable
not applicable
b. specialists
not applicable
not applicable
not applicable
not applicable
not applicable
c. other
not applicable
not applicable
not applicable
not applicable
not applicable
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not available
not available
not available
not available
601,240,469
653,290,519
700,465,401
721,552,291
789,101,000
16,578,401
17,466,368
16,794,320
16,959,865
18,011,980
415,749,772
442,485,124
438,813,332
459,573,573
476,227,782
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
209,152
228,090
248,900
290,775
243,881
8,109,229
8,966,703
9,997,409
9,985,987
9,721,570
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
5,714
6,138
6,486
6,414
7,446
426,937
608,524
541,403
701,829
725,382
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
114
115
122
120
131
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
3,774
3,863
4,205
4,616
4,833
875,657
936,091
984,621
1,107,357
1,175,314
Canada Health Act — Annual Report 2008–2009
117
118
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
• monitors and enforces standards in privately
delivered programs such as personal care
homes;
• administers public health insurance programs
such as the Saskatchewan Medical Care
Insurance Plan;
• delivers the Saskatchewan Prescription Drug
Plan;
Saskatchewan
• operates the Saskatchewan Disease Control
Laboratory;
Introduction
• maintains relationships with regulated health
profession groups; and
Through leadership and partnership, the Ministry of
Health is dedicated to achieving a responsive, integrated and efficient health care system that puts the
patient first, and enables people to achieve their best
possible health by promoting healthy choices and
responsible self-care.
• provides leadership on health human resource
issues.
The Ministry oversees a complex, multi-faceted
health care system. It establishes policy direction,
sets and monitors standards, provides funding, supports regional health authorities (RHAs) and other
agencies, and ensures the provision of essential and
appropriate services. The Ministry works in partnership with organizations at the local, regional,
provincial, national and international level to ensure
Saskatchewan residents have access to quality health
care delivered under the Canada Health Act.
The Ministry works with a range of stakeholders to
recruit and retain health care providers, including
nurses and physicians, and regulates the delivery
of health care. It is responsible for approximately
50 pieces of health-related legislation.
The Ministry is committed to encouraging and assisting Saskatchewan residents in achieving their best
possible health and well-being. In carrying out this
responsibility, the Ministry:
The Ministry has a dedicated workforce which provides strategic direction to the health care system
and carries out a number of other activities, such as
processing applications, paying bills, explaining programs and answering inquiries from the public. The
Ministry is organized into 16 branches, each working
to ensure that the province’s health care system operates in an effective and sustainable manner while
remaining accountable to the people of Saskatchewan.
The Ministry oversees a health care system that provides a range of services through a complex delivery
system that includes 12 RHAs and the Athabasca
Health Authority, the Saskatchewan Cancer Agency
(SCA), affiliated health care organizations and a
diverse group of professionals, many of whom are
in private practice. The health system as a whole
employs more than 37,000 individuals. The province
has 26 self-regulated health professions. The scope
of services provided is illustrated by the following
statistics, compiled during the 2008–09 fiscal year:
• 75,822 operating room surgeries
• More than 80,000 CT scans
• provides leadership on strategic policy and
health professional groups;
• 4.2 million family physician visits /11,500 visits
per day
• establishes goals and objectives for the provision
of health services;
• 540,000 immunizations
• leads financial planning for the health system
and administers the allocation of funding;
• provides provincial oversight for programs and
services, including acute and emergency care,
community services, and long-term care;
Canada Health Act — Annual Report 2008–2009
• More than 47,000 mammograms
For more information on the Ministry’s programs and
services, please visit the Ministry of Health website at:
www.health.gov.sk.ca.
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Chapter 3: Saskatchewan
1.0 Public Administration
1.2 Reporting Relationship
1.1
The Ministry of Health is directly accountable, and
regularly reports, to the Minister of Health on the
funding and administering the funds for insured
physician, surgical-dental and hospital services.
Health Care Insurance Plan and
Public Authority
The provincial government is responsible for funding
and ensuring the provision of insured hospital, physician and surgical-dental services in Saskatchewan.
Section 6.1 of the Department of Health Act authorizes
that the Minister of Health may:
• pay part of, or the whole of, the cost of providing health services for any persons or classes of
person who may be designated by the Lieutenant
Governor in Council;
• make grants or loans or provide subsidies to
regional health authorities, health care organizations or municipalities for providing
and operating health services or public
health services;
• pay part of or the whole of the cost of providing
health services in any health region or part of
a health region in which those services are considered by the Minister to be required;
• make grants or provide subsidies to any health
agency that the Minister considers necessary; and
• make grants or provide subsidies to stimulate and
develop public health research and to conduct
surveys and studies in the area of public health.
Sections 8 and 9 of the Saskatchewan Medical Care
Insurance Act provide the authority for the Minister
of Health to establish and administer a plan of medical care insurance for residents. The Regional Health
Services Act provides the authority to establish
12 regional health authorities, replacing the former
32 district health boards.
Sections 3 and 9 of the Cancer Agency Act provide
for establishing a Saskatchewan Cancer Agency and
for the Agency to coordinate a program for diagnosing,
preventing and treating cancer.
The mandates of the Ministry of Health, regional
health authorities and the Saskatchewan Cancer
Agency are outlined in the Department of Health
Act, the Regional Health Services Act and the
Cancer Agency Act.
120
Section 36 of the Saskatchewan Medical Care Insurance
Act prescribes that the Minister of Health submit an
annual report concerning the medical care insurance
plan to the Legislative Assembly.
The Regional Health Services Act prescribes that a
regional health authority shall submit to the Minister
of Health:
• a report on the activities of the regional health
authority; and
• a detailed, audited set of financial statements.
Section 54 of the Regional Health Services Act
requires that regional health authorities and the
Cancer Agency shall submit to the Minister any
reports that the Minister may request from time to
time. Regional health authorities and the Cancer
Agency are required to submit a financial and
health service plan to Saskatchewan Health.
1.3 Audit of Accounts
The Provincial Auditor conducts an annual audit
of government departments and agencies, including Saskatchewan Health. It includes an audit of
Ministry payments to regional health authorities,
the Saskatchewan Cancer Agency and to physicians
and dental surgeons for insured physician and
surgical-dental services.
Section 57 of the Regional Health Services Act
requires that an independent auditor, who possesses
the prescribed qualification and is appointed for
that purpose by a regional health authority and the
Cancer Agency, shall audit the accounts of a regional
health authority or the Cancer Agency at least once
in every fiscal year. Each regional health authority
and the Cancer Agency must annually submit to the
Minister of Health a detailed, audited set of financial
statements.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
Section 34 of the Cancer Foundation Act prescribes
that the records and accounts of the Foundation
shall be audited at least once a year by the Provincial
Auditor or by a designated representative.
The most recent audits were for the year ended
March 31, 2009.
The audits of the Government of Saskatchewan,
regional health authorities and Saskatchewan Cancer
Agency are tabled in the Saskatchewan Legislature
each year. The reports are available to the public
directly from each entity or are available on their
websites.
The Provincial Auditor’s Office of Saskatchewan
also prepares reports to the Legislative Assembly of
Saskatchewan. These reports are designed to assist
the government in managing public resources and to
improve the information provided to the Legislative
Assembly. They are available on the Provincial
Auditor’s website:
http://www.auditor.sk.ca
2.0 Comprehensiveness
2.1
Insured Hospital Services
Section 8 of the Regional Health Services Act (the
Act) gives the Minister the authority to provide
funding to a regional health authority or a health
care organization for the purpose of the Act.
Section 10 of the Regional Act permits the Minister
to designate facilities including hospitals, specialcare homes and health centres. Section 11 allows the
Minister to prescribe standards for delivering services
in those facilities by regional health authorities and
health care organizations that have entered into service agreements with a regional health authority.
The Act sets out the accountability requirements for
regional health authorities and health care organizations. These requirements include submitting annual
operational and financial and health service plans
for Ministerial approval (sections 50–51); establishing community advisory networks (section 28); and
reporting critical incidents (section 58). The Minister
also has the authority to establish a provincial surgical
registry to help manage surgical wait times (section 12).
The Minister retains authority to inquire into matters
(section 59); appoint a public administrator if necessary (section 60); and approve general and staff
practitioner by-laws (sections 42–44).
Canada Health Act — Annual Report 2008–2009
Funding for hospitals is included in the funding
provided to regional health authorities.
As of March 31, 2009, the following facilities were
providing insured hospital services to both in- and
out-patients:
• 66 acute care hospitals provided in- and
out-patient services; and
• one rehabilitation hospital provided treatment,
recovery and rehabilitation care for patients
disabled by injury or illness. Rehabilitation
services are also provided in a geriatric rehabilitation unit in one other hospital and in two
special-care facilities.
A comprehensive range of insured services is provided by hospitals. These may include: public ward
accommodation; necessary nursing services; the use
of operating room and case room facilities; required
medical and surgical materials and appliances; x-ray,
laboratory, radiological and other diagnostic procedures; radiotherapy facilities; anaesthetic agents and
the use of anaesthesia equipment; physiotherapeutic
procedures; all drugs, biological and related preparations required for hospitalized patients; and services
rendered by individuals who receive remuneration
from the hospital.
Hospitals are grouped into the following five categories: Community Hospitals; Northern Hospitals;
District Hospitals; Regional Hospitals; and Provincial
Hospitals, so people know what they can expect
24 hours a day, 365 days a year at each hospital.
While not all hospitals will offer the same kinds
of services, reliability and predictability means:
• it is widely understood which services each
hospital offers; and
• these services will be provided on a continuous
basis, subject to the availability of appropriate
health providers.
Regional health authorities have the authority to
change the manner in which they deliver insured
hospital services based on an assessment of their
population health needs and available health professional funding resources.
The process for adding a hospital service to the list
of services covered by the health care insurance plan
involves a comprehensive review, which takes into
account such factors as service need, anticipated
service volume, health outcomes by the proposed
and alternative services, cost and human resource
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Chapter 3: Saskatchewan
requirements, including availability of providers
as well as initial and ongoing competency assurance demands. A regional health authority initiates
the process and, depending on the specific service
request, it could include consultations involving
several branches within Saskatchewan Health as
well as external stakeholder groups such as health
regions, service providers and the public.
2.2 Insured Physician Services
Sections 8 and 9 of the Saskatchewan Medical Care
Insurance Act enable the Minister of Health to establish and administer a plan of medical care insurance
for provincial residents. All fee items for physicians
can be found in the Physician Payment Schedule:
www.health.gov.sk.ca/physician-information
The Saskatchewan Health Medical Services Branch
2008–09 Annual Statistical Report is available on
the website:
www.health.gov.sk.ca/medical-services-2008-09
Physicians may provide insured services in
Saskatchewan if they are licensed by the College
of Physicians and Surgeons of Saskatchewan and
have agreed to accept payment from the Ministry
of Health without extra-billing for insured services.
As of March 31, 2009, there were 1,836 physicians
licensed to practice in the province and eligible to
participate in the medical care insurance plan.
Physicians may opt out or not participate in the
Medical Services Plan but if doing so, they must fully
opt out of all insured physician services. The optedout physician must also advise beneficiaries that the
physician services to be provided are not insured and
that the beneficiary is not entitled to be reimbursed
for those services. Written acknowledgement from the
beneficiary indicating that he or she understands the
advice given by the physician is also required.
As of March 31, 2009, there were no opted-out physicians in Saskatchewan.
Insured physician services are those that are medically necessary, are covered by the Medical Services
Plan of the Ministry of Health and are listed in the
Physician Payment Schedule of The Saskatchewan
Medical Care Insurance Payment Regulations (1994)
of the Saskatchewan Medical Care Insurance Act.
122
There were approximately 3,300 different insured
physician services as of March 31, 2009.
A process of formal discussion between the Medical
Services Plan and the Saskatchewan Medical Association addresses new insured physician services
and definition or assessment rule revisions to existing
selected services (modernization) with significant
monetary impact. The Executive Director of the
Medical Services Branch manages this process.
When the Medical Services Plan covers a new
insured physician service or significant revisions
occur to the Physician Payment Schedule, a regulatory amendment is made to the Physician Payment
Schedule.
Although formal public consultations are not held,
any member of the public may make recommendations
about physician services to be added to the Plan.
2.3 Insured Surgical-Dental Services
Dentists registered with the College of Dental Surgeons
of Saskatchewan and designated by the College as
specialists able to perform dental surgery may provide
insured surgical-dental services under the Medical
Services Plan. As of March 31, 2009, 79 dental specialists were providing such services.
Dentists may opt out or not participate in the Medical
Services Plan, but if doing so, must opt out of all
insured surgical-dental services. The dentist must
also advise beneficiaries that the surgical-dental
services to be provided are not insured and that the
beneficiary is not entitled to reimbursement for those
services. Written acknowledgement from the beneficiary indicating that he or she understands ​t he advice
given by the dentist is also required.
There were no opted-out dentists in Saskatchewan as
of March 31, 2009.
Insured surgical-dental services are limited to:
services in connection with maxillo-facial surgery
required as a result of trauma; treatment services
for the orthodontic care of cleft palate; extraction
of teeth when medically required for the provision
of heart surgery, services for chronic renal disease
and services for total joint replacement by prosthesis when a proper referral has been made and prior
approval obtained from Medical Services Branch;
and certain services in connection with abnormalities of the mouth and surrounding structures.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
Surgical-dental services can be added to the list of
insured services covered under the Medical Services
Plan through a process of discussion and consultation with provincial dental surgeons. The Executive
Director of the Medical Services Branch manages the
process of adding a new service.
Insured surgical-dental services could be de-insured
if they were determined not to be medically necessary.
The process is based on discussion and consultation
with the dental surgeons of the province and managed by the Executive Director of the Medical Services
Branch.
Although formal public consultations are not held,
any member of the public may recommend that
surgical-dental services be added to the Plan.
Insured physician services could be de-insured if
they were determined not to be medically required.
The process is based on consultations with the
Saskatchewan Medical Association and managed
by the Executive Director of the Medical Services
Branch.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital, physician and surgical-dental
services in Saskatchewan include: in-patient and
outpatient hospital services provided for reasons
other than medical necessity; the extra cost of private
and semi-private hospital accommodation not ordered
by a physician; physiotherapy and occupational
therapy services not provided by or under contract
with a regional health authority; services provided
by health facilities other than hospitals unless
through an agreement with Saskatchewan Health;
non-emergency bone mineral densitometry provided outside Saskatchewan without prior written
approval; non-emergency insured hospital, physician
or surgical-dental services obtained outside Canada
without prior written approval; non-medically required
elective physician services; surgical-dental services
that are not medically necessary; and services received
under other public programs including the Workers’
Compensation Act, the federal Department of Veteran
Affairs and the Mental Health Services Act.
As a matter of policy and principle, insured hospital,
physician and surgical-dental services are provided
to residents on the basis of assessed clinical need.
Compliance is periodically monitored through
consultation with regional health authorities, physicians and dentists. There are no charges allowed
in Saskatchewan for medically necessary hospital,
physician or surgical-dental services. Charges for
enhanced medical services or products are permitted
only if the medical service or product is not deemed
medically necessary. Compliance is monitored
through consultations with regional health authorities, physicians and dentists.
Insured hospital services could be de-insured by
the government if they were determined to be no
longer medically necessary. The process is based
on discussions among regional health authorities,
practitioners and officials from the Ministry of
Health.
Canada Health Act — Annual Report 2008–2009
Formal public consultations about de-insuring hospital, physician or surgical-dental services may be held
if warranted.
No health services were de-insured in 2008–09.
3.0 Universality
3.1
Eligibility
The Saskatchewan Medical Care Insurance Act
(sections 2 and 12) and The Medical Care Insurance
Beneficiary and Administration Regulations define
eligibility for insured health services in Saskatchewan. Section 11 of the Act requires that all residents
register for provincial health coverage. The penalty
provisions in section 11 of the Act (Duty to Register)
provide for a fine of up to $50,000 for giving false
information or withholding information necessary
for registering an individual.
Eligibility is limited to residents. A “resident”
means a person who is legally entitled to remain
in Canada, who makes his or her home and is
ordinarily present in Saskatchewan, or any other
person declared by the Lieutenant Governor-inCouncil to be a resident. Canadian citizens and
permanent residents of Canada relocating from
within Canada to Saskatchewan are generally
eligible for coverage on the first day of the third
month following the establishing of residency in
Saskatchewan.
Returning Canadian citizens, the families of returning
members of the Canadian Forces, international students
and international workers are eligible for coverage on
establishing residency in Saskatchewan, provided that
residency is established before the first day of the third
month following their admittance to Canada.
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Chapter 3: Saskatchewan
The following persons are not eligible for insured
health services in Saskatchewan:
• members of the Canadian Forces and the Royal
Canadian Mounted Police (RCMP), federal
inmates and refugee claimants; visitors to the
province; and
• persons eligible for coverage from their home
province or territory for the period of their stay
in Saskatchewan (e.g., students and workers covered under temporary absence provisions from
their home province or territory).
Such people become eligible for coverage as follows:
• discharged members of the Canadian Forces
and the RCMP, if stationed in or resident in
Saskatchewan on their discharge date;
• released federal inmates (this includes those
prisoners who have completed their sentences
in a federal penitentiary and those prisoners
who have been granted parole and are living
in the community); and
• refugee claimants, on receiving Convention
Refugee status (immigration documentation
is required).
3.2 Registration Requirements
The following process is used to issue a health services card and to document that a person is eligible
for insured health services:
• every resident, other than a dependent child
under 18 years, is required to register;
• registration should take place immediately
following the establishment of residency in
Saskatchewan;
• registration can be carried out either in person
in Regina or by mail;
• each eligible registrant is issued a plastic health
services card bearing the registrant’s unique
lifetime nine-digit health services number; and
• cards are renewed every three years. (Current
cards expire in December 2011.)
All registrations are family-based. Parents and guardians can register dependent children in their family
units if they are under 18 years of age. Children 18
124
and over living in the parental home or on their own
must self-register.
The number of persons registered for health services
in Saskatchewan on June 30, 2008 was 1,035,544.
3.3 Other Categories of Individual
Other categories of individual who are eligible for
insured health service coverage include persons
allowed to enter and remain in Canada under authority of a work permit, student permit or Minister’s
permit issued by Citizenship and Immigration
Canada. Their accompanying family may also be
eligible for insured health service coverage.
Refugees are eligible on confirmation of Convention
status combined with an employment/student permit,
Minister’s permit or permanent resident, that is, landed
immigrant, record.
On June 30, 2008, there were 7,290 such temporary
residents registered with Saskatchewan Health.
4.0 Portability
4.1
Minimum Waiting Period
In general, insured persons from another province
or territory who move to Saskatchewan are eligible
on the first day of the third month following establishment of residency. However, where one spouse
arrives in advance of the other, the eligibility for the
later arriving spouse is established on the earlier of
a) the first day of the third month following arrival of
the second spouse; or b) the first day of the thirteenth
month following the establishment of residency by
the first spouse.
4.2 Coverage During Temporary
Absences in Canada
Section 3 of The Medical Care Insurance Beneficiary
and Administration Regulations of the Saskatchewan
Medical Care Insurance Act prescribes the portability
of health insurance provided to Saskatchewan residents while temporarily absent within Canada. There
were no changes to the in-Canada temporary absence
provisions in 2008–09.
Continued coverage during a period of temporary
absence is conditional upon the registrant’s intent to
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
return to Saskatchewan residency immediately on
expiration of the approved absence period as follows:
• education: for the duration of studies at a recognized educational facility (written confirmation
by a Registrar of full-time student status is
required annually);
• employment of up to 12 months (no documentation required); and
• vacation and travel of up to 12 months.
Section 6.6 of the Department of Health Act provides the authority for paying in-patient hospital
services to Saskatchewan beneficiaries temporarily residing outside the province. Section 10 of The
Saskatchewan Medical Care Insurance Payment
Regulations (1994) provides payment for physician
services to Saskatchewan beneficiaries temporarily
residing outside the province.
Saskatchewan has bilateral reciprocal billing agreements with all provinces for hospital services and
all but Quebec for physician services. Rates paid are
at the host province rates. The reciprocal arrangement for physician services applies to every province
except Quebec.
Payments/reimbursement to Quebec physicians,
for services to Saskatchewan residents, are made at
Saskatchewan rates (Saskatchewan Physician Payment
Schedule). However, the physician fees may be paid at
Quebec rates with prior approval. In recent years, the
out-of-province reciprocal hospital per diem billing
rates have increased significantly.
In 2008–09, expenditures for insured physician
services in other provinces were $27.75 million.
Insured hospital services in other provinces were
$61.57 million.
4.3 Coverage During Temporary
Absences Outside Canada
Section 3 of The Medical Care Insurance Beneficiary
and Administration Regulations describe the portability of health insurance provided to Saskatchewan
residents who are temporarily absent from Canada.
Continued coverage for students, temporary workers
and vacationers and travellers during a period of
temporary absence from Canada is conditional on
the registrant’s intent to return to Saskatchewan
residence immediately on the expiration of the
approved period as follows:
Canada Health Act — Annual Report 2008–2009
• education: for the duration of studies at a recognized educational facility (written confirmation
by a Registrar of full-time student status is
required annually);
• contract employment of up to 24 months (written
confirmation from the employer is required); and
• vacation and travel of up to 12 months.
Section 3 of The Medical Care Insurance Beneficiary
and Administration Regulations provides openended temporary absence coverage for persons whose
principal place of residence is in Saskatchewan, but
who are not able to satisfy the annual six months
physical presence requirement because the nature of
their employment requires travel from place to place
outside Canada (e.g., cruise line workers).
Section 6.6 of the Department of Health Act provides
the authority under which a resident is eligible for
health coverage when temporarily outside Canada.
In summary, a resident is eligible for medically
necessary hospital services at the rate of $100 per
in-patient and $50 per out-patient visit per day.
In 2008–09, $1.64 million was paid for in-patient
hospital services and $1.47 million was spent on outpatient hospital services outside Canada. In 2008–09,
expenditures for insured physician services outside
Canada were $647,700.
4.4 Prior Approval Requirement
Out-of-Province
Saskatchewan Health covers most hospital and medical out-of-province care received by its residents in
Canada through a reciprocal billing arrangement.
This arrangement means that residents do not need
prior approval and may not be billed for most services
received in other provinces or territories while travelling within Canada. The cost of travel, meals and
accommodation are not covered.
Prior approval is required for the following services
provided out-of-province:
• alcohol and drug, mental health and problem
gambling services; and
• bone mineral densitometry testing.
Prior approval from the Ministry must be obtained
by the patient’s specialist.
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Chapter 3: Saskatchewan
Out-of-Country
Prior approval is required for the following services
provided outside Canada:
• If a specialist physician refers a patient outside Canada for treatment not available in
Saskatchewan or another province, the referring
specialist must seek prior approval from the
Medical Services Plan of Saskatchewan Health.
The Saskatchewan Cancer Agency is consulted
for out-of-country cancer treatment requests.
If approved, Saskatchewan Health will pay
the full cost of treatment, excluding any items
that would not be covered in Saskatchewan.
5.0 Accessibility
5.1
Access to Insured Health Services
To ensure that access to insured hospital, physician and surgical-dental services are not impeded
or precluded by financial barriers, extra-billing by
physicians or dental surgeons and user charges by
hospitals for insured health services are not allowed
in Saskatchewan.
The Saskatchewan Human Rights Code prohibits
discrimination in providing public services, which
include insured health services on the basis of race,
creed, religion, colour, sex, sexual orientation, family status, marital status, disability, age, nationality,
ancestry or place of origin.
5.2 Access to Insured Hospital Services
As of March 31, 2009, Saskatchewan had 3,040 staffed
hospital beds in 66 acute care hospitals, including
2,415 acute care beds, 210 psychiatric beds and
415 other beds. The Wascana Rehabilitation Centre
had 54 rehabilitation beds and 196 extended care
beds. Rehabilitation services are also provided in a
Geriatric Rehabilitation Unit in one acute care hospital and in two special care facilities.
Supply of Health Providers
Saskatchewan is committed to ensuring that its
residents have access to the health providers and services they require. A key priority for Saskatchewan’s
government is to ensure that Saskatchewan recruits,
retains and trains the necessary health providers for
its system in the next few years, and additional initiatives and activities will be implemented as a result
126
of a new 10-year health human resource plan that
will be developed in the coming months.
In looking at the trend of selected health professionals, the majority of Saskatchewan’s health
professionals have increased between 2003 and
2007 (Table 1).
Regarding the availability of selected diagnostic,
medical, surgical and treatment equipment and services in facilities providing insured hospital services,
the Ministry of Health notes the following:
• MRI machines are located in Saskatoon (3) and
Regina (2); mobile MRI visits Lloydminster one
(1) week out of every five (5) weeks.
• CT scanners are available in Saskatoon (4),
Regina (3), Prince Albert (1), Swift Current (1),
Moose Jaw (1), Yorkton (1), North Battleford (1)
and Lloydminster (1). The Cancer Agency also
operates 2 CT scanners for the purpose of cancer
staging only (1 each in Regina and Saskatoon).
• In-centre hemodialysis is provided at Saskatoon,
Regina, Lloydminster, Prince Albert, Tisdale,
Yorkton, Swift Current, North Battleford,
Estevan and Moose Jaw. As well, a self-care
(home) hemodialysis service is being implemented in the province.
• Cancer treatment services are provided by the
Saskatchewan Cancer Agency’s two cancer
clinics, the Saskatoon Cancer Centre and
the Allan Blair Cancer Centre in Regina. In
calendar year 2008, over 5,800 new patients
began treatment for cancer. Both centres provided over 22,000 chemotherapy treatments
to cancer patients in Saskatoon and Regina.
• Sixteen (16) sites are involved in the Community
Oncology Program of Saskatchewan (COPS)
that allows patients to receive chemotherapy
and other supports closer to home, while maintaining a close link to expertise at the Cancer
Centres in Regina and Saskatoon. In 2008, nearly
2,400 patient received over 7,200 chemotherapy
treatments at COPS centres.
• Approximately 72 percent of surgery services
are provided in Saskatoon and Regina, where
there are specialized physicians and staff and
the equipment to perform a full range of surgical
services. An additional 24 percent is provided in
six mid-sized hospitals in Prince Albert, Moose
Jaw, Yorkton, Swift Current, North Battleford and
Lloydminster, with the remaining surgery performed in smaller hospitals across the province.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
Table 1: Number of Selected Health Professionals, Saskatchewan and Canada
Occupations
Saskatchewan
Canada
2003
2004
2005
2006
2007*
2007*
Audiologists
33
35
30
34
30
1,344
Chiropractors
182
182
184
184
176
7,434
Dental Hygienists
334
336
347
355
378
20,928
Dentists
378
376
364
368
378
19,201
Dietitians
242
251
251
262
276
8,797
Environmental Public Health Professionals
63
63
64
80
76
1,420
Health Information Management Professionals
221
230
246
294
312
3,714
2,056
2,131
2,194
2,224
2,381
69,709
Medical Laboratory Technologists
938
949
984
977
963
19,813
Medical Physicists
10
10
9
12
11
352
Medical Radiation Technologists
445
429
453
479
486
16,940
Midwives
5
8
10
10
n/a
665
Nurse Practitioners
-
42
75
91
100
1,395
Occupational Therapists
211
214
217
232
211
12,296
Optometrists
108
113
117
117
120
4,255
Pharmacists
1,142
1,170
1,177
1,027
1,142
28,433
Physicians
1,751
1,745
1,770
1,818
1,644~
63,682~
Family Medicine
1,007
913
930
952
922
32,598
Specialists
744
832
840
866
722
31,084
Physiotherapists
530
526
534
551
522
16,463
Psychologists
374
404
418
431
445
16,097
8,503
8,481
8,549
8,480
8,669
257,961
Registered Psychiatric Nurses
939
935
933
900
880
5,124
Respiratory Therapists
97
103
97
116
128
8,168
1,004
1,019
1,161
1,118
1,166
32,043
213
216
240
234
231
6,989
Licensed Practical Nurses
Registered Nurses
Social Workers
Speech-Language Pathologists
n/a – Not available.
~ Excludes 191 and 7,004 physicians in Saskatchewan and Canada, respectively. Included in this group are military, semi-retired, residents and non-licensed
physicians who requested that their information not be published as of December 31, 2007.
Note:
Comparing the number of professionals per 100,000 population may not provide a good comparison, as it does not recognize the different ways health
services are delivered.
Sources: Canada’s Health Care Providers, 1997 to 2006, A Reference Guide: Canadian Institute for Health Information (CIHI), 2008;
~ Supply, Distribution and Migration of Canadian Physicians, 2007: CIHI, 2008; and
*Canada’s Health Care Providers 2007 Provincial Profiles: CIHI, 2009.
Canada Health Act — Annual Report 2008–2009
127
Chapter 3: Saskatchewan
• Telehealth Saskatchewan links continue to provide residents in a number of rural and remote
areas with access to specialist, family physician
and other health provider services without having to travel long distances.
A number of measures were taken in 2008–09 to
improve information about and access to insured
health services:
• Access and use of specialized medical imaging
services, including MRI, CT and bone mineral
density testing, has grown steadily in Saskatchewan. In 2008–09, approximately 17,808 patients
received MRI services and approximately
80,053 patients received CT services.
• The Chronic Kidney Disease Programs that
were established in the Regina Qu’Appelle and
Saskatoon regions in summer 2001 continue to
grow. The goals of these clinics are to delay the
need for dialysis and to better prepare patients
in making their treatment choices: haemodialysis, peritoneal or home dialysis or transplant.
The number of patients served by these clinics
significantly surpasses the number of patients
on dialysis. By March 31, 2005, 817 patients
were being supported through CRI clinics. As
of March 31, 2009 this figure was 1,275.
• The Cancer Agency is responsible for the provincial Screening Program for Breast Cancer.
The Screening Program has seven sites around
the province and one mobile mammography
unit that travels into communities not served
by a stationary site. The Screening Program
provides mammograms to between 34,000 and
39,000 women annually.
• The Provincial Malignant Haematology/Stem
Cell Transplant Program continues to provide
transplants to Saskatchewan residents. In 2008–09,
31 patients with aggressive or advanced blood or
other system cancers received stem cell or bone
marrow transplants. The program also provides
teaching as a formal part of the haematology
clinic rotation for residents of Internal Medicine
at the University of Saskatchewan.
Saskatchewan Health continues to place priority on
promoting surgical access and improving the province’s surgical system. In 2008–09 new interactive
patient educational and decision support tools were
developed to support patient decisions regarding
prostate health and prostate cancer treatments
(www.health.gov.sk.ca/prostate-cancer).
128
In January 2003, the Saskatchewan surgical website
was launched. Located at [www.sasksurgery.ca] this
surgical access website provides a range of surgical
care system information and wait list information,
including wait time and wait list data, and physician
location and specialty. The website also provides
information on surgeries performed, patients waiting
and waiting times, as well as how the system works
and how to access surgical services in the province.
Saskatchewan Health is currently working closely
with members of the health regions, physicians and
other health partners to maximize access to diagnostic imaging services in Saskatchewan. The focus is
on improving access to specialized diagnostic services (MRI, CT), while at the same time providing
a basis for improved, sustainable health delivery in
the future.
On January 31, 2005, the Minister of Health announced
the establishment of a Diagnostic Imaging Network.
This Network is a partnership among clinicians, service providers, regional health authorities, regulatory
agencies, health training institutions, community and
government representatives, that works toward the
goal of ensuring equitable access to quality diagnostic
imaging services in Saskatchewan. Through collaboration with participating partners, the Network acts as
a provincial advisory body to assist in province-wide
strategic planning and coordination of the diagnostic
imaging system.
The Diagnostic Imaging Network is currently overseeing the following initiatives:
• Implementation of a Radiology Information and
Picture Archiving and Communication System
(RIS/PACS) in the Province. The RIS is a system
for tracking patients and diagnostic imaging
procedures that are provided to them. The PACS
is a system that allows for the viewing, storage
and retrieval of a digital diagnostic image.
• Oversight of a multi-year Capital Equipment
Replacement Plan. Saskatchewan Health and
Regional Health Authorities have created an
inventory of the Province’s diagnostic imaging equipment and developed a plan for the
acquisition and deployment of future diagnostic
imaging equipment purchases.
• Monitoring of access to MRI and CT services.
Urgency classifications and wait time targets for
ultrasound and nuclear medicine are currently
under development.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
• A Provincial Decision Support Tool pilot project:
A decision support tool for diagnostic imaging
will assist the referring physician in ordering
the right test the first time by incorporating
evidence-based guidelines for radiology into a
quick, user friendly electronic order entry tool.
• Diagnostic Imaging information on Ministry of
Health website (http://www.health.gov.sk.ca/
diagnostic-imaging-wait-times).
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2009, there were 1,836 physicians
licensed to practice in the province and eligible to
participate in the Medical Care Insurance Plan. Of
these, 1,003 (54.6 percent) were family practitioners
and 833 (45.4 percent) were specialists.
As of March 31, 2009, there were approximately
372 practising dentists and dental surgeons located
in all major centres in Saskatchewan. Seventynine provided services insured under the Medical
Services Plan.
A number of new or continuing initiatives were
underway in 2008–09 to recruit and retain physicians
thereby enhancing access to insured physician services and reducing waiting times.
Specialist Programs
Rural and Regional Programs
• The Regional Practice Establishment Program
provides grants of $10,000 to eligible family
physicians who establish a practice in a regional
centre for a minimum of 18 months.
• A Re-entry Training Program provides two grants
annually to rural family physicians wishing to
enter specialty training, and requires a return
service commitment.
• The Saskatchewan Health International Medical
Graduates (IMG) Residency Training Program
funds up to 4 positions annually at the University of Saskatchewan. These positions are
dedicated to international medical graduates
who require a period of residency training
in order to qualify for licensure to practise
in Saskatchewan.
• Rural physicians are supported through an integrated Emergency Room Coverage and Weekend
Relief Program, which compensates physicians
providing emergency room coverage in rural
areas and helps those communities with fewer
than three physicians gain access to other physicians to provide weekend relief.
• The Rural Practice Establishment Grant Programs make grants of $25,000 to Canadiantrained landed immigrant or foreign trained
physicians who establish new practices in rural
Saskatchewan for a minimum of 18 months.
• A Specialist Physician Enhancement Training
Program provides grants of up to $80,000 per
year to allow practising specialists the opportunity to obtain additional training and requires
a return service commitment.
• The Family Medicine Resident Bursary Program
provides bursaries of $25,000 to family medicine
residents to help them with medical educational expenses in return for a rural service
commitment.
• A Specialist Emergency Coverage Program
compensates specialist physicians who make
themselves available to provide emergency
coverage to acute care facilities.
• The Undergraduate Medical Student Bursary
Program provides an annual grant of $15,000
to medical students who sign a return service
commitment to a rural community.
• The Specialist Resident Bursary Program offers
up to 15 bursary spots per year to residents for a
maximum of three years funding with a returnof-service commitment.
• The Rural Practice Enhancement Training
Program provides income replacement to
practising rural physicians and assistance
to medical residents wishing to take specialized training in an area of need in rural
Saskatchewan. A return service commitment
is required.
• The Specialist Physician Establishment Grant
provides up to 15 grants to eligible specialists
who establish a practice in Saskatchewan for
a minimum of 36 months.
Canada Health Act — Annual Report 2008–2009
129
Chapter 3: Saskatchewan
• The Rural Emergency Care Continuing Medical
Education Program provides funds to rural physicians for certification and re-certification of
skills in emergency care and risk management.
Approved physicians are required to provide
service in rural Saskatchewan after completing
an educational program.
• The Saskatchewan Medical Association is
funded to provide locum relief to rural physicians through the Locum Service Program while
they take vacation, education or other leave.
• The Northern Medical Services Program
is a tripartite endeavour of Saskatchewan
Health, Health Canada and the University
of Saskatchewan to help stabilize the supply
of physicians in northern Saskatchewan.
• The Rural Extended Leave Program supports
physicians in rural practice who want to
upgrade their skills and knowledge in areas
such as anaesthesia, obstetrics and surgery by
reimbursing educational costs and foregone
practice income for up to six weeks.
• The Rural Travel Assistance Program provides
travel assistance to rural physicians participating in educational activities.
• The Northern Telehealth Network provides physicians in remote or isolated areas with access to
colleagues, specialty expertise and continuing
education.
Other Programs
• Support is provided to initiatives for physicians
to use allied health professionals and enhance
the integration of medical services with other
community-based services through the Alternate
Payments and Primary Health Services Program.
• A Long-term Service Retention Program rewards
physicians who work in the province for 10 or
more years.
• The Parental Leave Program was developed
in 2004 to provide benefits for self-employed
physicians who take a maternity, paternity or
adoption child care leave from clinical practice.
130
5.4 Physician Compensation
The process for negotiating compensation agreements
for insured services with physicians and dentists
is prescribed by section 48 of the Saskatchewan
Medical Care Insurance Act as follows:
• a Medical Compensation Review Committee
is established within 15 days of either the
Saskatchewan Medical Association or the government providing notice to begin discussing
a new agreement;
• each party shall appoint no more than six representatives to the Committee;
• the objective of the Committee is to prepare an
agreement respecting insured services that is
satisfactory to both parties;
• in the case that a satisfactory agreement cannot
be reached, the matter may be referred to the
Medical Compensation Review Board, consisting of an appointee by either party who in turn
select a third member; and
• the Board has the authority to make a decision
binding on the parties.
The latest three-year agreement with the Saskatchewan
Medical Association, which expired March 31, 2009,
provided increases in the Physician Payment Schedule
of 2.8 percent in each year of the agreement. Similar
increases were applied to non-fee-for-service physicians. Additional improvements included a total of
$11.8 million to support a number of innovative incentive programs focussing on recruitment, retention and
improved patient care. These include:
• increases to existing on-call programs;
• $2 million to improve patient access to
specialists;
• $2 million to introduce on-call payment for
some urban family physicians and to support
improve compensation to family physicians
who provide assistance during surgery;
• $4 million to enhance management of chronic
diseases; and
• $3.8 million to improve ongoing retention
programs.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
Section 6 of The Saskatchewan Medical Care
Insurance Payment Regulations, 1994, outlines
the obligation of the Minister of Health to make
payment for insured services in accordance with
the Physician Payment Schedule and the Dentist
Payment Schedule.
Fee-for-service is the most widely used method of
compensating physicians for insured health services
in Saskatchewan, although sessional payments, salaries, capitation arrangements and blended methods
are also used. Fee-for-service is the only mechanism
used to fund dentists for insured surgical-dental
services. Total expenditures for in-province physician services and programs in 2008–09 amounted
to $656.2 million: $394.8 million for fee-for-service
billings; $22.8 million for Emergency Coverage
Programs; $212.7 million in non-fee-for-service
expenditures; and $26.0 million for Saskatchewan
Medical Association programs as outlined in the
agreement.
5.5 Payments to Hospitals
In 2007–08, funding to regional health authorities
was based on historical funding levels adjusted for
inflation, collective agreement costs and utilization
increases. Each regional health authority is given a
global budget and is responsible for allocating funds
within that budget to address service needs and
priorities identified through its needs assessment
processes.
Regional health authorities may receive additional
funds for providing specialized hospital programs
(e.g., renal dialysis, specialized medical imaging services, specialized respiratory services and surgical
services) or for providing services to residents from
other health regions.
Payments to regional health authorities for delivering services are made pursuant to section 8 of
the Regional Health Services Act. The legislation
provides the authority for the Minister of Health
to make grants to regional health authorities and
health care organizations for the purposes of the
Act and to arrange for providing services in any
area of Saskatchewan if it is in the public interest
to do so.
Regional health authorities provide an annual report
on the aggregate financial results of their operations.
Canada Health Act — Annual Report 2008–2009
6.0 Recognition Given to
Federal Transfers
The Government of Saskatchewan publicly acknowledged the federal contributions provided
through the Canada Health Transfer (CHT) in the
Ministry’s 2008–09 Annual Report, the Government
of Saskatchewan 2008–09 Annual Budget and related
budget documents, its 2008–09 Public Accounts and
the Quarterly and Mid-Year Financial Reports. These
documents were tabled in the Legislative Assembly
and are publicly available to Saskatchewan residents.
Federal contributions have also been acknowledged
on the Saskatchewan Health website, news releases,
issue papers, in speeches and remarks made at various conference, meetings and public policy forums.
7.0 Extended Health Care
Services
As of March 31, 2008, the range of extended health
care services provided by the provincial government
included long-term residential care services for
Saskatchewan residents, certain community-based
health services such as home care, as well as a wide
range of other health, social support, mental health,
addiction treatment, palliative care, problem gambling
and drug benefit programs.
7.1
Nursing Home Intermediate Care
and Adult Residential Care Services
Special-care homes provide institutional long-term
care services to meet the needs of individuals,
primarily with heavy care needs. Services offered
include care and accommodation, respite care, day
programs, night care, palliative care and, in some
instances, convalescent care. These facilities are
publicly funded by Saskatchewan Health through
regional health authorities, are designated under the
Regional Health Services Act and are governed by the
Housing and Special-care Homes Act and regulations.
Under the provincial immunization program,
Saskatchewan Health purchases vaccines for
regional health authorities to provide immunization for residents in long-term care facilities
and other similar residential facilities. Influenza
and pneumococcal vaccines are provided free
131
Chapter 3: Saskatchewan
of charge to regional public health services and
other health care providers for administration to
residents in the facilities.
Adult Residential Care Services are delivered through
the regional health authorities by Mental Health and
Addictions Services programs. Apartment Living
Programs and Group Homes provide a continuum
of support and living assistance to individuals with
long-term mental illnesses. These programs are governed by the Residential Services Act.
Saskatchewan Health, in partnership with the
Heartland Regional Health Authority, offers a rehabilitation program for people and families struggling
with eating disorders. BridgePoint Centre delivers
this program and abides by the Registered Charities
and the Income Tax Act, and the Regional Health
Services Act.
The types of facilities that provide residential alcohol
and drug services are listed below. Saskatchewan
Health or the regional health authorities may contract
with community-based and non-profit organizations
governed by the Non-profit Corporations Act to provide services. Facilities providing service typically
are designated by the Minister of Health or licensed
under the Residential Services Act.
Detoxification services provide a safe and supportive
environment in which the client is able to undergo
the process of alcohol and/or other drug withdrawal
and stabilization. Accommodation, meals and selfhelp groups are offered for up to 10 days.
In-patient services are provided to individuals
requiring intensive rehabilitative programming
for their own or others’ use of alcohol or drugs.
Services offered include assessments, counselling,
education and support for up to four weeks or
longer depending on individual needs.
Long-term residential services provide maintenance
and transition programs for an extended period to
individuals recovering from chemical dependency
and addiction. These facilities offer counselling,
education and relapse-prevention in a safe and
supportive environment.
7.2
Home Care Services
The Home Care Program provides an option for
people with varying degrees of short and longterm illness or disabilities to remain in their own
homes rather than in a care facility. The Program is
132
designed to provide care and services for individuals with palliative, acute and supportive care needs.
Services include assessment and care coordination,
nursing, personal care, respite care, homemaking,
meals, home maintenance, therapy and volunteer
services. Individualized funding is an option of the
Home Care Program. It provides funding directly
to people with disabilities so they can arrange and
manage their own supportive services. There is also
a Collective Funding option for groups of people with
disabilities to arrange and manage their own supportive services.
The Home Care Program is funded by Saskatchewan
Health, delivered by the Regional Health Authorities,
and governed by the Regional Health Services Act.
7.3
Ambulatory Health Care Services
Saskatchewan regional health authorities provide
a full range of community-based mental health and
alcohol and drug services. Mental health services are
governed by the Mental Health Services Act. The provision of Alcohol and Drug services generally falls
under the Regional Health Services Act.
Regional health authorities offer podiatry services.
Services include assessment, consultation and treatment. The Chiropody Services Regulation of the
Department of Health Act provides chiropodists
and podiatrists with the ability to self-regulate their
profession.
Regina Qu’Appelle and Saskatoon regional health
authorities provide a provincial Hearing Aid
Program. Services include hearing testing, assessments for at-risk infants, and the selling, fitting and
maintenance of hearing aids. The provision of these
hearing services generally falls under the Regional
Health Services Act.
Rehabilitation therapies, including occupational and
physical therapies and speech and language pathology, are offered by the regional health authorities to
help individuals of all ages improve their functional
independence. Services are provided in hospitals,
rehabilitation centres, long-term care facilities, community health centres, schools and private homes
and include assessment, consultation and treatment. The Regional Health Services Act and The
Community Therapy Regulations, which are under
the authority of the Department of Health Act, govern
these programs.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Saskatchewan
Registered Persons
1. Number as of June 30th (#).
1
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
1,018,057
1,021,080
1,003,231
1,014,649
1,035,544
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
65
66
66
66
66
b. chronic care
0
0
0
0
0
c. rehabilitative care
1
1
1
1
1
d. other
0
0
0
0
0
e. total
66
67
67
67
67
3. Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
867,261,000
2
922,675,000
2
1,173,115,000
2
1,277,632,000
2
1,402,109,000
not applicable
not applicable
not applicable
not applicable
not available
not available
not available
not applicable
not applicable
d. other
not applicable
not applicable
not applicable
not applicable
not applicable
e. total
867,261,000
922,675,000
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
2
1,173,115,000
2
1,277,632,000
2
not applicable
2
1,402,109,000
2
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
4,307
4,566
4,627
4,212
2008–2009
4,365
30,461,943
33,671,100
36,828,100
31,569,400
43,631,600
51,678
55,067
52,591
81,787
65,274
9,345,190
11,044,200
11,573,400
17,240,900
17,936,200
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
254
248
242
245
251
730,849
2,033,300
2,473,400
2,291,200
1,637,300
1,002
1,194
1,454
1,381
1,437
251,957
1,486,500
1,019,500
970,500
1,468,500
1. Saskatchewan’s numbers as of June 30, 2008.
2. This number includes estimated government funding to Regional Health Authorities (RHAs) based on total projected expenditures less non-government revenue, as provided to
Saskatchewan Health through the RHA annual operational plans.
— Acute care funding includes: acute care services, specialized hospital services, and in-hospital specialist services.
— Does not include inpatient rehabilitative care, inpatient mental health, or addiction treatment services.
— Does not include payments to Saskatchewan Cancer Agency for outpatient chemotherapy and radiation.
Canada Health Act — Annual Report 2008–2009
133
Chapter 3: Saskatchewan
Insured Physician Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
14.Number of participating physicians (#):
a. general practitioners
967
990
1,003
1,029
1,003
b. specialists
718
729
750
766
833
c. other
0
0
0
0
0
d. total
1,685
1,719
1,753
1,795
1,836
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
not available
not available
not available
not available
not available
491,805,817
528,759,380
554,193,389
585,863,285
630,253,960
9,970,606
10,033,881
9,944,187
10,289,448
9,800,308
337,816,629
362,884,810
369,664,529
401,172,658
398,867,624
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
513,694
542,651
603,687
561,415
599,106
20,379,200
20,541,894
24,239,622
25,442,417
27,753,524
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
not available
not available
not available
not available
not available
510,600
695,900
692,600
637,600
647,700
Insured Surgical-Dental Services Within Own Province or Territory
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
134
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
84
78
74
82
79
19,400
18,511
18,203
16,347
18,085
1,442,800
1,539,420
1,511,882
1,577,176
1,840,276
Canada Health Act — Annual Report 2008–2009
Chapter 3: Alberta
reports directly to the Minister of Alberta Health
and Wellness.
The Health Governance Transition Amendment Act
provided for the dissolution of the Alberta Cancer
Board and the Alberta Alcohol and Drug Abuse
Commission, both of which were established by
legislation. The legislation allowed the government
to complete the transition to Alberta Health Services.
Alberta
Introduction: Alberta’s Health
Care System
Alberta provides medically necessary, insured services in a public system that follows the principles
of the Canada Health Act: public administration,
comprehensiveness, universality, portability and
accessibility. Medically necessary services include
hospital and physician services and specific kinds of
services provided by oral surgeons and other dental
professionals.
Health System Governance
Alberta’s health care system is defined in legislation and is governed by the Minister of Health and
Wellness. The role of the Ministry of Health and
Wellness is to assure accountability and balance
health service needs with fiscal responsibility, and
provide strategic direction and leadership to the
provincial health system through:
• policy, legislation and standards;
• allocating resources;
• helping develop and support the health system; and
• administering provincial programs such as the
Alberta Health Care Insurance Plan and communicable disease control expertise.
On May 15, 2008, the Alberta government announced
that one provincial governance board would replace
Alberta’s nine regional health authority boards, the
Alberta Mental Health Board, the Alberta Cancer
Board and the Alberta Alcohol and Drug Abuse
Commission. Effective April 1 2009, the new Alberta
Health Services Board became fully responsible for
health service delivery for the entire province, and
Canada Health Act — Annual Report 2008–2009
Health services in Alberta are delivered by Alberta
Health Services through health professionals in feefor-service practice and others who provide equipment,
supplies and services. Some public health services may
also be provided by private health care clinics providing they have contracts with Alberta Health Services
to provide publicly insured services.
The Office of the Chief Medical Officer of Health,
which is part of the Ministry of Health and Wellness,
provides direction and guidelines on public health
policy to Alberta Health Services, and gives information to the public about communicable diseases and
public health programs.
The Health Quality Council of Alberta is an organization engaged in gathering knowledge and translating
it into practical actions that can improve the quality,
safety and performance of Alberta’s health system.
Alberta’s health legislation can be accessed at:
http://www.health.alberta.ca/about/
health-legislation.html
Significant Events in 2008/2009
In 2008/2009 the Alberta Ministry of Health and
Wellness continued to pursue its goal of improving the performance and accessibility of the health
system in meeting the needs of Albertans. Some key
achievements include:
• In December 2008, government released Vision
2020, a report that outlines a number of actions
that will build, improve and guide Alberta’s
health system into the future. The five main
goals in Vision 2020 are:
• providing the right service, in the right place,
and at the right time;
• enhancing access to high quality services in
rural areas;
• matching workforce supply to demand for
services;
135
Chapter 3: Alberta
• improving co-ordination of care and delivery
of care; and
• building a strong foundation for public health.
• A new Alberta Pharmaceutical Strategy was
released in December 2008 to provide an accessible, sustainable and affordable pharmaceutical
system for Alberta. Key components include
redesigned drug coverage for seniors, revised
premiums for non-group drug benefit programs,
consolidation and alignment of government drug
programs, a program to provide drug therapy to
those with rare diseases, and an improved process for drug pricing and purchasing.
• A new provincial Continuing Care Strategy was
released in December 2008 to improve health
and personal care service options for seniors
and persons with disabilities. The strategy will
enhance supports to help individuals live in
the community and provide incentives for
renovations to long-term care facilities and
new supportive living spaces.
• Health care premiums were eliminated in
Alberta as of January 1, 2009. This elimination
is expected to equal an estimated savings of
almost $1 billion annually for Albertans.
• The governance and funding of Emergency
Medical Services (ambulances) was transferred
from more than 300 municipalities to Alberta
Health Services. Completed on April 1, 2009,
this transition lays the foundation for a patient
centered, high quality service, ensuring that
Albertans are receiving the right ambulance at
the right time and the right place, and are not
limited or restricted by geographic boundaries.
• The Children’s Mental Health Plan for Alberta:
Three Year Action Plan was released in August
2008. The government will invest more than
$50 million over three years to implement the
23 actions in the plan, which will improve access
to mental health services for infants, children,
youth and their families. The plan will also
address the needs of children and youth who
are at risk for mental health problems.
• The government announced approximately
$34 million in capital funding for a new cancer radiation therapy centre in Lethbridge. The
centre, which is part of the Cancer Radiation
Therapy Capacity Corridor, will help improve
access to cancer treatment in southern Alberta.
A centre in Red Deer is currently in the project
planning stage.
136
• As part of Alberta’s Tobacco Reduction Act,
retailers across the province were required
to remove all point-of-sale advertising and
displays of tobacco products from their shelves
and to store tobacco products out of sight. As
well, the sale of all tobacco products in pharmacies, stores that contain pharmacies, health-care
facilities and public post-secondary institutions
was prohibited.
• In June 2008, Alberta Health and Wellness announced a new program that will ensure all
girls entering Grade 5 will be eligible to receive
a vaccine to help prevent Human Papillomavirus
infection, which causes 70 per cent of all cervical cancers.
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
The Ministry of Health and Wellness administers the
Alberta Health Care Insurance Plan on a nonprofit
basis and in accordance with the Canada Health
Act. Since 1969, the Alberta Health Care Insurance
Act has governed the operation of the Alberta Health
Care Insurance Plan. The Minister determines which
services are covered by the Alberta Health Care
Insurance Plan.
1.2 Reporting Relationship
The Minister of Health and Wellness is fully accountable for the Alberta Health Care Insurance Plan. The
Government Accountability Act establishes the planning, reporting and accountability structures that
government and accountable organizations must
adhere to.
1.3 Audit of Accounts
The Auditor General of Alberta audits all government ministries, departments, regulated funds, and
provincial agencies and is responsible for assuring
the public that the government’s financial reporting
is credible. The Auditor General of Alberta completed
its audit of Health and Wellness on June 5, 2009, and
indicated that the statements fairly present, in all
material respects, the financial position and results
of operations for the year ended March 31, 2009.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Alberta
2.0 Comprehensiveness
2.1
Insured Hospital Services
• the physicians providing the services will
comply with the conflict of interest and ethical
requirements of the Medical Profession Act and
bylaws.
In Alberta, Alberta Health Services is the body
responsible to the Minister for ensuring the provision
of insured hospital services. The Hospitals Act, the
Hospitalization Benefits Regulation (AR 244/1990),
the Health Care Protection Act and the Health Care
Protection Regulation (AR 208/2000) define how
insured services are provided by hospitals or designated surgical facilities. According to the legislation,
all hospitals and surgical facilities must be approved
by the Minister. A directory of approved hospitals in
Alberta can be found at:
The publicly funded services provided by approved
hospitals in Alberta range from the most advanced levels of diagnostic and treatment services for in-patients
and out-patients to the routine care and management of
patients with previously diagnosed chronic conditions.
The benefits available to hospital patients in Alberta are
established in the Hospitalization Benefits Regulation
(AR244/1990). The Regulation is available at:
http://www.health.alberta.ca/documents/
hospital-directory.pdf
There is no regular process to review insured hospital
services, as the list of insured services included in
the regulations is intended to be both comprehensive
and generic and does not require routine review and
updating. Changes to specific physician services can
be found in the Schedule of Medical Benefits, and are
described in the next section.
During 2008/2009 no amendments were made to the
legislation regarding insured hospital services.
Alberta’s Health Care Protection Act governs the
provision of insured surgical services performed in
non-hospital surgical facilities (NHSF). Ministerial
approval of a contract between the facility and/or
operator and Alberta Health Services is required to
provide insured services. Ministerial designation of
a non-hospital surgical facility and accreditation by
the College of Physicians and Surgeons of Alberta
are also required. At the end of 2008 there were
70 accredited non-hospital surgical facilities. For the
2008/2009 fiscal year, 45 operators in 32 accredited
facilities had contracts with regional health authorities to provide a variety of insured surgical services.
According to the Health Care Protection Act,
Ministerial approval for a contractual agreement
shall not be given unless:
• the insured surgical services are consistent with
the principles of the Canada Health Act;
• there is a current and likely future need for the
services in the geographical area;
• the proposed surgical services will not have a
negative impact on the province’s public health
system;
• there will be an expected benefit to the public;
• Alberta Health Services has an acceptable business plan to pay for the services;
• the proposed agreement contains performance
expectations and measures; and
Canada Health Act — Annual Report 2008–2009
http://www.health.alberta.ca/about/
health-legislation.html
2.2 Insured Physician Services
The Alberta Health Care Insurance Act governs the
payment of physicians for insured physician services
under the Alberta Health Care Insurance Plan (section 6). Only physicians who meet the requirements
stated in the Alberta Health Care Insurance Act
are allowed to provide insured services under the
Alberta Health Care Insurance Plan.
As of March 31, 2009, 6,266 physicians were enrolled
in the Alberta Health Care Insurance Plan.
Before being registered with the Alberta Health Care
Insurance Plan, a practitioner must complete the
appropriate registration forms and include a copy
of his or her license issued by the appropriate governing body or association, such as the College of
Physicians and Surgeons of Alberta. Under section 8
of the Alberta Health Care Insurance Act, physicians
may opt-out of the Alberta Health Care Insurance
Plan. As of March 31, 2009, there were zero nonparticipating physicians in the province.
The Alberta Health Care Insurance Regulation
defines which services are not deemed to be either
basic or extended health services. The Medical
Benefits Regulation establishes the benefits payable
for insured medical services provided to a resident
of Alberta. Descriptions of those services are set out
137
Chapter 3: Alberta
in the Schedule of Medical Benefits, which can be
accessed at:
http://www.health.alberta.ca/professionals/
SOMB.html
The Schedule of Medical Benefits (SOMB) is continuously being revised for improvements made to
physician services insured under the Alberta Health
Care Insurance Plan. Effective April 1, 2009, extensive changes were made to the SOMB as a result of
the new Physician Services Budget.
Included in these changes was the introduction of
two new Health Service Codes (HSC) for patients
with a combination of eligible chronic diseases
and patients in need of geriatric care services. With
Alberta’s aging population, the number of patients
in these two groups is increasing and will require
improved resource efficiencies to ensure their needs
continue to be addressed.
Under the new chronic disease HSC, general practice physicians are now able to receive an annual
fee for the development, documentation and administration of a patient care plan. Previously, these
physicians received a multitude of fees-for-service
that were based on short-term assessments. This
complex care plan will provide improved benchmarks for a patient’s overall health in a given year.
This new geriatric HSC enables more comprehensive
geriatric assessments, for example, as it includes
medical, functional, cognitive, social and environmental assessments over a period of time instead of
instances in time.
In addition to the full coverage provided for those
physician and dental surgery services listed in the
SOMB, the Alberta Health Care Insurance Plan
provides partial coverage for podiatry and optometry services received in Alberta. These services
have benefit limits or maximums per benefit year,
which runs from July 1 to June 30. When the charge
for a service exceeds the benefit limit, patients are
required to pay the difference in cost. These services
are listed in separate Schedules of Benefits.
2.3 Insured Surgical-Dental Services
In Alberta a dentist may perform a small number of
insured surgical-dental services. The majority of
dental procedures that can be billed to the Alberta
Health Care Insurance Plan can only be performed
by a dentist certified as an oral and maxillofacial
surgeon who meets the requirements stated in the
138
Alberta Health Care Insurance Act. Under section 7
of the Alberta Health Care Insurance Act all dentists
are deemed to have opted into the plan. A dentist
may opt out of the plan by notifying the Minister
in writing of the effective date of their opting out
and ensuring that each patient is advised of their
opted out status before any service is provided to
the patient. As of March 31, 2009, no dentists were
opted out of the Plan in Alberta.
Alberta insures a number of medically necessary oral
surgical and dental procedures that are listed in the
Schedule of Oral and Maxillofacial Surgery Benefits
available at:
http://www.health.alberta.ca/professionals/
allied-services-schedule.html
In 2008/2009, 202 dentists/oral surgeons provided
insured services under the Alberta Health Care
Insurance Plan. Although there is no formal agreement between dentists and the Alberta Ministry of
Health and Wellness, the department meets with
members of the Alberta Dental Association and
College to discuss changes to the Schedule of Oral
and Maxillofacial Surgery Benefits. All changes to
the benefit schedule require ministerial approval.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Section 12 of the Alberta Health Care Insurance
Regulation defines which services are not considered to be insured services. Section 4(2) of the
Hospitalization Benefits Regulation provides a list
of uninsured hospital services.
Alberta’s policy for Preferred Accommodation and
Non-Standard Goods or Services is posted on the
AHW website at:
http://www.health.alberta.ca/newsroom/
pub-health-authorities.html
The policy describes the province’s expectations
of Alberta Health Service and guides its decisionmaking with respect to provision of preferred
accommodation and enhanced or non-standard
goods and services. This policy framework requires
Alberta Health Service to provide 30 days advance
notice to the Minister’s designate regarding the
categories of preferred accommodation offered and
the charges associated with each category. Alberta
Health Service is also required to provide 30 days
Canada Health Act — Annual Report 2008–2009
Chapter 3: Alberta
advance notice to the Minister’s designate regarding
any goods or services that will be provided as nonstandard goods or services. They are also required
to provide information about the associated charge
for these goods or services, and when applicable,
the criteria or clinical indications that may qualify
patients to receive it as a standard good or service.
Finally, Alberta Health Service must publish and
keep current a list of non-standard medical goods
or services. These lists are periodically reviewed by
the Ministry of Health and Wellness and by Alberta
Health Service.
3.0 Universality
3.1
Eligibility
Under the terms of the Alberta Health Care Insurance
Act, all Alberta residents are eligible to receive publicly funded health care services under the Alberta
Health Care Insurance Plan. A resident is defined as a
person lawfully entitled to be or to remain in Canada
who makes the province his or her home and is ordinarily present in Alberta. The term “resident” does
not include a tourist, transient or visitor to Alberta.
Persons moving permanently to Alberta from outside
Canada are eligible for coverage if they are landed
immigrants, returning landed immigrants or returning Canadian citizens. Temporary residents may also
be eligible for coverage, if they intend to remain in
Alberta for 12 months and their Canada entry documents are in order.
Residents who are not eligible for coverage under the
Alberta Health Care Insurance Plan, but are covered
by the federal government include:
months of arrival. For persons moving from outside Canada their registration is effective as of the
day they become an Alberta resident. The Alberta
Health Care Insurance Plan processes for registering Albertans and issuing replacement health cards
require registrants to provide documentation that
proves their identity, legal entitlement to be in
Canada and Alberta residency. These requirements
have improved security and confidentiality, while
reducing the potential for fraud or abuse.
As of March 31, 2009, 3,589,494 Alberta residents were registered with the Alberta Health
Care Insurance Plan. Under the Health Insurance
Premiums Act a resident may opt out of the Alberta
Health Care Insurance Plan by filing a declaration
with the Minister. As of March 31, 2009, 283 Alberta
residents were opted out of the Plan.
3.3 Other Categories of Individual
Temporary residents arriving from outside Canada who
may be deemed residents include persons on Visitor
Records, Student or Employment Authorizations and
Minister’s Permits. There were 67,018 people covered
under these conditions as of March 31, 2009.
3.4 Premiums
On January 1, 2009, health care premiums were eliminated in Alberta. Premiums up to that date, and
any outstanding premiums owed, were required to
be paid by Alberta residents. Exceptions include:
• dependants (residents, however, are required to
pay premiums on behalf of their dependants);
• members of the Canadian Forces;
• members of the Canadian Forces;
• members of the Royal Canadian Mounted Police
(RCMP) who are appointed to a rank in it; and
• members of the Royal Canadian Mounted Police
(RCMP) who are appointed to a rank in it;
• persons serving a term in a federal penitentiary.
• persons serving a term in a federal penitentiary;
During 2008/2009 no amendments were made to the
legislation regarding eligibility.
• seniors aged 65 and older, their spouses and
dependants;
3.2 Registration Requirements
• individuals enrolled in special groups such
as Alberta Widows’ Pension or income support
programs;
All new Alberta residents are required to register
themselves and their eligible dependants with the
Alberta Health Care Insurance Plan. Family members
are registered on the same account. New residents
in Alberta should apply for coverage within three
Canada Health Act — Annual Report 2008–2009
• anyone eligible for full premium assistance; and
• any resident who elects to opt-out of the plan.
139
Chapter 3: Alberta
Two programs were used to help lower-income, nonsenior Albertans with the cost of their premiums:
the Premium Subsidy Program and the Waiver of
Premiums Program.
4.0 Portability
4.1
Minimum Waiting Period
Under the Alberta Health Care Insurance Act, persons moving permanently to Alberta from another
part of Canada are eligible for coverage on the first
day of the third month following their arrival.
4.2 Coverage During Temporary
Absences in Canada
The Alberta Health Care Insurance Plan provides
coverage for the first 12 months of absence to eligible
Alberta residents who temporarily leave Alberta for
other parts of Canada. Residents who wish to maintain coverage for a longer period may apply for the
following extensions of coverage:
• four years (48 months) if the absence is due to
work, business or missionary service;
• two years (24 months) if the absence is due to
travel, personal visits or an educational leave
(sabbatical);
• duration of studies if absence is due to fulltime attendance at an accredited educational
institute.
Individuals who are routinely absent from Alberta
every year normally need to spend a cumulative total
of 183 days in a 12-month period in Alberta to maintain continuous coverage. Individuals not present in
Alberta for the required 183 days may be considered
residents of Alberta if they satisfy the Ministry of
Health and Wellness that Alberta is their permanent
and principal place of residence.
Alberta participates in the inter-provincial hospital
and medical reciprocal agreements. These agreements were established to minimize complex billing
processes and help ensure timely payments to health
practitioners and hospitals when they provide services
to residents from other provinces/territories (Quebec
does not participate in the medical reciprocal agreement). Under these agreements Alberta pays for insured
services Albertans receive in other parts of Canada
at the host province or territorial rates. In 2008/2009
no amendments were made to the legislation regarding in-Canada portability. During 2008/2009 Alberta
paid $93.31 million for in-patient and out-patient hospital services provided to Alberta residents in other
provinces. More information on coverage during
temporary absences outside Alberta is available at:
http://www.health.alberta.ca/AHCIP/
Q-travel-coverage.html
Section 16 of the Hospitalization Benefits Regulation
addresses payment for hospital services obtained
outside of Alberta within Canada. Section 4 of the
Medical Benefits Regulation addresses physician
services obtained outside of Alberta within Canada.
These sections were not amended in 2008/2009.
4.3 Coverage During Temporary
Absences Outside Canada
The Alberta Health Care Insurance Plan provides
coverage for the first six consecutive months of temporary absence from Canada. Residents who wish to
maintain coverage for a longer period may apply for
the following extensions of coverage:
• four years (48 months) if the absence is due to
work, business or missionary service;
• two years (24 months) if the absence is due to
travel, personal visits or an educational leave
(sabbatical);
• duration of studies if absence is due to fulltime attendance at an accredited educational
institute.
Individuals who are routinely absent from Alberta
every year normally need to spend a cumulative total
of 183 days in a 12-month period in Alberta to maintain continuous coverage. Individuals not present in
Alberta for the required 183 days may be considered
residents of Alberta if they satisfy the Ministry of
Health and Wellness that Alberta is their permanent
and principal place of residence.
The maximum amount payable for out-of-country
in-patient hospital services is $100 (Canadian) per
1. This number may not match the figures provided in the statistical table. It is based on date of payment for the fiscal year with a 365 day lag for claim submissions and is obtained from
the Alberta Health and Wellness IMAGIS system. The numbers in the statistical table are based on date of service with a three month service lag and are obtained from the Hospital
Medical Reciprocal reporting system.
140
Canada Health Act — Annual Report 2008–2009
Chapter 3: Alberta
day (not including day of discharge). The maximum
hospital out-patient visit rate is $50 (Canadian), with
a limit of one visit per day. The only exception is haemodialysis, which is paid at a maximum of $341 per
visit, with a limit of one visit per day. Physician and
allied health practitioner services are paid according
to Alberta rates. More information on coverage during
temporary absences outside Canada is accessible at:
http://www.health.alberta.ca/AHCIP/
Q-travel-coverage.html
During 2008/2009, Alberta paid $7.382 million for
insured in-patient and out-patient services provided
to Albertans in another country.
Section 16 of the Hospitalization Benefits Regulation
addresses payment for hospital services obtained
outside of Canada. Section 5 of the Medical Benefits
Regulation addresses physician services obtained
outside of Canada. These sections were not amended
in 2008/2009.
4.4 Prior Approval Requirement
Prior approval is not required for elective insured
services received in another Canadian province/
territory, except for high-cost items not included in
reciprocal agreements such as gender reassignment
surgery, and gamma knife surgery. Prior approval is
required for elective services received out-of-country
and will only be given for insured services that are
medically required, are not experimental, and are
not available in Alberta or elsewhere in Canada.
Approval must be received before these services
can be covered.
5.0 Accessibility
5.1
Access to Insured Health Services
All Alberta residents have access to provincially
funded and insured health services regardless of
where they live in the province. In the province,
Alberta Health Service works to ensure that all
Albertans have access to needed health services.
There are two major metropolitan regions, Calgary
region and the Capital (Edmonton) region, which
provide provincially funded, province-wide services
to Alberta residents who need tertiary-level diagnostic
and treatment services.
Alberta is committed to ensuring that Albertans
have access to new health services and technologies,
and that they are introduced based on clinical and
economic evidence that respects benefits and costs.
The Alberta Health Technologies Decision Process
and the Alberta Advisory Committee on Health
Technologies have been established to support coverage and funding decisions at the provincial level
related to non-pharmaceutical services and technologies using an evidence-informed process.
5.2 Access to Insured Hospital Services
The Ministry of Health and Wellness and Alberta
Health Services actively participate in a health
workforce planning process to ensure an adequate
supply of key personnel. The key professions utilized in providing insured hospital services include:
physicians, nurses (RNs, LPNs, RPNs), pharmacists,
rehabilitation therapists (OTs, PTs, RTs) and clinical
support personnel. As of March 31, 2009 there were
approximately 103,200 people employed in health
occupations in Alberta.
Alberta Health Services is required to develop
capital equipment plans as part of its annual business plan submissions to the Minister of Health
and Wellness. Funding to Alberta Health Services
in 2008/2009 (which includes health services,
hospitals, medical equipment and province-wide
services) was $7.487 billion.
The Ministry’s 2009–2012 capital plan funded
several ambulatory care projects, including:
• renovation of ambulatory care and emergency
departments at the Northern Lights Regional
Health Centre in Fort McMurray;
• redevelopment of the emergency department and
the endoscopy suite in Grande Prairie’s Queen
Elizabeth II Hospital;
• redevelopment of the Viking Health Centre;
• development of the new Eastwood Primary
Health Care Centre in Edmonton;
• a new primary care clinic in the Sheldon M.
Chumir Health Centre in Calgary; and
• upgrading of the Richmond Road Diagnostic and
Treatment Centre in Calgary.
2. Ibid.
Canada Health Act — Annual Report 2008–2009
141
Chapter 3: Alberta
Funding was continued for the following acute care
projects:
• the expansions of the Foothills Medical Centre,
Peter Lougheed Centre and Rockyview General
Hospital in Calgary;
• the new South Calgary Hospital and Health
Campus;
• a new orthopedic surgical facility at the Royal
Alexandra Hospital in Edmonton;
• the Mazankowski Alberta Heart Institute in
Edmonton; and
• redevelopment of the Grey Nuns Community
Hospital in Edmonton and replacement of the
Fort Saskatchewan Health Centre.
5.3 Access to Insured Physician and
Dental-Surgical Services
Alberta continues to implement its Health Workforce
Action Plan (2007 to 2016), which was released in
September 2007. The plan outlines 19 key initiatives
to address Alberta health workforce issues. Some of
the actions taken in 2008/2009 to improve access to
physician and dental services include:
• The Alberta International Medical Graduate
Program assessed more than 240 international
medical graduates for medical residency training, and matched a record 59 international
medical graduates to residency positions.
This program increases the number of people
completing medical residency training in
Alberta, which ultimately increases the
number of physicians practicing in Alberta.
• An additional four Primary Care Networks were
launched, bringing the total number to 30. The
30 networks involve approximately 1,750 family
physicians providing care to more than 1.9 million
Albertans. Family physicians working in these
networks partner with health regions and use
a team approach to improve access and provide
coordinated and comprehensive primary health
care services to Albertans.
• Patient navigators were implemented in several
areas of the health system, including cardiac care
and breast cancer care. The patient navigator helps
to coordinate the patient’s services, serves as a
liaison with other health care providers, provides
referrals, and offers advocacy and ongoing support.
142
• The Alberta Provincial Stroke Strategy established
four new primary stroke centres. This brings the
total primary stroke centres across the province
to 11. Also, there are two comprehensive stroke
centres and twelve stroke prevention clinics that
have been developed.
• Fifteen new Telehealth projects and expansions
were approved to enhance delivery of health
services particularly to rural and remote communities in Alberta. Projects are in a wide variety of
clinical areas such as Oncology, Opthalmology
and Cardiology.
• Nine additional clinical alternate relationship
plans (ARP) were implemented bringing the
total number of clinical ARPs in Alberta to
42 and involving approximately 700 physicians.
ARPs are alternative funding models to fee for
service. ARPs encourage innovation in health
service delivery and are intended to enhance
the recruitment and retention of health care
providers, interdisciplinary team approaches
to service delivery, improve access to care and
increase patient satisfaction.
• One additional academic alternate relationship
plan (AARP) was implemented bringing the total
number to eight. The new AARP was implemented in the Division of Physical Medicine
and Rehabilitation at the University of Calgary.
AARPs now involve nine academic programs
with approximately 600 physicians, primarily
specialists, working in either Calgary or Edmonton.
5.4 Physician Compensation
The Alberta Health Care Insurance Act governs the
payment of physicians. Most physicians are compensated through the Alberta Health Care Insurance
Plan on a traditional, volume-driven, fee-for-service
basis. Alternate Relationship Plans and Primary
Care Networks for specialists and family physicians
offer alternative compensation models to the feefor-service payment system and contribute to better
health outcomes by supporting innovative health
care delivery.
Physician compensation is negotiated as part of a
tri-lateral agreement involving the Alberta Medical
Association, the Alberta Ministry of Health and
Wellness and Alberta Health Services. The agreement also contains provisions to improve access to
physician services. Under this agreement, Alternate
Relationship Plans (ARPs) have been established to
Canada Health Act — Annual Report 2008–2009
Chapter 3: Alberta
enhance specialist physician recruitment and retention, team-based approaches to service delivery,
access to services, patient satisfaction and value
for money. ARPs provide predictable funding that
enables physician groups to recruit new physicians
to their programs and retain their services. ARPs
are unique in that they offer alternatives to the way
government has traditionally funded health service
delivery.
Also under the agreement, family physicians can
partner with their health regions to create Primary
Care Networks that manage access to front-line services. Primary Care Networks use a team approach to
coordinate care for their patients. Family physicians
work with health regions to better integrate health
services by linking to regional services such as home
care. Family physicians also work with other health
providers such as nurses, dieticians, pharmacists,
physiotherapists and mental health workers who
help to provide services within the Networks.
As with the majority of physicians, dentists performing oral surgical services insured under the Alberta
Health Care Insurance Plan are compensated through
the Plan on a volume driven, fee-for-service basis.
The Ministry of Health and Wellness establishes
fees through a consultation process with the Alberta
Dental Association and College.
Any changes to the insured physician services
listed in the SOMB are the result of trilateral negotiations between the Alberta Ministry of Health
and Wellness, the Alberta Medical Association,
and Alberta Health Services.
Canada Health Act — Annual Report 2008–2009
5.5 Payments to Hospitals
The Regional Health Authorities Act governs the
funding of Alberta’s single regional health authority —
Alberta Health Services. Most insured hospital services
in Alberta are funded through a population-based
funding formula. A mental health funding grant is provided for insured services provided in mental health
hospitals and for community mental health services. A
funding grant is provided for insured services in cancer
hospitals and to pay for cancer services that patients
receive in regional hospitals. Hospitals in Edmonton
and Calgary receive funding to provide highly specialized province-wide services to all Alberta residents.
6.0 Recognition Given to
Federal Transfers
The Government of Alberta publicly acknowledged the
federal contributions provided through the Canada
Health Transfer in its 2008/2009 publications.
7.0 Extended Health Care
Services
Alberta also provides full or partial coverage for
health care services not required by the Canada
Health Act. They include: home care and longterm care, mental health services, dental, denturist
and eyeglass benefits for recipients of the Alberta
Widows’ pension and their eligible dependants, palliative care, immunization programs for children,
allied health services such as optometry, chiropractic
and podiatry services, and drugs and other benefits
through Alberta Blue Cross for eligible residents.
143
Chapter 3: Alberta
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
3,210,035
3,275,931
3,384,625
3,473,996
3,589,494
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
101
101
102
102
117
b. chronic care
106
103
98
98
96
c. rehabilitative care
1
1
1
1
1
d. other
3
3
3
3
37
e. total
211
208
204
204
251
3
4
3. Payments for insured health services ($):
a. acute care
not available
not available
not available
not available
not available
b. chronic care
not available
not available
not available
not available
not available
c. rehabilitative care
not available
not available
not available
not available
not available
d. other
not available
not available
not available
not available
not available
e. total
not available
not available
not available
not available
not available
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
not available
not available
5
not available
5
26
b. diagnostic imaging facilities
not available
not available
5
not available
5
c. total
not available
not available
5
not available
5
32
not available
5
not available
5
not available
5
not available
5
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
not available
not available
not available
not available
not available
b. diagnostic imaging facilities
not available
not available
not available
not available
not available
c. total
not available
not available
not available
not available
not available
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
4,550
4,508
4,608
5,334
2008–2009
5,447
20,139,919
21,080,232
22,005,293
27,481,524
31,475,940
72,495
77,438
82,710
101,455
104,124
11,473,142
12,820,959
14,305,024
18,004,246
25,346,678
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
4,266
4,124
3,698
4,014
4,762
381,217
379,710
336,859
378,043
446,718
4,089
3,918
3,816
3,934
4,305
227,609
222,896
224,761
214,162
291,836
3. Acute Care Facilities includes 15 new cancer clinics which provide regional cancer services troughout Alberta.
4. “Other Facilities” includes 34 new community ambulatory care facilities which provide basic ambulatory care services. These facilities were not counted in previous years.
5. These data are available from the College of Physicians and Surgeons of Alberta at http://www.cpsa.ab.ca/home/home.asp
144
Canada Health Act — Annual Report 2008–2009
Chapter 3: Alberta
Insured PHYSICIAN Sevices Within Own Province or TErrITitory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
3,026
3,122
3,237
3,361
3,492
14.Number of participating physicians (#):
a. general practitioners
b. specialists
2,475
2,463
2,613
2,697
2,774
c. other
not applicable
not applicable
not applicable
not applicable
not applicable
d. total
5,501
5,585
5,850
6,058
6,266
15.Number of opted-out physicians (#):
a. general practitioners
not applicable
not applicable
not applicable
not applicable
0
b. specialists
not applicable
not applicable
not applicable
not applicable
0
c. other
not applicable
not applicable
not applicable
not applicable
0
d. total
not applicable
not applicable
not applicable
not applicable
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
not available
not available
not available
not available
not available
b. total payments ($)
not available
not available
not available
not available
not available
31,683,660
33,428,098
34,031,123
35,054,154
35,838,334
1,348,724,184
1,472,634,054
1,558,128,163
1,718,717,023
1,851,703,042
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
444,884
479,029
463,410
548,423
696,639
15,871,755
17,745,928
17,450,377
20,899,683
22,614,491
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
26,017
24,944
22,909
22,055
22,817
1,208,422
1,049,384
1,054,544
1,105,831
1,245,840
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
216
230
220
207
202
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
14,658
17,007
16,783
16,769
18,075
2,843,638
3,275,978
3,637,243
3,913,975
4,479,725
Canada Health Act — Annual Report 2008–2009
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Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
Services Commission, which provides ambulance
services across the province and operates HealthLink
BC, a confidential information, advice and health
navigation system available by telephone or on the
web (see www.healthlinkbc.ca). HealthLink BC
also publishes the BC HealthGuide and operates
bcbedline, the provincial acute bed management
system.
British Columbia
Introduction
British Columbia has a progressive and integrated
health system that includes insured services under
the Canada Health Act, services funded wholly or
partially by the Government of British Columbia and
services regulated, but not funded by government.
In June 2008, the Ministry of Health became two
separate ministries — The Ministry of Health
Services and the Ministry of Healthy Living and
Sport. Cabinet created the Ministry of Healthy Living
and Sport to better emphasize population health
promotion, health protection and disease and injury
prevention; and align programs and initiatives that
help British Columbians make healthier choices and
increase participation and excellence in sport and
recreation. It supports all five of government’s Great
Goals, in particular Great Goal 2: Lead the way in
North America in healthy living and physical fitness.
The province’s six health authorities are the
main organizations responsible for local health
service delivery. Five regional health authorities
are responsible for delivering a full continuum
of health services to meet the needs of the population within their respective regions. A sixth
health authority, the Provincial Health Services
Authority, is responsible for managing the quality, coordination and accessibility of selected,
specialized, province-wide health programs and
services provided through the following agencies: BC Cancer Agency, BC Centre for Disease
Control, BC Children’s Hospital and Sunny Hill
Health Centre for Children, BC Mental Health and
Addiction Services, BC Provincial Renal Agency,
BC Transplant, BC Women’s Hospital & Health
Centre, and Provincial Cardiac Services.
The delivery of health services and the health of the
population are continuously monitored and evaluated by the Ministries. These activities inform the
Ministries’ strategic planning and policy direction
to ensure the delivery of health services continues
to meet the needs of British Columbians.
The British Columbia Ministry of Health Services
has overall responsibility for ensuring that high
quality, appropriate and timely health services are
available to British Columbians. The Ministries
of Health work with six health authorities, care
providers, agencies and other groups to provide
access to care. The Ministry provides stewardship,
leadership, direction and support to service delivery
partners and sets province-wide goals, standards
and expectations for health service delivery by
health authorities.
Activities for 2008–2009
The Ministry of Health Services directly manages a
number of provincial programs and services. These
programs include: the Medical Services Plan, which
covers most physician services; PharmaCare, which
provides prescription drug insurance for British
Columbians; the BC Vital Statistics Agency, which
registers and reports on vital events, such as a birth,
death or marriage; and, the Emergency and Health
The British Columbia health system continues to be
challenged by an ever-increasing demand for health
services, global competition for health care workers and
professionals, and the need to maintain and improve
buildings and equipment. As well, BC wants to ensure
that all its residents enjoy access to health services
and good health; regrettably, though, BC’s Aboriginal
population does not have the same level of good health
Canada Health Act — Annual Report 2008–2009
In 2008–2009, the Government of British Columbia
invested $13.59 billion (plus $72 million through
the Ministry of Healthy Living and Sport) to meet
the health needs of British Columbians. This investment was made across a wide spectrum of programs
and services aligned with the Ministries’ goals to
improve health and wellness, deliver high quality
patient care, and ensure the publicly-funded health
system is sustainable over the long term.
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Chapter 3: British Columbia
as the rest of province, and the government is working
with First Nations, Métis, and other partners to close
this gap.
Rising rates of obesity, a lack of physical activity,
injuries, and problematic substance use all affect the
health status of individuals and increase the demand
for health services. In addition, the province’s aging
population is exhibiting a high incidence of chronic
illness.
In 2008–2009, the Ministries of Health introduced,
continued or enhanced a number of strategies across
the span of health services. These include: population health promotion and health protection, disease
and injury prevention, primary care, chronic disease management, Fair PharmaCare, ambulance
services, community programs for mental health
and addictions, hospital and surgical services, home
care, assisted living, residential care and end-of-life
care. The Ministries also worked to ensure that an
adequate supply of skilled health care providers continued to be available across the continuum of care.
Significant Achievements in 2008–2009
Health and Wellness
• Maintained the lowest smoking rate in Canada
at 14.7 per cent.
• Launched Seniors in BC: A Healthy Living
Framework – BC’s framework to support older
British Columbians to live healthy, active lives.
• Provided $1.8 million to 18 ActNow BC Seniors’
Community Parks.
• Created the Seniors Healthy Living Secretariat,
which is leading implementation of the Healthy
Living Framework across government and with
other key partners.
• Established a Women’s Healthy Living Secretariat
to support and advance the health and well-being
of women in British Columbia.
• Became the first province to restrict trans fat in
all foods prepared and served in restaurants.
• Banned smoking in vehicles in which children
are passengers.
• Launched the ActNow BC Prescription for Health
pilot program, helping patients increase their
physical activity levels and learn about healthier
eating.
• Translated the Healthy Eating for Seniors handbook into Chinese and Punjabi.
• Achieved the lowest self-reported obesity rates
in many years and the lowest rates among provinces and territories.
• Launched the QuitNow and Win contest to help
British Columbians quit smoking.
• Supported a number of successful sporting events,
including the World Triathlon Championships,
North American Indigenous Games and World
Cup events in winter sports, which were “test”
events for the 2010 Winter Olympic and Paralympic Games.
• The Transformative Change Accord (TCA) was
signed by the First Nations Leadership Council,
the Government of British Columbia and the
Government of Canada in 2005; it committed
to, over ten years, closing the gap between First
Nations and other British Columbians in the
areas of education, health, housing and economic
opportunities.
• The Tripartite First Nations Health Plan (TFNHP)
was created out of the TCA and receives $14 million annually over ten years from the Government
of British Columbia, the First Nations Leadership
Council and the Government of Canada for various projects including the Lytton Health Centre
which opened in 2009 and provides culturallyappropriate community health services and
seniors’ housing.
High Quality, Patient-Centred Care
• Invested $11.3 million in a state-of-the-art
emergency department at Victoria General
Hospital to benefit southern Vancouver
Island’s growing population.
• Completed $32 million in renovations and
upgrades at East Kootenay Regional Hospital,
bringing diagnostic imaging-like ultrasound,
closer to more patients.
• Launched the World Healthy Living Challenge,
a request to British Columbians and people
around the world to adopt healthier lifestyles.
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Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
• Brought a new, comprehensive Public Health
Act into force to modernize and strengthen the
legislative base for public health services; and
revised the regulations under the Community
Care and Assisted Living Act, including increased
measures to prevent falls in residential care
facilities.
• Allocated base funding of $13.3 million (excluding
Medical Services Plan funding of $0.7 million) to
establish the Burnaby Centre, a 100-bed treatment
resource for clients with complex addiction and
mental health issues.
• British Columbia has a five-year agreement with Health Canada, under the Drug
Treatment Funding Program, for an Assertive
Community Treatment (ACT) team to support
Burnaby Centre waitlist and post-discharge
clients. As well, three community-based ACT
teams (with case-managing psychiatrists)
have been established in Victoria.
• A new 8-1-1 telephone service was implemented
as part of HealthLink BC’s suite of services to
ensure British Columbians have 24-hour access
to non-emergency health information.
Providing increased access to care
• Increased the number of surgeries in priority
areas and reduced waiting times. The median
wait times for patients who received surgery
in 2008–2009, compared to 2001/02 were:
• 7.9 weeks for cataracts, compared to 9.0 weeks
• 6.9 weeks for open heart, compared to 15.1 weeks
• 10 weeks for hip replacement, compared to
18.7 weeks
• 13 weeks for knee replacement, compared to
25.4 weeks
• Increased the number of MRI and CT scanners
resulting in thousands more exams. Since 2001,
19 new CT scanners and 13 new MRI machines
have been added to the health system resulting
in a 90 per cent increase in the number of CT
scans and a 170 per cent increase in the number of MRI scans in 2008–2009 compared to
2001–2002.
• Built 6,027 net new residential care beds,
assisted living units and supportive housing units in communities throughout British
Canada Health Act — Annual Report 2008–2009
Columbia, bringing the total of new and replacement beds since June 2001 to over 12,746.
• Increased the number of disorders screened for
at birth, from three screening tests to 19.
• Opened a multi-organ transplant clinic at BC
Children’s Hospital to provide access to very
specialized care for children who have had an
organ transplant, and their families.
• Introduced a program to fund insulin pumps
for eligible children with type 1 diabetes.
• Provided free Human Papillomavirus (HPV)
vaccine to girls in grades six and nine to prevent
cervical cancer.
Ensuring quality and safety of health services
• Invested more than $2.3 million to support the
implementation of the Patient Safety Learning
System, a tracking system that helps health care
organizations identify and examine safety and risk
related incidents occurring in the health system.
• Created a Health Professions Review Board to provide an independent review of certain decisions
made by self-regulating colleges regarding the
registration of their members and the timeliness
and disposition of complaints made against their
registrants.
• The Ministry established a Patient Care Quality
Review Board in each health authority and passed
the Patient Care Quality Review Board Act. It
outlines a clear, consistent, timely and transparent approach to patient complaints and concerns
throughout health authorities. The Act also
establishes independent review mechanisms
for people who are not satisfied with a health
authority’s response to their complaint.
A Sustainable, Affordable, Publicly Funded
Health System
• The health profession regulatory framework
was streamlined and strengthened to increase
the accountability and transparency of selfgoverning regulatory bodies, and to support
more patient-focused care and more patient
choice.
• BC became the first Canadian jurisdiction to
bring into force legislative change requiring
regulatory bodies to promote and enhance
interprofessional collaborative practice.
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Chapter 3: British Columbia
• The transition of all professions to a uniform
legislative regime was substantially completed.
• An independent review board was established
to review the decisions of regulatory bodies.
• The scope of practice of optometrists was
expanded to include medication-prescribing
authority.
• Work continued on implementation of a new
‘shared scope of practice’ regulatory model
and on improving the ability of internationallyeducated medical doctors and registered nurses
to enter practice in BC.
• $300 million was targeted over three years for
a Transformation Fund dedicated to projects to
transform and modernize the health system.
• The number of physicians practicing in British
Columbia was increased. In December 2008, the
Canadian Medical Association reported a total
of 9,733 physicians in British Columbia. This
translates to 220 physicians per 100,000 population — compared to 200 per 100,000 for Canada.
• The number of nurse training spaces since 2001
was doubled and 24 nursing programs were added.
Also, the number of medical school training positions more than doubled in that time, and 990 new
allied health education seats were added.
• A three-year accelerated bachelor of science in
nursing degree program option at the British
Columbia Institute of Technology was created.
• Construction began for a fourth medical program — the Southern Medical Program — at
UBC Okanagan. When it opens in 2011, the
new Health Sciences Centre will accommodate
32 first-year, full-time medical students.
Legislation
The Medicare Protection Act, RSBC 1996, c. 286,
provides the authority for the Medical Services
Commission to administer the Medical Services
Plan of British Columbia.
The Medicare Protection Act was amended to:
• enshrine in provincial law the Canada Health
Act principles of public administration, comprehensiveness, universality, portability, and
accessibility;
150
• provide clear definitions of these principles; and
• add and define the principle of sustainability.
These amendments fulfilled the 2006 Throne Speech
commitment and made British Columbia the first
province in Canada to define and enshrine in legislation the principles of the Canada Health Act and add
a sixth principle of sustainability. The amendments
clarify the province’s commitment to the Canada
Health Act and strengthen our health system today
and secure it for future generations.
The Health Authorities Act was amended by adding a
section which requires the minister to have regard to
the above principles set out the Medicare Protection
Act when establishing provincial standards for the
provision of health services.
Other Health legislation passed in 2008–2009:
• The Public Health Act represented a major overhaul of British Columbia’s Health Act which had
become outdated.
• The eHealth (Personal Information Access and
Protection of Privacy) Act created the statutory
foundation for the development of the Electronic
Health Record. This will enhance citizen access
to their health records.
• The Health Professions (Regulatory Reform) Act
made a number of amendments to the Health
Professions Act to increase patient choice and
access and to create more openness and transparency in the regulation of health professions.
• The Health Statutes Amendment Act amended a
number of health statutes including the Emergency
and Health Services Act (to facilitate changes in
ambulance fees), the Medicare Protection Act (to
enhance ministerial ability to report out on disposition of complaints), as well as the Health and
Social Services Delivery Improvement Act and the
Health Sector Partnerships Agreement Act.
• The Patient Care Quality Review Board Act
established a publicly accessible and uniform
province-wide complaints registry and appeals
system. It fulfilled government’s Throne Speech
commitment by establishing uniform patient
care quality offices in each health authority,
including the Provincial Health Services
Authority.
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
The British Columbia Medical Services Plan (MSP)
is administered by the British Columbia Ministry of
Health Services. The Plan insures medically required
services provided by physicians and supplementary
health care practitioners, laboratory services and
diagnostic procedures. The Ministry of Health
Services sets goals, standards and performance
agreements for health service delivery and works
with the six health authorities to provide quality,
appropriate and timely health services to British
Columbians. General hospital services are provided
under the Hospital Insurance Act (section 8) and
its Regulation; the Hospital Act (section 4); the
Continuing Care Act (section 3); and the Hospital
District Act (section 20).
The Medical Services Commission (MSC) manages
MSP on behalf of the Government of British Columbia
in accordance with the Medicare Protection Act (section 3) and its Regulation. The purpose is to preserve
a publicly-managed and fiscally sustainable health
care system for British Columbia, in which access to
necessary medical care is based on need and not on an
individual’s ability to pay. The function and mandate
of the MSC is to facilitate, under MSP, reasonable
access to quality medical care, health care and diagnostic services for British Columbians.
The MSC is a nine-member statutory body made up
of three representatives from Government, three
representatives from the British Columbia Medical
Association (BCMA) and three members from
the public, jointly nominated by the BCMA and
Government.
1.2 Reporting Relationship
The MSC is accountable to the Government of British
Columbia through the Minister of Health Services; a
report is published annually for the prior fiscal year
which provides an annual accounting of the business
of the MSC, its subcommittees and other delegated
bodies. In addition, the MSC Financial Statement is
published annually: it contains an alphabetical listing of payments made by the MSC to practitioners,
groups, clinics, hospitals and diagnostic facilities for
each fiscal year.
Canada Health Act — Annual Report 2008–2009
The Ministries of Health provide extensive information in their Annual Service Plan Reports on the
performance of British Columbia’s publicly-funded
health system. Tracking and reporting this information is consistent with the Ministry’s strategic
approach to performance planning and reporting
and is consistent with requirements contained
in the province’s Budget Transparency and
Accountability Act (2000).
In addition to the Annual Service Plan Report,
The Ministries of Health report through various
publications, including:
• Vital Statistics Annual Report;
• Health Authority Government Letters of
Expectations and Reports;
• Provincial Health Officer’s Annual Report
(on the health of the population);
• Nationally Comparable Indicators Report
(Canadian Institute for Health Information);
and
• Medical Services Plan Resource Management
Reports.
1.3 Audit of Accounts
The Ministries of Health are subject to audit of
accounts and financial transactions through:
• The Office of the Comptroller General’s Internal
Audit and Advisory Services, the government’s
internal auditor. The Comptroller General determines the scope of the internal audits and timing
of the audits in consultation with the audit committee of the Ministry.
• The Office of the Auditor General (OAG) of British
Columbia is responsible for conducting audits and
reporting its findings to the Legislative Assembly.
The OAG initiates its own audits and the scope
of its audits. The Public Accounts Committee
of the Legislative Assembly reviews the recommendations of the OAG and determines when the
Ministries of Health have complied with the audit
recommendations.
1.4 Designated Agency
The Medical Service Plan (MSP) of British Columbia
requires premiums to be paid by eligible residents.
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Chapter 3: British Columbia
The monies were collected by the Ministry of Small
Business and Revenue during the 2008–2009 fiscal year.
Revenue Services of British Columbia (RSBC) performs
revenue management services, including account
management, billing, remittance and collection, on
behalf of the Province of British Columbia (Ministry of
Small Business and Revenue). The Province remains
responsible for, retains control of and performs all
government-administered collection actions.
RSBC is required to comply with all applicable laws,
including:
• Ombudsman Act (British Columbia)
• Business Practices and Consumer Protection Act
(British Columbia)
• Financial Administration Act (British Columbia)
• Freedom of Information Legislation: i.e., Freedom
of Information and Protection of Privacy Act
(British Columbia) including FOIPPA Inspections;
the Personal Information Protection Act (British
Columbia) and the equivalent federal legislation,
if applicable.
The enabling legislation is:
• Medicare Protection Act (British Columbia),
Part 2 — Beneficiaries section 8
• Medical and Health Care Services Regulation
(British Columbia) Part 3 — Premiums
In 2005, the Ministry of Health contracted with
MAXIMUS BC to deliver the operations of the
Medical Services Plan and PharmaCare (including
responding to public inquiries, registering clients
and processing medical and pharmaceutical claims
from health professionals). The new organization
is called Health Insurance BC (HIBC). Policy and
decision-making functions remain with the Ministry
of Health Services.
• HIBC submits monthly reports to the Ministry,
reporting performance on service levels to the
public and health care providers. HIBC also
posts quarterly reports on its website on performance of key service levels.
• HIBC applies payments against fee items
approved by the Ministry. The Ministry
of Health Services approves all payments
before they are released.
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2.0 Comprehensiveness
2.1
Insured Hospital Services
The Hospital Act and Hospital Act Regulation provide authority for the Minister to designate facilities
as hospitals, to license private hospitals, to approve the
bylaws of hospitals, to inspect hospitals and to appoint
a public administrator. This legislation also establishes
broad parameters for the operation of hospitals.
The Hospital Insurance Act provides the authority for
the Minister to make payments to health authorities
for the purpose of operating hospitals, outlines who
is entitled to receive insured services and defines the
“general hospital services” which are to be provided
as benefits. There were no legislative or regulatory
amendments made to the Hospital Act in 2008–2009.
The Hospital Insurance Act was not amended.
However, the Hospital Insurance Act Regulation
was amended to repeal s. 5.24 regarding laboratory
services.
In 2008–2009, there were 139 facilities designated
as hospitals:
• 80 acute care hospitals (community hospital,
large tertiary care and teaching hospitals)
• 19 chronic care hospitals
• 3 rehabilitation hospitals
• 37 other hospitals (including diagnostic and
treatment centres, cancer clinics, etc.)
Hospital services are insured when they are provided
to a beneficiary, in a publicly-funded hospital and are
deemed medically required by the attending physician, nurse practitioner or midwife. These services
are provided to beneficiaries without charge, with the
exception of incremental charges for preferred, but not
medically required, medical/surgical supplies, nonstandard accommodation when not medically required
and, for residential care patients in extended care or
general hospitals — a daily fee based on income.
General hospital services and the conditions under
which they are provided are described in the Hospital
Insurance Act Regulations and include the following
for in-patients: accommodation and meals at the standard or public ward level; necessary nursing services;
laboratory and radiological procedures and necessary
interpretations together with such other diagnostic
procedures as approved by the Minister in a particular hospital with the necessary interpretations, for
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
maintaining health, preventing disease and helping
diagnose and treat illness, injury or disability; drugs,
biologicals and related preparations; routine surgical
supplies; use of operating room and case room and
anaesthetic facilities, including necessary equipment
and supplies; use of radiotherapy and physiotherapy
facilities, where available; and other services approved
by the Minister.
The following out-patient general hospital services are
also insured: day care surgical services; out-patient
renal dialysis treatments in designated hospitals or
other approved facilities; diabetic day-care services in
designated hospitals; out-patient dietetic counselling
services at hospitals with qualified staff dieticians;
psychiatric out-patient and day-care services; rehabilitation out-patient services; cancer therapy and cytology
services; out-patient psoriasis treatment; abortion services; and magnetic resonance imaging (MRI) services.
Insured services in rehabilitation hospitals include:
accommodation and meals at the standard or public
ward level; necessary nursing services; drugs, biologicals and related preparations; use of physiotherapy
and occupational therapy facilities; laboratory and
radiological procedures and necessary interpretations together with such other diagnostic procedures
as approved by the Minister in a particular hospital
with the necessary interpretations, for maintaining
health, preventing disease and helping diagnose and
treat illness, injury or disability; and other services
approved by the Minister.
Insured services in extended care hospitals include:
accommodation and meals at the standard ward level;
necessary nursing services; drugs, biologicals, and
related preparations; laboratory and radiological procedures and necessary interpretations together with
such other diagnostic procedures as approved by the
Minister in a particular hospital with the necessary
interpretations, for maintaining health, preventing
disease and helping diagnose and treat illness, injury or
disability; and other services approved by the Minister.
Insured hospital services do not include: transportation
to and from hospital (however, ambulance transfers are
insured under another Ministry program, with a small
user charge); services provided to non-beneficiaries
(with the exception of emergency treatment); services
or treatment that the Minister, or a person designated
by the Minister, determines, on a review of the medical evidence, the beneficiary does not require; and
services or treatment for an illness or condition excluded by regulation of the Lieutenant Governor
in Council.
Canada Health Act — Annual Report 2008–2009
No new hospital services were added during the
fiscal year 2008–2009.
There is no regular process to review insured hospital
services, as the list of insured services included in
the regulations is intended to be both comprehensive
and generic and does not require routine review and
updating. There is a formal process to add specific
medical services (physician fee items) to the list of
services insured under the Medicare Protection Act,
and this process is described elsewhere.
2.2 Insured Physician Services
The range of insured physician services covered by
MSP includes all medically necessary diagnostic and
treatment services.
Insured physician services are provided under the
Medicare Protection Act (MPA). Section 13 provides
that practitioners (including medical practitioners
and health care practitioners, such as midwives) who
are enrolled and who render benefits to a beneficiary
are eligible to be paid for services rendered in accordance with the appropriate payment schedule.
Unless specifically excluded, the following medical
services are insured as Medical Services Plan (MSP)
benefits under the MPA in accordance with the
Canada Health Act:
• medically required services provided to “beneficiaries” (residents of British Columbia) by a
medical practitioner enrolled with MSP; and
• medically required services performed in an
approved diagnostic facility under the supervision
of an enrolled medical practitioner.
To practice in British Columbia, physicians must
be registered and in good standing with the College
of Physicians and Surgeons of British Columbia. To
receive payment for insured services, they must be
enrolled with MSP. In the fiscal year 2008–2009,
8,986 physicians [includes only GPs and Medical
Specialists who billed fee-for-service (FFS) in
2008–2009] were enrolled with MSP and billed feefor-service. In addition, some physicians practice
solely on salary, receive sessional payments, or are
on contract (service agreements) with the health
authorities. Physicians paid by these alternative
mechanisms may also practice on a FFS basis.
Non-physician healthcare practitioners who may be
enrolled to provide insured services under MSP are
midwives and supplementary benefit practitioners
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Chapter 3: British Columbia
(dental surgeons, optometrists, osteopaths, surgical podiatrists). Only those MSP beneficiaries with
premium assistance status qualify for MSP coverage of physiotherapy, massage therapy, chiropractic,
naturopathy, acupuncture and non-surgical podiatry
services. In 2008–2009, there were 144 midwives and
5,526 supplementary benefits practitioners (including
acupuncturists) paid FFS through MSP.
A physician may choose not to enrol or to de-enrol
with the Medical Services Commission (MSC).
Enrolled physicians may cancel their enrolment
by giving 30 days written notice to the Commission.
Patients are responsible for the full cost of services
provided by non-enrolled physicians. In 2008–2009,
the Medical Services Plan had five opted-out physicians and two de-enrolled physicians.
Enrolled physicians can elect to be paid directly by
patients by giving written notice to the Commission.
The Commission will specify the effective date between
30 and 45 days following receipt of the notice. In this
case, patients may apply to MSP for reimbursement of
the fee for insured services rendered.
Under the Master Agreement between the government,
MSC and the British Columbia Medical Association
(BCMA), modifications to the Payment Schedule such
as additions, deletions or fee changes are made by the
Commission, upon advice from the BCMA. Physicians
who wish to modify the payment schedule must submit
proposals to the BCMA Tariff Committee. On recommendation of the Tariff Committee, interim listings
may be designated by the Commission for new procedures or other services for a limited period of time
while definitive listings are established.
• Automatic Implantable Cardioverter Defibrillator
insertion and single ventricular lead and additional leads up to 3 extra leads,
• Diagnostic Laboratories: Serum assay for
kappa- and lambda- free light chains, with
ratio-quantitative analysis,
• General Internal Medicine complex
consultation,
• Reconstruction of abdominal wall with
myofacial advancement flaps,
• Cardiac ablation for atrial fibrillation, and
• Subureteric endoscopic injection for vesicoureteral reflux (VUR).
2.3 Insured Surgical-Dental Services
Surgical-dental services are covered by MSP when
hospitalization is medically required for the safe and
proper completion of surgery and when they are listed
in the Dental Payment Schedule. Additions or changes
to the list of insured services are managed by MSP on
the advice of the Dental Liaison Committee. Additions
and changes must be approved by the Medical Services
Commission. Included as insured surgical-dental
procedures are those related to remedying a disorder
of the oral cavity or a functional component of mastication. Generally this would include: oral surgery
related to trauma; orthognathic surgery; medically
required extractions; and surgical treatment of temporomandibular joint dysfunction.
• Cerebral arterial balloon occlusion tolerance
test (procedural fee),
Any general dental and/or oral surgeon in good
standing with the College of Dental Surgeons and
enrolled in the Medical Services Plan may provide
insured surgical-dental services in hospital. There
were 249 dentists (includes only Oral Surgeons,
Dental Surgeons, Oral Medicine and Orthodontists
who billed FFS in 2008–2009) enrolled with MSP
and billing FFS in 2008–2009.
• Percutaneous sclerotherapy of head and neck
vascular lesions under fluoroscopic guidance
(procedural fee),
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
During fiscal year 2008–2009 physician services which
were added as MSP insured benefits included fee items
which reflect current practice standards, for example:
• Lysis of intra-abdominal adhesions,
• Complex diagnostic neuroangiography up to
4 hrs, and after 4 hrs,
• General Practitioners: Management of labour
and transfer to higher level of care facility for
delivery,
• Trichomonas Antigen Test,
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For out-patients, take-home drugs and certain hospital
drugs are not insured, except those provided under
the provincial PharmaCare program. Other procedures not insured under the Hospital Insurance Act
include: services of medical personnel not employed
by the hospital; treatment for which Worksafe BC, the
Department of Veterans Affairs or any other agency
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
is responsible; services solely for the alteration of
appearance; and reversal of sterilization procedures.
A person must be a resident of British Columbia to
qualify for provincial health care benefits.
Uninsured hospital services also include: preferred
accommodation at the patient’s request; televisions,
telephones and private nursing services; preferred
medical/surgical supplies; dental care that could be
provided in a dental office including prosthetic and
orthodontic services; and, preferred services provided to patients of extended care units or hospitals.
The Medicare Protection Act, in section 1, defines a
resident as a person who:
Services not insured under the Medical Services Plan
include: those covered by the Workers’ Compensation
Act or by other federal or provincial legislation; provision of non-implanted prostheses; orthotic devices;
proprietary or patent medicines; any medical examinations that are not medically required; oral surgery
rendered in a dentist’s office; telephone advice unrelated to insured visits; reversal of sterilization
procedures; in vitro fertilization; medico-legal
services; and most cosmetic surgeries.
Medical necessity, as determined by the attending
physician and hospital, is the basis for access to
hospital and medical services.
The Medicare Protection Act (Section 45) prohibits the
sale or issuance of health insurance by private insurers to patients for services that would be benefits if
performed by a practitioner. Section 17 prohibits persons from being charged for a benefit or for “materials,
consultations, procedures, and use of an office, clinic
or other place or for any other matters that relate to the
rendering of a benefit.”
The Ministries of Health respond to complaints made
by patients and take appropriate actions to correct
situations identified to each Ministry. The Medical
Services Commission determines which services
are benefits and has the authority to de-list insured
services. Proposals to de-insure services must be
made to the Commission. Consultation may take
place through a sub-committee of the Commission
and usually includes a review by the BCMA’s Tariff
Committee. No services were de-listed in 2008–2009.
3.0 Universality
3.1 Eligibility
Section 7 of the Medicare Protection Act defines
the eligibility and enrolment of beneficiaries for
insured services. Part 2 of the Medical and Health
Care Services Regulation made under the Medicare
Protection Act details residency requirements.
Canada Health Act — Annual Report 2008–2009
• is a citizen of Canada or is lawfully admitted to
Canada for permanent residence;
• makes his or her home in British Columbia;
• is physically present in British Columbia at least
six months in a calendar year; and
• is deemed under the regulations to be a resident.
Certain other individuals, such as some holders of
permits issued under the federal Immigration and
Refugee Protection Act are deemed to be residents
(see section 3.3 below), but this does not include a
tourist or visitor to British Columbia.
New residents or persons re-establishing residence
in British Columbia are eligible for coverage after
completing a waiting period that normally consists of
the balance of the month of arrival plus two months.
For example, if an eligible person arrives during
the month of July, coverage is available October 1.
If absences from Canada exceed a total of 30 days
during the waiting period, eligibility for coverage
may be affected.
All residents are entitled to hospital and medical
care insurance coverage. Those residents who are
members of the Canadian Forces, appointed members
of the Royal Canadian Mounted Police, or serving a
term of imprisonment in a penitentiary as defined in
the Penitentiary Act, are eligible for federally funded
health insurance.
The Medical Services Plan (MSP) provides first-day
coverage to discharged members of the Royal Canadian
Mounted Police and the Canadian Forces, and to those
returning from an overseas tour of duty, as well as to
released inmates of federal penitentiaries.
3.2 Registration Requirements
Residents must be enrolled in the Medical Services
Plan (MSP) to receive insured hospital and physician services. Those who are eligible for coverage
are required to enrol. Once enrolled, beneficiaries
are assigned a unique Personal Health Number and
issued a CareCard. There is no expiration date on the
card. New residents are advised to make application
immediately upon arrival in the province.
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Beneficiaries may cover their dependents, provided the
dependents are residents of the province. Dependents
include a spouse (either married to or living and cohabiting in a marriage-like relationship), any unmarried
child or legal ward supported by the beneficiary, and
either under the age of 19 or under the age of 25 and in
full-time attendance at a school or university.
The number of MSP registrants on March 31, 2009,
was 4,402,540. Enrolment in MSP is mandatory, in
accordance with the Medicare Protection Act
(section 7). Only those adults who formally opt
out of all provincial health care programs are
exempt. A beneficiary who wishes to opt out of
MSP can do so by completion and submission of
the Election to Opt Out form. The term of this decision is 12 months from the first of the month of
receipt of the application, after which each adult
must re-apply to remain opted out of MSP.
3.3 Other Categories of Individual
Holders of Minister’s Permits, Temporary Resident
Permits, study permits, and work permits are eligible
for benefits when deemed to be residents under the
Medicare Protection Act and section 2 of the Medical
and Health Care Services Regulation.
3.4 Premiums
Enrolment in MSP is mandatory and payment of
premiums is ordinarily a requirement for coverage.
However, failure to pay premiums is not a barrier
to coverage for those who meet the basic enrolment
eligibility criteria. Monthly premiums for MSP are
$54 for one person, $96 for a family of two, and
$108 for a family of three or more.
Residents with limited incomes may be eligible for
premium assistance. There are five levels of assistance,
ranging from 20 to 100 per cent of the full premium.
Premium assistance is available only to beneficiaries
who, for the last 12 consecutive months, have resided
in Canada and are either a Canadian citizen or holder
of permanent resident (landed immigrant) status under
the Immigration and Refugee Protection Act (Federal).
4.0 Portability
4.1
Minimum Waiting Period
New residents or persons re-establishing residence
in British Columbia are eligible for coverage after
completing a waiting period that normally consists
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of the balance of the month of arrival plus two
months. For example, if an eligible person arrives
during the month of July, coverage is available
October 1. If absences from Canada exceed a total
of 30 days during the waiting period, eligibility
for coverage may be affected. New residents from
other parts of Canada are advised to maintain
coverage with their former medical plan during
the waiting period.
4.2 Coverage During Temporary
Absences in Canada
Sections 3, 4 and 5 of the Medical and Health Care
Services Regulation of the Medicare Protection Act
define portability provisions for persons temporarily
absent from British Columbia with regard to insured
services. In 2008–2009, there were no amendments
to the Medical and Health Care Services Regulation
with respect to portability provisions.
Individuals leaving the province temporarily on
extended vacations, or for temporary employment, may
be eligible for coverage for up to 24 months. Approval
is limited to once in five years for absences exceeding
six months in a calendar year. Residents who spend
part of every year outside British Columbia must be
physically present in Canada at least six months in a
calendar year and continue to maintain their home in
British Columbia in order to retain coverage. When a
beneficiary stays outside British Columbia longer than
the approved period, they will be required to fulfill a
waiting period upon returning to the province before
coverage can be renewed. Students attending a recognized school in another province or territory on a
full-time basis are entitled to coverage for the duration
of their studies.
According to inter-provincial and inter-territorial
reciprocal billing arrangements, physicians, except
in Quebec, bill their own medical plans directly for
services rendered to eligible British Columbia residents, upon presentation of a valid MSP CareCard.
British Columbia then reimburses the province or
territory at the rate of the fee schedule in the province or territory in which services were rendered.
For in-patient hospital care, charges are paid at the
standard ward rate actually charged by the hospital.
For out-patient services, the payment is at the interprovincial and inter-territorial reciprocal billing
rate. Payment for these services, except for excluded
services that are billed to the patient, is handled
though inter-provincial and inter-territorial reciprocal billing procedures. In 2008–2009, the amount
paid to physicians in other provinces and territories
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
was $28.6 million. Quebec does not participate in
reciprocal billing agreements for physician services.
As a result, claims for services provided to British
Columbia beneficiaries by Quebec physicians must be
handled individually. When travelling in Quebec or
outside of Canada, the beneficiary is usually required
to pay for medical services and seek reimbursement
later from MSP.
British Columbia pays host provincial rates for
insured services according to rates established by
the Interprovincial Health Insurance Agreements
Coordinating Committee.
4.3 Coverage During Temporary
Absences Outside Canada
The enabling legislation that defines portability of
health insurance during temporary absences outside
Canada is stated in the Hospital Insurance Act, s. 24;
the Hospital Insurance Act Regulations, Division 6;
the Medicare Protection Act, s. 51; and the Medical
and Health Care Service Regulation, ss. 3, 4, 5. The
Medical and Health Care Services Regulation was
amended by British Columbia Reg. 111/2005.
The relevant issues addressed by the amendments are
as follows:
• All provinces, except Quebec, have eliminated
caps on MSP coverage for students studying
abroad, enabling them to finish their undergraduate and graduate studies. The amendment brings
British Columbia in line with other provinces and
removes the 60-month cap for full-time students
studying abroad at an educational institution.
The students must be enrolled in and attending
the institution.
• Because of increasing demand for a specialized
and mobile work force employed for short-term
contracts and assignments, many provinces
have extended health insurance coverage to
24 months of absence. British Columbians were
deemed residents for the first 12 months of
absence. This amendment extends coverage to
24 months; approval is limited to once in five
years for absences exceeding six months in a
calendar year. This brings British Columbia
in line with practices in other provinces.
• British Columbia residents who are temporarily
absent from British Columbia and cannot return
due to extenuating health circumstances are
deemed residents for an additional 12 months
if they are visiting in Canada or abroad. This
Canada Health Act — Annual Report 2008–2009
amendment also applies to the person’s spouse
and children provided they are with the person
and they are also residents or deemed residents.
4.4 Prior Approval Requirement
No prior approval is required for elective procedures
that are covered under the inter-provincial reciprocal agreements with other provinces. Prior approval
from the Medical Services Commission is required
for procedures that are not covered under the reciprocal agreements.
The physician services excluded under the
Inter-Provincial Agreements for the Reciprocal
Processing of Out-of-Province Medical Claims
are: surgery for alteration of appearance (cosmetic
surgery); gender reassignment surgery; surgery
for reversal of sterilization; therapeutic abortions;
routine periodic health examinations including
routine eye examinations; in vitro fertilization,
artificial insemination; acupuncture, acupressure,
transcutaneous electro-nerve stimulation (TENS),
moxibustion, biofeedback, hypnotherapy; services
to persons covered by other agencies (e.g., RCMP,
Canadian Armed Forces, Workers’ Compensation
Board, Department of Veterans Affairs, Correctional
Services of Canada); services requested by a “third
party”; team conference(s); genetic screening and
other genetic investigation, including DNA probes;
procedures still in the experimental/developmental
phase; and anaesthetic services and surgical assistant services associated with all of the foregoing.
The services on this list may or may not be reimbursed by the home province. The patient should
make enquires of that home province after direct
payment to the British Columbia physician.
Some treatments (e.g., treatment for anorexia) may
require the approval of the Health Authorities
Division of the Ministry of Health Services.
All non-emergency procedures performed outside
Canada require approval from the Commission before
the procedure.
5.0 Accessibility
5.1
Access to Insured Health Services
Beneficiaries in British Columbia, as defined in section 1 of the Medicare Protection Act, are eligible for
all insured hospital and medical care services as
required. To ensure equal access to all, regardless of
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income, the Medicare Protection Act, sections 17 and
18, prohibits extra-billing by enrolled practitioners.
5.2 Access to Insured Hospital Services
Nursing
Nurses comprise the largest group of professional staff
within the health care sector. The number of Registered
Nurses licensed to practice in British Columbia as of
March 31, 2009 was 33,974. British Columbia hospitals
also employ Registered Psychiatric Nurses (RPNs) and
Licensed Practical Nurses (LPNs). On March 31, 2009,
there were 2,236 RPNs and 7,996 LPNs licensed to practice in the province.
In 2008–2009, the British Columbia government
provided additional funding to build on successful
recruitment, retention and education nursing strategies. This funding brought the government’s total
commitment to nursing strategies to $189 million
since 2001.
British Columbia’s nursing strategies are developed
and implemented annually by the Nursing Directorate,
Ministry of Health Services, through consultation with
stakeholders, input from chief nursing officers of health
authorities and the Nursing Advisory Committee of
British Columbia, and a review of national trends and
policies. The following priorities form the broad strategy framework:
• human resources planning for recruitment,
retention and education of nurses in British
Columbia to address population-based health
care needs;
• enhancing nursing practice environments by
supporting health authorities and government
to make sound nursing policy in keeping with
current research and provincial, national and
global trends;
• analyzing nursing data to enhance the
Ministry’s understanding of trends and
changing needs in nursing and health care;
• recruiting students of Aboriginal descent into
nursing, supporting those already in nursing
programs, and recruiting/retaining Aboriginal
nurses currently practising in British Columbia,
and;
• promoting nursing as a career of choice to ensure
the future of a quality British Columbia health
care system.
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Some of the programs funded in 2008–2009 included:
expansion of recruitment initiatives for internationallyeducated nurses, including the new Internationally
Educated Nurse Assessment Service of BC, Aboriginal
nursing strategies, undergraduate nurse program,
internship/new graduate transition program, post-basic
rural acute nursing certificate program pilot project,
and expansion of Nurse Practitioner (NP) integration
in primary care. Further strategies to mitigate the
supply/demand equation include increasing frontline leadership positions, and enhancing specialty
and continuing education.
In 2008–2009, British Columbia has increased the
number of Nurse Practitioners in areas of need, both
in urban and rural settings. In addition, the Nurse
Practitioner Innovation initiative provided funding
for NP positions in emergency departments and primary care clinics. As of March 31, 2009, there were
128 practicing NPs in British Columbia.
In addition, the Ministry of Health Services has partnered with the Ministries of Advanced Education
and Labour Market Development to work closely
with educational institutions to increase nursing
education spaces. In addition, the first three-year
accelerated Bachelor of Science in Nursing degree
program was announced at the British Columbia
Institute of Technology on March 8, 2008, with an
initial intake of 64 students in August 2008.
Infrastructure and Capital Planning
In recent years, the British Columbia government has
initiated changes that encourage strategic investment
in capital infrastructure, and fostered innovative
approaches to meeting health service delivery needs,
now and in future.
The Ministries of Health have introduced a longer
capital planning cycle and have gathered better
data on current capital assets to support improved
decision-making and better forecasting of needs. The
Ministries of Health are now working to extend the
capital planning horizon to coincide with longer term
acute care and complex care planning. This is particularly beneficial in planning for major infrastructure
such as hospitals that have life-cycles encompassing
several decades. It also gives health authorities more
time to explore creative ways of addressing capital
requirements.
The Province committed $86.5 million to expand and
upgrade clinical-academic space to support increased
enrolment of medical students at teaching hospitals in
British Columbia.
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
In 2008, construction began on the UBC Medical
School Facility in Kelowna, part of the Southern
Medical Program. The program will welcome
32 new first-year medical students when the
building opens in 2011.
5.3 Access to Insured Physician and
Dental-Surgical Services
In 2008–2009, approximately 2,900 general practitioners and specialists received all or part of their
income through British Columbia’s Alternative
Payments Program (APP).
APP funds regional health authorities to hire salaried
physicians or contract with physicians, in order to
deliver insured clinical services.
The Ministries of Health implemented several
programs under the 2002 Subsidiary Agreement
for Physicians in Rural Practice, which were continued in the recently signed Physician Master
Agreements (PMA) to enhance the availability and
stability of physician services in smaller urban,
rural and remote areas of British Columbia.
These programs include:
• Rural Retention Program which provides eligible physicians (estimated at 1,300) with fee
premiums. It is available to resident, visiting
physicians and locums and also provides a flat
fee sum for eligible physicians who reside and
practice in a rural community.
• Northern and Isolation Travel Assistance
Outreach Program which provides funding
support for approved physicians who visit rural
and isolated communities to provide medical
service. This program funded an estimated
2,625 visits in 2008–2009 by family doctors
and specialists to rural communities.
• Rural General Practitioner Locum Program which
assists rural general practitioners in taking reasonable periods of leave from their practices by
providing up to 43 days of paid locum coverage
per year. This program assisted physicians in
approximately 56 small communities to attend
continuing medical education and also provided
vacation relief.
Canada Health Act — Annual Report 2008–2009
• Rural Specialist Locum Program which assists
rural specialists in taking vacations and continuing medical education by providing paid
locum support. The program provided locum
support for core specialists in 10 rural communities to provide vacation relief and assistance
while physician recruitment efforts were
underway.
• Rural Education Action Plan which supports the
training needs of physicians in rural practice.
This program supports training in physicians’
rural practices through several components,
including rural practice experience for medical students and enhanced skills for practicing
physicians.
• Isolation Allowance Fund which provides funding
to communities with fewer than four physicians
and no hospital, and where the Medical On-Call/
Availability Program, call-back, or Doctor of
the Day payments is not available. Rural Loan
Forgiveness Program which decreases British
Columbia student loans by 20 per cent for each
year of rural practice for physicians, nurse practitioners, nurses, midwives and pharmacists.
The Full-Service Family Practice Incentive Program
has been expanded as the Ministry of Health Services
and physicians continue to work together to develop
incentives aimed at helping to support and sustain
full service family practice. In 2008–2009, new and
revised fees were in place to support general practitioners in providing primary care to their patients. As
of March 31, 2009, 2,550 GPs had billed complex care
fee items for 108,145 patients, 1,829 GPs had developed
mental health care plans for 49,697 patients, 1,579 GPs
had liaised with other health care practitioners to
build complex care action plans for 13,255 patients,
and 1,103 GPs had billed the conferencing fee for
8,434 patients in residential care.
5.4 Physician Compensation
Through negotiations with the British Columbia
Medical Association (BCMA), British Columbia
establishes the compensation and benefit structure
for physicians who perform publicly funded medical
procedures.
Funding in 2008–2009 for physicians accounted
for $3.08 billion, or 22.4 per cent of the Ministry’s
budget.
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In 2007, as provided for by the 2006 Letter of Agreement, the Province and the BCMA concluded
negotiations for a Physician Master Agreement
(PMA). The PMA remains in effect until 2012.
In addition to the PMA, the Province and the
BCMA also have five subsidiary agreements:
General Practitioners Subsidiary Agreement;
Specialists Subsidiary Agreement; Rural Practice
Subsidiary Agreement; Alternative Payments
Subsidiary Agreement; and Benefits Subsidiary
Agreement. These agreements address matters
unique to each aspect of medicine addressed
by an individual subsidiary agreement. All five
subsidiary agreements terminate in 2012 along
with the PMA.
Being long-term, the PMA provides support for a
more structured relationship between the BCMA
and the Province than had been in place previously.
Health authorities have a larger role in making decisions which affect health care in their respective
regions. A main focus of the PMA is the establishment of mechanisms which promote enhanced
collaboration and accountabilities between the
province and the BCMA. Key to the success of
these mechanisms is a strengthened conflict
resolution process.
British Columbia anticipates additional benefits from
the new PMA structure including: efficiencies stemming from the amalgamation of most agreements
with the BCMA into a single agreement framework;
streamlining committee structure and communication; providing a formal conflict management process
which addresses issues at both the local and provincial levels; limiting physician service withdrawals;
and establishing a structured process for physicians
wishing to change their method of compensation
to better align with strategies and priorities of the
Province and of health authorities.
Effective April 1, 2008, physician compensation
rates were increased by 2 per cent. Over the life of
the PMA the province also provides financial support targeted towards: increasing rural physician
incentive programs; providing for new fee items;
increasing physician benefit programs; supporting
full service family practices; and improving information technology and promoting eHealth initiatives.
The Province and the BC Dental Association (BCDA)
negotiated a Memorandum of Understanding (MOU)
in 2007 that is effective through March 2010 and
covers the following services: dental surgery; oral
surgery; orthodontic services; oral medicine; and
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dental technical procedures. Fee schedules for these
services increased 3 per cent in April 2008. Both the
Province and the BCDA agree to meet through a Joint
Dental Surgery Policy Committee for the duration of
the Agreement.
Medical practitioners are licensed under the Medical
Practitioners Act and dentists were licensed under the
Dentists Act in fiscal 2008–2009. In April 2009, dentists
were regulated under the Health Professions Act.
Compensation Methods for Physicians and Dentists
Payment for medical services delivered in the
Province is made through the Medical Services
Plan to individual physicians, based on submitted claims, and through the Alternative Payments
Program to health authorities for contracted physicians’ services. Over 74 per cent of payments were
distributed as fee-for-service payments and nearly
11.5 per cent were distributed as alternative payments. Of the alternative payments, 76 per cent
are distributed through contracts, 22 per cent as
sessions (3.5-hour units of service) and 2 per cent
as salaried arrangements. The government funds
health authorities for alternative payments; it does
not pay physicians directly. In British Columbia,
for dentistry services, MSP pays for medically
required dental services and medically required
dental surgical services performed in a hospital;
the rest is self-pay.
5.5 Payments to Hospitals
Funding for hospital services is included in the
annual funding allocation and payments made to
regional health authorities. This funding allocation
is to be used to fund the full range of necessary
health services for the population of the region (or
for specific provincial services, for the population
of British Columbia), including the provision of
hospital services.
While the hospitals’ portion of the funding allocation
is normally not specified, the exception to this rule
is funding targeted for specific priority projects (e.g.,
reduction in wait times for hips and knees). For these
initiatives, funding is specifically earmarked and
must be reported on separately.
Annual funding allocations to health authorities are
determined as part of the Ministry’s annual budget
process in consultation with the Ministries of Health,
of Finance and Treasury Board. The final funding
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
amount is conveyed to health authorities by means
of an annual funding letter.
The accountability mechanisms associated with
government funding for hospitals is part of several
comprehensive documents which set expectations
for health authorities. These are the annual funding
letter, annual service plans, and annual Government
Letters of Expectations. Taken together, these documents convey the Ministries’ broad expectations for
health authorities and explain how performance will
be monitored in relation to these expectations.
The Hospital Insurance Act and its related regulations
govern payments made by the health care plan to health
authorities. This statute establishes the authority of the
Minister to make payments to hospitals, and specifies
in broad terms what services are insured when provided within a hospital.
No amendments were made during 2008–2009 to
legislation or regulations concerning payments for
insured hospital services.
Insured hospital services are included within the
annual funding allocations to health authorities, as
well as specific targeted funding from time to time.
Incremental funding is allocated to health authorities
using the Ministry of Health Services’ Population
Needs-Based Funding Formula and other funding
allocation methodologies (e.g. to reflect targeted
funding allocations directed to specific health
authorities).
In 2008–2009, a full continuum of care (acute,
residential, community care, public and preventive
health, adult mental health, addictions programs,
etc.) was provided.
The annual funding allocation to health authorities
does not include funding for programs directly
operated by the Ministry, such as the payments to
physicians, payments for prescription drugs covered
under PharmaCare, or for provincial ambulance
services.
6.0 Recognition Given to
Federal Transfers
Funding provided by the federal government through
the Canada Health Transfer is recognized and reported
by the Government of British Columbia through various government websites and provincial government
documents.
Canada Health Act — Annual Report 2008–2009
In 2008–2009, these documents included:
• 2008–2009 First Quarterly Report available at:
http://www.fin.gov.bc.ca/qrt-rpt/qr08/Q1_08.pdf
• Estimates, Fiscal Year Ending March 31, 2009
available at http://www.bcbudget.gov.bc.ca/
2008/bfp/2008_Budget_Fiscal_Plan.pdf
• 2008–2009 Budget and Fiscal Plan available at:
http://www.bcbudget.gov.bc.ca/2008/estimates/
2008_Estimates.pdf
• Public Accounts 2008–2009 available at:
http://www.fin.gov.bc.ca/OCG/pa/07_08/
Pa07_08.htm
7.0 Extended Health Care
Services
British Columbia also provides full or partial coverage for health care services not required by the
Canada Health Act. British Columbia has established
community-based services as appropriate alternatives
to hospital services. The Home and Community Care
program provides a range of health care and support
services for eligible residents with a frailty or with
acute, chronic, palliative, or rehabilitative health care
needs. The type of assistance and support required
will vary from one person to another, and the amount
of service necessary may change over time.
The services may include case management, home
support, adult day services, meal programs, home
care nursing, community rehabilitation, assisted
living, residential care, family care homes, group
homes for adults with disabilities, hospice, respite,
and convalescent care as described below.
7.1
Nursing Home Intermediate
Care and Adult Residential
Care Services
Residential care facilities provide 24-hour professional nursing care and supervision in a protective,
supportive environment for adults who have complex
care needs and can no longer be cared for in their
own homes.
Residential care clients pay a daily fee based on
their after-tax income. Rates are adjusted annually
based on the Consumer Price Index. The legislation pertaining to residential care facilities is the
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Community Care and Assisted Living Act, the Adult
Care Regulations, the Hospital Act, the Hospital Act
Regulation, the Hospital Insurance Act, the Hospital
Insurance Act Regulations, and the Continuing Care
Act, the Continuing Care Programs Regulation and
the Continuing Care Fees Regulation.
Family care homes are single family residences that
provide meals, housekeeping services and assistance
with daily activities for up to two clients. The cost for
family care homes is the same as for residential care
facilities.
The legislation pertaining to family care homes is the
Continuing Care Act, the Continuing Care Programs
Regulation and the Continuing Care Fees Regulation.
Adults with disabilities can also live independently
in the community in publicly-funded group homes.
Group homes are safe, affordable, four-bed to six-bed
housing projects. They offer short- and long-term
accommodation, skills training, peer support and
counselling. Group home clients are responsible for
living costs, such as food and rent, not associated
with their care. Rental costs vary, depending on
income. The legislation pertaining to group homes
is the Continuing Care Act and the Continuing Care
Programs Regulation, as well as the Community
Care and Assisted Living Act and the Adult Care
Regulation.
Assisted living residences provide housing, hospitality and personal assistance services for adults who
can live independently, but require regular assistance
with daily activities, usually because of age, illness
or disabilities. Residences typically consist of onebedroom apartments.
Services include help with bathing, grooming,
dressing or mobility. Meals, housekeeping, laundry,
social and recreational opportunities and a 24-hour
response system are also provided. Clients pay a
monthly charge based on 70 per cent of their aftertax income, up to a maximum of a combination of
the average market rent for housing and hospitality
in a particular geographic area and the actual cost
of personal care. The legislation pertaining to assisted
living residences is the Community Care and Assisted
Living Act, the Assisted Living Regulation, the
Continuing Care Act, the Continuing Care Programs
Regulation and the Continuing Care Fees Regulation.
Hospice Services
Hospice services provide a residential home-like
setting where supportive and professional care
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services are provided to British Columbians of any
age who are in the end stages of a terminal illness or
preparing for death. Services may include medical
and nursing care, advance care planning, pain and
symptom management, and psycho-social, spiritual
and bereavement support. There may be a charge for
some hospice services. The legislation pertaining to
hospices is the Community Care and Assisted Living
Act, the Adult Care Regulations, the Hospital Act and
the Hospital Act Regulation.
Services for Persons with Mental Illness
and Addictions
There are five distinct types of housing and support
programs for people with severe mental illness and
or addictions: Community Residential Care Facilities;
Family Care Homes; Supported Housing; Residential
Addictions Treatment; and Support Recovery Facilities.
Community Residential Care Facilities
These facilities provide 24-hour care, intensive treatment and support services, including psycho-social
rehabilitation, such as assistance with personal care,
home/money management, socialization, medication
administration and linking with external services such
as supported education and supported employment programs. For some residents, community residential care
is a ‘stepping stone’ towards more independent housing
while others stay long-term. All facilities are licensed
under the Community Care and Assisted Living Act.
Clients pay a standard daily fee for room and board.
Family Care Homes
These private homes, operated by families or individuals, provide basic living skills and psycho-social
rehabilitation services for clients unable to live
independently, who require support within a family
setting to acquire the skills and confidence necessary for independent living. Homes are not licensed
or registered but must meet standards set out by the
health authority. Clients pay a standard daily fee for
room and board.
Supported Housing
Supported housing programs include affordable,
safe and secure accommodation and the availability of a range of psycho-social rehabilitation and
home support services, such as assistance with meal
preparation, personal care, home management, medication support, socialization, and crisis management.
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
Supported Housing programs include: supported
apartments, block apartments, congregate housing;
group homes and low barrier housing. Clients pay
reduced rent based on income.
Residential Addiction Treatment
These residential addictions treatment facilities
provide a safe, structured, and substance-free living
environment and are licensed under the Community
Care and Assisted Living Act. Treatment includes
assessment, education, structured individual, group
and family counselling/therapy. Length of stay
generally ranges from 30-90 days and clients pay
a standard daily fee.
Support Recovery Facilities
These facilities provide a temporary residential
setting and a basic level of support appropriate for
longer-term recovery from addiction. Individuals
access outpatient and other community treatment
services and supports. Clients pay a standard
daily fee.
7.2 Home Care Services
Home care nursing and community rehabilitation
services are professional services, delivered to people
of all ages by registered nurses and rehabilitation
therapists. These services are available on a nonemergency basis and include assessment, teaching
and consultation, care coordination and direct care
or treatment for clients with chronic, acute, palliative
or rehabilitative needs. There is no charge for these
services.
Home support services help clients remain in their
own homes. Home support workers provide personal
assistance with daily activities, such as bathing,
dressing, grooming and, in some cases, light household tasks that help maintain a safe and supportive
home. Depending on an individual’s income, there
may be a cost associated with home support services.
The legislation pertaining to home support services
Canada Health Act — Annual Report 2008–2009
is the Continuing Care Act, the Continuing Care
Programs Regulation and the Continuing Care Fees
Regulation.
End-of-life care preserves clients’ comfort, dignity
and quality of life by relieving or controlling symptoms so those facing death, and their loved ones, can
devote their energies to embracing the time they have
together. Professional care givers and support staff
provide supportive and compassionate care in the
client’s home, in hospital, hospice, an assisted living
residence or a residential care facility. Depending on
the type of care required and an individual’s income,
there may be a cost associated with some services. A
Palliative Care Benefits Program was implemented in
2001 to provide people living at home who are nearing the end of their life with approved medications
for pain or symptom relief and some medical supplies
and equipment, at no charge. Approved medications
can be obtained through a local pharmacy.
7.3 Ambulatory Health Care Services
Adult day programs assist seniors and adults with
disabilities to function as independently as possible. They provide supportive group programs and
activities that give clients a opportunities to be more
involved in their community and offer caregivers
respite. Services vary with each centre, but may
include personal care, social activities, meals and
transportation.
Centres usually charge a minimal daily fee to assist
with the cost of craft supplies, transportation and
meals. The legislation pertaining to adult day programs is the Continuing Care Act and the Continuing
Care Programs Regulation.
Health authorities also provide ambulatory health
care services such as home care nursing, community
rehabilitation, nutrition and social work, in a variety
of community settings (i.e. wellness clinics, ambulatory home care nursing clinics, and community health
clinics for the frail elderly). These may be coordinated
in partnership with primary health care physicians.
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Chapter 3: British Columbia
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
4,182,682
4,216,199
4,279,734
4,335,676
4,402,540
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number (#):
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
1
a. acute care
92
82
82
80
80
b. chronic care
18
19
18
19
19
c. rehabilitative care
d. other
e. total
3. Payments for insured health services ($):
4
4
4
3
3
23
32
35
37
37
137
137
139
139
139
2
a. acute care
not available
not available
not available
not available
not available
b. chronic care
not available
not available
not available
not available
not available
c. rehabilitative care
not available
not available
not available
not available
not available
d. other
not available
not available
not available
not available
not available
e. total
not available
not available
not available
not available
not available
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
17
18
22
18
14
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
b. diagnostic imaging facilities
c. total
1
1
0
not available
not available
18
19
22
not available
not available
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
not available
not available
not available
not available
not available
b. diagnostic imaging facilities
not available
not available
not available
not available
not available
c. total
not available
not available
not available
not available
not available
For items 1–2: Historical and current data may differ from report to report because of changes in data sources, definitions and methodology from year to year.
1. In British Columbia, the categories under which these facilities are reported in this Health Act report table do not match those normally used in the BC Ministry of Health Services,
but facilities have been matched to this report’s specifications as closely as possible.
— Acute Care includes only acute care inpatient facilities from 2005/06 onward. In previous years this category also included acute care ambulatory facilities and one psychiatric
inpatient facility (both now counted under “Other”).
— Chronic Care includes extended care facilities. The one additional facility in 2005/06 is not a new facility. In the past, statistics for this facility were reported as part of a larger
group of facilities, but are now reported separately.
— Rehabilitative care includes rehabilitation facilities.
— Other includes acute care ambulatory care facilities, diagnostic and treatment centres and one inpatient pyschiatric inpatient facility.
The count of facilities in this table may not match counts produced from the Discharge Abstract Database, the MIS reporting system, or the Societies Act because each reporting
system has different approaches to counting multiple site facilities and categorizing them by function.
2. In British Columbia, regional health authorities are responsible for the delivery of a wide range of health care services including hospital acute care, residential care, home and
community care, community mental health care, and public health services, but excluding physican, laboratory and pharmacare services. Financial reporting does not separate
expenditures for services provided under the Canada Health Act.
BC Ministry of Health Funding to Health Authorities for the provision of the full range of regionally delivered services are as follows: $4.59 billion in 1999–2000, $5.20 billion in
2000–2001, $5.62 billion in 2001–2002, $6.06 billion in 2002–2003, $6.21 billion in 2003–04, $6.25 billion in 2004–2005, $6.62 billion in 2005–2006, $7.1 billion in 2006–2007 and
$ 7.64 billion in 2007-2008.
164
Canada Health Act — Annual Report 2008–2009
Chapter 3: British Columbia
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
7,467
6,517
7,172
7,160
2008–2009
7,102
51,869,175
49,899,859
65,678,542
55,309,733
64,550,692
80,386
77,537
81,878
95,677
95,326
13,574,737
14,089,042
17,937,647
19,088,368
24,262,195
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
2,294
2,345
1,858
1,603
1,963
3,811,717
4,248,649
3,452,739
14,486,341 11,811,654
761
1,247
960
1,215
1,630
741,617
770,215
453,698
553,661
967,704
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
Insured PHYSICIAN Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
14.Number of participating physicians (#):
a. general practitioners
4,629
4,681
4,756
4,806
4,899
b. specialists
3,642
3,773
3,870
3,966
4,087
c. other
0
0
0
0
0
d. total
8,271
8,454
8,626
8,772
8,986
15.Number of opted-out physicians (#):
a. general practitioners
4
4
3
3
3
b. specialists
2
2
2
2
2
c. other
0
0
0
0
0
d. total
6
6
5
5
5
16.Number of not participating physicians (#):
a. general practitioners
1
1
1
2
2
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
1
1
1
2
2
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
not available
not available
not available
not available
not available
b. total payments ($)
not available
not available
not available
not available
not available
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
65,944,973
70,083,943
72,660,315
1,956,374,356
2,032,708,002
2,134,722,094
75,659,148
3
2,231,717,012
78,936,388
3
2,322,851,307
3
3. The MSP Fee-For-Service payments for 2006/2007, 2007/2008 and 2008/2009 listed in 18b include all retroactive fee increases paid up to and including September 30, 2009.
Retroactive fee increases for 2007/08 and 2008/09 scheduled to be paid after September 30, 2009 are not included.
Canada Health Act — Annual Report 2008–2009
165
Chapter 3: British Columbia
Insured Physician Services Provided to Residents in Another Province or Territory
19.Number of services (#).
20.Total payments ($).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
628,546
674,830
869,072
724,805
734,584
23,641,538
25,801,030
27,402,542
26,458,974
28,643,860
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
72,905
76,146
80,795
76,092
36,205
3,145,564
3,471,693
3,739,263
4,005,493
2,276,570
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
166
2005–2006
2006–2007
2007–2008
2008–2009
228
238
234
245
249
38,310
41,965
44,015
43,262
46,736
5,268,900
5,833,105
6,087,395
6,305,343
7,289,302
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
include Continuing Care; Community Nursing;
Community Health; and Mental Health Services.
Health care initiatives in the Territory target areas such
as access and availability of services, recruitment and
retention of health care professionals, primary health
care, systems development and alternative payment and
service delivery systems. Specifically:
Yukon
Introduction
The health care insurance plans operated by the
Government of Yukon Territory are the Yukon
Health Care Insurance Plan (YHCIP) and the
Yukon Hospital Insurance Services Plan (YHISP).
The YHCIP is administered by the Director, as
appointed by the Executive Council Member
(Minister). The YHISP is administered by the
Administrator, as appointed by the Commissioner
in Executive Council (Commissioner of the Yukon
Territory). The Director of the YHCIP and the
Administrator of the YHISP are hereafter referred
to as the Director, Insured Health and Hearing
Services. References in this text to the “Plan” refer
to either the Yukon Health Care Insurance Plan or
the Yukon Hospital Insurance Services Plan. There
are no regional health boards in the Territory.
The objective of the Yukon health care system
is to ensure access to, and portability of, insured
physician and hospital services according to the
provisions of the Health Care Insurance Plan Act
and the Hospital Insurance Services Act. Coverage
is provided to all eligible residents of the Yukon
Territory on uniform terms and conditions. The
Minister, Department of Health and Social Services,
is responsible for delivering all insured health care
services. Service delivery is administered centrally
by the Department of Health and Social Services.
There were 33,983 eligible persons registered with
the Yukon health care plan on March 31, 2009.
Other insured services provided to eligible Yukon
residents include the Travel for Medical Treatment
Program; the Chronic Disease and Disability Benefits
Program; the Pharmacare and Extended Benefits
Programs; and the Children’s Drug and Optical
Program. Non-insured health service programs
Canada Health Act — Annual Report 2008–2009
• Primary care initiatives are proceeding that
will broaden and strengthen service delivery
and modernize and improve system capabilities.
These initiatives include:
• Insured Health Information System—a new
system has been in use for just over three years
for the processing of Health Care Registration,
Medical Claims, Hospital Claims and Drug
Claims. The Medical Travel Claims component
was implemented in the summer of 2008;
• work with the Yukon Medical Association to
find solutions for a number of Yukon residents
without a family physician continues;
• Yukon has recruited a broader base of visiting
specialists to provide services at the Visiting
Specialist Clinic; and
• the Diabetes Collaborative, which helps physicians
provide improved care for patients with diabetes
is moving to another phase that will see an expansion to other chronic conditions (CHF, COPD,
hypertension, kidney disease) as well as diabetes
in Whitehorse and communities.
Some of the major challenges facing the advancement of insured health care service delivery in the
Territory are:
• effective linkages and coordination of existing
services and service providers;
• recruitment and retention of qualified health
care professionals;
• increasing costs related to service delivery;
• increasing costs related to changing demographics;
and
• acquiring and maintaining new and advanced
high-technology diagnostic and treatment
equipment.
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Chapter 3: Yukon
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
The Health Care Insurance Plan Act, sections 3(2)
and 4, establishes the public authority to operate the
health medical care plan. There were no amendments
made to these sections of the legislation in 2008–2009.
The Hospital Insurance Services Act, sections 3(1)
and 5, establishes the public authority to operate
the health hospital care plan. There were no amendments made to these sections of the legislation in
2008–2009.
Subject to the Health Care Insurance Plan Act
(section 5) and Regulations, the mandate and
function of the Director, Insured Health and
Hearing Services, is to:
• develop and administer the Plan;
• determine eligibility for entitlement to insured
health services;
• register persons in the Plan;
• make payments under the Plan, including the
determination of eligibility and amounts;
• determine the amounts payable for insured
health services outside the Yukon;
• establish advisory committees and appoint individuals to advise or assist in operating the Plan;
• conduct actions and negotiate settlements in
the exercise of the Government of Yukon’s right
of subrogation under this Act to the rights of
insured persons;
• conduct surveys and research programs and
obtain statistics for such purposes;
• determine the information required under this
Act and the form such information must take;
• appoint inspectors and auditors to examine
and obtain information from medical records,
reports and accounts; and
• perform such other functions and discharge
such other duties as are assigned by the
Executive Council Member under this Act.
Subject to the Hospital Insurance Services Act
(section 6) and Regulations, the mandate and
168
function of the Director, Insured Health and
Hearing Services, is to:
• develop and administer the hospital insurance
plan;
• determine eligibility for and entitlement
to insured services;
• determine the amounts that may be paid
for the cost of insured services provided
to insured persons;
• enter into agreements on behalf of the Government of Yukon with hospitals in or outside the
Yukon, or with the Government of Canada or any
province or an appropriate agency thereof, for the
provision of insured services to insured persons;
• approve hospitals for purposes of this Act;
• conduct surveys and research programs and
obtain statistics for such purposes;
• appoint inspectors and auditors to examine
and obtain information from hospital records,
reports and accounts;
• prescribe the forms and records necessary to
carry out the provisions of this Act; and
• perform such other functions and discharge
such other duties as may be assigned by the
regulations.
1.2 Reporting Relationship
The Department of Health and Social Services is
accountable to the Legislative Assembly and the
Government of Yukon through the Minister.
Section 6 of the Health Care Insurance Plan Act
and section 7 of the Hospital Insurance Services Act
require that the Director, Insured Health and Hearing
Services, make an annual report to the Executive
Council Member respecting the administration of the
two health insurance plans. A Statement of Revenue
and Expenditures is tabled in the Legislature and is
subject to discussion at that level.
1.3 Audit of Accounts
The Health Care Insurance Plan and the Hospital
Insurance Services Plan are subject to audit by the
Office of the Auditor General of Canada. The Auditor
General of Canada is the auditor of the Government
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
of Yukon in accordance with section 30 of the Yukon
Act (Canada). The Auditor General is required to
conduct an annual audit of the transactions and consolidated financial statements of the Government of
Yukon. Further, the Auditor General of Canada is to
report to the Yukon Legislative Assembly any matter
falling within the scope of the audit that, in his or
her opinion, should be reported to the Assembly.
The most recent audit was for the year ended
March 31, 2009.
Regarding the Yukon Hospital Corporation, section
13(2) of the Hospital Act requires every hospital to submit a report of the operations of the Corporation for that
fiscal year; the report is to include the financial statements of the Corporation and the auditor’s report. The
report is to be provided to the Department of Health
and Social Services within six months of the end of
each fiscal year.
1.4 Designated Agency
The Yukon Health Care Insurance Plan has no
other designated agencies authorized to receive
monies or to issue payments pursuant to the
Health Care Insurance Plan Act or the Hospital
Insurance Services Act.
2.0 Comprehensiveness
2.1
Insured Hospital Services
The Hospital Insurance Services Act, sections 3, 4, 5
and 9, establish authority to provide insured hospital
services to insured residents. The Yukon Hospital
Insurance Services Ordinance was first passed
in 1960 and came into effect April 9, 1960. There
were no amendments made to these sections of the
legislation in 2008–2009.
In 2008–2009, insured in-patient and out-patient
hospital services were delivered in 15 facilities
throughout the Territory. These facilities include
one general hospital, one hospital and 13 Health
Centres.
Adopted on December 7, 1989, the Hospital Act establishes the responsibility of the Legislature and the
Government to ensure “compliance with appropriate
methods of operation and standards of facilities and
care”. Adopted on November 11, 1994, the Hospital
Standards Regulation sets out the conditions under
which all hospitals in the Territory are to operate.
Canada Health Act — Annual Report 2008–2009
Section 4(1) provides for the Ministerial appointment
of one or more investigators to report on the management and administration of a hospital. Section 4(2)
requires that the hospital’s Board of Trustees establishes and maintains a quality assurance program.
Currently, the Yukon Hospital Corporation is operated under a three-year accreditation through the
Canadian Council on Health Services Accreditation.
The surveyors are scheduled to do their accreditation
review for renewal in May 2010.
The Yukon government assumed responsibility for
operating Health Centres from the federal government in April 1997. These facilities, including the
Watson Lake Cottage Hospital, operate in compliance
with the adopted Medical Services Branch Scope
of Practice for Community Health Nurses/Nursing
Station Facility/Health Centre Treatment Facility,
and the Community Health Nurse Scope of Practice.
The General Duty Nurse Scope of Practice was completed and implemented in February 2002.
Pursuant to the Hospital Insurance Services Regulations, sections 2(e) and (f ), services provided in an
approved hospital are insured. Section 2(e) defines
in-patient insured services as all of the following
services to in-patients, namely: accommodation
and meals at the standard or public ward level;
necessary nursing service; laboratory, radiological
and other diagnostic procedures together with the
necessary interpretations for the purpose of maintaining health, preventing disease and assisting in
the diagnosis and treatment of an injury, illness or
disability; drugs, biologicals and related preparations as provided in Schedule B of the Regulations,
when administered in the hospital; use of operating
room, case room and anaesthetic facilities, including
necessary equipment and supplies; routine surgical
supplies; use of radiotherapy facilities where available; use of physiotherapy facilities where available;
and services rendered by persons who receive remuneration therefore from the hospital.
Section 2(f) of the same Regulations defines “outpatient insured services” as all of the following services
to out-patients, when used for emergency diagnosis or
treatment within 24 hours of an accident, which period
may be extended by the Administrator, provided the
service could not be obtained within 24 hours of the
accident, namely: necessary nursing service; laboratory, radiological and other diagnostic procedures,
together with the necessary interpretations for the
purpose of assisting in the diagnosis and treatment
of an injury; drugs, biologicals and related preparations as provided in Schedule B, when administered
in a hospital; use of operating room and anaesthetic
169
Chapter 3: Yukon
facilities, including necessary equipment and supplies;
routine surgical supplies; services rendered by persons
who receive remuneration therefore from the hospital;
use of radiotherapy facilities where available; and use
of physiotherapy facilities where available.
Pursuant to the Hospital Insurance Services Regulations, all in- and out-patient services provided in
an approved hospital by hospital employees are
insured services. Standard nursing care, pharmaceuticals, supplies, diagnostic and operating services are
provided. Any new programs or enhancements with
significant funding implications or reductions to
services or programs require the prior approval
of the Minister, Department of Health and Social
Services. This process is managed by the Director,
Insured Health and Hearing Services. Public representation regarding changes in service levels is
made through membership on the hospital board.
Additional funds have been provided to Yukon to assist
patients with recourse options who have orthopaedic
(knees and hip) or ophthalmology surgery requirements. It is hoped that the investment of these funds
will result in a significant reduction in the wait times.
These measures will help reduce the Territory’s
reliance on out-of-territory services.
2.2 Insured Physician Services
Sections 1 to 8 of the Health Care Insurance Plan
Act and sections 2, 3, 7, 10 and 13 of the Health Care
Insurance Plan Regulations provide for insured physician services. There were no amendments made to
these sections of the legislation in 2008–2009.
The Yukon Health Care Insurance Plan covers physicians providing medically required services. The
conditions a physician must meet to participate in
the Yukon Health Care Insurance Plan are to:
• register for licensure pursuant to the Medical
Professions Act; and
• maintain licensure, pursuant to the Medical
Professions Act.
The estimated number of resident physicians participating in the Yukon Health Care Insurance Plan in
2008–2009 was 67.
Section 7(5) of the Yukon Health Care Insurance Plan
Regulations allows physicians in the Territory to
bill patients directly for insured services by giving
notice in writing of this election. In 2008–2009, no
170
physicians provided written notice of their election
to collect fees other than from the Yukon Health Care
Insurance Plan.
Insured physician services in the Yukon are defined
as medically required services rendered by a medical
practitioner. Services not insured by the Plan are listed
in section 3 of the Regulations. Services not covered
by the Plan include advice by telephone; medical-legal
services; preparation of records and reports; services
required by a third party; cosmetic services; and services determined to be not medically required.
The process used to add a new fee to the Payment
Schedule for Yukon is administered through a committee structure. This process requires physicians to
submit requests in writing to the Yukon Health Care
Insurance Plan/Yukon Medical Association Liaison
Committee.
Following review by this committee, a decision is
made to include or exclude the service. The relevant
costs or fees are normally set in accordance with
similar costs or fees in other jurisdictions. Once a
fee-for-service value has been determined, notification
of the service and the applicable fee is provided to all
Yukon physicians. Public consultation is not required.
Alternatively, new fees can be implemented as a
result of the fee negotiation process between the
Yukon Medical Association and the Department of
Health and Social Services. The Director, Insured
Health and Hearing Services, manages this process
and no public consultation is required.
2.3 Insured Surgical-Dental Services
Dentists providing insured surgical-dental services
under the health care insurance plan of the Territory
must be licensed pursuant to the Dental Professions
Act and are given billing numbers to bill the Yukon
Health Care Insurance Plan for providing insured
dental services. In 2008–2009, one dentist billed the
Plan for insured dental services that were provided
to Yukon residents. The Plan is also billed directly
for services provided outside the territory.
Dentists are able to opt out of the health care plan
in the same manner as physicians. In 2008–2009, no
dentists provided written notice of their election to
collect fees other than from the Yukon Health Care
Insurance Plan.
Insured dental services are limited to those surgicaldental procedures listed in Schedule B of the
Regulations and require the unique capabilities
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
of a hospital for their performance (e.g., surgical
correction of prognathism or micrognathia).
The addition or deletion of new surgical-dental
services to the list of insured services requires
amendment by Order-in-Council to Schedule B of
the Regulations Respecting Health Care Insurance
Services. Coverage decisions are made on the basis
of whether or not the service must be provided in
hospital under general anaesthesia. The Director,
Insured Health and Hearing Services, administers
this process.
2.4 Uninsured Hospital, Physician
and Surgical-Dental Services
Only services prescribed by and rendered in accordance with the Health Care Insurance Plan Act and
Regulations and the Hospital Insurance Services Act
and Regulations are insured. All other services are
uninsured.
Uninsured physician services include: services
that are not medically necessary; charges for long
distance telephone calls; preparing or providing
a drug; advice by telephone at the request of the
insured person; medico legal services including
examinations and reports; cosmetic services;
acupuncture; and experimental procedures.
Section 3 of the Yukon Health Care Insurance
Plan Regulations contains a non-exhaustive list
of services that are prescribed as non-insured.
Uninsured hospital services include: non-resident
hospital stays; special/private nurses requested by
the patient or family; additional charges for preferred
accommodation unless prescribed by a physician;
crutches and other such appliances; nursing home
charges; televisions; telephones; and drugs and biologicals following discharge. (These services are not
provided by the hospital.)
Uninsured dental services include: procedures
considered restorative; and procedures that are not
performed in a hospital under general anaesthesia.
Further, the Act states that any service that a person
is eligible for, and entitled to, under any other Act is
not insured.
All Yukon residents have equal access to services.
Third parties, such as private insurers or the Worker’s
Compensation Health and Safety Board, do not receive
priority access to services through additional payment.
Canada Health Act — Annual Report 2008–2009
The purchase of non-insured services, such as
fibreglass casts, does not delay or prevent access
to insured services at any time. Insured persons
are given treatment options at the time of service.
The Territory has no formal process to monitor
compliance; however, feedback from physicians,
hospital administrators, medical professionals
and staff allows the Director, Insured Health and
Hearing Services, to monitor usage and service
concerns.
Physicians in the Territory may bill patients directly
for non-insured services. Block fees are not used at
this time; however, some do bill by service item.
Billable services include, but are not limited to, completion of employment forms; medical-legal reports;
transferring records; third party examinations; some
elective services; and telephone prescriptions, advice
or counselling. Payment does not affect patient access
to services because not all physicians or clinics bill
for these services and other agencies or employers may
cover the cost.
The process used to de-insure services covered by the
Yukon Health Insurance Plan is as follows:
• Physician services — the Yukon Health Care
Insurance Plan/Yukon Medical Association
Liaison Committee is responsible for reviewing
changes to the Payment Schedule for Yukon,
including decisions to de-insure certain services. In consultation with the Yukon Medical
Advisor, decisions to de-insure services are
based on medical evidence that indicates the
service is not medically necessary, is ineffective
or a potential risk to the patient’s health. Once
a decision has been made to de-insure a service, all physicians are notified in writing. The
Director, Insured Health and Hearing Services,
manages this process. No services were removed
from the Payment Schedule for Yukon in fiscal
year 2008–2009.
• Hospital services — an amendment by OrderIn-Council to section 2 (e) (f ) of the Yukon
Hospital Insurance Services Regulations would
be required. As of March 31, 2009, no insured
in-patient or out-patient hospital services, as
provided for in the Regulations, have been
de-insured. The Director, Insured Health and
Hearing Services, is responsible for managing
this process in conjunction with the Yukon
Hospital Corporation.
171
Chapter 3: Yukon
• Surgical-dental services — an amendment by
Order-In-Council to Schedule B of the Regulations
Respecting Health Care Insurance Services is
required. A service could be de-insured if determined not medically necessary or is no longer
required to be carried out in a hospital under general anaesthesia. The Director, Insured Health and
Hearing Services, manages this process.
3.0 Universality
3.1
Eligibility
Eligibility requirements for insured health services
are set out in the Health Care Insurance Plan Act and
Regulations, sections 2 and 4 respectively, and the
Hospital Insurance Services Act and Regulations, sections 2 and 4 respectively. Subject to the provisions of
these Acts and Regulations, every Yukon resident is
eligible for and entitled to insured health services on
uniform terms and conditions. The term “resident” is
defined using the wording of the Canada Health Act
and means a person lawfully entitled to be or to remain
in Canada, who makes his or her home and is ordinarily present in the Yukon, but does not include a tourist,
transient or visitor to the Yukon. Where applicable, the
eligibility of all persons is administered in accordance
with the Inter-Provincial Agreement on Eligibility and
Portability.
Under section 4(1) of both Regulations “an insured
person is eligible for and entitled to insured services
after midnight on the last day of the second month
following the month of arrival to the Territory”.
Changes affecting eligibility made to the legislation
in 2004–2005 now require that all persons returning
to or establishing residency in Yukon complete the
waiting period. The only exception is for children
adopted by insured persons.
The following persons are not eligible for coverage in
the Yukon:
• persons entitled to coverage from their home
province or territory (e.g., students and workers
covered under temporary absence provisions);
• visitors to the Territory;
• refugee claimants;
172
• members of the Canadian Forces;
• convention refugees;
• members of the Royal Canadian Mounted Police
(RCMP);
• inmates in federal penitentiaries;
• study permit holders, unless they are a child and
they are listed as the dependent of a person who
holds a one year work permit; and
• employment authorizations of less than one year.
The above persons may become eligible for coverage
if they meet one or more of the following conditions:
• establish residency in the Territory;
• become a permanent resident; and
• the day following discharge or release if
stationed in or resident in the Territory.
3.2 Registration Requirements
Section 16 of the Health Care Insurance Plan Act
states: “Every resident other than a dependant or a
person exempted by the Regulations from so doing,
shall register himself and his dependants with the
Director, Insured Health and Hearing Services, at
the place and in the manner and form and at the
times prescribed by the Regulations”. Registration is
administered in accordance with the Inter-Provincial
Agreement on Eligibility and Portability.
Persons and dependants under the age of 19 who
move permanently to the Yukon are advised to apply
for health care insurance upon arrival. Application
is made by completing a registration form available
from the Insured Health and Hearing Services office
or community Territorial Agents. Once coverage
becomes effective, a health care card is issued.
Family members receive separate health care cards
and numbers. Health care cards expire every year
on the resident’s birthday and an updated label with
the new expiry date is mailed out accordingly.
As of March 31, 2009, there were 33,983 residents
registered with the Yukon Health Care Insurance
Plan. There were no residents who notified Insured
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
Health Services of their decision to opt out of the
Yukon Health Care Insurance Plan in 2008–2009.
3.3 Other Categories of Individual
The Yukon Health Care Insurance Plan provides health
care coverage for other categories of individuals, as
follows:
• Returning Canadians — waiting period
is applied
• Permanent Residents — waiting period
is applied
• Minister’s Permit — waiting period is applied,
if authorized
• Foreign Workers — waiting period is applied,
if holding Employment Authorization
• Clergy — waiting period is applied, if holding
Employment Authorization
Employment Authorizations must be in excess of
12 months.
The estimated number of new individuals receiving
coverage in 2008–2009 under the following conditions is:
• Returning Canadians — 96
• Permanent Residents — 558
• Minister’s Permit — 0
• Convention Refugees — 0
• Armed Forces — 7
• RCMP — 16
The estimated number of individuals receiving coverage in 2008–2009 under the following conditions is:
• Foreign Workers — 250
• Clergy — 0
3.4 Premiums
The payment of premiums by Yukon residents was
eliminated on April 1, 1987.
Canada Health Act — Annual Report 2008–2009
4.0 Portability
4.1
Minimum Waiting Period
Pursuant to section 4(1) of the Yukon Health Care
Insurance Plan Regulations and the Yukon Hospital
Insurance Services Regulations, “an insured person
is eligible for and entitled to insured services after
midnight on the last day of the second month following the month of arrival to the Territory”. All persons
entitled to coverage are required to complete the minimum waiting period with the exception of children
adopted from outside Canada by insured persons.
(See section 3.1.)
4.2 Coverage During Temporary
Absences in Canada
The provisions relating to portability of health care
insurance during temporary absences outside Yukon,
but within Canada, are defined in sections 5, 6, 7
and 10 of the Yukon Health Care Insurance Plan
Regulations and sections 6, 7(1), 7(2), and 9 of the
Yukon Hospital Insurance Services Regulations.
The Regulations state that “where an insured person
is absent from the Territory and intends to return,
he is entitled to insured services during a period of
12 months continuous absence”. Persons leaving the
Territory for a period exceeding three months are
advised to contact the Yukon Health Care Insurance
Plan and complete a form of “Temporary Absence”.
Failure to do so may result in cancellation of the
coverage.
Students attending educational institutions outside
the Territory remain eligible for the duration of their
academic studies. The Director, Insured Health and
Hearing Services, may approve other absences in
excess of 12 consecutive months upon receiving a
written request from the insured person. Requests
for extensions must be renewed yearly and are subject to approval by the Director.
For temporary workers and missionaries, the Director,
Insured Health and Hearing Services, may approve
absences in excess of 12 consecutive months upon
receiving a written request from the insured person.
Requests for extensions must be renewed yearly and
are subject to approval by the Director.
173
Chapter 3: Yukon
The provisions regarding coverage during temporary absences in Canada fully comply with the terms
and conditions of the Inter-Provincial Agreement on
Eligibility and Portability effective February 1, 2001.
Definitions are consistent in regulations, policies and
procedures.
No amendments were made to these sections of the
legislation in 2008–2009.
The Yukon participates fully with the Inter-Provincial
Medical Reciprocal Billing Agreements and Hospital
Reciprocal Billing Agreements in place with all other
provinces and territories with the exception of Quebec,
which does not participate in the medical reciprocal billing arrangement. Persons receiving medical
(physician) services in Quebec may be required to
pay directly and submit claims to the Yukon Health
Care Insurance Plan for reimbursement.
The Hospital Reciprocal Billing Agreements provide
for payment of insured in-patient and out-patient hospital services to eligible residents receiving insured
services outside the Yukon, but within Canada.
The Medical Reciprocal Billing Agreements provide
for payment of insured physician services on behalf
of eligible residents receiving insured services outside the Yukon, but within Canada. Payment is made
to the host province at the rates established by that
province.
Insured services provided to Yukon residents while
temporarily absent from the Territory are paid at the
rates established by the host province. The following
amounts were paid to out-of-territory hospitals for
the fiscal year 2008–2009:
• In-patient services — $11,183,888
• Out-patient services — $2,888,247
These figures are by date of service and may be subject to adjustment.
In 2008–2009 payments to out-of-territory physicians
totalled $2,297,501.
4.3 Coverage During Temporary
Absences Outside Canada
The provisions that define portability of health care
insurance to insured persons during temporary
absences outside Canada are defined in sections 5,
6, 7, 9, 10 and 11 of the Yukon Health Care Insurance
Plan Regulations and sections 6, 7(1), 7(2) and 9 of
the Yukon Hospital Insurance Services Regulations.
174
No amendments were made to these sections of the
legislation in 2008–2009. Sections 5 and 6 state that
“Where an insured person is absent from the Territory
and intends to return, he is entitled to insured services
during a period of 12 months continuous absence”.
Persons leaving the Territory for a period exceeding three months are advised to contact the Yukon
Health Care Insurance Plan and complete a form of
“Temporary Absence.” Failure to do so may result
in cancellation of the coverage.
The provisions for portability of health insurance
during out-of-country absences for students, temporary workers and missionaries are the same as for
absences within Canada. (See section 4.2.)
Insured physician services provided to eligible Yukon
residents temporarily outside the country are paid at
rates equivalent to those paid had the service been
provided in the Yukon. Reimbursement is made to the
insured person by the Yukon Health Care Insurance
Plan or directly to the provider of the insured service.
Insured in-patient hospital services provided to eligible Yukon residents outside Canada are paid at the rate
established in the Standard Ward Rates Regulation for
the Whitehorse General Hospital. The standard ward
rate for the Whitehorse General Hospital as of April 1,
2008 was $1,473 and April 1, 2009 was $1,605. This
rate is established through Order-in-Council and is
derived as follows:
• Standard Ward Rate = (total operating expenses –
non-related in-patient costs – related newborn costs
– associated out-patient costs) / (total patient days –
patient days for other services; e.g., non-Canadians).
Insured out-patient hospital services provided to
eligible Yukon residents outside Canada are paid
at the rate established in the Charges for OutPatient Procedures Regulation. The out-patient
rate as of April 1, 2008 was $231 and April 1, 2009
was $238 and is established through Order-inCouncil and derived by the Inter-provincial Health
Insurance Agreements Coordinating Committee
(IHIACC).
The following amounts were paid in 2008–2009 for
elective and emergency services provided to eligible
Yukon residents outside Canada:
• In-patient services — $12,003
• Out-patient services — $8,233
These figures are by date of service and may be subject to adjustment.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
4.4 Prior Approval Requirement
Treatment Program. These programs ensure that there
is minimal or no delay in receiving medically necessary services.
There is no legislated requirement that eligible
residents must seek prior approval before seeking
elective or emergency hospital or physician services
outside Canada.
There is no extra-billing in the Yukon for any services
covered by the Plan.
5.2 Access to Insured Hospital Services
5.0 Accessibility
Pursuant to the Hospital Act, the “Legislature and
Government have responsibility to ensure the availability of necessary hospital facilities and programs”.
The Minister must approve any significant changes
to the level of service delivery. Acute care beds are
readily available and no waitlist for admission exists
at either of Yukon’s two acute care facilities. The estimated number of full-time equivalent (FTEs) nurses
and other health care professionals working in facilities providing insured hospital services in the Yukon
as of March 31, 2009, is:
5.1 Access to Insured Health Services
There are no user fees or co-insurance charges under
the Yukon Health Care Insurance Plan or the Yukon
Hospital Insurance Services Plan. All services are
provided on a uniform basis and are not impeded by
financial or other barriers.
Access to hospital or physician services not available
locally are provided through the Visiting Specialist
Program, Telehealth Program or the Travel for Medical
Profession
Whitehorse
General Hospital
Watson Lake
Cottage Hospital
# of FTEs
# of FTEs
Registered Nurses
79.42
7.5
Licensed Practical
8.00
0
0
0
Social Worker
1.00
0
Pharmacist
2.27
0
Physiotherapist
4.55
0
Occupational Therapist
1.40
0
0
0
34.64
0
5.0
0
Public Health
0
2.00
Home Care
0
1.00
Nurse Practitioner
Psychologist
Medical Lab/X-Ray
Dietician
Canada Health Act — Annual Report 2008–2009
175
Chapter 3: Yukon
The Whitehorse General Hospital and Community
Nursing manage the supply of nurses and health care
professionals in the Territory’s two hospitals with the
Department of Health and Social Services. Shortfalls
in staffing are covered by temporary, casual or auxiliary workers to ensure residents have continued
access to insured services.
Recruitment and Retention
Recruitment and retention initiatives include:
Community Nursing
A Yukon Advisory Committee on Nursing was struck
to advise the Department of Health and Social Services
on nursing issues. Recommendations will help Yukon
recruit and retain nurses in both the long and short
term. Yukon is providing:
Elective surgery patients are normally seen within
one to two weeks. The number of Visiting Specialist
clinics is routinely adjusted to address wait times,
particularly for orthopaedics, ear/nose/throat and
ophthalmology (see section 5.3).
Surgical services provided include:
• minor orthopaedics;
• selected major orthopaedics;
• gynecology/obstetrical;
• paediatrics;
• general abdominal;
• mastectomy;
• emergency trauma;
• competitive salaries;
• ear/nose/throat/otolaryngology; and
• recruitment and retention bonuses;
• ophthalmology including cataracts.
• participation at job fairs;
• training and educational opportunities;
• travel bonus / $2,000 after one year; and
• relief positions.
Whitehorse General Hospital
• competitive salaries;
• wage scale recognizes experience;
• cooperative work schedules;
• on-site fitness centre/24-hour;
• monthly clinical skill development;
• continuing education/development; and
• travel bonus / $2,000 after one year.
Facilities
Whitehorse General Hospital
As the only major acute care hospital facility in the
Territory, this facility provides in-patient, out-patient
and 24-hour emergency services. Local physicians
provide Emergency Department services on rotation.
Emergency surgery patients at the Whitehorse General
Hospital are normally seen within 24 hours.
176
Diagnostic services include:
• radiology (including ultrasound, computed
tomography, x-ray and mammography);
• laboratory;
• electrocardiogram; and
• cardiac stress testing.
Selected rehabilitative services are available through
out-patient therapies.
Watson Lake Hospital
This primary acute care facility is located in Watson
Lake. Medical services include emergency trauma,
low-risk maternity, medicine, paediatrics, palliative
and respite care. Diagnostic services include x-ray,
laboratory and electrocardiogram. This is a 12-bed
facility and there is no waitlist for admission.
Health Centres
Out-patient and 24-hour emergency services are
provided at the remaining 13 community Health
Centres by Community Nurse Practitioners and
auxiliary nursing staff.
Patients requiring insured hospital services not
available locally are transferred to acute care
facilities in territory or out-of-territory through
the Travel for Medical Treatment Program.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
Measures to Improve Access
• General/Family Practitioners — 58
A number of measures have been taken to better
manage access to insured hospital services. The
Department of Health and Social Services continues
to work with the Yukon Hospital Corporation and
Community Nursing to ensure the current waiting
time for insured hospital services in the Territory
is reduced or maintained at existing levels. For
example:
• Specialists — 9
• Heart defibrillators were made available in all
rural Yukon Health Centres. This provides an
important tool for Community Nurse Practitioners
and improves local access to cardiac care.
• Officials from the Department attend nursing
recruitment fairs across Canada and provide
information on working in the Territory to
nurses in attendance.
• The Technical Review Committee continues to
make recommendations to the Department on
health programs and services in the Yukon as
required. Its mandate is to develop criteria for
initiating, eliminating, expanding or reducing
programs or services.
• Telehealth provides real-time video in all Yukon
communities, giving outlying rural communities
access to Whitehorse. As well, Whitehorse and
the rural communities can access services from
outside centres in British Columbia or Alberta.
• Telehealth educational sessions continue to
occur regularly between Whitehorse and rural
Yukon as well as between Whitehorse and
British Columbia. These sessions are attended
by patients, physicians, nurses, social workers,
psychiatrists, mental health counsellors and
allied professionals such as Community Health
Representatives and First Nation Wellness
workers.
• Dentists — 1
Beyond the usual distribution of physicians and
specialists in the Territory, uniform access to
insured physician and dental services is ensured
through the Travel for Medical Treatment Program.
This program covers the cost of medically necessary
transportation, allowing eligible persons to access
services that are not available in their home communities. Eligible persons are routinely sent to
Whitehorse, Vancouver, Edmonton or Calgary to
receive services.
Most physicians in the Yukon are located in Whitehorse.
Beyond Whitehorse, only two rural communities have
resident fee-for-service physicians: Dawson City and
Watson Lake. One contracted physician provides resident services in Mayo.
The Visiting Physician Program provides local access
to insured physician services to 10 rural and remote
locations. The frequency of visiting clinics is based
on demand and utilization. Physicians providing
visiting services through this program are compensated under contract for travel time, mileage, meals
and accommodation, in addition to a sessional rate
or fee-for-service billings.
In addition, the Department of Health and Social
Services and the Visiting Specialist Program provide
local access at the Whitehorse General Hospital, Mental
Health Services or the Yukon Communicable Disease
Unit to non-resident visiting specialist services not
regularly available in the Territory. Visiting specialists
are reimbursed for expenses in addition to a sessional
rate or fee-for-service billings.
The number of specialists providing services under
the Visiting Specialist Program and the Department
of Health and Social Services is:
5.3 Access to Insured Physician and
Surgical-Dental Services
• Ophthalmology — 2
Existing legislation and administration of services
provides all eligible Yukon residents with equal
access to insured physician and dental services on
uniform terms and conditions.
• Internal Medicine — 2
The following resident physicians, specialists
and dentists provided services in the Yukon as
of March 31, 2009, (see Statistical Table item #14):
Canada Health Act — Annual Report 2008–2009
• Oncology — 3
• Otolaryngology — 2
• Neurology — 2
• Dermatology — 2
• Infectious Disease — 1
177
Chapter 3: Yukon
• Psychiatry — 2
• Orthopaedics — 5
• Cardiology — 3
Visiting Specialist clinics at Whitehorse General
Hospital are held between one and eight times per
year depending on demand and availability of
specialists. As of December 1, 2009, the waitlist for
non-emergency specialist services was estimated at:
• Ophthalmology (general) — 18 to 24 months
• Ophthalmology (cataracts) — 1 to 3 months
• Orthopaedics — 6 to 24 months
• Otolaryngology — 2 to 4 months
• Rheumatology — 1 to 4 months
Visiting Specialist Clinics at the Satellite clinic are
held between one and twelve times per year depending on demand and availability of specialists. As
of March 31, 2009, the waitlist for non-emergency
specialist services was estimated at:
• Neurology — 1 to 4 months
• Gastroenterology — 1 to 6 months
• Support students in obtaining health profession
education through bursaries in medicine, nursing and other health professions.
• Support entry to practice in the Yukon with
incentive programs for physicians to enter
practice and with mentorship of other health
professionals, including nurses, social workers
and rehabilitation therapists. Incentives for new
Canadian medical graduates are provided over
several years to encourage retention.
• Support development of the Yukon health workforce through funding of education to support
service needs.
• Support collaboration within the health care
system. At present, collaboration is supported
through the Yukon Chronic Disease Management Program. Future initiatives will be planned
in collaboration with health professionals.
• Improve Health Human Resource Planning
capacity, including foundational policy, data
and communications.
Physicians have indicated that they are interested in
exploring new models for health care provision. The
Government is working with physicians in Yukon to
facilitate this.
• Internal Medicine — 1 to 2 months
Dental surgery services are not provided through the
Visiting Specialist as administered by the Whitehorse
General Hospital. There are no waitlists for visiting
services not included in the above listing. Patients are
seen on the next scheduled visit.
The Department of Health and Social Services has
taken several measures to reduce waiting times for
insured physician services. A variety of recruitment
and retention initiatives were begun in 2001–2002 and
2002–2003 such as a Resident Support Program; Locum
Support Program; Physician Relocation Program;
Education Support; and a Rural Training Fund. The
Department of Health and Social Services continues
to work with the Yukon Medical Association to find
additional cooperative initiatives to be implemented
within the terms of the Memorandum of Understanding
in effect for the duration of this reporting period.
The Department of Health and Social Services began
development of a Health Human Resource Strategy in
2006. The strategy includes initiatives to:
• Attract people into health care professions
through provision of updated information at
career fairs.
178
5.4 Physician Compensation
The Department of Health and Social Services seeks
its negotiating mandate from the Government of
Yukon, before entering into negotiations with the
Yukon Medical Association (YMA). The YMA and
the Government each appoint members to the negotiating team. Meetings are held as required until an
agreement has been reached. The YMA’s negotiating
team then seeks approval of the tentative agreement
from the YMA membership. The Department seeks
ratification of the agreement from the Government of
Yukon. The final agreement is signed with the concurrence of both parties.
The Memorandum of Understanding in effect for the
time period of this report came into effect April 1,
2008, ending March 31, 2012. That MOU established
the terms and conditions for payment of physicians.
The legislation governing payments to physicians
and dentists for insured services are the Health Care
Insurance Plan Act and the Health Care Insurance
Plan Regulations. No amendments were made to
these sections of the legislation in 2008–2009.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
The fee-for-service system is used to reimburse
the majority of physicians and dentists providing
insured services to residents. In 2008–2009, one
full-time resident rural physician and four resident
specialists were compensated on a contractual basis.
A number of physicians providing visiting clinics in
outlying communities were paid a sessional rate for
services.
5.5 Payments to Hospitals
The Government of Yukon funds the Yukon Hospital
Corporation (Whitehorse General Hospital) through
global contribution agreements with the Department
of Health and Social Services. Global operations
and maintenance (O&M) and capital funding levels
are negotiated and adjusted based on operational
requirements and utilization projections from prior
years. In addition to the established O&M and capital funding set out in the agreement, provision is
made for the hospital to submit requests for additional funding assistance for implementing new
or enhanced programs.
Only the Whitehorse General Hospital is funded
directly through a contribution agreement. The
Watson Lake Cottage Hospital and all Health Centres
are funded through the Yukon government’s budget
process.
The legislation governing payments made by the
health care plan to facilities that provide insured
hospital services is the Hospital Insurance Services
Plan Act and Regulations. The legislation and
Regulations set out the legislative framework for
payment to hospitals for insured services provided
by that hospital to insured persons. No amendments
were made to these sections of the legislation in
2008–2009.
6.0 Recognition Given to
Federal Transfers
The Government of Yukon has acknowledged the
federal contributions provided through the Canada
Health and Social Transfer (CHST) in its 2008–2009
annual Main Estimates and Public Accounts publications, which are available publicly. Section 3(1) (d) (e)
of the Health Care Insurance Plan Act and section 3
of the Hospital Insurance Services Act acknowledge
the contribution of the Government of Canada.
Canada Health Act — Annual Report 2008–2009
7.0 Extended Health Care
Services
7.1
Nursing Home Intermediate Care
and Adult Residential Care
Continuing Care Health Services are available to
eligible Yukon residents. In 2007–2008, there were
three facilities providing services in the Yukon.
These facilities provide one or more of the following
services:
• personal care;
• extended care services;
• intermediate care;
• special care;
• complex care;
• respite care;
• day program; and
• meals on wheels.
In total, there were 151 continuing care beds in the
Territory in 2008–2009.
Home Care Services
The Yukon Home Care Program provides assessment
and treatment, care management, personal support,
homemaking services, social support, respite services and palliative care. In Whitehorse, services are
provided by home support workers, nurses, social
workers and therapists. Some rural communities
have a dedicated home care nurse, though many rural
communities provide nursing services through the
community nursing program. Home support workers
assist clients with personal care, homemaking and
respite services. Therapy services are provided by a
travelling regional team of physiotherapists and occupational therapists. Services are available Monday
through Friday. In Whitehorse, additional services
such as planned weekend and evening support may
be provided. Twenty-four hour care is not available.
There is no legislated requirement for home care services in Yukon. No other major changes were made
in the administration of these services in 2008–2009.
179
Chapter 3: Yukon
7.3
Ambulatory Health Care Services
The Yukon Home Care Program provides the majority
of ambulatory health care services outside institutional
settings. Most other services are provided through
Community Nursing or Public Health. All residents
have equal access to services.
These services are not provided for in legislation.
In addition to the services described above, the following are also available to eligible Yukon residents
outside the requirements of the Canada Health Act:
• The Chronic Disease and Disability Benefits
Program provides benefits for eligible Yukon
residents who have specific chronic diseases
or serious functional disabilities: coverage of
related prescription drugs and medical surgical
supplies and equipment. (Chronic Disease and
Disability Benefits Regulation)
• The Pharmacare Program and Extended Benefits
programs are designed to assist registered senior
citizens with the cost of prescription drugs, dental care, eye care, hearing services and medical
surgical supplies and equipment. (Pharmacare
Plan Regulation and Extended Health Care Plan
Regulation)
• The Travel for Medical Treatment Program assists
eligible Yukon residents with the cost of emergency and non-emergency medically necessary air
and ground transportation to receive services not
available locally. (Travel for Medical Treatment
Act and Travel for Medical Treatment Regulation)
180
• The Children’s Drug and Optical Program is
designed to assist eligible low-income families
with the cost of prescription drugs, eye exams
and eye glasses for children 18 and younger.
(Children’s Drug and Optical Program Regulation)
• Mental Health Services provide assessment,
diagnostic, individual and group treatment,
consultation and referral services to individuals
experiencing a range of mental health problems. (Mental Health Act and Mental Health
Act Regulations)
• Public Health is designed to promote health and
well-being throughout the Territory through a
variety of preventive and education programs.
This is a non-legislated program.
• Emergency Medical Services is responsible for
the emergency stabilization and transportation
of sick and injured persons from an accident
scene to the nearest health care facility capable
of providing the required level of care. This is a
non-legislated program.
• Hearing Services provides services designed to
help people of all ages with a variety of hearing
disorders, by providing routine and diagnostic
hearing evaluations and community outreach.
This is a non-legislated program.
• Dental Services provides a comprehensive diagnostic, preventive and restorative dental service
to children from preschool to grade eight in
Whitehorse and Dawson City. All other Yukon
communities receive services for preschool to
grade 12. This is a non-legislated program.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Yukon
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
31,505
32,226
33,103
33,423
33,983
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
2
2
2
2
2
b. chronic care
0
0
0
0
0
c. rehabilitative care
d. other
e. total
0
0
0
0
0
13
13
13
13
13
15
15
15
15
15
26,255,596
26,867,501
36,330,706
33,825,619
38,283,525
not applicable
1
3. Payments for insured health services ($):
2
a. acute care
b. chronic care
not applicable
not applicable
not applicable
not applicable
c. rehabilitative care
not applicable
not applicable
not applicable
not applicable
d. other
6,509,897
6,862,368
7,718,344
10,748,019
e. total
32,765,493
33,729,869
44,049,050
44,573,638
10,767,965
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
not applicable
2
49,051,490
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
Insured Hospital Services Provided to residents in another province or territory
2004–2005
2005–2006
2006–2007
2007–2008
674
714
738
976
1,013
5,857,725
8,698,387
8,808,130
10,742,393
11,183,888
7,412
8,450
8,735
9,027
9,983
1,306,531
1,735,520
2,168,964
2,155,225
2,888,247
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2008–2009
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
14
15
11
15
13
30,566
43,454
20,257
32,075
12,003
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
64
55
42
74
40
9,965
8,372
7,101
11,782
8,233
1. 13 Health Centres (Beaver Creek, Destruction Bay, Carcross, Carmacks, Dawson, Faro, Haines Junction, Mayo, Old Crow, Pelly Crossing, Ross River, Teslin and Whitehorse).
2. Added Whitehorse Health Centre expenditures for 2007/08.
Canada Health Act — Annual Report 2008–2009
181
Chapter 3: Yukon
Insured PHYSICIAN Sevices Within Own Province or TErrITitory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
54
55
57
58
58
14.Number of participating physicians (#):
a. general practitioners
b. specialists
8
9
9
9
9
c. other
0
0
0
0
0
d. total
62
64
66
67
67
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
238,797
248,646
254,170
280,718
304,487
12,892,522
13,752,251
13,788,028
16,342,282
19,139,117
219,031
225,815
245,069
255,143
277,118
9,201,579
9,847,991
11,076,701
12,003,059
14,159,297
13,035
17,127
32,272
17,936
18,099
1,495,701
1,886,289
2,232,060
2,124,340
2,135,068
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Visiting Specialists, Locum Doctors
and Member Reimbursements 3
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
35,401
35,781
39,669
38,512
45,744
1,921,260
1,873,508
2,139,805
1,977,052
2,297,501
Insured Physician Services Provided Outside Canada
21.Number of services (#).
not available
not available
not available
not available
not available
22.Total payments ($).
not available
not available
not available
not available
not available
Insured Surgical-Dental Services Within Own Province or Territory 4
23.Number of participating dentists (#).
24.Number of services provided (#).
25.Total payments ($).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
6
6
2
1
1
30
24
2
1
20
29,712
25,072
941
587
4,723
3. Includes Visiting Specialists, Member Reimbursements, Locum Doctors, and Optometrist testing paid through fee-for-service. Excludes services and costs provided by alternative
payment agreements.
4. Includes direct billings for insured surgical-dental services received outside the territory.
182
Canada Health Act — Annual Report 2008–2009
Chapter 3: Northwest Territories
• Initiating work on a new Health Information
Act, including the establishment of an Experts
Panel and a Northerners Panel. The Experts
Panel includes representation from the NWT
Information and Privacy Commissioner, physicians, nurses and pharmacists, while the
Northerners Panel is composed of members
of the public.
Northwest Territories
Introduction
In the Northwest Territories (NWT), the Department of Health and Social Services (henceforth
the Department), together with seven Health and
Social Services Authorities (HSSAs) and the Tlicho
Community Services Agency (TCSA), plan, manage,
and deliver a wide spectrum of community and facility-based services for health care and social services.
Community health programs include drop-in clinics,
public health clinics, home care, mental health and
addictions, child protection, school health programs,
and educational programs. Communities without
resident health care providers, such as physicians,
are routinely visited.
As of April 1, 2009, there were more than 42,800 people
living in the Northwest Territories, half of whom are
Aboriginal. The NWT continues to have a relatively
young population and a high birth rate, combined now
with a fast growing seniors population. According
to 2008 population estimates, approximately 24 percent of the NWT population is under 15 years of age,
compared with 17 percent in the overall Canadian
population.1
During the reporting period, the Department undertook several important initiatives, including:
• Conducting extensive consultations in preparation for a forthcoming Medical Profession Act
Bill. The Bill is designed to replace the current
legislation, as well as modernize the processes
for the registration and discipline of medical
practitioners in the Northwest Territories.
• Drafting of regulations for the Public Health
Act, which was passed the previous year.
Among the regulations worked on are those
for water supply systems, disease surveillance,
and food establishment safety.
• Initiating work on a new system-wide action plan
as well as implementation of an accreditation
process for all hospitals and Health and Social
Service Authorities across the NWT.
The Department maintains a bilingual (English
and French) public website (www.hlthss.gov.nt.ca)
that provides an exhaustive source of information,
including electronic copies of reports published by
the Department and public health advisories.
1.0 Public Administration
1.1 Health Care Insurance Plans and
Public Authority
The NWT Health Care Plan includes the Medical
Care Plan and the Hospital Insurance Plan. The
public authority responsible for administering
the Medical Care Plan is the Director of Medical
Insurance as appointed under the Medical Care Act.
The Minister administers the Hospital Insurance
Plan through Boards of Management established
under section 10 of the Hospital Insurance and
Health and Social Services Administration Act
(HIHSSA).
Legislation that enables the Health Care Insurance
Plan in the NWT includes the Medical Care Act and
Hospital Insurance and Health and Social Services
Administration Act.
1. Statistics Canada & NWT Bureau of Statistics.
Canada Health Act — Annual Report 2008–2009
183
Chapter 3: Northwest Territories
1.2 Reporting Relationship
2.0 Comprehensiveness
Reporting to the Minister, the Department, the
HSSAs and the TCSA plan, manage, and deliver a
wide spectrum of community and facility-based
services for health care and social services.
2.1 Insured Hospital Services
In the NWT, the Minister of Health and Social
Services appoints a Director of Medical Insurance.
The Director is responsible for administering the
Medical Care Act and the Regulations and to report
to the Minister concerning the operation of the
Medical Care Plan.
During 2008–2009, four hospitals and 28 health
centres delivered insured hospital services to both
in- and out-patients.
The Minister also appoints public members to a Board
of Management for each Health and Social Services
Authority in the NWT. Boards of Management provide NWT residents with the opportunity to shape
priorities and service delivery for their communities.
The Boards manage, control and operate health and
social services facilities within the government’s
existing resources; policies and directions and are
accountable to the Minister. The Boards’ chairpersons hold office indefinitely, while other members
hold office for three-year terms. The exception is the
TCSA, where every Tlicho community government is
responsible for appointing one member to the Board,
for a maximum of four years. The Minister responsible for the Department of Aboriginal Affairs and
Intergovernmental Relations will, after consulting
with the members appointed by the community
governments, appoint a chairperson and fix the
length of that term.
An annual audit of accounts is performed on each
Board of Management. In addition, the Minister and
Deputy Minister have regular meetings with Board
of Management chairpersons, which allow the chairpersons to provide non-financial reporting.
1.3 Audit of Accounts
The Hospital Insurance Plan and the Medical
Care Plan are administered by the Department of
Health and Social Services. The Office of the Auditor
General of Canada (OAG) audits the payments made
under each plan, as part of the Government of the
Northwest Territories (GNWT) annual audit.
184
Insured hospital services are provided under the
authority of the HIHSSA and the Regulations.
The NWT provides coverage for a full range of insured
hospital services consistent with the Canada Health
Act. Insured in-patient services include: accommodation and meals at the standard ward level; necessary
nursing services; laboratory, radiological and other
diagnostic procedures together with the necessary
interpretations; drugs, biologicals and related preparations prescribed by a physician and administered
in hospital; routine surgical supplies; use of operating room, case room and anaesthetic facilities; use
of radiotherapy and physiotherapy services, where
available; psychiatric and psychological services provided under an approved program; services rendered
by persons who are paid by the hospital; and services
rendered by an approved detoxification centre.
The NWT also provides a number of out-patient
services. These include: laboratory tests, x-rays,
including interpretations, when requested by a
physician and performed in an out-patient facility
or in an approved hospital; hospital services in
connection with most minor medical and surgical
procedures; physiotherapy, occupational therapy
and speech therapy services in an approved hospital;
and psychiatric and psychology services provided
under an approved hospital program.
A detailed list of insured in- and out-patient services
is contained in the Hospital Insurance Regulations.
Section 1 of the Regulations states that “out-patient
insured services” means the following services and
supplies are provided to out-patients: laboratory, radiological and other diagnostic procedures together with
the necessary interpretations for helping diagnose and
treat any injury, illness or disability, but not including
simple procedures such as examinations of blood and
urine, which ordinarily form part of a physician’s routine office examination of a patient; necessary nursing
services; drugs, biologicals and related preparations as
provided in Schedule B, when administered in a hospital; use of operating room and anaesthetic facilities,
including necessary equipment and supplies; routine
Canada Health Act — Annual Report 2008–2009
Chapter 3: Northwest Territories
surgical supplies; services rendered by persons who
receive remuneration for those services from a hospital; radiotherapy services within insured facilities;
and physiotherapy services within insured facilities.
The Minister may add, change or delete insured
hospital services. The Minister also determines if
any public consultation will occur before making
changes to the list of insured services.
Where medically necessary services are not available
in the NWT, travel to hospitals or clinics in other
jurisdictions can be approved for residents requiring
those services. The NWT provides Medical Travel
Assistance (as outlined in the Medical Travel Policy),
which ensures that NWT residents have no barriers to accessing medically necessary services. The
Department also administers several supplementary
health benefits programs.
It is the responsibility of the Director of Medical
Insurance to prepare and recommend to the Minister
a tariff itemizing the benefits payable in respect of
insured services. However, it is the Minister who
makes the determination to add or delete insured
hospital services to the Regulations, as follows:
• establishing a medical care plan that provides
insured services to insured persons by medical
practitioners that will in all respects qualify and
enable the NWT to receive payments of contributions from the Government of Canada under the
Canada Health Act; and
• prescribing rates of fees and charges that may be
paid in respect of insured services rendered by
medical practitioners whether in or outside the
NWT, and the conditions under which the fees
and charges are payable.
2.2 Insured Physician Services
2.3 Insured Surgical-Dental Services
The NWT Medical Care Act and the NWT Medical
Care Regulations provide for insured physician
services.
Only licensed oral surgeons may submit claims for
billing. The NWT uses the Province of Alberta’s
Schedule of Oral and Maxillofacial Surgery Benefits
as a guide.
Physicians, nurses, nurse practitioners and midwives
are allowed to provide insured services under the
health care insurance plan. All are required by legislation to be licensed to practice in the NWT under the
Medical Profession Act (physicians), Nursing Profession
Act (nurses and nurse practitioners), and the Midwifery
Profession Act (midwives). As of March 31, 2009, there
were approximately 265 licensed physicians, most of
whom provide locum services.
A physician may opt-out and collect her or his fees
other than under the Medical Care Plan by delivering a written notice to that effect to the Director of
Medical Insurance. No physicians had opted-out of
the Medical Care plan as of March 2009.
A wide range of medically necessary services are
provided in the NWT. The Medical Care Plan insures
all medically required procedures provided by medical practitioners, including: approved diagnostic and
therapeutic services; medically necessary surgical
services; complete obstetrical care; and eye examinations provided by an ophthalmologist. Visits to
specialists are also insured as long as proper referrals
and approvals from an approved medical practitioner
are provided.
Canada Health Act — Annual Report 2008–2009
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Services provided by hospitals, physicians and
dentists, but not covered by the NWT Health Care
Insurance Plan, include: medical-legal services;
third-party examinations; services not medically
required; group immunization; in vitro fertilization;
services provided by a doctor to his or her own family; advice or prescriptions given over the telephone;
surgery for cosmetic purposes except where medically
required; dental services other than those specifically
defined for oral surgery; dressings, drugs, vaccines,
biologicals and related materials administered in a
physician’s office; eyeglasses and special appliances;
plaster and surgical appliances or special bandages;
treatments in the course of chiropractics, podiatry,
naturopathy, osteopathy or any other practice ordinarily carried out by persons who are not medical
practitioners as defined by the Medical Care Act and
Regulations; physiotherapy and psychology services
received from other than an insured out-patient facility; services covered by the Workers’ Compensation
Act or by other federal or territorial legislation; and
routine annual checkups where there is no definable
diagnosis.
185
Chapter 3: Northwest Territories
In the NWT, applications for prior approval must
be made to the Director of Insured Services for
uninsured medical goods or services provided
in conjunction with an insured health service.
A Medical Advisor provides the Director with
recommendations regarding the appropriateness
of the request.
The NWT Medical Care Act includes Medical Care
Regulations and provides for the authority to negotiate changes or deletions to tariffs. The process is
described in section 2.2 of this report.
3.0 Universality
3.1
Eligibility
The Medical Care Act defines the eligibility of NWT
residents for the NWT Health Care Insurance Plan.
The NWT uses the Interprovincial Agreement on
Eligibility and Portability in conjunction with the
NWT Health Care Plan Registration Guidelines to
define eligibility. There were no changes to eligibility
for the reporting period.
Ineligible individuals for NWT health care coverage are members of the Canadian Forces, the Royal
Canadian Mounted Police (RCMP), federal inmates
and residents who have not completed the minimum
waiting period. For persons discharged from the
Canadian Armed Forces, RCMP, federal penitentiary,
or Canadian citizens returning to the NWT from
living outside Canada, coverage is effective the day
permanent residency is established.
3.2 Registration Requirements
Registration requirements include a completed
application form and supporting documentation
as applicable; e.g., visas and immigration papers.
The applicant must be prepared to provide proof of
residency if requested. Registration should occur
before the actual eligibility date of the client. NWT
health care cards are valid for a five-year period.
Registration and eligibility for coverage are directly
linked. Only claims from registered clients are paid.
As of March 2009, there were 46,792 individuals
registered with the NWT Health Care Plan.
No formal provisions are in place for clients to opt
out of the Health Care Insurance Plan.
186
3.3 Other Categories of Individual
Holders of employment visas, student visas and,
in some cases, visitor visas are covered if they meet
the provisions of the Eligibility and Portability
Agreement and Guidelines for health care plan
coverage.
4.0 Portability
4.1
Minimum Waiting Period
There are waiting periods imposed on insured
persons moving to the NWT. The waiting periods
are consistent with the Interprovincial Agreement
on Eligibility and Portability. Generally the waiting
periods are the first day of the third month of residency, for those who move permanently to the NWT,
or the first day of the thirteenth month for those with
temporary employment of less than 12 months, but
who can confirm that the employment period has
been extended beyond the 12 months.
4.2 Coverage During Temporary
Absences in Canada
The Interprovincial Agreement on Eligibility
and Portability and the NWT Health Care Plan
Registration Guidelines define the portability
of health insurance during temporary absences
within Canada.
Coverage is provided to students who are temporarily out of the NWT for full-time attendance in a
post-secondary institution, and for up to one year
for individuals who are temporarily absent from the
NWT for work, vacation, etc. Once an individual
has completed a Temporary Absence form and been
approved by the Department as being temporarily absent from the NWT, the full cost of insured
services is paid for all services received in other
jurisdictions.
When a valid NWT health care card is produced, most
doctor visits and hospital care for medically necessary
services will be billed directly to the NWT Department
of Health and Social Services. General reimbursement
guidelines are in place for patients who are required to
pay for medically necessary services up front. During
the 2008–2009 fiscal year, over $15.7 million was paid
for in- and out-patient hospital services received in
other provinces and territories.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Northwest Territories
The NWT participates in both the Hospital Reciprocal
Billing Agreement and the Medical Reciprocal Billing
Agreement with other jurisdictions.
4.3 Coverage During Temporary
Absences Outside Canada
The NWT Health Care Plan Registration Guidelines
set the criteria to define coverage for absences outside
Canada.
Per subsection 11 (1) (b) (ii) of the Canada Health Act,
the NWT provides personal reimbursement when a
NWT resident leaves Canada for a temporary period
for personal reasons, such as vacations, and requires
medical attention during that time. Individuals are
required to cover their own costs and seek reimbursement upon their return to the NWT. Benefits payable
are provided in the approved tariff. If services are
rendered outside Canada, the benefits payable must
not exceed the benefits for insured services rendered
in the Territories.
Individuals may be granted coverage for up to a year
with prior approval, if they are outside the country.
In the eligibility rules, NWT residents may continue
their coverage for up to one year if they are leaving
Canada, but they must provide extensive information
confirming that they are maintaining their permanent residence in the NWT.
4.4 Prior Approval Requirement
The NWT requires prior approval if coverage is to be
considered for elective services in other provinces,
territories and outside the country. Prior approval is
also required if insured services are to be obtained
from private facilities.
5.0 Accessibility
5.1
Access to Insured Health Services
The Medical Travel Program ensures that economic
barriers are reduced for all NWT residents. As per
section 14 of the Medical Care Act, extra-billing
is not allowed unless the medical practitioner has
made an election to collect her or his fees for medical
services to insured persons otherwise than under the
Medical Care Plan.
Canada Health Act — Annual Report 2008–2009
5.2 Access to Insured Hospital Services
Facilities in the NWT do offer a range of medical, surgical, rehabilitative, and diagnostic services. The NWT
Medical Travel Program ensures through an approval
process that residents can access approved necessary
services not available in NWT facilities. Through the
use of medical travel arrangements, access to services
was maintained throughout the year.
During 2008–2009, Telehealth services included a
total of 20 units across the NWT.
With regards to recruiting and retaining professional
staff, the NWT faces many of the same challenges experienced by other provinces and territories. In addition,
the NWT faces unique demands due to its remoteness
and socio-economic realities. In an effort to maximize
the effectiveness of recruitment for all allied health professionals, the GNWT established a Health Recruitment
unit in July 2006. The Health Recruitment Unit results
in the following advantages:
• the ability to leverage candidate pools to fill
multiple needs for the same candidate type,
across the NWT;
• the ability to view trends and to react to changes
in health care personnel needs across the NWT;
and
• the creation of economies of scale, thereby
reducing costs.
5.3 Access to Insured Physician and
Surgical-Dental Services
All NWT residents have access to all facilities
operated by the GNWT.
Through the Medical Travel Program, the GNWT
ensures that residents have access to physicians,
while the Telehealth program expands the specialist services available to residents in isolated
communities.
5.4 Physician Compensation
Physician compensation is determined through negotiations between the NWT Medical Association and
the Department. The majority of family physicians
are employed through a contractual arrangement with
the GNWT. The remainder provide services through
187
Chapter 3: Northwest Territories
a fee-for-service arrangement. The Medical Care
Act and Regulations are used in the NWT to govern
amounts to be paid to physicians where insured
services are provided on a fee-for-service basis.
5.5 Payments to Hospitals
Payments are made to HSSAs based on contribution
agreements between the Boards of Management and
the Department. Amounts allocated in the agreements are based on the resources available in the
total government budget and level of services provided by the hospital.
Payments to HSSAs providing insured hospital
services are governed under the HIHSSA and the
Financial Administration Act. No amendments
were implemented in 2008–2009 to provisions
involving payments to facilities. A comprehensive
budget is used to fund hospitals in the NWT.
6.0 Recognition Given to
Federal Transfers
Federal funding received through the Canada Health
Transfer (CHT) has been recognized and reported by
the Government of the Northwest Territories through
press releases and various other documents.
For fiscal year 2008–2009, these documents included:
• 2008–2009 Budget Address;
• 2008–2009 Main Estimates;
• 2008–2009 Public Accounts; and
• 2007–2010 Business Plan for the Department
of Finance.
The Main Estimates (noted above) represent the government’s financial plan, and are presented each year
by the Government to the Legislative Assembly.
188
7.0 Extended Health Care
Services
Continuing Care programs and services offered in
NWT communities may include: supported living,
mental health and addictions, adult group homes,
long-term care facilities, and extended care facilities.
Where applicable, these programs and services operate according to HIHSSA and the Hospital Standards
Regulations.
Supported living services provide a home-like environment with increased assistance and a degree of
supervision unavailable through home care services.
Current services in this area include supported
living arrangements in family homes, apartments
and group-living homes, where clients live as independently as possible. Group homes, long-term care
facilities and extended care facilities provide more
complex medical, physical and/or mental supports
on a 24-hour basis.
7.2
Home Care Services
The NWT Home Care Program is established to provide
community health care services to support independent
living, to develop appropriate care options to support
continued community living, and to facilitate admission to institutional care when community living is no
longer a viable alternative. Home Care is based on need
and is available to NWT residents without charge. The
range of Home Care services include: acute care, posthospital care, chronic illness care, nutrition services,
palliative care, personal care, medication management
and monitoring, foot care, social support, ambulation,
physical/occupational therapy, transportation assistance, equipment loan, and respite care.
Home care services are delivered through the HSSAs
and the Tlicho Community Services Agency, and are
based on multi-disciplinary assessments of individual
needs. The Home Care Program provides services to the
seven regions of Yellowknife, Hay River, Fort Smith,
Beaufort-Delta, Sahtu, Deh Cho, and Tlicho. There is
no specific NWT Home Care legislation. Home care
is funded through the Department of Health and
Social Services as a core service. The services have
been enhanced through funding from the First
Nations and Inuit Health Branch.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Northwest Territories
Registered Persons
2004–2005
1. Number as of March 31st (#).
44,504
2005–2006
2
44,082
2006–2007
2
45,551
2007–2008
46,177
2
2008–2009
46,792
2
2
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
b. chronic care
not applicable
4
3
not applicable
4
3
not applicable
4
3
not applicable
3
not applicable
3
c. rehabilitative care
not applicable
3
not applicable
3
not applicable
3
not applicable
3
not applicable
3
d. other
23
4
23
4
23
4
23
4
23
4
e. total
27
27
4
27
4
27
27
3. Payments for insured health services ($):
a. acute care
not available
b. chronic care
c. rehabilitative care
d. other
not available
not available
not available
not available
not available
e. total
56,143,626
56,388,405
64,852,441
85,818,370
67,081,326
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
not available
not applicable
3
not applicable
3
not available
not applicable
3
not applicable
3
not available
not applicable
3
not applicable
3
not available
not applicable
3
not applicable
3
not applicable
3
not applicable
3
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
b. diagnostic imaging facilities
not applicable
not applicable
not applicable
not applicable
not applicable
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
1,248
1,198
1,051
1,193
2008–2009
1,149
9,020,790
11,482,462
11,429,716
12,811,594
12,038,325
10,252
10,666
11,930
11,901
12,560
2,572,486
2,633,954
2,690,116
2,739,494
3,721,556
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
2
9
8
14
8
165
14,868
16,970
41,786
13,145
19
54
43
35
12
4,972
7,280
9,635
6,666
4,653
All data are subject to future revisions. 2008/09 estimated based on claim data as of August 28 2009.
2. The 2004–05 figure as of September 1, 2005, 2005–06 figure as of September 6, 2006, the 2006–07 figure as of September 6, 2007, the 2007–08 figure as of September 5, 2008, and the
2008/09 figure as of September 1, 2009.
3. Northwest Territories does not have facilities that provide these services as their primary type of care. Instead, the 4 hospital acute care facilities provide long term care, extended
care, day surgery, out-patient services, diagnostic services and rehabilitative care.
4. Includes Health Centres and Public Health Units.
Canada Health Act — Annual Report 2008–2009
189
Chapter 3: Northwest Territories
Insured PHYSICIAN Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
14.Number of participating physicians (#):
a. general practitioners
56
5
56
5
57
5
57
5
58
5
b. specialists
21
5
21
5
21
5
21
5
21
5
c. other
139
6
155
6
184
6
208
6
186
6
d. total
216
7
232
7
262
7
286
7
265
7
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
213,431
196,210
184,844
183,823
187,556
29,447,633
30,080,888
31,586,793
34,266,876
34,194,377
28,509
28,844
28,409
28,270
31,269
1,570,686
1,576,406
1,696,823
1,791,593
1,930,160
18.Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
43,252
51,203
62,903
57,530
51,200
3,137,568
3,985,084
3,593,718
4,085,187
3,839,291
Insured Physician Services Provided Outside Canada
21.Number of services (#).
22.Total payments ($).
88
85
94
100
85
19,417
3,611
4,142
9,051
5,043
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
23.Number of participating dentists (#).
not available
not available
not available
not available
not available
24.Number of services provided (#).
not available
not available
not available
not available
not available
25.Total payments ($).
not available
not available
not available
not available
not available
All data are subject to future revisions. 2008/09 estimated based on claim data as of August 28 2009.
5. The 2004/05 to 2008/09 figures are based on funded positions.
6. This is an estimate of the number of locum physicians.
7. Estimate based on total active physicians for each fiscal year.
190
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nunavut
(1) improving education and training outcomes;
(2) reducing poverty;
(3) connecting the community;
(4) increasing housing options;
(5) increasing support for culture and the arts;
(6) helping those at risk in the communities;
Nunavut
(7) supporting community-based, sustainable
economies;
Introduction
(8) addressing social concerns at their roots;
On April 1, 1999, Nunavut became Canada’s third
and newest territory. The Territory spans two million
square kilometres and covers one-fifth of Canada’s
total landmass. There are 25 communities located
across three time zones in Nunavut. Nunavut is
divided into three regions: the Baffin (or Qikiqtaaluk),
which consists of 13 communities; the Kivalliq, which
consists of seven communities; and the Kitikmeot,
which consists of five communities. There are no
roads or railways connecting Nunavut’s communities;
air travel is the only means of travelling into, around
and out of the Territory. The population of Nunavut
was 31,762 as of April 1, 20091.
Approximately 53 percent of the population is under
the age of 25 years2. Inuit make up about 84 percent
of Nunavut’s population3. There is a small Frenchspeaking population located predominantly in the
capital city of Iqaluit. There is also a highly transient
workforce in some communities in Nunavut, which
includes skilled labourers and seasonal workers from
other provinces and territories.
Legislation governing the administration of health and
social services in Nunavut was carried over from the
Northwest Territories (as Nunavut statutes) pursuant to
the Nunavut Act (1999). The Department of Health and
Social Services (the Department) continues to review
existing legislation to ensure its relevancy and appropriateness with the Government of Nunavut’s mandate
and objectives. Tamapta: Building Our Future Together
2009–2013 describes the Government’s vision and commitment to 10 strategic priorities:
(9) improving health through prevention; and
(10)enhancing Nunavut’s recognition in Canada
a nd the world.
All Government of Nunavut departments and agencies also strive to incorporate Inuit societal values
into program and policy development as well as into
service design and delivery.
The delivery of health services in Nunavut is based
on a primary health care model. There are local
health centres in 24 communities across Nunavut,
including new regional facilities in Rankin Inlet
(Kivalliq) and Cambridge Bay (Kitikmeot) with inand out-patient capacity and one hospital in Iqaluit.
The Qikiqtani General Hospital (QGH), formerly
known as the Baffin Regional Hospital is a $64 million dollar, 54,000 square foot, acute care facility that
officially opened in October 2007. Services based in
the new hospital include 24 hour emergency services,
inpatient care (including obstetrics, paediatrics and
palliative care), surgical services, laboratory services,
diagnostic imaging, respiratory therapy and health
records and information. QGH remains connected
to the old hospital building (46,000 square feet).
Repurposing activities to accommodate some services
that were unable to be accommodated in the new
QGH building due to cost and space considerations
are in the planning stage. This includes pharmacy,
medical support services, cafeteria, administration,
housekeeping and office space for physicians and
medical specialists.
1. Statistics Canada, Quarterly Demographic Estimates – January to March 2009, Catalogue no. 91-002-X
2. Statistics Canada, 2006 Census
3. Ibid
Canada Health Act — Annual Report 2008–2009
191
Chapter 3: Nunavut
Nunavut’s primary health care providers are family
physicians, nurse practitioners, community health
nurses, and pharmacists. Nunavut recruits and hires
its own family physicians and accesses specialist
services primarily from its main referral centres in
Ottawa, Winnipeg, and Yellowknife. Recruitment
of full-time family physicians has improved significantly. There are 21 family physician positions
funded through the Department providing over
5,000 days of service annually across the Territory.
In 2008–2009, all family physician positions in
Nunavut were staffed. Recruitment and retention
efforts are now focused on increasing the number of
long-term family physicians practicing in Nunavut
to provide consistent care for the population.
In November 2007, the Department introduced its
Nunavut Nursing Recruitment and Retention Strategy.
The Strategy was developed to address the long-term
health care needs of Nunavut by focusing on: promoting recruitment of new nursing personnel; further
educating, training and retaining nurses in the territorial workforce; and preparing Inuit for careers in
the nursing profession. In 2008–2009, comprehensive
implementation of the Strategy got underway, including the introduction of an enhanced compensation
and benefits package, a dedicated nursing website
[www.nunavutnurses.ca], a professional development
fund, and the introduction of an access year for students entering the nursing education program offered
by Nunavut Arctic College.
The management and delivery of health services
in Nunavut were integrated into the overall operations of the Department on March 31, 2000, when the
former regional boards (Baffin, Keewatin (Kivalliq)
and Kitikmeot) were dissolved. Former board staff
became employees of the Department at that time.
The Department has a regional office in each of the
three regions that manages the delivery of health
services at a regional level. Iqaluit operations are
administered separately.
Over one quarter of the Department’s total operational
budget is spent on costs associated with medical travel
and treatment provided in out-of-territory facilities. Due
to the very low population density in this vast territory and limited health infrastructure (i.e. diagnostic
services), access to a range of hospital and specialist
services often requires that residents be sent out of the
Territory. The two regional health facilities (Rankin
Inlet and Cambridge Bay), as well as the Qiqiktani
General Hospital, enable Nunavut to build internal
capacity and enhance the range of services that can be
provided within the Territory. For example, on May 19,
2008, the Kivalliq Regional Health Facility opened
its Day Hospital Program which allows for the treatment and observation of patients who require a stay for
periods longer than can normally be accommodated in
a health centre. Patients admitted are assessed throughout their stay to determine whether plans will be made
for a medical evacuation or a release and return home.
The territorial operations and maintenance budget
for the Department of Health and Social Services
in 2008–2009 was $251,388,0004. An additional
$14,373,000 was allocated to the Department for
capital projects5.
In 2008–2009, Telehealth was accessible in all
25 communities in Nunavut. Nunavut’s Telehealth
network provides communities with a broad range
of health-related services, which include: clinical
program delivery such as specialist consultation
services; health education; continuing medical
education; family visitation; and administrative
functions. The network is used for a wide range
of services such as: discharge planning, telepsychiatry, geriatrics, occupational therapy, and
patient post-operation follow-up. In 2008–2009,
use of the Telehealth network totalled approximately
4,030 hours, of which 1,678 hours were for clinical
services.
Nunavut has many unique needs and challenges
with respect to the health and well-being of its residents. Despite aggressive national and international
recruitment and retention activities, Nunavut continues to be challenged by the acute shortage of nurses.
The Department continues to operate a Family
Practice Clinic in Iqaluit. The Clinic, established in
2006 with funding from the Primary Health Care
Transition Fund, has been successful in helping to
reduce pressure on the emergency and out-patient
departments of the QGH during working hours. At
present, the Clinic is staffed by two nurse practitioners (with consult visits from doctors of the hospital)
and continues to be quite busy, with approximately
500 patient visits per month.
The Department is committed to providing a health
system that focuses not only on treating illness but also
on promoting healthy living. In November 2007, the
Department introduced its first public health strategy.
Developing Healthy Communities: A Public Health
Strategy for Nunavut is a 5-year plan that focuses on
4. Government of Nunavut. 2008–2009 Main Estimates. This figure does not include any supplementary appropriations or budget adjustments.
5. Government of Nunavut 2008–2009 Capital Estimates. This figure does not include capital carryovers from 2007–2008.
192
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nunavut
two priority areas: (1) healthy children and families;
and (2) addiction reduction. The Strategy outlines
specific measures to promote and protect health and
to prevent disease and injury. Implementation efforts
in 2008–2009 focused on initiatives such as maternal
and newborn care, sexual health, food security and
chronic disease and injury prevention. Integration
of the Strategy at the regional and community level
is a top priority for the Department.
The Department is committed to supporting and
increasing access to midwifery services and improving maternal care services across the territory.
In September 2008, the Midwifery Profession Act
was passed in the Legislative Assembly, enabling
the Government of Nunavut to regulate registered
Midwives. The supporting regulatory framework
will be in place in 2009–2010 and a Maternal and
Newborn Health Care Strategy will be introduced
to integrate new maternal and midwifery services
into the health system.
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
The health care insurance plans of Nunavut, including physician and hospital services, are administered
by the Department on a non-profit basis.
The Medical Care Act (NWT, 1988 and as duplicated
for Nunavut by section 29 of the Nunavut Act, 1999)
governs the entitlement to and payment of benefits
for insured medical services. The Hospital Insurance
and Health and Social Services Administration
Act (NWT, 1988 and as duplicated for Nunavut by
section 29 of the Nunavut Act, 1999) enables the
establishment of hospital and other health services.
Through the Dissolution Act (Nunavut, 1999), the
three former Health and Social Services Boards of
Baffin, Keewatin and Kitikmeot were dissolved and
their operations were integrated into the Department
effective April 1, 2000. The Department retained
regional operations in each region of Nunavut to
support front-line workers and community-based
delivery of a wide range of health and social services
programs and services.
There were no legislative amendments in fiscal year
2008–2009.
Canada Health Act — Annual Report 2008–2009
1.2 Reporting Relationship
A Director of Medical Insurance is appointed under the
Medical Care Act and is responsible for the administration of the Territory’s medical care insurance plan. The
Director reports to the Minister of Health and Social
Services and is required to submit an annual report
on the operations of the medical insurance plan. The
Department’s annual submissions to the Canada Health
Act Annual Report serve as the basis for these reports
under the Medical Care Act.
1.3 Audit of Accounts
The Auditor General of Canada is the auditor of
the Government of Nunavut in accordance with
section 30.1 of the Financial Administration Act
(Nunavut, 1999). The Auditor General is required
to conduct an annual audit of the transactions and
consolidated financial statements of the Government
of Nunavut. The most recent audited report tabled
in the Legislative Assembly of Nunavut was for the
year ended March 31, 2008.
The Auditor General has the mandate to audit the
activities of the Department. A report specific to the
financial management practices of the Department
of Health and Social Services will be issued by the
Office of the Auditor General in 2009–2010.
2.0 Comprehensiveness
2.1
Insured Hospital Services
Insured hospital services are provided in Nunavut
under the authority of the Hospital Insurance and
Health and Social Services Administration Act and
Regulations, sections 2 to 4. No amendments were
made to the Act or regulations in 2008–2009.
In 2008–2009, insured hospital services were delivered
in 28 facilities across Nunavut, including one general
hospital (Iqaluit), two regional health facilities (Rankin
Inlet and Cambridge Bay), 22 Community Health
Centres, one public health facility (Iqaluit), and one
family practice clinic (Iqaluit). There is also rehabilitative treatment available through the Timimut
Ikajuksivik Centre located in Iqaluit. The Qikiqtani
General Hospital is currently the only acute care
facility in Nunavut providing a range of in- and outpatient hospital services as defined by the Canada
Health Act. However, as the two regional facilities in
193
Chapter 3: Nunavut
Rankin Inlet and Cambridge Bay are able to recruit
additional physicians, they will also be able to offer
a broader range of in-patient and out-patient services.
Community health centres provide public health,
out-patient services and urgent treatment services.
There are also a limited number of birthing beds at
the Rankin Inlet Birthing Centre. Public health services are provided at public health clinics located
in Rankin Inlet and Iqaluit.
The Department is responsible for authorizing,
licensing, inspecting and supervising all health facilities and social services facilities in the Territory.
Insured in-patient hospital services include: accommodation and meals at the standard ward level;
necessary nursing services; laboratory, radiological and other diagnostic procedures, together with
the necessary interpretations; drugs, biological and
related preparations prescribed by a physician and
administered in hospital; routine surgical supplies;
use of operating room, case-room and anaesthetic
facilities; use of radiotherapy and physiotherapy
services where available; psychiatric and psychological services provided under an approved program;
services rendered by persons who are paid by the
hospital; and services rendered by an approved
detoxification centre.
Out-patient services include: laboratory tests and
x-rays, including interpretations, when requested by
a physician and performed in an out-patient facility or in an approved hospital; hospital services in
connection with most minor medical and surgical
procedures; physiotherapy, occupational therapy,
limited audiology and speech therapy services in an
out-patient facility or in an approved hospital; and
psychiatric and psychology services provided under
an approved hospital program.
The Department makes the determination to add
insured services in its facilities based on the availability of appropriate resources, equipment and overall
feasibility in accordance with financial guidelines
set by the Department and with the approval of the
Financial Management Board. No new services were
added in 2008–2009 to the list of insured hospital
services.
2.2 Insured Physician Services
The Medical Care Act, section 3(1), and Medical Care
Regulations, section 3, provide for insured physician
services in Nunavut. No amendments were made to
194
the Act or regulations in 2008–2009. The Nursing
Act now allows for licensure of nurse practitioners
in Nunavut; previously only medical doctors were
permitted to deliver insured physician services
in Nunavut.
Physicians must be in good standing with a College
of Physicians and Surgeons (Canada) and be licensed
to practice in Nunavut. The Government of Nunavut’s
Medical Registration Committee currently manages
this process for Nunavut physicians. There are a total
of 24 full-time physician positions in Nunavut (14 in
the Baffin region; 4.5 positions in the Kivalliq region;
2.5 positions in the Kitikmeot region; as well as 1 surgeon, 1 anaesthetist and 1 pediatrician at the Qiqiktani
General Hospital). Visiting specialists, general practitioners and locums, through arrangements made by
each of the Department’s three regions, also provide
insured physician services. On March 31, 2009,
Nunavut had 218 physicians participating in the
health insurance plan.
Physicians can make an election to collect fees other
than those under the Medical Care Plan in accordance
with section 12 (2)(a) or (b) of the Medical Care Act
by notifying the Director in writing. An election can
be revoked the first day of the following month after
a letter to that effect is delivered to the Director. In
2008–2009, no physicians provided written notice
of this election.
All physicians practicing in Nunavut are under
contract with the Department.
Insured physician services refers to all services
rendered by medical practitioners that are medically
required. Where insured services are unavailable
in some places in Nunavut, the patient is referred to
another jurisdiction to obtain the insured service.
Nunavut has in place health service agreements with
medical and treatment centres in Ottawa, Winnipeg,
Churchill, Yellowknife and Edmonton. These are the
out-of-territory sites to which Nunavut mainly refers
its patients to access medical services not available
within the Territory.
The addition or deletion of insured physician
services requires government approval. For this,
the Director of Medical Insurance would become
involved in negotiations with a collective group of
physicians to discuss the service. Then the decision of the group would be presented to Cabinet
for approval. No insured physician services were
added or deleted in 2008–2009.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nunavut
2.3 Insured Surgical-Dental Services
Dentists providing insured surgical-dental services under the Medical Care Insurance Plan of the
Territory must be licensed pursuant to the Dental
Professions Act (NWT, 1988 and as duplicated for
Nunavut by section 29 of the Nunavut Act, 1999).
Billing numbers are provided for billing the Plan
regarding the provision of insured dental services.
In 2008–2009, 3 oral surgeons were permitted to
bill the Nunavut Medical Care Insurance Plan for
insured dental services.
Insured dental services are limited to those dentalsurgical procedures scheduled in the Regulations,
requiring the unique capabilities of a hospital for
their performance; for example, orthognathic surgery. Oral surgeons are brought to Nunavut on a
regular basis, but on rare occasions, for medically
complicated situations, patients are flown out of
the Territory.
The addition of new surgical-dental services to
the list of insured services requires government
approval. No new services were added to the list
in 2008–2009.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Services provided under the Workers’ Compensation
Act (NWT, 1988 and as duplicated for Nunavut by
section 29 of the Nunavut Act, 1999) or other Acts of
Canada, except the Canada Health Act, are excluded.
Services provided by physicians that are not insured
include: yearly physicals; cosmetic surgery; services
that are considered experimental; prescription drugs;
physical examinations done at the request of a third
party; optometric services; dental services other than
specific procedures related to jaw injury or disease;
the services of chiropractors, naturopaths, podiatrists,
osteopaths and acupuncture treatments; and physiotherapy, speech therapy and psychology services,
received in a facility that is not an insured out-patient
facility (hospital).
Services not covered in a hospital include: hospital
charges above the standard ward rate for private or
semi-private accommodation; services that are not
medically required, such as cosmetic surgery; services that are considered experimental; ambulance
Canada Health Act — Annual Report 2008–2009
charges (except inter-hospital transfers); dental services, other than specific procedures related to jaw
injury or disease; and alcohol and drug rehabilitation, without prior approval.
The Qikiqtani General Hospital charges $1,876
per diem for services provided for non-Canadian
resident stays.
When residents are sent out of the Territory for services,
the Department relies on the policies and procedures
guiding that particular jurisdiction when they provide services to Nunavut residents that could result
in additional costs, only to the extent that these costs
are covered by Nunavut’s Medical Insurance Plan (see
section 4.2 under Portability). Any query or complaint
is handled on an individual basis with the jurisdiction
involved.
The Department also administers the Non-Insured
Health Benefits (NIHB) Program on behalf of Health
Canada for Inuit and First Nations residents in Nunavut.
NIHB covers a co-payment for medical travel, accommodations and meals at boarding homes (in Ottawa,
Winnipeg, Churchill, Edmonton, Yellowknife and
Iqaluit), prescription drugs, dental treatment, vision
care, medical supplies and prostheses, and a number
of other incidental services.
3.0 Universality
3.1
Eligibility
Eligibility for the Nunavut Health Care Plan is briefly
defined under sections 3(1), (2), and (3) of the Medical
Care Act. The Department also adheres to the InterProvincial Agreement on Eligibility and Portability
as well as internal guidelines. No amendments were
made to the Act or regulations in 2008–2009.
Subject to these provisions, every Nunavut resident
is eligible for and entitled to insured health services
on uniform terms and conditions. A resident means a
person lawfully entitled to be or to remain in Canada,
who makes his or her home and is ordinarily present
in Nunavut, but does not include a tourist, transient
or visitor to Nunavut. Applications are accepted for
health coverage, and supporting documentation is
required to confirm residency. Eligible residents
receive a health card with a unique health care
number.
195
Chapter 3: Nunavut
Coverage generally begins the first day of the third
month after arrival in Nunavut, but first-day coverage
is provided under a number of circumstances (e.g.,
newborns whose mothers or fathers are eligible for
coverage). As well, permanent residents (landed immigrants), returning Canadians, repatriated Canadians,
returning permanent residents and a non-Canadian
who has been issued an employment visa for a period of
12 months or more are also granted first-day coverage.
Members of the Canadian Armed Forces, the Royal
Canadian Mounted Police (RCMP) and inmates of a
federal penitentiary are not eligible for registration.
These groups are granted first-day coverage under
the Nunavut Health Care Plan upon discharge.
Pursuant to section 7 of the Inter-Provincial Agreement
on Eligibility and Portability, persons in Nunavut who
are temporarily absent from their home province/
territory and who are not establishing residency in
Nunavut remain covered by their home provincial or
territorial health insurance plans for up to one year.
3.2 Registration Requirements
Registration requirements include a completed
application form and supporting documentation. A health care card is issued to each resident.
To streamline document processing, a staggered
renewal process was initiated in Nunavut in 2006.
No premiums exist. Coverage under the Nunavut
Medical Insurance Plan is linked to verification of
registration, although every effort is made to ensure
registration occurs when a coverage issue arises for
an eligible resident. For non-residents, a valid health
care card from their home province/territory is
required.
On March 31, 2009, 32,207 individuals were registered with the Nunavut Health Care Plan, up by
795 from the previous year. There are no formal
provisions for Nunavut residents to opt out of the
health care insurance plan.
3.3 Other Categories of Individual
Non-Canadian holders of employment visas of less
than 12 months, foreign students with visas of less
than 12 months, transient workers and individuals
holding a Minister’s Permit (with one exception) are
not eligible for coverage. When unique circumstances
occur, assessment is done on an individual basis.
This is consistent with section 15 of the Northwest
Territories’ Guidelines for Health Care Plan Registration,
which was adopted by Nunavut in 1999.
196
4.0 Portability
4.1
Minimum Waiting Period
Consistent with section 3 of the Inter-Provincial/
Territorial Agreement on Eligibility and Portability,
the waiting period before coverage begins for individuals moving within Canada is three months; or
the first day of the third month following the establishment of residency in a new province or territory;
or the first day of the third month when an individual, who has been temporarily absent from his
or her home province, decides to take up permanent
residency in Nunavut.
4.2 Coverage During Temporary
Absences in Canada
The Medical Care Act, section 4(2), prescribes the
benefits payable where insured medical services are
provided outside Nunavut but within Canada. The
Hospital Insurance and Health and Social Services
Administration Act, sections 5(d) and 28(1)(j)(o),
provide the authority for the Minister to enter into
agreements with other jurisdictions to provide health
services to Nunavut residents and the terms and
conditions of payment. No legislative or regulatory
changes were made in 2008–2009 with respect to
coverage outside Nunavut.
Students studying outside Nunavut must notify the
Department and provide proof of enrolment to ensure
continuing coverage. Requests for extensions must
be renewed yearly and are subject to approval by the
Director. Temporary absences for work, vacation or
other reasons for up to one-year are approved by the
Director upon receipt of a written request from the
insured person. The Director may approve absences
in excess of 12 continuous months, upon receiving
a written request from the insured person.
The provisions regarding coverage during temporary
absences in Canada fully comply with the terms
and conditions of the Inter-Provincial/Territorial
Agreement on Eligibility and Portability, as of
January 1, 2001.
Nunavut participates in physician and hospital reciprocal billing. As well, special bilateral agreements
are in place with Ontario, Manitoba, Alberta and
the Northwest Territories. The Hospital Reciprocal
Billing Agreements provide payment of in- and
out-patient hospital services to eligible Nunavut
residents receiving insured services outside the
Territory. High-cost procedure rates, newborn rates
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nunavut
and out-patient rates are based on those established
by the Interprovincial Health Insurance Agreements
Coordinating Committee. A special agreement exists
between the Northwest Territories and Nunavut,
which, based on a block-funding approach, enables
the Stanton Hospital in Yellowknife to provide
services to Nunavut residents in the hospital and
through visiting specialist services in the Kitikmeot
area (western part of the Territory).
The Physician Reciprocal Billing Agreements provide
payment of insured physician services on behalf of
eligible Nunavut residents receiving insured services
outside the Territory. Payment is made to the host
province at the rates established by that province.
In the fiscal year 2008–2009, a total of $29,030,549
was paid for in-patient ($19,205,288) and out-patient
($5,056,873) hospital and physician ($4,768,388)
services.
4.3 Coverage During Temporary
Absences Outside Canada
The Medical Care Act, section 4(3), prescribes the
benefits payable where insured medical services are
provided outside Canada. The Hospital Insurance
and Health and Social Services Administration Act,
section 28(1) (j) (o), provides the authority for the
Minister to set the terms and conditions of payment
for services provided to Nunavut residents outside
Canada. Individuals are granted coverage for up to
one year if they are temporarily out of the country for
any reason, although they must give prior notice in
writing. For services provided to residents who have
been referred out of the country for highly specialized procedures unavailable in Nunavut and Canada,
Nunavut will pay the full cost. For non-referred or
non-emergency services, the payment for hospital
services is $1,876 per day and $231 for out-patient
care. These rates increased by $480 and $73 respectively from 2007–2008.
In 2008–2009 there were no payments for insured
emergency in-patient and out-patient health services
to eligible residents temporarily outside Canada.
In the fiscal year 2008–2009, a total of $2,458 was paid
for physician services provided outside of Canada.
Insured physician services provided to eligible
residents temporarily outside the country are paid
at rates equivalent to those paid had that service
been provided in the Territory. Reimbursement is
Canada Health Act — Annual Report 2008–2009
made to the insured person or directly to the provider of the insured service.
4.4 Prior Approval Requirement
Prior approval is required for elective services provided in private facilities in Canada or in any facility
outside the country.
5.0 Accessibility
5.1
Access to Insured Health Services
The Medical Care Act, section 14, prohibits extrabilling by physicians unless the medical practitioner
has made an election that is still in effect. Access to
insured services is provided on uniform terms and
conditions. To break down the barrier posed by distance and cost of travel, the Government of Nunavut
provides medical travel assistance. Interpretation
services in the Inuit language are also provided to
patients in any health care setting.
5.2 Access to Insured Hospital Services
The Qikiqtani General Hospital in Iqaluit is the only
operating acute care hospital facility in Nunavut.
The hospital has a total of 35 beds available for acute,
rehabilitative, palliative and chronic care services.
There are also 6 day surgery beds and 4 recovery
beds. The facility provides in-patient, out-patient
and 24-hour emergency services. On-site physicians
provide emergency services on rotation. Medical
services provided include an ambulatory care/outpatient clinic, limited intensive care services, and
general medical care, maternity and palliative care.
Surgical services provided include minor orthopaedics, gynaecology, paediatrics, general abdominal,
emergency trauma and ENT/otolaryngology. Patients
requiring specialized surgeries are sent to other
jurisdictions. Diagnostic services include radiology,
laboratory and electrocardiogram. Rehabilitative
services are limited to Iqaluit. Although nursing and
other health professionals were not at full capacity,
basic services were provided in 2008–2009.
Outside of Iqaluit, out-patient and 24-hour emergency
nursing services are provided by local health centres
in Nunavut’s 24 other communities. Telehealth services are available in all 25 communities in Nunavut.
The long-term goal is to integrate Telehealth into the
primary care delivery system, enabling residents of
197
Chapter 3: Nunavut
Nunavut greater access to a broader range of service
options and allowing service providers and communities to use existing resources more effectively.
6.0 Recognition Given to
Federal Transfers
Nunavut has formalized arrangements with outof-territory facilities to provide insured services
to referred patients.
The Government of Nunavut recognized the Canada
Health Transfer in the Director of Medical Insurance
Annual Report on the Operation of the Medical Care
Plan for Fiscal Year 2007–2008 which was tabled in
the Legislative Assembly on March 27, 2009.
5.3 Access to Insured Physician and
Surgical-Dental Services
Nunavut has agreements in place with a number
of out-of-territory regional health authorities and
specific facilities to provide medical specialists
and other visiting health practitioner services.
The following specialist services were provided
in Nunavut during 2008–2009 under the visiting
specialists program: ophthalmology; orthopaedics; internal medicine; otolaryngology; neurology;
rheumatology; dermatology; paediatrics; obstetrics;
physiotherapy; occupational therapy; psychiatry;
and dental surgery. Visiting specialist clinics are
held depending on demand and availability of
specialists.
Nunavut’s Telehealth network, linking all 25 communities, allows for the delivery of a broad range of
services over distances: specialist consultation services such as dermatology, psychiatry and internal
medicine; rehabilitation services; regularly scheduled
counselling sessions; family visitation; and continuing medical education.
For services and equipment unavailable in Nunavut,
patients are referred to other jurisdictions.
5.4 Physician Compensation
All full-time physicians in Nunavut work under contract with the Department. The terms of the contracts
are set by the Department. Visiting consultants are
either paid on a per-diem basis or fee-for-service.
5.5 Payments to Hospitals
Funding for the Qiqiktani General Hospital, regional
health facilities and community health centres is
provided through the Government of Nunavut’s budget process.
198
7.0 Extended Health Care
Services
Nursing Home Intermediate Care and Adult
Residential Care
Adult residential care facilities are located in a total
of five communities with a total of 64 beds, and serve
the needs of Nunavummiut through a mix of predominately privately owned service providers and
one publicly-owned and operated facility. Licensing
agreements are in place to provide for the leasing of
the publicly-owned facilities. Each facility welcomes
both male and female clients and offers Level III or
Level IV type care on an indeterminate basis. Most
facilities offer respite services and nursing services
on an as needed or on a regular (8 hour/day and
hereafter on-site basis). Personal care is provided
to all residents on a round-the-clock basis, with home
care services generally offered on an as-needed basis.
Rehabilitation services (physiotherapy, occupational
therapy and speech-language pathology) are also
offered to residents.
The Naja Isabelle Home in Chesterfield Inlet provides supervised care and treatment and specialized
programming for 10 clients assessed at care levels IV
and V on a 24/7 basis. The facility employs Licensed
Practical Nurses (registered in Nunavut as Certified
Nursing Assistants) and acute care needs are provided by the Chesterfield Inlet Health Centre. The
facility is often able to provide respite care for levels
IV and V clients.
Nursing home services are available at the Iqaluit
and Arviat Elders Homes. These facilities provide
the highest level of long-term care in Nunavut; that
is, extensive chronic care services up to the point
of requiring acute care when they would need to be
transferred to the closest hospital.
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nunavut
No legislation currently exists in Nunavut to formally enable the extended health care services
described above.
Home and Continuing Care Coordinator, in consultation with the three Regional Home and Community
Care Managers.
Home Care Services
No legislation currently exists in Nunavut to formally enable the home and community care services
described above.
The Home and Community Care (HCC) program provides health care and support services to people who
require extra attention because of illness, poor health,
or disability. The HCC program supports the efforts
of Nunavummiut to care for themselves with help
from family and community. This is accomplished by
providing care in a person’s home and/or community,
thereby allowing individuals to remain in familiar
surroundings close to loved ones and to maintain
their sense of independence and well-being.
The guiding objectives of the program are to respect
the traditional and contemporary Inuit approach to
health and well-being, to support family and community-based healthcare, to be available to individuals
of any age with an assessed need, and to provide a
level of care equal to that of other Canadians.
During 2008–2009, a full array of home care services was offered in Nunavut, including nursing
and personal care, respite care, elders programs and
home-making services (which generally represent
the majority of service hours provided). In addition,
rehabilitation services in the form of physiotherapy
and occupational therapy were offered to clients on
an as needed basis. Services offered in communities
across the Territory vary, as a result of staffing capacity, community needs and fiscal constraints.
The HCC program is coordinated through three
regional centres with service delivery by: Home and
Community Care Workers; Home and Community
Care Representatives; Home Care Nurses; and
Physiotherapists and Occupational Therapists. HCC
program standards are developed by the Territorial
Canada Health Act — Annual Report 2008–2009
Ambulatory Health Care Services
In 2008–2009, ambulatory health care services were
not offered across Nunavut.
In October of 2004, the Department formed a Continuing Care Task Force to provide recommendations
to address Nunavut’s aging population as part of a
coordinated territorial continuum of care. A report
issued by the Task Force outlined several recommendations, including: the construction of four
new continuing care facilities; the development of
a Healthy Living Strategy for elders (intended to
decrease illness and the onset of diseases that may
become chronic for the elderly); the increase of home
and community care services to support independent
living; and the ongoing collaboration with and provision of funding to Nunavut Arctic College to provide
health care training and certification in continuing
care, either through distance education or on campus
learning.
Construction of two new continuing care facilities
in Gjoa Haven and Igloolik was nearing completion
in 2008–2009. These 10-bed facilities will provide
long term care for elders and other adults that require
24 hour, 7 days a week access to nursing and other
care that cannot be provided in their homes. To meet
the staffing needs of the facilities, Nunavut Arctic
College began offering a Home and Continuing
Worker Program in both Gjoa Haven and Igloolik
in 2008–2009.
199
Chapter 3: Nunavut
Registered Persons
1. Number as of March 31st (#).
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
31,525
31,172
30,104
31,412
32,207
Insured Hospital Services Within Own Province or Territory
Public Facilities
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
2. Number (#):
a. acute care
1
1
1
1
1
b. chronic care
not available
not available
not available
not available
not available
not available
c. rehabilitative care
d. other
25
1
e. total
not available
28
28
28
28
6
26
1
6
26
1
26
6
1
26
6
6
3. Payments for insured health services ($):
a. acute care
not available
not available
not available
not available
not available
b. chronic care
not available
not available
not available
not available
not available
c. rehabilitative care
not available
not available
not available
not available
not available
d. other
not available
not available
not available
not available
not available
e. total
not available
not available
not available
not available
not available
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
Private For-Profit Facilities
4. Number of private for-profit facilities
providing insured health services (#): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
5. Payments to private for-profit facilities for
insured health services($): a. surgical facilities
0
0
0
0
0
b. diagnostic imaging facilities
0
0
0
0
0
c. total
0
0
0
0
0
Insured Hospital Services Provided to residents in another province or territory
6. Total number of claims, in-patient (#).
7. Total payments, in-patient ($).
8. Total number of claims, out-patient (#).
9. Total payments, out-patient ($).
2004–2005
2005–2006
2006–2007
2007–2008
2,603
2,752
2,761
2,255
2008–2009
1,953
16,452,793
18,179,969
21,829,373
19,001,348
19,205,288
14,538
17,269
16,242
15,192
16,297
2,683,401
3,719,884
3,652,515
3,659,654
5,056,873
Insured Hospital Services Provided Outside Canada
10.Total number of claims, in-patient (#).
11.Total payments, in-patient ($).
12.Total number of claims, out-patient (#).
13.Total payments, out-patient ($).
1
1
0
0
0
6,345
954
0
0
0
1
16
5
0
0
433
2,637
1,105
0
0
6. This includes 22 community health centres and two regional health centres located in communities throughout the Territory, as well as a public health unit and family practice clinic
(both located in Iqaluit). The family practice clinic currently has two nurse practitioners on staff offering primary health care, as it would if located in one of the communities and
operating as a community health centre.
200
Canada Health Act — Annual Report 2008–2009
Chapter 3: Nunavut
Insured PHYSICIAN Sevices Within Own Province or TErrITitory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
14.Number of participating physicians (#):
a. general practitioners
86
74
60
91
134
b. specialists
82
61
67
65
84
c. other
0
0
0
0
0
d. total
168
135
127
156
218
15.Number of opted-out physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
16.Number of not participating physicians (#):
a. general practitioners
0
0
0
0
0
b. specialists
0
0
0
0
0
c. other
0
0
0
0
0
d. total
0
0
0
0
0
17.Services provided by physicians paid
through all payment methods:
a. number of services (#)
not available
not available
not available
not available
not available
b. total payments ($)
not available
not available
not available
not available
not available
59,542
57,363
46,368
44,071
27,406
7
3,112,661
2,863,075
2,380,746
2,158,549
1,021,829
7
18.Services provided by physicians paid
through fee-for-service: 7
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2004–2005
19.Number of services (#).
20.Total payments ($).
2005–2006
2006–2007
2007–2008
2008–2009
45,334
57,332
59,121
53,022
65,171
2,816,282
3,471,307
3,623,163
3,845,570
4,768,388
Insured Physician Services Provided Outside Canada
21.Number of services (#).
0
36
5
15
36
22.Total payments ($).
0
2,459
1,105
796
2,458
Insured Surgical-Dental Services Within Own Province or Territory
2004–2005
2005–2006
2006–2007
2007–2008
2008–2009
23.Number of participating dentists (#).
not available
not available
not available
not available
not available
24.Number of services provided (#).
not available
not available
not available
not available
not available
25.Total payments ($).
not available
not available
not available
not available
not available
8
7. Nunavut does not pay physicians through fee-for-service. Instead, the majority of physicians are compensated through salaries and alternative methods. Information on salaried
physicians is reported via the shadow billing process. Figures include shadow billed claims.
8. In Nunavut, oral surgeries are only performed at the Qiqiktani General Hospital in Iqaluit. The three oral surgeons permitted to bill Nunavut Medical Care Insurance Plan in
2008–2009 for insured dental services are reflected in reporting numbers contained under 14b (specialists).
Canada Health Act — Annual Report 2008–2009
201
202
Canada Health Act — Annual Report 2008–2009
Annex A: Canada Health Act and the Extra-Billing and User Charges Information Regulations
Annex A
Canada Health Act and the Extra-Billing
and User Charges Information Regulations
This annex provides the reader with an office consolidation of the Canada Health Act and the Extra-billing
and User Charges Information Regulations. An “office
consolidation” is a rendering of the original Act, which
includes any amendments that have been made since
the Act’s passage. The only regulations in force under
the Act are the Extra-billing and User Charges Information Regulations. These regulations require the
provinces and territories to provide estimates of extrabilling and user charges prior to the beginning of
Canada Health Act — Annual Report 2008–2009
each fiscal year so that appropriate penalties can
be levied, as well as financial statements showing
the amounts actually charged so that reconciliations
with any estimated charges can be made. These
regulations are also presented in an office consolidation format. This unofficial consolidation is current to
October 2009. It is provided for the convenience of the
reader only. For the official text of the Canada Health
Act, please contact Justice Canada.
203
204
Canada Health Act — Annual Report 2008–2009
CANADA
OFFICE CONSOLIDATION
CODIFICATION ADMINISTRATIVE
Canada
Health Act
Loi canadienne
sur la santé
R.S., 1985, c. C-6
L.R. (1985), ch. C-6
Canada Health Act — Annual Report 2008–2009
205
WARNING NOTE
Users of this office consolidation are reminded that
it is prepared for convenience of reference only and
that, as such, it has no official sanction.
206
AVERTISSEMENT
La présente codification administrative n’est
préparée que pour la commodité du lecteur et
n’a aucune valeur officielle.
Canada Health Act — Annual Report 2008–2009
Preamble
CHAPTER C-6
CHAPITRE C-6
An Act relating to cash contributions by Canada and
relating to criteria and conditions in respect of
insured health services and extended health care
services
Loi concernant les contributions pécuniaires du Canada
ainsi que les principes et conditions applicables
aux services de santé assurés et aux services complémentaires de santé
Whereas the Parliament of Canada recognizes:
Considérant que le Parlement du Canada reconnaît :
— that it is not the intention of the Government
of Canada that any of the powers, rights,
privileges or authorities vested in Canada
or the provinces under the provisions of the
Constitution Act, 1867, or any amendments
thereto, or otherwise, be by reason of this Act
abrogated or derogated from or in any way
impaired;
–
que le gouvernement du Canada n’entend pas
par la présente loi abroger les pouvoirs, droits,
privilèges ou autorités dévolus au Canada ou
aux provinces sous le régime de la Loi constitutionnelle de 1867 et de ses modifications
ou à tout autre titre, ni leur déroger ou porter
atteinte,
–
que les Canadiens ont fait des progrès remarquables, grâce à leur système de services de
santé assurés, dans le traitement des maladies
et le soulagement des affections et déficiences
parmi toutes les catégories socio-économiques,
–
que les Canadiens peuvent encore améliorer
leur bien-être en joignant à un mode de vie
individuel axé sur la condition physique, la
prévention des maladies et la promotion de la
santé, une action collective contre les causes
sociales, environnementales ou industrielles
des maladies et qu’ils désirent un système de
services de santé qui favorise la santé physique
et mentale et la protection contre les maladies,
–
que les améliorations futures dans le domaine
de la santé nécessiteront la coopération des gouvernements, des professionnels de la santé, des
organismes bénévoles et des citoyens canadiens,
–
que l’accès continu à des soins de santé
de qualité, sans obstacle financier ou autre,
sera déterminant pour la conservation et
l’amélioration de la santé et du bien-être des
Canadiens;
— that Canadians, through their system of
insured health services, have made outstanding
progress in treating sickness and alleviating
the consequences of disease and disability
among all income groups;
— that Canadians can achieve further improvements in their well-being through combining
individual lifestyles that emphasize fitness,
prevention of disease and health promotion
with collective action against the social, environmental and occupational causes of disease,
and that they desire a system of health services
that will promote physical and mental health
and protection against disease;
— that future improvements in health will require
the cooperative partnership of governments,
health professionals, voluntary organizations
and individual Canadians;
— that continued access to quality health care without financial or other barriers will be
critical to maintaining and improving the
health and well-being of Canadians;
And whereas the Parliament of Canada wishes to
encourage the development of health services throughout
Canada by assisting the provinces in meeting the costs
thereof;
Canada Health Act — Annual Report 2008–2009
Préambule
considérant en outre que le Parlement du Canada
souhaite favoriser le développement des services de
santé dans tout le pays en aidant les provinces à en
supporter le coût,
207
Chap. C–6
Short title
Canada Health Act
Now, therefore, Her Majesty, by and with the advice
and consent of the Senate and House of Commons of
Canada, enacts as follows:
Sa Majesté, sur l’avis et avec le consentement
du Sénat et de la Chambre des communes du Canada,
édicte :
SHORT TITLE
TITRE ABRÉGÉ
1. This Act may be cited as the Canada Health Act.
1. Loi canadienne sur la santé.
1984, c. 6, s. 1.
1984, ch. 6, art. 1.
DÉFINITIONS
INTERPRETATION
Definitions
2. In this Act,
“Act of 1977” [Repealed, 1995, c. 17, s. 34]
“cash contribution” means the cash contribution in
respect of the Canada Health and Social Transfer
that may be provided to a province under subsections 15(1) and (4) of the Federal-Provincial
Fiscal Arrangements Act;
“contribution” [Repealed, 1995, c. 17, s. 34]
“dentist” means a person lawfully entitled to practise
dentistry in the place in which the practice is carried
on by that person;
“extended health care services” means the following services, as more particularly defined in the regulations,
provided for residents of a province, namely,
(a) nursing home intermediate care service,
(b) adult residential care service,
(c) home care service, and
(d) ambulatory health care service;
“extra-billing” means the billing for an insured health
service rendered to an insured person by a medical
practitioner or a dentist in an amount in addition
to any amount paid or to be paid for that service by
the health care insurance plan of a province;
“health care insurance plan” means, in relation to a
province, a plan or plans established by the law of
the province to provide for insured health services;
“health care practitioner” means a person lawfully
entitled under the law of a province to provide
health services in the place in which the services
are provided by that person;
“hospital” includes any facility or portion thereof that
provides hospital care, including acute, rehabilitative
or chronic care, but does not include
(a) a hospital or institution primarily for the mentally disordered, or
(b) a facility or portion thereof that provides
nursing home intermediate care service or
adult residential care service, or comparable
services for children;
208
Titre abrégé
2. Les définitions qui suivent s’appliquent à la présente loi.
Définitions
« assuré » Habitant d’une province, à l’exception :
a) des membres des Forces canadiennes;
b) des membres de la Gendarmerie royale du
Canada nommés à un grade;
c)
des personnes purgeant une peine d’em­
prisonnement dans un pénitencier, au sens de
la Partie I de la Loi sur le système correctionnel et
la mise en liberté sous condition;
d) des habitants de la province qui s’y trouvent
depuis une période de temps inférieure au
délai minimal de résidence ou de carence d’au
plus trois mois imposé aux habitants par la
province pour qu’ils soient admissibles ou
aient droit aux services de santé assurés.
« contribution » [Abrogée, 1995, ch. 17, art. 34]
« contribution pécuniaire » La contribution au titre
du Transfert canadien en matière de santé et de
programmes sociaux qui peut être versée à une
province au titre des paragraphes 15(1) et (4) de la
Loi sur les arrangements fiscaux entre le gouvernement
fédéral et les provinces.
« dentiste » Personne légalement autorisée à exercer
la médecine dentaire au lieu où elle se livre à cet
exercice.
« frais modérateurs » Frais d’un service de santé
assuré autorisés ou permis par un régime provincial
d’assurance-santé mais non payables, soit directement soit indirectement, au titre d’un régime
provincial d’assurance-santé, à l’exception des frais
imposés par surfacturation.
« habitant » Personne domiciliée et résidant habituellement dans une province et légalement autorisée
à être ou à rester au Canada, à l’exception d’une
personne faisant du tourisme, de passage ou en
visite dans la province.
« hôpital » Sont compris parmi les hôpitaux tout ou
partie des établissements où sont fournis des soins
hospitaliers, notamment aux personnes souffrant
de maladie aiguë ou chronique ainsi qu’en matière
de réadaptation, à l’exception :
Canada Health Act — Annual Report 2008–2009
Loi canadienne sur la santé
“hospital services” means any of the following services
provided to in-patients or out-patients at a hospital,
if the services are medically necessary for the purpose of maintaining health, preventing disease or
diagnosing or treating an injury, illness or disability,
namely,
(a) accommodation and meals at the standard or
public ward level and preferred accommodation if medically required,
(b) nursing service,
(c) laboratory, radiological and other diagnostic
procedures, together with the necessary inter­
pretations,
(d) drugs, biologicals and related preparations
when administered in the hospital,
(e) use of operating room, case room and
anaesthetic facilities, including necessary
equipment and supplies,
(f) medical and surgical equipment and supplies,
(g) use of radiotherapy facilities,
(h) use of physiotherapy facilities, and
Chap. C–6
a) des hôpitaux ou institutions destinés principalement aux personnes souffrant de troubles
mentaux;
b) de tout ou partie des établissements où sont
fournis des soins intermédiaires en maison
de repos ou des soins en établissement pour
adultes ou des soins comparables pour les
enfants.
« loi de 1977 » [Abrogée, 1995, ch. 17, art. 34]
« médecin » Personne légalement autorisée à exercer la
médecine au lieu où elle se livre à cet exercice.
« ministre » Le ministre de la Santé.
« professionnel de la santé » Personne légalement autorisée en vertu de la loi d’une province à fournir des
services de santé au lieu où elle les fournit.
« régime d’assurance-santé » Le régime ou les régimes
constitués par la loi d’une province en vue de la
prestation de services de santé assurés.
« services complémentaires de santé » Les services définis
dans les règlements et offerts aux habitants d’une
province, à savoir :
(i) services provided by persons who receive
remuneration therefor from the hospital,
a) les soins intermédiaires en maison de repos;
but does not include services that are excluded by
the regulations;
c) les soins à domicile;
“insured health services” means hospital services, physician services and surgical-dental services provided
to insured persons, but does not include any health
services that a person is entitled to and eligible for
under any other Act of Parliament or under any
Act of the legislature of a province that relates to
workers’ or workmen’s compensation;
“insured person” means, in relation to a province, a
resident of the province other than
(a) a member of the Canadian Forces,
(b) a member of the Royal Canadian Mounted
Police who is appointed to a rank therein,
(c) a person serving a term of imprisonment in a
penitentiary as defined in the Penitentiary Act,
or
(d) a resident of the province who has not completed such minimum period of residence or
waiting period, not exceeding three months, as
may be required by the province for eligibility
for or entitlement to insured health services;
“medical practitioner” means a person lawfully entitled
to practise medicine in the place in which the
practice is carried on by that person;
“Minister” means the Minister of Health;
Canada Health Act — Annual Report 2008–2009
b) les soins en établissement pour adultes;
d) les soins ambulatoires.
« services de chirurgie dentaire » Actes de chirurgie
dentaire nécessaires sur le plan médical ou dentaire,
accomplis par un dentiste dans un hôpital, et qui
ne peuvent être accomplis convenablement qu’en
un tel établissement.
« services de santé assurés » Services hospitaliers, médicaux ou de chirurgie dentaire fournis aux assurés,
à l’exception des services de santé auxquels une
personne a droit ou est admissible en vertu d’une
autre loi fédérale ou d’une loi provinciale relative
aux accidents du travail.
«services hospitaliers » Services fournis dans un hôpital
aux malades hospitalisés ou externes, si ces services
sont médicalement nécessaires pour le maintien de
la santé, la prévention des maladies ou le diagnostic
ou le traitement des blessures, maladies ou invalidités, à savoir :
a)
l’hébergement et la fourniture des repas en salle
commune ou, si médicalement nécessaire, en
chambre privée ou semi-privée;
b) les services infirmiers;
c)
les actes de laboratoires, de radiologie ou autres
actes de diagnostic, ainsi que les interprétations
nécessaires;
d) les produits pharmaceutiques, substances
biologiques et préparations connexes administrés à l’hôpital;
209
Chap. C–6
Canada Health Act
“physician services” means any medically required
services rendered by medical practitioners;
“resident” means, in relation to a province, a person
lawfully entitled to be or to remain in Canada who
makes his home and is ordinarily present in the
province, but does not include a tourist, a transient
or a visitor to the province;
“surgical-dental services” means any medically or dentally required surgical-dental procedures performed
by a dentist in a hospital, where a hospital is required
for the proper performance of the procedures;
“user charge” means any charge for an insured health
service that is authorized or permitted by a provincial health care insurance plan that is not payable,
directly or indirectly, by a provincial health care
insurance plan, but does not include any charge
imposed by extra-billing.
R.S., 1985, c. C-6, s. 2; 1992, c. 20, s. 216(F); 1995, c. 17,
s. 34; 1996, c.8, s. 32; 1999, c. 26, s. 11.
e)
l’usage des salles d’opération, des salles d’ac­
couche­ment et des installations d’anesthésie,
ainsi que le matériel et les fournitures
nécessaires;
f)
le matériel et les fournitures médicaux et
chirurgicaux;
g)
l’usage des installations de radiothérapie;
h) l’usage des installations de physiothérapie;
i)
les services fournis par les personnes rémunérées
à cet effet par l’hôpital.
Ne sont pas compris parmi les services hospitaliers
les services exclus par les règlements.
« services médicaux » Services médicalement nécessaires
fournis par un médecin.
« surfacturation » Facturation de la prestation à un
assuré par un médecin ou un dentiste d’un service
de santé assuré, en excédent par rapport au montant
payé ou à payer pour la prestation de ce service au
titre du régime provincial d’assurance-santé.
L.R. (1985), ch. C-6, art. 2; 1992, ch. 20, art. 216(F); 1995,
ch. 17, art. 34; 1996, ch. 8, art. 32; 1999, ch. 26, art. 11.
Primary objective of Canadian
health care policy
Purpose
of this Act
Cash
contribution
CANADIAN HEALTH CARE POLICY
POLITIQUE CANADIENNE DE LA SANTÉ
3. It is hereby declared that the primary objective of
Canadian health care policy is to protect, promote
and restore the physical and mental well-being of
residents of Canada and to facilitate reasonable
access to health services without financial or other
barriers.
3. La politique canadienne de la santé a pour premier
objectif de protéger, de favoriser et d’améliorer
le bien-être physique et mental des habitants du
Canada et de faciliter un accès satisfaisant aux
services de santé, sans obstacles d’ordre financier
ou autre.
1984, c. 6, s. 3.
1984, ch. 6, art. 3.
PURPOSE
RAISON D’ÊTRE
4. The purpose of this Act is to establish criteria and
conditions in respect of insured health services
and extended health care services provided under
provincial law that must be met before a full cash
contribution may be made.
4. La présente loi a pour raison d’être d’établir les
conditions d’octroi et de versement d’une pleine
contribution pécuniaire pour les services de santé
assurés et les services complémentaires de santé
fournis en vertu de la loi d’une province.
R.S., 1985, c. C-6, s. 4; 1995, c. 17, s. 35.
L.R. (1985), ch. C-6, art. 4; 1995, ch. 17, art. 35.
CASH CONTRIBUTION
CONTRIBUTION PÉCUNIAIRE
5. Subject to this Act, as part of the Canada Health and
Social Transfer, a full cash contribution is payable by
Canada to each province for each fiscal year.
5. Sous réserve des autres dispositions de la présente
loi, le Canada verse à chaque province, pour chaque
exercice, une pleine contribution pécuniaire à
titre d’élément du Transfert canadien en matière
de santé et de programmes sociaux (ci-après,
Transfert).
R.S., 1985, c. C-6, s. 5; 1995, c. 17, s. 36.
6. [Repealed, 1995, c. 17, s. 36]
Objectif premier
Raison d’être de
la présente loi
Contribution
pécuniaire
L.R. (1985), ch. C-6, art. 5; 1995, ch. 17, art. 36.
6. [Abrogé, 1995, ch. 17, art. 36]
210
Canada Health Act — Annual Report 2008–2009
Loi canadienne sur la santé
Program criteria
PROGRAM CRITERIA
CONDITIONS D’OCTROI
7. In order that a province may qualify for a full cash
contribution referred to in section 5 for a fiscal
year, the health care insurance plan of the province
must, throughout the fiscal year, satisfy the criteria
described in sections 8 to 12 respecting the following
matters:
7. Le versement à une province, pour un exercice, de
la pleine contribution pécuniaire visée à l’article 5
est assujetti à l’obligation pour le régime d’assurancesanté de satisfaire, pendant tout cet exercice, aux
conditions d’octroi énumérées aux articles 8 à 12
quant à :
(a) public administration;
a) la gestion publique;
(b) comprehensiveness;
b) l’intégralité;
(c) universality;
c)
(d) portability; and
d) la transférabilité;
(e) accessibility.
Public
administration
e)
8. (1) In order to satisfy the criterion respecting
public administration,
8. (1) La condition de gestion publique suppose que :
(2) The criterion respecting public administration
is not contravened by reason only that the public
authority referred to in subsection (1) has the
power to designate any agency
(a) to receive on its behalf any amounts payable
under the provincial health care insurance
plan; or
(b) to carry out on its behalf any responsibility
in connection with the receipt or payment of
accounts rendered for insured health servi­ces,
if it is a condition of the designation that all
those accounts are subject to assessment and
approval by the public authority and that the
public authority shall determine the amounts
to be paid in respect thereof.
1984, c. 6, s. 8.
9. In order to satisfy the criterion respecting comprehensiveness, the health care insurance plan of a
province must insure all insured health services
provided by hospitals, medical practitioners or dentists, and where the law of the province so permits,
similar or additional services rendered by other
health care practitioners.
Gestion publique
a) le régime provincial d’assurance-santé soit géré
sans but lucratif par une autorité publique
nommée ou désignée par le gouvernement de
la province;
b) l’autorité publique soit responsable devant le
gouvernement provincial de cette gestion;
(b) the public authority must be responsible to
the provincial government for that admini­
stration and operation; and
Comprehensive­ness
l’accessibilité.
1984, ch. 6, art. 7.
(c) the public authority must be subject to audit
of its accounts and financial transactions by
such authority as is charged by law with the
audit of the accounts of the province.
Règle générale
l’universalité;
1984, c. 6, s. 7.
(a) the health care insurance plan of a province
must be administered and operated on a nonprofit basis by a public authority appointed or
designated by the government of the province;
Designation of
agency permitted
Chap. C–6
c)
l’autorité publique soit assujettie à la vérification de ses comptes et de ses opérations
financières par l’autorité chargée par la loi de
la vérification des comptes de la province.
(2) La condition de gestion publique n’est pas
enfreinte du seul fait que l’autorité publique visée
au paragraphe (1) a le pouvoir de désigner un mandataire chargé :
Désignation d’un
mandataire
a) soit de recevoir en son nom les montants payables au titre du régime provincial d’assurancesanté;
b) soit d’exercer en son nom les attributions liées
à la réception ou au règlement des comptes
remis pour prestation de services de santé
assurés si la désignation est assujettie à la
vérification et à l’approbation par l’autorité
publique des comptes ainsi remis et à la détermination par celle-ci des montants à payer à
cet égard.
1984, ch. 6, art. 8.
9. La condition d’intégralité suppose qu’au titre
du régime provincial d’assurance-santé, tous les
services de santé assurés fournis par les hôpitaux,
les médecins ou les dentistes soient assurés, et
lorsque la loi de la province le permet, les services
semblables ou additionnels fournis par les autres
professionnels de la santé.
Intégralité
1984, ch. 6, art. 9.
1984, c. 6, s. 9.
Canada Health Act — Annual Report 2008–2009
211
Chap. C–6
Universality
Canada Health Act
10.In order to satisfy the criterion respecting universality, the health care insurance plan of a province
must entitle one hundred per cent of the insured
persons of the province to the insured health services provided for by the plan on uniform terms
and conditions.
1984, c. 6, s. 10.
Portability
11.(1) In order to satisfy the criterion respecting portability, the health care insurance plan of a province
10.La condition d’universalité suppose qu’au titre du
régime provincial d’assurance-santé, cent pour cent
des assurés de la province ait droit aux services de
santé assurés prévus par celui-ci, selon des modalités
uniformes.
1984, ch. 6, art. 10.
11.(1) La condition de transférabilité suppose que le
régime provincial d’assurance-santé :
b) prévoie et que ses modalités d’application
assurent le paiement des montants pour le coût
des services de santé assurés fournis à des assurés
temporairement absents de la province :
(b) must provide for and be administered and
operated so as to provide for the payment of
amounts for the cost of insured health services
provided to insured persons while temporarily
absent from the province on the basis that
(i) si ces services sont fournis au Canada,
selon le taux approuvé par le régime
d’assurance-santé de la province où ils
sont fournis, sauf accord de répartition
différente du coût entre les provinces
concernées,
(i) where the insured health services are
provided in Canada, payment for health
services is at the rate that is approved
by the health care insurance plan of
the province in which the services are
provided, unless the provinces concerned
agree to apportion the cost between
them in a different manner, or
(ii) s’il sont fournis à l’étranger, selon le
montant qu’aurait versé la province pour
des services semblables fournis dans la
province, compte tenu, s’il s’agit de
ser­vices hospitaliers, de l’importance de
l’hôpital, de la qualité des services et des
autres facteurs utiles;
(ii) where the insured health services are provided out of Canada, payment is made
on the basis of the amount that would
have been paid by the province for
similar services rendered in the province,
with due regard, in the case of hospital
services, to the size of the hospital,
standards of service and other relevant
factors; and
Requirement
for consent for
elective insured
health services
permitted
212
(2) The criterion respecting portability is not contravened by a requirement of a provincial health care
insurance plan that the prior consent of the public
authority that administers and operates the plan
must be obtained for elective insured health services
provided to a resident of the province while tempo­
rarily absent from the province if the services in
question were available on a substantially similar
basis in the province.
Transférabilité
a) n’impose pas de délai minimal de résidence ou
de carence supérieur à trois mois aux habitants
de la province pour qu’ils soient admissibles
ou aient droit aux services de santé assurés;
(a) must not impose any minimum period of resi­
dence in the province, or waiting period, in
excess of three months before residents of the
province are eligible for or entitled to insured
health services;
(c) must provide for and be administered and
operated so as to provide for the payment,
during any minimum period of residence, or
any waiting period, imposed by the health
care insurance plan of another province, of
the cost of insured health services provided
to persons who have ceased to be insured
persons by reason of having become residents
of that other province, on the same basis as
though they had not ceased to be residents of
the province.
Universalité
c)
prévoie et que ses modalités d’application
assurent la prise en charge, pendant le délai
minimal de résidence ou de carence imposé
par le régime d’assurance-santé d’une autre
province, du coût des services de santé assurés
fournis aux personnes qui ne sont plus assurées du fait qu’elles habitent cette province,
dans les mêmes conditions que si elles habitaient encore leur province d’origine.
(2) La condition de transférabilité n’est pas enfreinte du fait qu’il faut, aux termes du régime
d’assurance-santé d’une province, le consentement
préalable de l’autorité publique qui le gère pour la
prestation de services de santé assurés facultatifs à
un habitant temporairement absent de la province,
si ces services y sont offerts selon des modalités
sensiblement comparables.
Consentement
préalable à la
prestation des
services de santé
assurés facultatifs
(3) Pour l’application du paragraphe (2), « services
de santé assurés facultatifs » s’entend des ser­vices de
santé assurés, à l’exception de ceux qui sont fournis
d’urgence ou dans d’autres circonstances où des
soins médicaux sont requis sans délai.
Définition de
«services de
santé assurés
faculta­tifs»
1984, ch. 6, art. 11.
Canada Health Act — Annual Report 2008–2009
Loi canadienne sur la santé
Definition of
“elective insured
health services”
(3) For the purpose of subsection (2), “elective
insured health services” means insured health ser­
vices other than services that are provided in an
emergency or in any other circumstance in which
medical care is required without delay.
12.(1) La condition d’accessibilité suppose que le
régime provincial d’assurance-santé :
12.(1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province
b) prévoie la prise en charge des services de santé
assurés selon un tarif ou autre mode de paiement autorisé par la loi de la province;
(a) must provide for insured health services on
uniform terms and conditions and on a basis
that does not impede or preclude, either
directly or indirectly whether by charges made
to insured persons or otherwise, reasonable
access to those services by insured persons;
c)
(d) must provide for the payment of amounts
to hospitals, including hospitals owned or
operated by Canada, in respect of the cost of
insured health services.
Reasonable
compensation
(2) In respect of any province in which extra-billing
is not permitted, paragraph (1)(c) shall be deemed
to be complied with if the province has chosen
to enter into, and has entered into, an agreement
with the medical practitioners and dentists of the
province that provides
(a) for negotiations relating to compensation for
insured health services between the province
and provincial organizations that represent
practising medical practitioners or dentists in
the province;
(b) for the settlement of disputes relating to
compensation through, at the option of the
appropriate provincial organizations referred
to in paragraph (a), conciliation or binding
arbitration by a panel that is equally representative of the provincial organizations and
the province and that has an independent
chairman; and
prévoie une rémunération raisonnable de tous
les services de santé assurés fournis par les
médecins ou les dentistes;
d) prévoie le versement de montants aux hôpitaux, y compris les hôpitaux que possède ou
gère le Canada, à l’égard du coût des services
de santé assurés.
(b) must provide for payment for insured health
services in accordance with a tariff or system of
payment authorized by the law of the province;
(c) must provide for reasonable compensation for
all insured health services rendered by medical
practitioners or dentists; and
Accessibilité
a) offre les services de santé assurés selon des
modalités uniformes et ne fasse pas obstacle,
directement ou indirectement, et notamment
par facturation aux assurés, à un accès satisfaisant par eux à ces services;
1984, c. 6, s. 11.
Accessibility
Chap. C–6
(2) Pour toute province où la surfacturation n’est
pas permise, il est réputé être satisfait à l’alinéa (1)
c) si la province a choisi de conclure un accord et a
effectivement conclu un accord avec ses médecins
et dentistes prévoyant :
Rémunération
raisonnable
a) la tenue de négociations sur la rémunération
des services de santé assurés entre la province
et les organisations provinciales représentant
les médecins ou dentistes qui exercent dans la
province;
b) le règlement des différends concernant la
rémunération par, au choix des organisations
provinciales compétentes visées à l’alinéa a),
soit la conciliation soit l’arbitrage obligatoire
par un groupe représentant également les
organisations provinciales et la province et
ayant un président indépendant;
c)
l’impossibilité de modifier la décision du
groupe visé à l’alinéa b), sauf par une loi de
la province.
1984, ch. 6, art. 12.
(c) that a decision of a panel referred to in paragraph (b) may not be altered except by an Act
of the legislature of the province.
1984, c. 6, s. 12.
Canada Health Act — Annual Report 2008–2009
213
Chap. C–6
Canada Health Act
CONDITIONS FOR CASH CONTRIBUTION
Conditions
13.In order that a province may qualify for a full cash
contribution referred to in section 5, the government of the province
(a) shall, at the times and in the manner prescribed
by the regulations, provide the Minister with
such information, of a type prescribed by the
regulations, as the Minister may reasonably
require for the purposes of this Act; and
CONTRIBUTION PÉCUNIAIRE
ASSUJETTIE À DES CONDITIONS
13.Le versement à une province de la pleine contri­
bution pécuniaire visée à l’article 5 est assujetti à
l’obligation pour le gouvernement de la province :
a)
(b) shall give recognition to the Canada Health and
Social Transfer in any public documents, or
in any advertising or promotional material,
relating to insured health services and extended
health care services in the province.
R.S., 1985, c. C-6, s. 13; 1995, c. 17, s. 37.
Referral to
Governor in
Council
Consultation
process
b) de faire état du Transfert dans tout document
public ou toute publicité sur les services de
santé assurés et les services complémentaires de
santé dans la province.
L.R. (1985), ch. C-6, art. 13; 1995, ch. 17, art. 37.
MANQUEMENTS
14.(1) Subject to subsection (3), where the Minister,
after consultation in accordance with subsection
(2) with the minister responsible for health care in
a province, is of the opinion that
14. (1) Sous réserve du paragraphe (3), dans le cas où
il estime, après avoir consulté conformément au
paragraphe (2) son homologue chargé de la santé
dans une province :
(a) the health care insurance plan of the province
does not or has ceased to satisfy any one of the
criteria described in sections 8 to 12, or
a)
(b) the province has failed to comply with any
condition set out in section 13,
b) soit que la province ne s’est pas conformée aux
conditions visées à l’article 13,
and the province has not given an undertaking
satisfactory to the Minister to remedy the default
within a period that the Minister considers reasonable, the Minister shall refer the matter to the
Governor in Council.
(2) Before referring a matter to the Governor in
Council under subsection (1) in respect of a pro­
vince, the Minister shall
et que celle-ci ne s’est pas engagée de façon
satisfaisante à remédier à la situation dans un délai
suffisant, le ministre renvoie l’affaire au gouverneur
en conseil.
(2) Avant de renvoyer une affaire au gouverneur en
conseil conformément au paragraphe (1) relativement à une province, le ministre :
(3) The Minister may act without consultation
under subsection (1) if the Minister is of the opinion
that a sufficient time has expired after reasonable
efforts to achieve consultation and that consultation will not be achieved.
1984, c. 6, s. 14.
214
Étapes de la
consultation
a) envoie par courrier recommandé à son homologue chargé de la santé dans la province un
avis sur tout problème éventuel;
b) tente d’obtenir de la province, par discussions
bilatérales, tout renseignement additionnel
disponible sur le problème et fait rapport à
la province dans les quatre-vingt-dix jours
suivant l’envoi de l’avis;
(b) seek any additional information available
from the province with respect to the problem through bilateral discussions, and make a
report to the province within ninety days after
sending the notice of concern; and
(c) if requested by the province, meet within a
reasonable period of time to discuss the report.
Renvoi au
gouverneur
en conseil
soit que le régime d’assurance-santé de la pro­
vince ne satisfait pas ou plus aux conditions
visées aux articles 8 à 12;
(a) send by registered mail to the minister
responsi­ble for health care in the province a
notice of concern with respect to any problem
foreseen;
Where no
consultation
can be achieved
de communiquer au ministre, selon les modali­
tés de temps et autres prévues par les règlements,
les renseignements du genre prévu aux règlements, dont celui-ci peut normalement avoir
besoin pour l’application de la présente loi;
DEFAULTS
Obligations
de la province
c)
si la province le lui demande, tient une réunion
dans un délai acceptable afin de discuter du
rapport.
(3) Le ministre peut procéder au renvoi prévu au
paragraphe (1) sans consultation préalable s’il conclut
à l’impossibilité d’obtenir cette consultation malgré
des efforts sérieux déployés à cette fin au cours d’un
délai convenable.
Impossibilité
de consultation
1984, ch. 6, art. 14.
Canada Health Act — Annual Report 2008–2009
Order reducing
or withholding
­contribution
Loi canadienne sur la santé
15.(1) Where, on the referral of a matter under section
14, the Governor in Council is of the opinion that
the health care insurance plan of a province does
not or has ceased to satisfy any one of the criteria
described in sections 8 to 12 or that a province
has failed to comply with any condition set out in
section 13, the Governor in Council may, by order,
15. (1) Si l’affaire lui est renvoyée en vertu de l’article
14 et qu’il estime que le régime d’assurance-santé
de la province ne satisfait pas ou plus aux conditions visées aux articles 8 à 12 ou que la province
ne s’est pas conformée aux conditions visées à
l’article 13, le gouverneur en conseil peut, par décret :
Amending orders
Notice of order
Commencement
of order
(2) The Governor in Council may, by order, repeal
or amend any order made under subsection (1)
where the Governor in Council is of the opinion
that the repeal or amendment is warranted in the
circumstances.
(3) A copy of each order made under this section
together with a statement of any findings on which
the order was based shall be sent forthwith by
registered mail to the government of the province
concerned and the Minister shall cause the order
and statement to be laid before each House of
Parliament on any of the first fifteen days on which
that House is sitting after the order is made.
(4) An order made under subsection (1) shall not
come into force earlier than thirty days after a copy
of the order has been sent to the government of the
province concerned under subsection (3).
R.S., 1985, c. C-6, s. 15; 1995, c. 17, s. 38.
Reimposition
of reductions or
withholdings
16.In the case of a continuing failure to satisfy any
of the criteria described in sections 8 to 12 or to
comply with any condition set out in section 13,
any reduction or withholding under section 15 of
a cash contribution to a province for a fiscal year
shall be reimposed for each succeeding fiscal year
as long as the Minister is satisfied, after consultation with the minister responsible for health care in
the province, that the default is continuing.
R.S., 1985, c. C-6, s. 16; 1995, c. 17, s. 39.
When reduction
or withholding
imposed
17.Any reduction or withholding under section 15 or
16 of a cash contribution may be imposed in the
fiscal year in which the default that gave rise to the
reduction or withholding occurred or in the following fiscal year.
Décret de
réduction ou
de retenue
a) soit ordonner, pour chaque manquement,
que la contribution pécuniaire d’un exercice
à la province soit réduite du montant qu’il
estime indiqué, compte tenu de la gravité du
manquement;
(a) direct that any cash contribution to that province for a fiscal year be reduced, in respect of
each default, by an amount that the Governor
in Council considers to be appropriate, having
regard to the gravity of the default; or
(b) where the Governor in Council considers it
appropriate, direct that the whole of any cash
contribution to that province for a fiscal year
be withheld.
Chap. C–6
b) soit, s’il l’estime indiqué, ordonner la retenue
de la totalité de la contribution pécuniaire
d’un exercice à la province.
(2) Le gouverneur en conseil peut, par décret, annuler ou modifier un décret pris en vertu du paragraphe
(1) s’il l’estime justifié dans les circonstances.
Modification
des décrets
(3) Le texte de chaque décret pris en vertu du
présent article de même qu’un exposé des motifs
sur lesquels il est fondé sont envoyés sans délai
par courrier recommandé au gouvernement de
la province concernée; le ministre fait déposer le
texte du décret et celui de l’exposé devant chaque
chambre du Parlement dans les quinze premiers
jours de séance de celle-ci suivant la prise du décret.
Avis
(4) Un décret pris en vertu du paragraphe (1) ne
peut entrer en vigueur que trente jours après l’envoi
au gouvernement de la province concernée du texte
du décret aux termes du paragraphe (3).
Entrée en
vigueur
du décret
L.R. (1985), ch. C-6, art. 15; 1995, ch. 17, art. 38.
16.En cas de manquement continu aux conditions
visées aux articles 8 à 12 ou à l’article 13, les réductions ou retenues de la contribution pécuniaire à
une province déjà appliquées pour un exercice en
vertu de l’article 15 lui sont appliquées de nouveau pour chaque exercice ultérieur où le ministre
estime, après consultation de son homologue chargé de la santé dans la province, que le manquement
se continue.
Nouvelle
application
des réductions
ou retenues
L.R. (1985), ch. C-6, art. 16; 1995, ch. 17, art. 39.
17.Toute réduction ou retenue d’une contribution
pécuniaire visée aux articles 15 ou 16 peut être
appliquée pour l’exercice où le manquement à son
origine a eu lieu ou pour l’exercice suivant.
Application
aux exercices
ultérieurs
L.R. (1985), ch. C-6, art. 17; 1995, ch. 17, art. 39.
R.S., 1985, c. C-6, s. 17; 1995, c. 17, s. 39.
Canada Health Act — Annual Report 2008–2009
215
Chap. C–6
Canada Health Act
EXTRA-BILLING AND USER CHARGES
SURFACTURATION ET FRAIS MODÉRATEURS
18.In order that a province may qualify for a full
cash contribution referred to in section 5 for a
fiscal year, no payments may be permitted by the
province for that fiscal year under the health care
insurance plan of the province in respect of insured
health services that have been subject to extrabilling by medical practitioners or dentists.
18.Une province n’a droit, pour un exercice, à la pleine contribution pécuniaire visée à l’article 5 que si,
aux termes de son régime d’assurance-santé, elle ne
permet pas pour cet exercice le versement de montants à l’égard des services de santé assurés qui ont
fait l’objet de surfacturation par les médecins ou les
dentistes.
1984, c. 6, s. 18.
1984, ch. 6, art. 18.
User charges
19.(1) In order that a province may qualify for a full
cash contribution referred to in section 5 for a
fiscal year, user charges must not be permitted by
the province for that fiscal year under the health
care insurance plan of the province.
19. (1) Une province n’a droit, pour un exercice, à la
pleine contribution pécuniaire visée à l’article 5 que
si, aux termes de son régime d’assurance-santé, elle
ne permet pour cet exercice l’imposition d’aucuns
frais modérateurs.
Limitation
Extra-billing
(2) Subsection (1) does not apply in respect of
user charges for accommodation or meals provided
to an in-patient who, in the opinion of the atten­
ding physician, requires chronic care and is more
or less permanently resident in a hospital or other
institution.
(2) Le paragraphe (1) ne s’applique pas aux frais
modérateurs imposés pour l’hébergement ou les
repas fournis à une personne hospitalisée qui, de
l’avis du médecin traitant, souffre d’une maladie
chronique et séjourne de façon plus ou moins permanente à l’hôpital ou dans une autre institution.
1984, c. 6, s. 19.
1984, ch. 6, art. 19.
Deduction for
extra-billing
20.(1) Where a province fails to comply with the condition set out in section 18, there shall be deducted
from the cash contribution to the province for a
fiscal year an amount that the Minister, on the
basis of information provided in accordance with
the regulations, determines to have been charged
through extra-billing by medical practitioners or
dentists in the province in that fiscal year or, where
information is not provided in accordance with the
regulations, an amount that the Minister estimates
to have been so charged.
20.(1) Dans le cas où une province ne se conforme
pas à la condition visée à l’article 18, il est déduit
de la contribution pécuniaire à cette dernière pour
un exercice un montant, déterminé par le ministre
d’après les renseignements fournis conformément
aux règlements, égal au total de la surfacturation
effectuée par les médecins ou les dentistes dans la
province pendant l’exercice ou, si les renseignements n’ont pas été fournis conformément aux
règlements, un montant estimé par le ministre égal
à ce total.
Deduction for
user charges
(2) Where a province fails to comply with the
condi­tion set out in section 19, there shall be
deducted from the cash contribution to the province for a fiscal year an amount that the Minister,
on the basis of information provided in accordance
with the regulations, determines to have been
charged in the province in respect of user charges
to which section 19 applies in that fiscal year or,
where information is not provided in accordance
with the regulations, an amount that the Minister
estimates to have been so charged.
(2) Dans le cas où une province ne se conforme
pas à la condition visée à l’article 19, il est déduit
de la contribution pécuniaire à cette dernière pour
un exercice un montant, déterminé par le ministre
d’après les renseignements fournis conformément
aux règlements, égal au total des frais modérateurs
assujettis à l’article 19 imposés dans la province
pendant l’exercice ou, si les renseignements n’ont
pas été fournis conformément aux règlements, un
montant estimé par le ministre égal à ce total.
(3) The Minister shall not estimate an amount
under subsection (1) or (2) without first under­
taking to consult the minister responsible for
health care in the province concerned.
Consultation
with province
(3) Avant d’estimer un montant visé au paragraphe
(1) ou (2), le ministre se charge de consulter son
homologue responsable de la santé dans la province
concernée.
(4) Any amount deducted under subsection (1) or (2)
from a cash contribution in any of the three con­
secutive fiscal years the first of which commences
on April 1, 1984 shall be accounted for separately
in respect of each province in the Public Accounts
for each of those fiscal years in and after which the
amount is deducted.
Separate
accounting
in Public
Accounts
(4) Les montants déduits d’une contribution pécuniaire en vertu des paragraphes (1) ou (2) pendant
les trois exercices consécutifs dont le premier
commence le 1er avril 1984 sont comptabilisés
séparément pour chaque province dans les comptes
publics pour chacun de ces exercices pendant et
après lequel le montant a été déduit.
216
Surfacturation
Frais modérateurs
Réserve
Déduction en cas
de surfacturation
Déduction en
cas de frais
modérateurs
Consultation
de la province
Comptabilisation
Canada Health Act — Annual Report 2008–2009
Chap. C–6
Loi canadienne sur la santé
Refund to province
(5) Where, in any of the three fiscal years referred
to in subsection (4), extra-billing or user charges
have, in the opinion of the Minister, been elimi­
nated in a province, the total amount deducted in
respect of extra-billing or user charges, as the case
may be, shall be paid to the province.
(5) Si, de l’avis du ministre, la surfacturation ou
les frais modérateurs ont été supprimés dans une
province pendant l’un des trois exercices visés au
paragraphe (4), il est versé à cette dernière le montant total déduit à l’égard de la surfacturation ou
des frais modérateurs, selon le cas.
Remboursement
à la province
Saving
(6) Nothing in this section restricts the power of
the Governor in Council to make any order under
section 15.
(6) Le présent article n’a pas pour effet de limiter
le pouvoir du gouverneur en conseil de prendre le
décret prévu à l’article 15.
Réserve
When
deduction
made
Regulations
1984, c. 6, s. 20.
1984, ch. 6, art. 20.
21.Any deduction from a cash contribution under
section 20 may be made in the fiscal year in which
the matter that gave rise to the deduction occurred
or in the following two fiscal years.
21.Toute déduction d’une contribution pécuniaire visée à l’article 20 peut être appliquée pour
l’exercice où le fait à son origine a eu lieu ou pour
les deux exercices suivants.
1984, c. 6, s. 21.
1984, ch. 6, art. 21.
REGULATIONS
RÈGLEMENTS
22.(1) Subject to this section, the Governor in Council
may make regulations for the administration of this
Act and for carrying its purposes and provisions
into effect, including, without restricting the gene­
rality of the foregoing, regulations
22. (1) Sous réserve des autres dispositions du présent
article, le gouverneur en conseil peut, par règlement, prendre toute mesure d’application de la
présente loi et, notamment :
Application
aux exercices
ultérieurs
Règlements
a) définir les services visés aux alinéas a) à d) de
la définition de « services complémentaires de
santé » à l’article 2;
(a) defining the services referred to in paragraphs
(a) to (d) of the definition “extended health
care services” in section 2;
b) déterminer les services exclus des services
hospitaliers;
(b) prescribing the services excluded from hospital services;
c)
(c) prescribing the types of information that the
Minister may require under paragraph 13(a)
and the times at which and the manner in
which that information shall be provided; and
déterminer les genres de renseignements
dont peut avoir besoin le ministre en vertu de
l’alinéa 13a) et fixer les modalités de temps et
autres de leur communication;
d) prévoir la façon dont il doit être fait état du
Transfert en vertu de l’alinéa 13b).
(d) prescribing the manner in which recognition
to the Canada Health and Social Transfer is
required to be given under paragraph 13(b).
Consentement
des provinces
(2) Subject to subsection (3), no regulation may be
made under paragraph (1)(a) or (b) except with the
agreement of each of the provinces.
(2) Sous réserve du paragraphe (3), il ne peut être
pris de règlements en vertu des alinéas (1)a) ou b)
qu’avec l’accord de chaque province.
(3) Le paragraphe (2) ne s’applique pas aux règlements pris en vertu de l’alinéa (1)a) s’ils sont
sensiblement comparables aux règlements pris en
vertu de la Loi sur les arrangements fiscaux entre le
gouvernement fédéral et les provinces, dans sa version
précédant immédiatement le 1er avril 1984.
Exception
(4) Il ne peut être pris de règlements en vertu des
alinéas (1)c) ou d) que si le ministre a au préalable
consulté ses homologues chargés de la santé dans
les provinces.
Consultation
des provinces
Agreement
of provinces
Exception
(3) Subsection (2) does not apply in respect of
regulations made under paragraph (1)(a) if they are
substantially the same as regulations made under
the Federal-Provincial Fiscal Arrangements Act, as it
read immediately before April 1, 1984.
Consultation
with provinces
(4) No regulation may be made under paragraph
(1)(c) or (d) unless the Minister has first consulted
with the ministers responsible for health care in the
provinces.
R.S., 1985, c. C-6, s. 22; 1995, c. 17, s. 40.
Canada Health Act — Annual Report 2008–2009
L.R. (1985), ch. C-6, art. 22; 1995, ch. 17, art. 40.
217
Chap. C–6
Annual report
by Minister
Canada Health Act
REPORT TO PARLIAMENT
RAPPORT AU PARLEMENT
23.The Minister shall, as soon as possible after the
termination of each fiscal year and in any event
not later than December 31 of the next fiscal year,
make a report respecting the administration and
operation of this Act for that fiscal year, including
all relevant information on the extent to which
provincial health care insurance plans have satisfied
the criteria, and the extent to which the provinces
have satisfied the conditions, for payment under
this Act and shall cause the report to be laid before
each House of Parliament on any of the first fifteen
days on which that House is sitting after the report
is completed.
23. Au plus tard pour le 31 décembre de chaque année,
le ministre établit dans les meilleurs délais un rapport sur l’application de la présente loi au cours du
précédent exercice, en y incluant notamment tous
les renseignements pertinents sur la mesure dans
laquelle les régimes provinciaux d’assurance-santé
et les provinces ont satisfait aux conditions d’octroi
et de versement prévues à la présente loi; le ministre
fait déposer le rapport devant chaque chambre du
Parlement dans les quinze premiers jours de séance
de celle-ci suivant son achèvement.
Rapport annuel du
ministre
1984, ch. 6, art. 23.
1984, c. 6, s. 23.
218
Canada Health Act — Annual Report 2008–2009
OFFICE CONSOLIDATION
CODIFICATION ADMINISTRATIVE
Extra-billing
and User Charges
Information
Regulations
Règlement concernant
les renseignements sur
la surfacturation et
les frais modérateurs
SOR/86-259
DORS/86-259
Canada Health Act — Annual Report 2008–2009
219
WARNING NOTE
Users of this office consolidation are reminded that
it is prepared for convenience of reference only and
that, as such, it has no official sanction.
220
AVERTISSEMENT
La présente codification administrative n’est
préparée que pour la commodité du lecteur et
n’a aucune valeur officielle.
Canada Health Act — Annual Report 2008–2009
REGULATIONS PRESCRIBING THE TYPES OF INFORMATION
THAT THE MINISTER OF NATIONAL HEALTH AND WELFARE
MAY REQUIRE UNDER PARAGRAPH 13(a) OF THE CANADA
HEALTH ACT IN RESPECT OF EXTRA-BILLING AND USER
CHARGES AND THE TIMES AT WHICH AND THE MANNER IN
WHICH SUCH INFORMATION SHALL BE PROVIDED BY THE
GOVERNMENT OF EACH PROVINCE
RÈGLEMENT DÉTERMINANT LES GENRES DE RENSEIGNEMENTS
DONT PEUT AVOIR BESOIN LE MINISTRE DE LA SANTÉ
NATIONALE ET DU BIEN-ÊTRE SOCIAL EN VERTU DE L’ALINÉA
13a) DE LA LOI CANADIENNE SUR LA SANTÉ QUANT À LA
SURFACTURATION ET AUX FRAIS MODÉRATEURS ET FIXANT
LES MODALITÉS DE TEMPS ET LES AUTRES MODALITÉS DE
LEUR COMMUNICATION PAR LE GOUVERNEMENT DE CHAQUE
PROVINCE
SHORT TITLE
TITRE ABRÉGÉ
1. These Regulations may be cited as the Extra-billing and User
Charges Information Regulations.
1. Règlement concernant les renseignements sur la surfacturation et
les frais modérateurs.
INTERPRETATION
DÉFINITIONS
2. In these Regulations,
2. Les définitions qui suivent s’appliquent au présent règlement.
“Act” means the Canada Health Act; ( Loi )
« exercice » La période commençant le 1er avril d’une année et se
terminant le 31 mars de l’année suivante. (fiscal year)
“Minister” means the Minister of National Health and Welfare;
( ministre )
« Loi » La Loi canadienne sur la santé. (Act)
“fiscal year” means the period beginning on April 1 in one year and
ending on March 31 in the following year. ( exercice )
« ministre » Le ministre de la Santé nationale et du Bien-être social.
(Minister)
TYPES OF INFORMATION
GENRE DE RENSEIGNEMENTS
3. For the purposes of paragraph 13(a) of the Act, the Minister may
require the government of a province to provide the Minister
with information of the following types with respect to extrabilling in the province in a fiscal year:
3. Pour l’application de l’alinéa 13a) de la Loi, le ministre peut
exiger que le gouvernement d’une province lui fournisse les
renseignements suivants sur les montants de la surfacturation
pratiquée dans la province au cours d’un exercice :
(a) an estimate of the aggregate amount that, at the time the
estimate is made, is expected to be charged through extrabilling, including an explanation regarding the method of
determination of the estimate; and
a) une estimation du montant total de la surfacturation, à la
date de l’estimation, accompagnée d’une explication de la
façon dont cette estimation a été obtenue;
(b) a financial statement showing the aggregate amount actually charged through extra-billing, including an explanation
regarding the method of determination of the aggregate
amount.
4. For the purposes of paragraph 13(a) of the Act, the Minister may
require the government of a province to provide the Minister
with information of the following types with respect to user
charges in the province in a fiscal year:
(a) an estimate of the aggregate amount that, at the time the
estimate is made, is expected to be charged in respect of user
charges to which section 19 of the Act applies, including an
explanation regarding the method of determination of the
estimate; and
(b) a financial statement showing the aggregate amount actually
charged in respect of user charges to which section 19 of the
Act applies, including an explanation regarding the method
of determination of the aggregate amount.
Canada Health Act — Annual Report 2008–2009
b) un état financier indiquant le montant total de la surfacturation effectivement imposée, accompagné d’une explication
de la façon dont cet état a été établi.
4. Pour l’application de l’alinéa 13a) de la Loi, le ministre peut
exiger que le gouvernement d’une province lui fournisse les
renseignements suivants sur les montants des frais modérateurs
imposés dans la province au cours d’un exercice :
a) une estimation du montant total, à la date de l’estimation,
des frais modérateurs visés à l’article 19 de la Loi, accom­
pagnée d’une explication de la façon dont cette estimation a
été obtenue;
b) un état financier indiquant le montant total des frais
modérateurs visés à l’article 19 de la Loi effectivement
imposés dans la province, accompagné d’une explication de
la façon dont le bilan a été établi.
221
TIMES AND MANNER OF FILING INFORMATION
COMMUNICATION DE RENSEIGNEMENTS
5. (1) The government of a province shall provide the Minister with
such information, of the types prescribed by sections 3 and 4, as
the Minister may reasonably require, at the following times:
5. (1) Le gouvernement d’une province doit communiquer au
mi­nistre les renseignements visés aux articles 3 et 4, dont le ministre peut normalement avoir besoin, selon l’échéancier suivant :
(a) in respect of the estimates referred to in paragraphs 3(a) and
4(a), before April 1 of the fiscal year to which they relate; and
a) pour les estimations visées aux alinéas 3a) et 4a), avant le
1er avril de l’exercice visé par ces estimations;
(b) in respect of the financial statements referred to in paragraphs
3(b) and 4(b), before the sixteenth day of the twenty-first
month following the end of the fiscal year to which they
relate.
b) pour les états financiers visés aux alinéas 3b) et 4b), avant
le seizième jour du vingt et unième mois qui suit la fin de
l’exercice visé par ces états.
(2) The government of a province may, at its discretion, provide
the Minister with adjustments to the estimates referred to in
paragraphs 3(a) and 4(a) before February 16 of the fiscal year to
which they relate.
(3) The information referred to in subsections (1) and (2) shall
be transmitted to the Minister by the most practical means of
communication.
222
(2) Le gouvernement d’une province peut, à sa discrétion, fournir
au ministre des ajustements aux estimations prévues aux alinéas
3a) et 4a), avant le 16 février de l’année financière visée par ces
estimations.
(3) Les renseignements visés aux paragraphes (1) et (2) doivent
être expédiés au ministre par le moyen de communication le plus
pratique.
Canada Health Act — Annual Report 2008–2009
Annex B : Policy Interpretation Letters
Annex B
Policy Interpretation Letters
There are two key policy statements that clarify
the federal position on the Canada Health Act.
These statements have been made in the form of
min­isterial letters from former Federal Health
Ministers to their provincial and territorial
counterparts.
Epp Letter
In June 1985, approximately one year following
the passage of the Canada Health Act in Parliament,
then-federal Health Minister Jake Epp wrote to his
provincial and territorial counterparts to set out and
confirm the federal position on the interpretation
and implementation of the Canada Health Act.
Minister Epp’s letter followed several months
of consultation with his provincial and territorial
counterparts. The letter sets forth statements
of federal policy intent which clarify the criteria,
conditions and regulatory provisions of the CHA.
These clarifications have been used by the federal
government in the assessment and interpretation
of compliance with the Act. The Epp letter remains
an important reference for interpretation of the Act.
Canada Health Act — Annual Report 2008–2009
Federal Policy on Private Clinics
Between February 1994 and December 1994, a series
of seven federal/provincial/territorial meetings dealing
wholly or in part with private clinics took place. At
issue was the growth of private clinics providing medically necessary services funded partially by the public
system and partially by patients and its impact on
Canada’s universal, publicly funded health care system.
At the Federal/Provincial/Territorial Health Ministers
Meeting of September 1994 in Halifax all Ministers of
Health present, with the exception of Alberta’s Health
Minister, agreed to “take whatever steps are required to
regulate the development of private clinics in Canada.”
Diane Marleau, the federal Minister of Health
at the time, wrote to all provincial and territorial
Ministers of Health on January 6, 1995 to announce
the new Federal Policy on Private Clinics. The
Minister’s letter provided the federal interpretation
of the Canada Health Act as it relates to the issue
of facility fees charged directly to patients receiving
medically necessary services at private clinics. The
letter stated that the definition of “hospital” contained
in the Canada Health Act, includes any facility that
provides acute, rehabilitative or chronic care. Thus,
when a provincial/territorial health insu­rance plan
pays the physician fee for a medically necessary
service delivered at a private clinic, it must also
pay the facility fee or face a deduction from federal
transfer payments.
223
Annex B : Policy Interpretation Letters
[Following is the text of the letter sent on June 18, 1985 to all provincial and territorial Ministers of Health
by the Honourable Jake Epp, Federal Minister of Health and Welfare. (Note: Minister Epp sent the French
equivalent of this letter to Quebec on July 15, 1985.) ]
June 18, 1985
OTTAWA, K1A 0K9
Dear Minister:
Having consulted with all provincial and territorial Ministers of Health over the past several months, both
individually and at the meeting in Winnipeg on May 16 and 17, I would like to confirm for you my intentions
regarding the inter­pretation and implementation of the Canada Health Act. I would particularly appreciate if
you could provide me with a written indication of your views on the attached proposals for regulations in order
that I may act to have these officially put in place as soon as conveniently possible. Also, I will write to you
further with regard to the material I will need to prepare the required annual report to Parliament.
As indicated at our meeting in Winnipeg, I intend to honour and respect provincial jurisdiction and authority
in matters pertaining to health and the provision of health care services. I am persuaded, by conviction and
experience, that more can be achieved through harmony and collaboration than through discord and confrontation.
With regard to the Canada Health Act, I can only conclude from our discussions that we together share a
public trust and are mutually and equally committed to the maintenance and improvement of a universal,
comprehensive, accessible and portable health insurance system, operated under public auspices for the
benefit of all residents of Canada.
Our discussions have reinforced my belief that you require sufficient flexibility and administrative versatility
to operate and administer your health care insurance plans. You know far better than I ever can, the needs and
priorities of your residents, in light of geographic and economic considerations. Moreover, it is essential that
provinces have the freedom to exercise their primary responsibility for the provision of personal health care
services.
At the same time, I have come away from our discussions sensing a desire to sustain a positive federal involvement and role—both financial and otherwise—to support and assist provinces in their efforts dedicated to the
fundamental objectives of the health care system: protecting, promoting and restoring the physicaland mental
well-being of Canadians. As a group, provincial/territorial Health Ministers accept a co-operative partnership
with the federal government based pri­marily on the contributions it authorizes for purposes of providing insured
and extended health care services.
I might also say that the Canada Health Act does not respond to challenges facing the health care system. I
look forward to working collaboratively with you as we address challenges such as rapidly advancing medical
technology and an aging pop-ulation and strive to develop health promotion strategies and health care delivery
alternatives.
Returning to the immediate challenge of implementing the Canada Health Act, I want to set forth some reasonably
comprehensive statements of federal policy intent, beginning with each of the criteria contained in the Act.
Public Administration
This criterion is generally accepted. The intent is that the provincial health care insurance plans be administered
by a public authority, accountable to the provincial government for decision-making on benefit levels and services,
and whose records and accounts are publicly audited.
224
Canada Health Act — Annual Report 2008–2009
Annex B : Policy Interpretation Letters
Comprehensiveness
The intent of the Canada Health Act is neither to expand nor contract the range of insured services covered
under previous federal legislation. The range of insured services encompasses medically necessary hospital
care, physician services and surgical-dental services which require a hospital for their proper performance.
Hospital plans are expected to cover in-patient and out-patient hospital services associated with the provision
of acute, rehabilitative and chronic care. As regards physician services, the range of insured services generally
encompasses medically required services rendered by licensed medical practitioners as well as surgical-dental
procedures that require a hospital for proper performance. Services rendered by other health care practitioners,
except those required to provide necessary hospital services, are not subject to the Act’s criteria.
Within these broad parameters, provinces, along with medical professionals, have the prerogative and
responsibility for interpreting what physician services are medically necessary. As well, provinces determine
which hospitals and hospital services are required to provide acute, rehabilitative or chronic care.
Universality
The intent of the Canada Health Act is to ensure that all bonafide residents of all provinces be entitled to
coverage and to the benefits under one of the twelve provincial/territorial health care insurance plans.
However, eligible residents do have the option not to participate under a provincial plan should they elect
to do so.
The Agreement on Eligibility and Portability provides some helpful guidelines with respect to the deter­
mination of residency status and arrangements for obtaining and maintaining coverage. Its provisions are
compatible with the Canada Health Act.
I want to say a few words about premiums. Unquestionably, provinces have the right to levy taxes and the
Canada Health Act does not infringe upon that right. A premium scheme per se is not precluded by the Act,
provided that the provincial health care insurance plan is operated and administered in a manner that does
not deny coverage or preclude access to necessary hospital and physician services to bonafide residents of a
province. Administrative arrangements should be such that residents are not precluded from or do not forego
coverage by reason of an inability to pay premiums.
I am acutely aware of problems faced by some provinces in regard to tourists and visitors who may require
health services while travelling in Canada. I will be undertaking a review of the current practices and
procedures with my Cabinet colleagues, the Minister of External Affairs, and the Minister of Employment and
Immigration, to ensure all reasonable means are taken to inform prospective visitors to Canada of the need to
protect themselves with adequate health insurance coverage before entering the country.
In summary, I believe all of us as Ministers of Health are committed to the objective of ensuring that all duly
qualified residents of a province obtain and retain entitlement to insured health services on uniform terms
and conditions.
Portability
The intent of the portability provisions of the Canada Health Act is to provide insured persons continuing protection under their provincial health care insurance plan when they are temporarily absent from their
province of residence or when moving from province to province. While temporarily in another province of
Canada, bona-fide residents should not be subject to out-of-pocket costs or charges for necessary hospital and
physician services. Providers should be assured of reasonable levels of payment in respect of the cost of those
services.
Insofar as insured services received while outside of Canada are concerned, the intent is to assure reasonable
indemni­fication in respect of the cost of necessary emergency hospital or physician services or for referred
services not available in a province or in neighbouring provinces. Generally speaking, payment formulae
Canada Health Act — Annual Report 2008–2009
225
Annex B : Policy Interpretation Letters
tied to what would have been paid for similar services in a province would be acceptable for purposes of the
Canada Health Act.
In my discussions with provincial/territorial Ministers, I detected a desire to achieve these portability objectives
and to minimize the difficulties that Canadians may encounter when moving or travelling about in Canada. In
order that Canadians may maintain their health insurance coverage and obtain benefits or services without
undue impediment, I believe that all provincial/territorial Health Ministers are interested in seeing these
services provided more efficiently and economically.
Significant progress has been made over the past few years by way of reciprocal arrangements which
contribute to the achievement of the in-Canada portability objectives of the Canada Health Act. These
arrangements do not interfere with the rights and prerogatives of provinces to determine and provide the
coverage for services rendered in another province. Likewise, they do not deter provinces from exercising
reasonable controls through prior approval mechanisms for elective procedures. I recognize that work
remains to be done respecting interprovincial payment arrangements to achieve this objective, especially
as it pertains to physician services.
I appreciate that all difficulties cannot be resolved overnight and that provincial plans will require sufficient
time to meet the objective of ensuring no direct charges to patients for necessary hospital and physician
services provided in other provinces.
For necessary services provided out-of-Canada, I am confident that we can establish acceptable standards
of indemnifi­cation for essential physician and hospital services. The legislation does not define a particular
formula and I would be pleased to have your views.
In order that our efforts can progress in a coordinated manner, I would propose that the Federal-Provincial
Advisory Committee on Institutional and Medical Services be charged with examining various options and
recommending arrangements to achieve the objectives within one year.
Reasonable Accessibility
The Act is fairly clear with respect to certain aspects of accessibility. The Act seeks to discourage all pointof-service charges for insured services provided to insured persons and to prevent adverse discrimination
against any population group with respect to charges for, or necessary use of, insured services. At the same
time, the Act accents a partnership between the providers of insured services and provincial plans, requiring that
provincial plans have in place reasonable systems of payment or compensation for their medical practitioners in
order to ensure reasonable access to users. I want to emphasize my intention to respect provincial prerogatives
regarding the organization, licensing, supply, distribution of health manpower, as well as the resource allocation
and priorities for health services. I want to assure you that the reasonable access provision will not be used to
intervene or interfere directly in matters such as the physical and geographic availability of services or provincial
governance of the institutions and professions that provide insured services. Inevitably, major issues or concerns
regarding access to health care services will come to my attention. I want to assure you that my Ministry will
work through and with provincial/territorial Ministers in addressing such matters.
My aim in communicating my intentions with respect to the criteria in the Canada Health Act is to allow
us to work together in developing our national health insurance scheme. Through continuing dialogue, open
and willing exchange of information and mutually understood rules of the road, I believe that we can implement the Canada Health Act without acrimony and conflict. It is my preference that provincial/territorial
Ministers themselves be given an oppor­tunity to interpret and apply the criteria of the Canada Health Act to
their respective health care insurance plans. At the same time, I believe that all provincial/territorial Health
Ministers understand and respect my accountability to the Parliament of Canada, including an annual report
on the operation of provincial health care insurance plans with regard to these fundamental criteria.
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Canada Health Act — Annual Report 2008–2009
Annex B : Policy Interpretation Letters
Conditions
This leads me to the conditions related to the recognition of federal contributions and to the provision of
information, both of which may be specified in regulations. In these matters, I will be guided by the following
principles:
1. to make as few regulations as possible and only if absolutely necessary;
2. to rely on the goodwill of Ministers to afford appropriate recognition of Canada’s role and contribution
and to provide necessary informa-tion voluntarily for purposes of administering the Act and reporting
to Parliament;
3. to employ consultation processes and mutually beneficial information exchanges as the preferred ways
and means of implementing and administering the Canada Health Act;
4. to use existing means of exchanging information of mutual benefit to all our governments.
Regarding recognition by provincial/territorial governments of federal health contributions, I am satisfied that
we can easily agree on appropriate recognition, in the normal course of events. The best form of recognition in
my view is the demonstration to the public that as Ministers of Health we are working together in the interests
of the taxpayer and patient.
In regard to information, I remain committed to maintaining and improving national data systems on a
collaborative and co-operative basis. These systems serve many purposes and provide governments, as well as
other agencies, organizations, and the general public, with essential data about our health care system and the
health status of our population. I foresee a continuing, co-operative partnership committed to maintaining
and improving health information systems in such areas as morbidity, mortality, health status, health
services operations, utilization, health care costs and financing.
I firmly believe that the federal government need not regulate these matters. Accordingly, I do not intend to
use the regulatory authority respecting information requirements under the Canada Health Act to expand,
modify or change these broad-based data systems and exchanges. In order to keep information flows related
to the Canada Health Act to an economical minimum, I see only two specific and essential information
transfer mechanisms:
1. estimates and statements on extra-billing and user charges;
2. an annual provincial statement (perhaps in the form of a letter to me) to be submitted approximately six
months after the completion of each fiscal year, describing the respective provincial health care insurance
plan’s operations as they relate to the criteria and conditions of the Canada Health Act.
Concerning Item 1 above, I propose to put in place on-going regulations that are identical in content to those
that have been accepted for 1985–86. Draft regulations are attached as Annex I. To assist with the preparation of
the “annual provincial statement” referred to in Item 2 above, I have developed the general guidelines attached
as Annex II. Beyond these specific exchanges, I am confident that voluntary, mutually beneficial exchange of
such subjects as Acts, regulations and program descriptions will continue.
One matter brought up in the course of our earlier meetings, is the question of whether estimates or de­ductions
of user charges and extra-billing should be based on “amounts charged” or “amounts collected”. The Act clearly
states that deductions are to be based on amounts charged. However, with respect to user fees, certain provincial
plans appear to pay these charges indirectly on behalf of certain individuals. Where a provincial plan demonstrates that it reimburses providers for amounts charged but not collected, say in respect of social assistance
recipients or unpaid accounts, consi­deration will be given to adjusting estimates/deductions accordingly.
I want to emphasize that where a provincial plan does authorize user charges, the entire scheme must be
consistent with the intent of the reasonable accessibility criterion as set forth [in this letter].
Canada Health Act — Annual Report 2008–2009
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Annex B : Policy Interpretation Letters
Regulations
Aside from the recognition and information regulations referred to above, the Act provides for regulations
concerning hospital services exclusions and regulations defining extended health care services.
As you know, the Act provides that there must be consultation and agreement of each and every province
with respect to such regulations. My consultations with you have brought to light few concerns with the
attached draft set of Exclusions from Hospital Services Regulations.
Likewise, I did not sense concerns with proposals for regulations defining Extended Health Care Services.
These help provide greater clarity for provinces to interpret and administer current plans and programs.
They do not alter significantly or substantially those that have been in force for eight years under Part VI
of the Federal Post-Secondary Education and Health Contributions Act (1977). It may well be, however,
as we begin to examine the future challenges to health care that we should re-examine these definitions.
This letter strives to set out flexible, reasonable and clear ground rules to facilitate provincial, as much
as federal, administration of the Canada Health Act. It encompasses many complex matters including
criteria interpretations, federal policy concerning conditions and proposed regulations. I realize, of course,
that a letter of this sort cannot cover every single matter of concern to every provincial Minister of Health.
Continuing dialogue and communication are essential.
In conclusion, may I express my appreciation for your assistance in bringing about what I believe is a generally
accepted concurrence of views in respect of interpretation and implementation. As I mentioned at the outset
of this letter, I would appreciate an early written indication of your views on the proposals for regulations
appended to this letter. It is my intention to write to you in the near future with regard to the voluntary information exchanges which we have discussed in relation to administering the Act and reporting to Parliament.
Yours truly,
Jake Epp
Attachments
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Canada Health Act — Annual Report 2008–2009
Annex B : Policy Interpretation Letters
[Following is the text of the letter sent on January 6, 1995 to all provincial and territorial Ministers of Health
by the Federal Minister of Health, the Honourable Diane Marleau.]
January 6, 1995
Dear Minister:
RE: Canada Health Act
The Canada Health Act has been in force now for just over a decade. The principles set out in the Act (public
admini­stration, comprehensiveness, universality, portability and accessibility) continue to enjoy the support
of all provincial and territorial governments. This support is shared by the vast majority of Canadians. At
a time when there is concern about the potential erosion of the publicly funded and publicly administered
health care system, it is vital to safeguard these principles.
As was evident and a concern to many of us at the recent Halifax meeting, a trend toward divergent inter­
pretations of the Act is developing. While I will deal with other issues at the end of this letter, my primary
concern is with private clinics and facility fees. The issue of private clinics is not new to us as Ministers of
Health; it formed an important part of our discussions in Halifax last year. For reasons I will set out below, I am
convinced that the growth of a second tier of health care facilities providing medically necessary services that
operate, totally or in large part, outside the publicly funded and publicly administered system, presents a serious
threat to Canada’s health care system.
Specifically, and most immediately, I believe the facility fees charged by private clinics for medically necessary
services are a major problem which must be dealt with firmly. It is my position that such fees constitute user
charges and, as such, contravene the principle of accessibility set out in the Canada Health Act.
While there is no definition of facility fees in federal or most provincial legislation, the term, generally speaking,
refers to amounts charged for non-physician (or “hospital”) services provided at clinics and not reimbursed by the
province. Where these fees are charged for medically necessary services in clinics which receive funding for these
services under a provincial health insurance plan, they constitute a financial barrier to access. As a result, they
violate the user charge provision of the Act (section 19).
Facility fees are objectionable because they impede access to medically necessary services. Moreover, when
clinics which receive public funds for medically necessary services also charge facility fees, people who can
afford the fees are being directly subsidized by all other Canadians. This subsidiza-tion of two-tier health
care is unacceptable.
The formal basis for my position on facility fees is twofold. The first is a matter of policy. In the context of
contemporary health care delivery, an interpretation which permits facility fees for medically necessary
services so long as the provincial health insurance plan covers physician fees runs counter to the spirit and
intent of the Act. While the appropriate pro­v ision of many physician services at one time required an overnight stay in a hospital, advances in medical technology and the trend toward providing medical services in
more accessible settings has made it possible to offer a wide range of medical procedures on an out-patient
basis or outside of full-service hospitals. The accessibility criterion in the Act, of which the user charge provision is just a specific example, was clearly intended to ensure that Canadian residents receive all medically
necessary care without financial or other barriers and regardless of venue. It must continue to mean that as the
nature of medical practice evolves.
Second, as a matter of legal interpretation, the definition of “hospital” set out in the Act includes any facility
which pro­vides acute, rehabilitative or chronic care. This definition covers those health care facilities known as
Canada Health Act — Annual Report 2008–2009
229
Annex B : Policy Interpretation Letters
“clinics”. As a matter of both policy and legal interpretation, therefore, where a provincial plan pays the physician
fee for a medically necessary service delivered at a clinic, it must also pay for the related hospital services provided
or face deductions for user charges.
I recognize that this interpretation will necessitate some changes in provinces where clinics currently charge
facility fees for medically necessary services. As I do not wish to cause undue hardship to those provinces, I will
commence enforcement of this interpretation as of October 15, 1995. This will allow the provinces the time to put
into place the necessary legislative or regu­latory framework. As of October 15, 1995, I will proceed to deduct
from transfer payments any amounts charged for facility fees in respect of medically necessary services,
as mandated by section 20 of the Canada Health Act. I believe this provides a reasonable transition period,
given that all provinces have been aware of my concerns with respect to private clinics for some time, and given
the promising headway already made by the Federal/Provincial/Territorial Advisory Committee on Health
Services, which has been working for some time now on the issue of private clinics.
I want to make it clear that my intent is not to preclude the use of clinics to provide medically necessary services. I realize that in many situations they are a cost-effective way to deliver services, often in a techno-logically
advanced manner. However, it is my intention to ensure that medically necessary services are provided on uniform terms and conditions, wherever they are offered. The principles of the Canada Health Act are supple
enough to accommodate the evolution of medical science and of health care delivery. This evolution must
not lead, however, to a two-tier system of health care.
I indicated earlier in this letter that, while user charges for medically necessary services are my most immediate
concern, I am also concerned about the more general issues raised by the proliferation of private clinics. In
particular, I am concerned about their potential to restrict access by Canadian residents to medically necessary
services by eroding our publicly funded system. These concerns were reflected in the policy statement which
resulted from the Halifax meeting. Ministers of Health present, with the exception of the Alberta Minister,
agreed to:
take whatever steps are required to regulate the development of private clinics in Canada, and to maintain
a high quality, publicly funded medicare system.
Private clinics raise several concerns for the federal government, concerns which provinces share. These relate to:
• weakened public support for the tax funded and publicly administered system;
• the diminished ability of governments to control costs once they have shifted from the public to the
private sector;
• the possibility, supported by the experience of other jurisdictions, that private facilities will concentrate
on easy procedures, leaving public facilities to handle more complicated, costly cases; and
• the ability of private facilities to offer financial incentives to health care providers that could draw them
away from the public system—resources may also be devoted to features which attract consumers,
without in any way contributing to the quality of care.
The only way to deal effectively with these concerns is to regulate the operation of private clinics.
I now call on Ministers in provinces which have not already done so to introduce regulatory frameworks
to govern the operation of private clinics. I would emphasize that, while my immediate concern is the
elimination of user charges, it is equally important that these regulatory frameworks be put in place to
ensure reasonable access to medically necessary services and to support the viability of the publicly
funded and administered system in the future. I do not feel the implementation of such frameworks
should be long delayed.
I welcome any questions you may have with respect to my position on private clinics and facility fees. My
officials are willing to meet with yours at any time to discuss these matters. I believe that our officials need to
focus their attention, in the coming weeks, on the broader concerns about private clinics referred to above.
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Canada Health Act — Annual Report 2008–2009
Annex B : Policy Interpretation Letters
As I mentioned at the beginning of this letter, divergent interpretations of the Canada Health Act apply to a
number of other practices. It is always my preference that matters of interpretation of the Act be resolved
by finding a Federal/Provincial/Territorial consensus consistent with its fundamental principles. I have
therefore encouraged F/P/T consul­tations in all cases where there are disagreements. In situations such as
out-of-province or out-of-country coverage, I remain committed to following through on these consultative
processes as long as they continue to promise a satis­factory conclusion in a reasonable time.
In closing, I would like to quote Mr. Justice Emmett M. Hall. In 1980, he reminded us:
“ we, as a society, are aware that the trauma of illness, the pain of surgery, the slow decline to death,
are burdens enough for the human being to bear without the added burden of medical or hospital bills
penalizing the patient at the moment of vulnerability.”
I trust that, mindful of these words, we will continue to work together to ensure the survival, and renewal,
of what is perhaps our finest social project.
As the issues addressed in this letter are of great concern to Canadians, I intend to make this letter publicly
available once all provincial Health Ministers have received it.
Yours sincerely,
Diane Marleau
Minister of Health
Canada Health Act — Annual Report 2008–2009
231
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Canada Health Act — Annual Report 2008–2009
Annex C : Dispute Avoidance and Resolution Process Under the Canada Health Act
Annex C
Dispute Avoidance and Resolution Process
Under the Canada Health Act
In April 2002, the Honourable A. Anne McLellan
outlined in a letter to her provincial and territorial
counterparts a Canada Health Act Dispute Avoidance
and Resolution process, which was agreed to by
provinces and territories, except Quebec. The process
meets federal and provincial/territorial interests of
avoiding disputes related to the interpretation of the
principles of the Canada Health Act, and when this
is not possible, resolving disputes in a fair, transparent and timely manner.
negotiations. If these are unsuccessful, either Minister
of Health involved may refer the issues to a third party
panel to undertake fact-finding and provide advice and
recommendations.
The process includes the dispute avoidance activities
of government-to-government information exchange;
discussions and clarification of issues, as they arise;
active participation of governments in ad hoc federal/
provincial/ territorial committees on Canada Health
Act issues; and Canada Health Act advance assessments, upon request.
In September 2004, the agreement reached between
the provinces and territories in 2002 was formalized
by First Ministers, thereby reaffirming their commitment to use the CHA dispute avoidance and
resolution process to deal with Canada Health
Act interpretation issues.
Where dispute avoidance activities prove unsuccessful,
dispute resolution activities may be initiated, beginning with government-to-government fact-finding and
Canada Health Act — Annual Report 2008–2009
The federal Minister of Health has the final authority
to interpret and enforce the Canada Health Act. In
deciding whether to invoke the non-compliance
provisions of the Act, the Minister will take the
panel’s report into conside­ration.
On the following pages you will find the full text of
Minister McLellan’s letter to the Honourable Gary
Mar, as well as a fact sheet on the Canada Health
Act Dispute Avoidance and Resolution process.
233
Annex C : Dispute Avoidance and Resolution Process Under the Canada Health Act
Minister of Health
Ministre de la Santé
Ottawa, Canada K1A 0K9
April 2, 2002
The Honourable Gary Mar, M.L.A.
Minister of Health and Wellness
Province of Alberta
Room 323, Legislature Building
Edmonton, Alberta
T5K 2B6
Dear Mr. Mar:
I am writing in fulfilment of my commitment to move forward on dispute avoidance and resolution as it
applies to the interpretation of the principles of the Canada Health Act.
I understand the importance provincial and territorial governments attach to having a third party provide
advice and recommendations when differences occur regarding the interpretation of the Canada Health
Act. This feature has been incorporated in the approach to the Canada Health Act Dispute Avoidance and
Resolution process set out below. I believe this approach will enable us to avoid and resolve issues related
to the interpretation of the principles of the Canada Health Act in a fair, transparent and timely manner.
Dispute Avoidance
The best way to resolve a dispute is to prevent it from occurring in the first place. The federal government
has rarely resorted to penalties and only when all other efforts to resolve the issue have proven unsuccessful.
Dispute avoidance has worked for us in the past and it can serve our shared interests in the future. Therefore,
it is important that governments continue to participate actively in ad hoc federal/provincial/territorial
committees on Canada Health Act issues and undertake government-to-government information exchange,
discussions and clarification on issues as they arise.
Moreover, Health Canada commits to provide advance assessments to any province or territory upon request.
Dispute Resolution
Where the dispute avoidance activities between the federal government and a provincial or territorial
government prove unsuccessful, either Minister of Health involved may initiate dispute resolution by
writing to his or her counterpart. Such a letter would describe the issue in dispute. If initiated, dispute
resolution will precede any action taken under the non-compliance provisions of the Act.
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Canada Health Act — Annual Report 2008–2009
Annex C : Dispute Avoidance and Resolution Process Under the Canada Health Act
As a first step, governments involved in the dispute will, within 60 days of the date of the letter initiating
the process, jointly:
• collect and share all relevant facts;
• prepare a fact-finding report;
• negotiate to resolve the issue in dispute; and
• prepare a report on how the issue was resolved.
If, however, there is no agreement on the facts, or if negotiations fail to resolve the issue, any Minister of
Health involved in the dispute may initiate the process to refer the issue to a third party panel by writing
to his or her counterpart. Within 30 days of the date of that letter, a panel will be struck. The panel will
be composed of one provincial/territorial appointee and one federal appointee who, together, will select
a chairperson. The panel will assess the issue in dispute in accordance with the provisions of the Canada
Health Act, will undertake fact-finding and provide advice and recommendations. It will then report to
the governments involved on the issue within 60 days of appointment.
The Minister of Health for Canada has the final authority to interpret and enforce the Canada Health Act. In
deciding whether to invoke the non-compliance provisions of the Act, the Minister of Health for Canada will take
the panel’s report into consideration.
Public Reporting
Governments will report publicly on Canada Health Act dispute avoidance and resolution activities,
including any panel report.
I believe that the Government of Canada has followed through on its September 2000 Health Agreement
commitments by providing funding of $21.1 billion in the fiscal framework and by working collaboratively in
other areas identified in the agreement. I expect that provincial and territorial premiers and Health Ministers
will honour their commitment to the health system accountability framework agreed to by First Ministers in
September 2000. The work of officials on performance indicators has been collaborative and effective to date.
Canadians will expect us to report on the full range of indicators by the agreed deadline of September 2002.
While I am aware that some jurisdictions may not be able to fully report on all indicators in this timeframe,
public accountability is an essential component of our effort to renew Canada’s health care system. As such,
it is very important that all jurisdictions work to report on the full range of indicators in subsequent reports.
In addition, I hope that all provincial and territorial governments will participate in and complete the
joint review process agreed to by all Premiers who signed the Social Union Framework Agreement.
The Canada Health Act Dispute Avoidance and Resolution process outlined in this letter is simple and
straightforward. Should adjustments be necessary in the future, I commit to review the process with
you and other Provincial/Territorial Ministers of Health. By using this approach, we will demonstrate
to Canadians that we are committed to strengthening and preserving medicare by preventing and resolving
Canada Health Act disputes in a fair and timely manner.
Yours sincerely,
A. Anne McLellan
Canada Health Act — Annual Report 2008–2009
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Annex C : Dispute Avoidance and Resolution Process Under the Canada Health Act
Fact Sheet: Canada Health
Act Dispute Avoidance and
Resolution Process
Scope
The provisions described apply to the interpretation
of the principles of the Canada Health Act.
Dispute Avoidance
To avoid and prevent disputes, governments will
continue to:
• participate actively in ad hoc federal/provincial/
terri­torial committees on Canada Health Act
issues; and
If however, there is no agreement on the facts, or
if negotiations fail to resolve the issue, any Minister
of Health involved in the dispute may initiate the
process to refer the issue to a third party panel by
writing to his or her counterpart.
• Within 30 days of the date of that letter, a panel
will be struck. The panel will be composed of
one provincial/territorial appointee and one
federal appointee, who, together will select a
chairperson.
• The panel will assess the issue in dispute in
accordance with the provisions of the Canada
Health Act, will undertake fact-finding and
provide advice and recommendations.
• The panel will then report to the governments involved on the issue within 60 days
of appointment.
Health Canada commits to provide advance assessments to any province or territory upon request.
The Minister of Health for Canada has the final
authority to interpret and enforce the Canada
Health Act. In deciding whether to invoke the noncompliance provisions of the Act, the Minister of
Health for Canada will take the panel’s report into
consideration.
Dispute Resolution
Public Reporting
Where the dispute avoidance activities between the
federal government and a provincial or territorial
government prove unsuccessful, either Minister
of Health involved may initiate dispute resolution
by writing to his or her counterpart. Such a letter
would describe the issue in dispute. If initiated,
dispute resolution will precede any action taken
under the non-compliance provisions of the Act.
Governments will report publicly on Canada Health
Act dispute avoidance and resolution activities,
including any panel report.
• undertake government-to-government information exchange, discussions and clarification on
issues as they arise.
As a first step, governments involved in the dispute
will, within 60 days of the date of the letter initiating
the process, jointly:
Review
Should adjustments be necessary in the future, the
Minister of Health for Canada commits to review
the process with Provincial and Territorial Ministers
of Health.
• collect and share all relevant facts;
• prepare a fact-finding report;
• negotiate to resolve the issue in dispute; and
• prepare a report on how the issue was resolved.
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Canada Health Act — Annual Report 2008–2009
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