Canada Health Act 2007–2008 Annual Report

Canada Health Act 2007–2008 Annual Report
Canada Health Act
Annual Report
2007– 2008
Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health.
Health Canada is committed to improving the lives of all of Canada’s people and to making this country’s population among
the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system.
Published by authority of the Minister of Health.
Canada Health Act — Annual Report 2007–2008
is available on Internet at the following address:
http://www.healthcanada.gc.ca/medicare
Également disponible en français sous le titre :
Loi canadienne sur la santé – Rapport Annuel 2007-2008
This publication can be made available on request on diskette, large print, audio-cassette and braille.
For further information or to obtain additional copies, please contact:
Health Canada
Address Locator 0900C2
Ottawa, Ontario
K1A 0K9
Telephone: (613) 957-2991
Toll free: 1-866-225-0709
Fax: (613) 941-5366
© Her Majesty the Queen in Right of Canada, represented by the Minister of Health Canada, 2008
All rights reserved. No part of this information (publication or product) may be reproduced or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or otherwise, or stored in a retrieval system, without
prior written permission of the minister of Public Works and Government Services Canada, Ottawa, Ontario K1A 0S5
or [email protected]
HC Pub.: 1263
Cat.: H1-4/2008E
ISBN: 978-1-100-11173-5
Minister of Health
Ministre de la Santé
The Honourable/L’honorable Leona Aglukkaq
Ottawa, Canada K1A 0K9
Her Excellency, the Right Honourable Michaëlle Jean,
Governor General and Commander-in-Chief of Canada
May it please Your Excellency:
The undersigned has the honour to present to Your Excellency the Annual Report
on the administration and operation of the Canada Health Act for the fiscal year
that ended March 31, 2008.
Leona Aglukkaq
ii Canada Health Act Annual Report, 2007–2008
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 Health Canada
at headquarters and in the regional offices.
Canada Health Act Annual Report, 2007–2008
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Canada Health Act Annual Report, 2007–2008
Table of Contents
Acknowledgements____________________________________________________________________ iii
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 2007–2008_________________________ 15
Newfoundland and Labrador__________________________________________________________________________________ 17
Prince Edward Island___________________________________________________________________________________________ 33
Nova Scotia_____________________________________________________________________________________________________ 45
New Brunswick_________________________________________________________________________________________________ 63
Quebec__________________________________________________________________________________________________________ 79
Ontario__________________________________________________________________________________________________________ 85
Manitoba_______________________________________________________________________________________________________ 103
Saskatchewan___________________________________________________________________________________________________ 125
Alberta__________________________________________________________________________________________________________ 145
British Columbia______________________________________________________________________________________________ 159
Yukon__________________________________________________________________________________________________________ 183
Northwest Territories__________________________________________________________________________________________ 201
Nunavut________________________________________________________________________________________________________ 211
Annex A — Canada Health Act and Extra-Billing and User Charges Information Regulations_____________ 223
Annex B — Policy Interpretation Letters________________________________________________________________________ 243
Annex C — Dispute Avoidance and Resolution Process under the Canada Health Act______________________ 253
Annex D — Glossary of Terms___________________________________________________________________________________ 259
Provincial and Territorial Departments of Health Contact Information ____________________________ inside back cover
Canada Health Act Annual Report, 2007–2008
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Canada Health Act Annual Report, 2007–2008
Introduction
and the national debate it generated, led to the
enactment of the Canada Health Act in 1984.
Introduction
Canada has a predominantly publicly financed
and administered health care system. The Canadian
health insurance system is achieved through 13 inter­
locking 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 pro­
vinces and territories had public insurance plans
that provided universal access to hospital services.
Saskatchewan again pioneered in providing in-­
surance 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,
Canada Health Act Annual Report, 2007–2008
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.
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 admi­
nistration 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 terri­
tories. 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
1
Introduction
been exhausted. Pursuant to the commitment made
by premiers under the 1999 Social Union Frame­
work 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.
2
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 2007–2008, 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.
Canada Health Act Annual Report, 2007–2008
Chapter 1 — Canada Health Act Overview
Key Definitions Under the Canada Health Act
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.
Canada Health Act Annual Report, 2007–2008
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.”
Persons excluded under the Act include serving
members of the Canadian Forces or Royal Canadian
Mounted Police and inmates of federal penitentiaries.
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 outpatient 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.
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Chapter 1 — Canada Health Act Overview
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.
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.
Requirements of the
Canada Health Act
2. Comprehensiveness (section 9)
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:
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.
five program criteria that apply only to insured
health services;
3. Universality (section 10)
two conditions that apply to insured health
services and extended health care services; and
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 pro­
vincial 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.
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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 pro­
vince or territory, not to exceed three months, before
they are entitled to receive insured health services.
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
Canada Health Act Annual Report, 2007–2008
Chapter 1 — Canada Health Act Overview
care insurance plan that they are leaving and to
register with the health care insurance plan of
their new province or territory.
reasonable compensation to physicians and
dentists for all the insured health services they
provide; and
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.
payment to hospitals to cover the cost of insured
health services.
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 condi­
tions, 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).
In addition, the health care insurance plans of the
province or territory must provide:
Canada Health Act Annual Report, 2007–2008
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))
The provincial and territorial governments shall
recognize the federal financial contributions toward
both insured and extended health care services.
Extra-billing and User Charges
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 Extrabilling and User Charges Information Regulations
(described below).
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Chapter 1 — Canada Health Act Overview
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.
Other Elements of the Act
Regulations (section 22)
Section 22 of the Canada Health Act enables the
federal government to make regulations for administering the Act in the following areas:
defining the services included in the Act’s
definition of “extended health care services”;
prescribing which services to exclude from
hospital services;
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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
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 extra-billing 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.
Canada Health Act Annual Report, 2007–2008
Chapter 1 — Canada Health Act Overview
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.
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,
Canada Health Act Annual Report, 2007–2008
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.
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 have been 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,
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Chapter 1 — Canada Health Act Overview
then-federal 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 clari­
fications 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
its 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.”
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 public facility that provides acute,
rehab­ilitative or chronic care. Thus, when a pro­
vincial/territorial health insurance plan pays the
8
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.
Canada Health Act Annual Report, 2007–2008
Chapter 2 — Administration and Compliance
informing the Minister of possible non-compliance
and recommending appropriate action to resolve
the issue;
CHAPTER 2
Administration
and Compliance
Administration
In administering the Canada Health Act, the
federal Minister of Health is assisted by Health
Canada policy, communications and information
officers located in Ottawa and in the seven regional
offices of the Department, and by lawyers with
the Department of Justice.
Health Canada works with the provinces and terri­
tories 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 terri­
torial health insurance plans for compliance
with the criteria, conditions and extra-billing
and user charges provisions of the Act;
working in partnership with the provinces and
territories to investigate and resolve compliance
issues and pursue activities that encourage compliance with the Act;
Canada Health Act Annual Report, 2007–2008
developing and producing the Canada Health
Act Annual Report on the administration and
operation of the Act;
developing and maintaining formal and informal
contacts and partnerships with health officials in
provincial and territorial governments to share
information;
collecting, summarizing and analysing relevant
information on provincial and territorial health
care systems;
disseminating information on the Act and on
publicly funded health care insurance programs
in Canada;
responding to information requests and correspondence relating to the Act by preparing responses
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;
conducting issue analysis and policy research to
provide policy advice;
collaborating with provincial and territorial
health department representatives on the
recommendations to the Minister concerning
the interpretation of the Act; and
collaborating with provincial and territorial
health department representatives through the
Interprovincial Health Insurance Agreements
Coordinating Committee (see below).
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
9
Chapter 2 — Administration and Compliance
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 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
As mentioned in Chapter 1, the provinces and territories must comply with the criteria and conditions
of the Canada Health Act to receive the full amount
of the Canada Health Transfer (CHT) cash contribution. The following section outlines how Health
Canada determines provincial/territorial 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 the issue have been exhausted.
To date, most disputes and issues related to admi­
10
nistering and interpreting the Canada Health Act
have been addressed and resolved without resorting
to deductions.
Health Canada officials routinely liaise with provincial
and territorial health ministry representatives and
health insurance plan administrators to help resolve
common problems experienced by Canadians related
to eligibility for health insurance coverage and portability of health services within and outside Canada.
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 Inter­
pretation 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 miscommunication, and are resolved
quickly with provincial assistance. In instances where
a Canada Health Act issue has been identified and
remains after initial enquiries, Division officials then
ask the jurisdiction in question to investigate the
matter and report back. Division staff then 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.
Compliance Issues
For the most part, provincial and territorial health
care insurance plans meet the criteria and conditions
Canada Health Act Annual Report, 2007–2008
Chapter 2 — Administration and Compliance
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 Quebec and British Columbia, for services
that are covered under their respective provincial
health insurance plans. 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 2007–2008, the outstanding concern under
the Act of patient charges for abortion services in
Quebec was resolved. The government of Quebec
decided to continue the provision of these insured
hospital services in private medical clinics in the community, and to fully cover the cost of these services.
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 extra-billing
and user charges, the federal government took steps
to eliminate the proliferation of direct charges for
hospital and physician services, judged to be restricting
Canada Health Act Annual Report, 2007–2008
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 were eliminated before April 1, 1987.
By March 31, 1987, it was determined that all pro­
vinces, 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 threeyear 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 extra-billing that occurred in the
province between 1992–1993 and 1995–1996.
These deductions were non-refundable, as were
all subsequent deductions.
In January 1995, the 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
11
Chapter 2 — Administration and Compliance
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 made to Alberta’s cash contri­
bution in respect of facility fees charged at clinics
providing 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 New­
foundland 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 made 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 made to
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.
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 made to 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 made to 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 made to Nova Scotia
as a reconciliation of deductions that had already
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, 2007–2008
Chapter 2 — Administration and Compliance
been made to Nova Scotia for patient charges at
a private clinic.
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, on the basis of charges
reported by the province to Health Canada.
A one-time positive adjustment in the amount
of $8,121 was made to Nova Scotia’s March 2006
CHT 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 provincial estimates reported for
fiscal 2003–2004.
Deductions were taken from the March 2007
CHT payments to British Columbia in respect
of extra-billing 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.
Canada Health Act Annual Report, 2007–2008
Deductions were also taken from the March 2007
CHT payments to Nova Scotia in respect of extrabilling during fiscal year 2004-2005 in the amount
of $9,460, on the basis of charges reported by the
province to Health Canada.
Deductions were taken from the March 2008
CHT payments to British Columbia in respect
of extra-billing and user charges that occurred
during fiscal year 2005–2006, in the amount
of $42,113, on the basis of charges reported by
the province to Health Canada.
Since the enactment of the Canada Health Act,
from April 1984 to March 2008, deductions
totalling $9,039,499 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 that were made between 1984
and 1987 and subsequently refunded to the
provinces when extra-billing and user charges
were eliminated.
13
14
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2007–2008
Chapter 3
Provincial and
Territorial Health
Care Insurance Plans
in 2007–2008
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 2007–2008.
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 territorial departments of health for the report
consists of two components:
Canada Health Act Annual Report, 2007–2008
a narrative description of the provincial or territorial health care system relating to the five criteria
and the first condition (that of providing the
Minister of Health with information in relation
to insured health services and extended health
care services) 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.
To help provinces and territories prepare their
submissions to the annual report, Health Canada
provided them with the document Canada Health
Act Annual Report 2007–2008: 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 2007–2008 was launched late spring 2008
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.
15
Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2007–2008
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 was retained for 2007-2008. 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.
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, 2008. All information was
provided by provincial and territorial officials.
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.
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 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.
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.
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.
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.
16
Canada Health Act Annual Report, 2007–2008
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, almost 19,000 health
care providers and administrators provide health services to 505,000 residents (based on 2006 census).
The re-registration of the province’s Medical Care Plan
(MCP) concluded in July 2007 with over 488,850 individuals, representing 97 per cent of the population,
receiving new cards. This measure ensures that only
eligible beneficiaries permanently residing in the
Canada Health Act Annual Report, 2007–2008
province are able to avail themselves of medical
care and hospital coverage under the MCP. All
residents of the province were required to complete
a re-registration form in order to receive a new MCP
card. Each new card has an expiry date which will
allow the government to effectively monitor MCP
claims and ensure that only eligible residents of
Newfoundland and Labrador are receiving services
under the provincial plan. This was the first major
change to the program since it began in 1969.
Other key initiatives during the year included:
The government invested $800,000 through
Budget 2007 to support the new Mental Health
Care and Treatment Act which took effect on
October 1, 2007. It contains several significant
changes including the provision of a range of
individual rights and protections and the provision of community treatment orders.
As part of the province’s Poverty Reduction
Strategy, the government extended eligibility for
the Children’s Dental Health Plan to children
aged 13 to 17 years in families with low incomes.
Investments worth $67 million were made in
health infrastructure. Construction is continuing
on new long-term care homes in Clarenville,
Corner Brook and Happy Valley/Goose Bay.
A new primary health centre in Grand Bank
and a provincial addictions centre in Corner
Brook are also being built.
New enhancements to the Medical Transportation
Assistance Program will provide increased financial assistance for residents who incur substantial
costs when travelling for insured medical services.
The government launched the Provincial Healthy
Aging Policy Framework to support its vision
of an age-friendly province which enables seniors
to live independently and experience good health
and well-being. The priority directions are the
Recognition of Older Persons, Celebrating
Diversity, Supportive Communities, Financial
Well-being, Health and Well-being and
Employment, Education and Research.
17
Chapter 3 — Newfoundland and Labrador
The government released planning guidelines
to enhance the protection of the public in the
event of a public health emergency with a view
to developing detailed operational plans at the
community level.
The Newfoundland and Labrador Prescription
Drug Program added an Assurance Plan for
residents with high drug costs. This offers all
residents protection against the financial burden
of drug costs by ensuring that their annual drug
expenses are capped at a percentage of their
net family income. The Assurance Plan costs
an additional $17.5 million annually.
The government launched an $8 million initiative to provide an enhanced board and lodging
supplement for adults with disabilities residing
with their own family. Approximately 2,500
individuals would be eligible for this increase
of up to $362 per month or $4,344 annually.
Budget 2007 provided $1.4 million to cover the
cost of insulin pumps and supplies for children
with Type 1 diabetes up to the age of 18 years.
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.
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.
18
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 2007–2008.
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 2007–2008
Annual Report in the House of Assembly in Fall
2008 as well as those of the four regional health
authorities.
The Department’s Annual Report highlights the
accomplishments of 2007–2008 and provides an
overview of the initiatives and programs that will
continue to be developed in 2008–2009. 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
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 14 hospitals, 22 community health
centres and 14 community clinics. Insured services
include: accommodations and meals at the standard
Canada Health Act Annual Report, 2007–2008
ward level; nursing services; laboratory, radiology
and other diagnostic procedures; drugs, biologicals
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
based on direction from the Minister. There were
no services added or de-listed in 2007–2008.
2.2 Insured Physician Services
The enabling legislation for insured physician
services is the Medical Care Insurance Act (1999).
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
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 2007–2008,
there were 989 physicians registered in the province.
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.
19
Chapter 3 — Newfoundland and Labrador
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:
(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:
(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
(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.
(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
20
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).
As of March 31, 2008, there were no physicians who
had opted out of the MCP.
Ministerial direction is required to add to or to
de-insure 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
2007–2008 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.
All oral surgeons or dentists licensed to practice in
Newfoundland and Labrador and who have hospital
privileges are allowed to provide surgical-dental services.
The dentist’s license is issued by the Newfoundland
and Labrador Dental Board. In 2007–08, 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.
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
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;
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 time taken or expenses incurred in travelling
to consult a beneficiary;
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:
the fees of a dentist, oral surgeon or general practitioner for routine dental extractions performed in
hospital;
any advice given by a physician to a beneficiary
by telephone;
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
Canada Health Act Annual Report, 2007–2008
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;
fluoride dental treatment for children under four
years of age;
excision of xanthelasma; circumcision of newborns;
hypnotherapy;
medical examination for drivers;
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);
21
Chapter 3 — Newfoundland and Labrador
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.
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
22
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; foreign students and their dependants;
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. A re-registration
of the province’s MCP plan was completed in
2007. All residents of the province were required
to complete a re-registration form in order to
receive a new MCP card.
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
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, 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.
International students studying in the province
became eligible for coverage in the MCP program
in June 2007.
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.
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,
although there is no formalized process.
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.
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:
4.2 Coverage During Temporary Absences
in Canada
Before leaving the province for extended periods,
a resident must contact the MCP to obtain an
out-of-province coverage certificate.
Newfoundland and Labrador is a party to the
Agreement on Eligibility and Portability regarding
matters pertaining to portability of insured services
in Canada.
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.
Sections 12 and 13 of the Hospital Insurance
Regulations (1996) define portability of hospital
coverage during temporary absences both within
Canada Health Act Annual Report, 2007–2008
23
Chapter 3 — Newfoundland and Labrador
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.
In 2007/2008, the total amount paid by MCP for
physician services received by residents in another
province or territory was $6,320,000.
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
24
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 outof-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 $220 per treatment. The
approved rates are paid in Canadian funds.
The total amount spent in 2007/2008 for insured
hospital services outside of Canada was approximately $1,148,560.
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 2007/2008
for insured physician services provided outside
Canada was $300,000.
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. 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
provincial health insurance plan will pay the costs of
services necessary for the patient’s care. However, it
is necessary in these circumstances for such referrals
to receive prior approval from the Department. The
referring physicians must contact the Department
or the MCP for prior approval.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
Prior approval is not required for physician services;
however, it is suggested that physicians obtain prior
approval from the MCP so that patients may be
made aware of any financial implications. General
practitioners and specialists may request prior approval
on behalf of their patients. 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.
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, 2008, regional health authorities
(RHAs) directly employed approximately 19,500
people in Newfoundland and Labrador. This figure
is comprised of 7,600 nurses (licensed practical
nurses and registered nurses, 730 social workers,
385 medical laboratory technologists, 305 medical
radiation technologists, a further 475 health service
providers of various occupations, 980 managers, and
approximately 9,000 support staff (housekeeping,
laundry, facilities, dietary, etc.) Additionally, approximately 989 physicians work in the province, with
about one-third employed directly by RHAs in salaried
positions (these are not included in the figure of
19,500 people).
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
Canada Health Act Annual Report, 2007–2008
external organizations for health professionals not
trained in this province.
Insured hospital services are provided by 36 hospitals and health centres across Newfoundland and
Labrador. All facilities provide 24-hour emergency
services, out-patient clinics, laboratory and x-ray
services. 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. Insured
services are also provided in 14 nursing stations.
The government continued to improve capacity
through a $22.3 million investment in 2007 for
new diagnostic and capital equipment including
two new linear accelerators to expand radiation
treatment capacity at the Dr. H. Bliss Murphy
Cancer Centre in St. John’s.
As of March 31, 2008, Newfoundland and Labrador
was within the national benchmarks for cardiac care,
joint replacement, and cancer care between 78%
to 100% of the time, demonstrating that the four
regional health authorities are providing access to
these services within close proximity to the target
timeframe.
The government provided $2 million in 2007 to
improve access to health services, including extended
hours of operation for MRI services in St. John’s
and Corner Brook, enhanced mammography and
CT services in Carbonear and expanded endoscopy
services in Gander and Grand Falls-Windsor. An
additional $11.5 milion was allocated to regional
health authorities to address utilization pressures
and invest in new initiatives including additional
long-term care and acute care beds, implementaion
of a new bilateral cochlear implant service in St. John’s,
establishing a specialized medical flight team for
the province’s air ambulance service and enhanced
services for dialysis, stroke care, respiratory therapy
and laboratory.
25
Chapter 3 — Newfoundland and Labrador
Newfoundland and Labrador has implemented the
Picture Archiving and Communications System
(PACS) and by December 2007 had achieved the
goal of having 95% of diagnostic images available
digitally throughout the province to authorized
health care providers.
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.
5.3 Access to Insured Physician and
Surgical-Dental Services
A pilot pediatric dental clinic, Operation Tooth,
was held in Labrador in January 2008. A surgical
team travelled to the Labrador Health Centre in
Happy Valley-Goose Bay to perform 38 surgeries
for children who were wait listed for dental surgery
and who would normally have to fly to St. John’s
for services.
A new Dental Bursary Program will support
an increase in the number of dentists practising
throughout the province, particularly in rural
areas. The government invested $150,000 to
implement the program in 2008 and $275,000
annually for the programs two components:
26
the Rural Dental Bursary Proram and Specialist
Bursary Program.
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.
As of March 31, 2008, there were 480 general
practitioners and 509 specialists in practice,
compared with 481 general practitioners and
504 specialists as of March 31, 2007.
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 $575,000
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 2007–2008, 27 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
regional health authorities play a significant role
in this 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.
Canada Health Act Annual Report, 2007–2008
6.0Recognition 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
other documents. For fiscal year 2007–2008, these
documents included:
the 2007–2008 Public Accounts;
the Estimates 2007–2008; and
the Budget Speech 2007.
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
three hospitals (including a psychiatric facility),
17 community health centres and 20 homes.
27
Chapter 3 — Newfoundland and Labrador
There are approximately 2,747 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.
helicopters. These helicopters are also used for
routine transportation of doctors and nurses to
remote communities for clinics. A third fixedwing aircraft is used in Labrador for regional
medical services transports, including routine
appointments by coastal residents in Happy
Valley/Goose Bay, Labrador.
Persons requiring supervised care or minimal
assistance with activities of daily living can avail
themselves of residential services in personal care
homes. There are approximately 3,529 beds located
in 104 homes across the province. These homes are
operated by the private for-profit sector. Residents
are subsidized to a maximum of $1,534 per
month, based on an individual client assessment
using standardized financial criteria.
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.
7.2 Home Care Services
Home care services include professional and nonprofessional supportive care to enable people to
remain in their own homes for as long as possible
without risk. 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 self-managed 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 2007–2008 was $2,707 for seniors and $3,875
for persons with disabilities.
7.3 Ambulatory Health Care Services
The Dental Health Plan incorporates a children’s
dental component and an Income Support component. 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 extractions, when
the patient is seen for pain, infection or trauma.
Adults receiving income support are eligible for
emergency care and extractions.
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. This program
uses two fixed-wing aircraft and five chartered
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
28
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
Benefit List. These approved benefits are supplied
as part of the Foundation Plan, 65 Plus Plan,
Special Needs 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 who, due to the high cost of
their medications, may qualify for drug card
only benefits, 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 are in receipt of the federal
Guaranteed Income Supplement (GIS) and
who are registered for the Old Age Security
(OAS) benefits. 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, 2007–2008
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 Special Needs Plan provides universal
coverage for patients with Cystic Fibrosis
and Growth Hormone Deficiency. The
Special 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.
The Access Plan provides prescription drug
coverage for residents of Newfoundland and
Labrador who are eligible for and in receipt
of a MCP card and who fall within specific
income thresholds. The Access Plan covers
a percentage of drug costs (ranging from
30–80%) dependant upon family income.
The Assurance Plan caps annual drug
expenses at a percentage of net family
income.
29
Chapter 3 — Newfoundland and Labrador
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
599,907
569,835
545,160
545,629
506,530
1
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Private For-Profit Facilities
4.
5.
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
36
0
0
0
36
36
0
0
0
36
36
0
0
0
36
36
0
0
0
36
36
0
0
14
50
666,773,382
0
0
0
666,773,382
679,024,717
0
0
0
670,024,717
740,235,437
0
0
0
740,235,437
743,680,905
0
0
0
743,680,905
798,018,159
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
1
0
1
1
0
1
1
0
1
1
0
1
1
0
1
280,250
0
280,250
264,575
0
264,575
285,475
0
285,475
288,800
0
288,800
307,825
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2
2
798,018,159
307,825
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
3
2005–2006
3
2003–2004
2004–2005
2006–2007
2007–2008
1,640
1,711
1,850
1,736
1,910
12,397,072
12,276,510
15,355,713
15,157,341
16,509,144
25,762
27,577
30,762
34,349
34,159
3,232,235
4,489,143
5,385,716
6,755,412
6,817,250
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
62
50
54
60
73
363,153
76,981
112,039
92,683
496,719
283
301
261
345
404
167,588
60,159
24,265
934,295
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
4
651,841
1. Newfoundland and Labrador has just completed the re-registration project that commenced in 2006. Thus, the 2007–2008 number represents
re-registered residents only.
2. Nursing stations/community clinics not included in previous reports.
3. Lines 6–9 changed to reflect date processing adjustments.
4. Increase attributable to patients who were granted prior approval to receive insured services outside the country.
30
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Newfoundland and Labrador
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
451
499
not applicable
950
460
494
not applicable
954
471
500
not applicable
971
481
504
not applicable
985
480
509
not applicable
989
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
not available
not available
not available
not available
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 ($)
3,953,889
153,352,000
4,019,000
175,910,000
4,234,000
180,263,000
4,295,000
182,730,000
4,361,000
189,169,000
14. Number of participating physicians (#): 5
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
139,000
113,000
136,000
139,000
168,000
4,518,000
4,770,000
5,197,000
6,290,000
6,320,000
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
1,800
2,400
2,300
2,100
2,300
199,000
136,000
135,000
130,000
300,000
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
25
31
26
27
25
3,609
3,022
2,633
2,044
885
462,000
329,000
313,000
123,000
73,000
5. Excludes inactive physicians. Total Salaried and Fee-for-service.
Canada Health Act Annual Report, 2007–2008
31
32
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Prince Edward Island
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
Canada Health Act Annual Report, 2007–2008
results. The Department is managed by a Departmental Management Committee comprised of the
Deputy Minister, the Assistant Deputy Minister of
Health Operations, and nine senior directors whose
responsibility it is to direct the overall departmental
management and day-to-day operations. A summary
of the principal roles of division is outlined below.
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.
Additionally, each of the five community hospitals
is governed by a Community Hospital Authority.
Each board is accountable to the Minister, and is
responsible for ensuring the completion of annual
business plans and reporting on facility performance
and results to the Minister and their local communities.
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.
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Chapter 3 — Prince Edward Island
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
recruitment and retention efforts to meet the
current and future needs for physicians, nurses
and allied health professionals.
1.0Public Administration
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 community needs.
The Department of Health is responsible for service
delivery and operates hospitals, health centres, manors
and mental health facilities. The Public Service
34
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.
The community hospital authority boards are
accountable to the Minister pursuant to the
Community Hospital Authorities Act and must
submit annual business plans and provide information to the Minister as and when required.
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. Community hospital
authorities are reporting entities under the
Financial Administration Act.
2.0 Comprehensiveness
2.1 Insured Hospital Services
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:
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Prince Edward Island
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.
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. A business plan would be developed
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 2008, there were seven acute care
facilities participating in the province’s Insurance
Plan. In addition to 427 acute care beds, these
facilities house 20 rehabilitative beds and 20 day
surgery beds, as defined under the Hospitals Act
(1988), for a total of 467 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, 2008, was 309.
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
Canada Health Act Annual Report, 2007–2008
physicians or practitioners and provide the patient
with sufficient information to enable recovery of the
cost of services from the Minister of Health.
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.
As of March 31, 2008, no physicians had opted
out of the Health Care Insurance Plan.
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.
The process to add a physician service to the list of
insured services involves negotiation between the
Department and the Medical Society. A business
plan would be developed which when approved by
the Minister would be taken to Treasury Board for
funding approval. Cabinet has the final authority
in adding new services.
35
Chapter 3 — Prince Edward Island
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.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Provincial hospital services not covered by the Hospital
Services Plan include:
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;
examinations required in connection with
employment, insurance, education, etc.;
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;
dental services other than those procedures
included as basic health services;
dressings, drugs, vaccines, biologicals and
related materials;
eyeglasses and special appliances;
36
physiotherapy, chiropractic, podiatry, optometry,
chiropody, osteopathy, psychology, naturopathy,
audiology, acupuncture and similar treatments;
reversal of sterilization procedures;
in vitro fertilization;
services performed by another person when
the supervising physician is not present or
not available;
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 2007/2008 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Prince Edward Island
3.0Universality
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
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.
Canada Health Act Annual Report, 2007–2008
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, 2008, was 146,518.
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.
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.
37
Chapter 3 — Prince Edward Island
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 2007/2008 was
$29,776,625.
for paying the difference between the full amount
charged and the amount paid by the Department.
In 2007–2008, the total amounts paid for in-patient
claims was $49,616 and $27,533 for out-patient
claims.
4.4 Prior Approval Requirement
The payment rate currently ranges from $772 at
the community hospitals to $780 at Prince County
Hospital and $990 at the Queen Elizabeth Hospital
per day for hospital stays. The standard interprovincial outpatient rate is $169. The methodology used
to derive these rates is as if the patient had the services provided in Prince Edward Island.
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-of-country hospital or medical services not
available in Canada.
4.3 Coverage During Temporary Absences
Outside Canada
5.0 Accessibility
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 institution
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
38
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
of 463 beds. Along with nine government manors
(and facilities) that house 558 (plus 10 respite)
long-term care nursing beds, Islanders have access
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Prince Edward Island
to an additional 389 (plus 11 temporary beds) 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 18 acute care beds and 57 long
term care beds.
This past year saw renovations undertaken to the
Emergency Departments at the Prince County
Hospital and the Kings County Memorial Hospital.
As well, the engineering and design work on Phase I
of a $52 million multi-phase redevelopment plan to
upgrade the 25-year-old Queen Elizabeth Hospital
is underway and construction is expected to begin
in mid-2008. This redevelopment will take up to
seven years to complete 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 Medical
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.
In addition to the aforementioned programs, other
current initiatives include:
Nurse Recruitment Strategy;
Provider Registry;
Musco-skeletal Injury Prevention Program
(Workplace safety);
Canada Health Act Annual Report, 2007–2008
Wait Times Strategy;
Youth Addictions Strategy;
Clinical Information System interoperable
Electronic Health Record;
Patient Safety Strategy;
Rural Physician Stabilization Initiative; and
Pandemic Planning.
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/inter-disciplinary approaches as well
as enhancements in the areas of ambulatory care
(including the multi-year QEH redevelopment
project) and primary health care will contribute
to chronic disease prevention, treatment, and
management.
Collaborative strategies focussed on promoting
healthier lifestyles include:
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;
39
Chapter 3 — Prince Edward Island
the PEI Strategy for Healthy Living, which
focuses on tobacco reduction and promoting
exercise and good nutrition; and
the PEI Active Living Alliance, which promotes
physical activity through a variety of community.
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 accessible throughout the province except for specialties where there are vacancies.
Recruitment processes have been undertaken for family
physicians, anaesthetists, radiologists, radiation and
medical oncologists, psychiatrists, and a pathologist
and plastic surgeon.
An enhanced Physician Recruitment/Retention and
Medical Education Strategy was announced to build
on existing initiatives and address 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.
As of March 31, 2008 there were the following
vacancies in the physician complement: Family
Medicine, Emergency Medicine, Addiction Services, Psychiatry, Radiology, Pathology, Physical
Medicine, Ophthalmology and Radiation Oncology,
overall totalling 13.8 vacancies. Recruitment to find
suitable placements for these positions is ongoing.
40
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. The
Physician Master Agreement expired March 31,
2007. A negotiation team has been appointed
and a number of meetings have been held to work
towards a negotiated settlement. 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.
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 almost
60 percent of physicians are compensated under
salary or sessional payments.
5.5 Payments to Hospitals
The community hospital authorities are responsible
for delivering hospital services in the province under
the Community Hospital Authorities Act. The financial
(budgetary) requirements are established annually
through annual business plans approved by the
Minister and are subject to approval by the Legislative
Assembly through the annual budget process.
Payments (advances) to provincial hospitals and the
community hospital authorities for hospital services
are approved for disbursement by the Department
in line with cash requirements and are subject to
approved budget levels.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Prince Edward Island
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.
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
2007–2008 Annual Budget and related budget
documents and its 2007–2008 Public Accounts,
which were tabled in the Legislative Assembly
and are publicly available to Prince Edward Island
residents.
7.0 Extended Health Care
Services
Extended health care services are not insured services,
except for the insured chronic care beds noted in
section 2.1.
7.1 Nursing Home Intermediate Care
and Adult Residential Care Services
Nursing home services are available on approval from
regional admission and placement committees for
placement into public manors and licensed private
nursing homes. There are currently 18 long-term
care facilities in the province, nine public manors
and 8 licensed private nursing homes, with a total
of 997 beds, including respite and temporary beds.
Nursing home admission is for individuals who
require 24 hour registered nurse (nursing care)
Canada Health Act Annual Report, 2007–2008
supervision and care management. The standardized Seniors Assessment Screening Tool is used to
determine service needs of residents for all admissions
to nursing homes.
Significant changes were made last year to long-term
nursing care funding and subsidization. First, selfpaying residents in nursing homes are no longer
required to cover the health care portion of their
cost and are only required to cover their accommodation cost. Secondly, eligibility for subsidization
was changed to be based on an assessment of income
rather than on the applicant’s total financial resources
which previously included income and assets. When
a resident of a facility or someone coming into a
facility does not have the financial resources to pay
for their own care, they can apply for financial assistance under the Social Assistance Act Regulations,
Part II. The Province subsidizes 78 percent of residents in nursing homes. The federal government
subsidizes approximately 8.2 percent of nursing
home residents through Veterans Affairs Canada.
The remaining 13.8 percent finance their own care.
In addition to nursing home facilities, there are
37 licensed community care facilities in Prince
Edward Island. As of March 31, 2008, the total
number of licensed community care facility beds
was 1,112. 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.
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Chapter 3 — Prince Edward Island
7.2 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 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
42
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.
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Prince Edward Island
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
142,022
143,261
144,159
145,047
146,518
Insured Hospital Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
7
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
7
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
121,944,000
not applicable
not applicable
not applicable
121,944,000
125,118,252
not applicable
not applicable
not applicable
125,118,252
129,976,900
not applicable
not applicable
not applicable
129,976,900
137,365,100
not appliciable
not appliciable
not appliciable
137,365,100
143,254,200
not applicable
not applicable
not applicable
143,254,200
Public Facilities
2.
3.
4.
5.
1
1
Private For-Profit Facilities
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
1
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
2,006
2,163
2,187
2,003
2,253
14,208,471
15,325,267
16,463,548
17,510,188
19,448,899
15,638
14,368
15,547
15,675
17,867
2,578,895
2,667,968
3,225,803
3,345,624
4,292,114
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
37
30
25
35
28
155,922
95,719
69,391
105,268
49,616
130
93
91
96
137
24,366
16,304
17,084
16,179
27,533
1. Figures are budget estimates, not actuals.
Canada Health Act Annual Report, 2007–2008
43
Chapter 3 — Prince Edward Island
Insured Physician Services Within Own Province or Territory
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total 2
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
96
94
not applicable
190
98
96
not applicable
194
113
98
not applicable
211
120
108
not applicable
228
111
110
not applicable
221
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
0
0
0
0
1,330,946
2,504,320
1,387,070
9,795,812
1,312,506
41,778,719
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. number of records
b. total payments ($)
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. number of records
b. total payments ($)
36,732,119
40,012,026
40,027,386
1,181,548
1,197,935
1,052,167
33,289,335
34,423,393
35,226,215
3
4
5
937,707
794,706
34,543,095
14,490,876
1,137,286
36,549,921
3
4
5
887,967
749,779
34,973,359
Insured Physician Services Provided to Residents in Another Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
45,255
48,928
54,269
73,399
58,284
77,992
60,044
3,795,244
4,122,725
4,674,004
5,221,586
6,035,626
19. Number of services (#).
Number of records
20. Total payments ($).
Insured Physician Services Provided Outside Canada
21. Number of services (#).
Number of records
22. Total payments ($).
706
627
534
746
681
562
541
37,100
21,849
15,844
27,899
23,979
Insured Surgical-Dental Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
2
2
3
3
3
393
410
303
442
332
364
263
90,851
96,490
115,918
106,708
95,749
23. Number of participating dentists (#).
24. Number of services provided (#).
Number of records provided
25. Total payments ($).
2. Total does not include locums.
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.
44
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
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, community-based 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 commu­
nity 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, 2007–2008
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.
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 of Nova Scotia 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 will be 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
45
Chapter 3 — Nova Scotia
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.
Other major cost drivers are a highly competitive
labour market for health human resources, the
increasing costs of pharmaceuticals and aging facility
infrastructure.
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.
Additional information related to health care in
Nova Scotia may be obtained from the Department
of Health website at:
www.gov.ns.ca/health
1.0Public 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).
46
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
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 Depart­
ment 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. A contract is in place
to have an annual audit performed on the Insured
Prescription Drug Plan Trust Fund. The Department
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
of Health has a service level agreement in place
with Medavie Blue Cross, effective August 1, 2005.
An audit plan is under development for this agreement, including Medicare payments, 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.
The June 2007 Report of the Auditor General of
Nova Scotia contained audits with respect to:
Management of Diagnostic Imaging Equipment
for the Capital District Health Authority and the
Cape Breton District Health Authority
Emergency Health Services
Long Term Care — Nursing Homes and Homes
for the Aged
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 authori­
zation 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 trans­
actions are subject to a review by the Office of the
Auditor General.
2.0Comprehensiveness
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.1
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.
Out-patient services include:
laboratory and radiological examinations;
diagnostic procedures involving the use of
radio-pharmaceuticals;
1. 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, 2007–2008
47
Chapter 3 — Nova Scotia
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 parenterel 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 Proposal2 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.
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 2007–2008,
2,290 physicians and 27 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, 2008, 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 medi­
cally necessary insured services.
No new large-scale services were added to the list
of insured physician services in 2007–2008. On an
as needed basis, new specific fee codes are approved
2. Emergency/unexpected requirements may be considered at any time throughout the fiscal year.
48
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
that represent enhancements, new technologies or
new ways of delivering a service.
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 Joint Fee and
Tariff Committee for review and approval. The Joint
Com­mittee is comprised of equal representation
from Doctors Nova Scotia and the Department of
Health. When approved by the Joint Fee Schedule
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, 2008, no
dentists had opted out. In 2007–2008, 27 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 (DoH) 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 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) immu­
nocompromised patients, and 4) radiation patients.
Routine extractions for these patients will be pro­
vided 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.
Other newly approved service includes coverage for
all precancerous or cancerous dental surgical biopsies.
Canada Health Act Annual Report, 2007–2008
49
Chapter 3 — Nova Scotia
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital services include:
services in connection with an electrocardiogram,
electromyogram or electroencephalogram, unless
the physician is a specialist in the appropriate
specialty;
preferred accommodation at the patient’s request;
telephones;
cosmetic surgery;
acupuncture;
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;
services such as gastric bypass for morbid obesity,
breast reduction/augmentation and newborn
circumcision;* and
services not deemed medically necessary that are
required by third parties, such as insurance companies.
* These services may be insured when approved as special
consideration for medical reasons only.
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;
preparation of certificates or reports;
testimony in court;
50
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 patient 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.
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 service 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
3.0Universality
3.1 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 citizens or hold “Perma­
nent 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 imme­
diately become eligible for provincial Medicare.
There were no changes to eligibility requirements
in 2007–2008.
Canada Health Act Annual Report, 2007–2008
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 2007–2008, the total number of residents registered with the health insurance plan was 970,450.
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:
51
Chapter 3 — Nova Scotia
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 2007–2008, there were 25,951 Permanent Resi­
dents 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
52
the above requirements before coverage will be
extended to him/her—or their dependents.
In 2007–2008, there were 1,733 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
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 maxi­
mum 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 2007–2008, there were 868 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.
4.0Portability
4.1 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
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 as per the Interprovincial Agreement
on Eligibility and Portability. 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 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 2007–2008, for in- and outpatient hospital services received in other provinces
and territories was $25,673,241. Nova Scotia pays
the host province rates for insured services in all
reciprocal-billing situations.
There were no changes made in Nova Scotia in
2007–2008 regarding in-Canada portability.
Canada Health Act Annual Report, 2007–2008
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.
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 2007–2008 for insured in-patient services pro­
vided outside Canada was $1,257,620.
There were no changes made in Nova Scotia in
2007–2008 regarding out-of-Canada portability.
53
Chapter 3 — Nova Scotia
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.
5.0Accessibility
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 orthopaedic surgeries. The
procedures are done by Capital District surgeons
and anaesthetists. The patients are taken from the
54
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. It 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. 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
Canada. This is being undertaken to address the
long orthopaedic wait list in the Halifax area.
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 (4) new sixty-four
(64) slice computed tomography units have been
installed/replaced in Halifax (2) and two rural sites.
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.
5.2 Access to Insured Hospital Services
The Government of Nova Scotia continues to
emphasize the provision of sustainable, quality
health care services to its citizens.
In 2007–2008, 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% or more
new graduates have renewed their license to practice
in Nova Scotia.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — 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.
Table 1: Health Personnel in Nova Scotia
5.3 Access to Insured Physician and
Surgical-Dental Services
In 2007–2008, 2,290 physicians and 27 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
Health Occupation
Registered/Licensed
to Practice 3
Physicians
2,455
4
511
Registered Nurses
9,650
Licensed Practical Nurses
3,271
Medical Radiation
Technologists
551
5.4 Physician Compensation
Respiratory Therapists
132
Pharmacists
788
Occupational Therapists
317
Speech-Language
Pathologists
174
Chiropractors
103
Opticians
199
Optometrists
92
Denturists
44
Dietitians
436
Psychologists
439
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.
Physiotherapists
532
Dentists
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.
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.
3. Not all professionals licensed to practice actually work.
4. A limited number of licensed dentists are approved for insured dental services.
Canada Health Act Annual Report, 2007–2008
55
Chapter 3 — 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 2007–2008, it is estimated that 33 percent of
physicians continue to be remunerated through
alternative funding, while approximately 76 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.
There are also a number of physicians who receive
a portion of their remuneration through alternative
funding. These alternative funding mechanisms
include Sessional, Psychiatry, Remote Practice,
Facility On-Call and Emergency Room funding.
In total, over 60 percent of physicians in Nova
Scotia receive all or a portion of their remuneration
through alternative funding mechanisms.
In 2007–2008, total payments to physicians for
insured services in Nova Scotia were $555,659,788.
The Department paid an additional $7,606,977 for
insured physician services provided to Nova Scotia
residents outside the province, but within Canada.
56
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, which was reached in April 2004, expired on
March 31, 2008.
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 2007–2008, there were 2,891 hospital beds
in Nova Scotia (3.0 beds per 1,000 population).
Department of Health direct expenditures for
insured hospital services operating costs were
increased to $1.3 billion.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
6.0Recognition 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 2007–2008:
Public Accounts 2007–2008; and
Budget Estimates 2007–2008.
7.0Extended 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.
Canada Health Act Annual Report, 2007–2008
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 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
7.2 Home Care Services
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
57
Chapter 3 — Nova Scotia
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.
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.
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:
58
www.nspharmacare.ca
Nova Scotia Family Pharmacare Program —
This provincial drug insurance plan began in
March 2008 and is designed to provide prescription drug coverage to Nova Scotians who
are at risk of having unmet drug needs because
they are un-insured or underinsured. The program is available to all residents of Nova Scotia,
however people cannot receive benefits from the
Family Pharma-care 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
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 province-wide system has been
rated in the top 10 percent of systems in North
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nova Scotia
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; and
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 and patients with a signed statement to the effect that they are severely mentally
challenged and require hospitalization for dental
treatment; and those residents requiring the
services of a maxillofacial prosthodontist.
Mental Health Services — The IWK Heath
Centre and the 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
Canada Health Act Annual Report, 2007–2008
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.
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 a 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.
Specific services include:
Prevention and community education;
Community Based Services, including:
Adolescent Services;
Driving While Impaired and Ignition Interlock;
Nicotine Treatment;
Problem Gambling Services;
Women’s Services;
59
Chapter 3 — Nova Scotia
Withdrawal Management;
Structured Treatment Program; and
Methadone Maintenance Treatment.
Client’s 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.
60
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.
Interpreter Service Program — This program
guarantees equal access to government services,
offered to the general public, to eligible deaf and
hard of hearing residents 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, 2007–2008
Chapter 3 — Nova Scotia
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
956,820
961,089
963,993
965,044
970,450
Insured Hospital Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
35
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
35
Payments for insured health services ($): 5
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
1,095,584,706
not applicable
not applicable
not applicable
1,095,584,706
1,133,215,533
not applicable
not applicable
not applicable
1,133,215,533
1,230,549,093
not applicable
not applicable
not applicable
1,230,549,093
1,301,306,116
not applicable
not applicable
not applicable
1,301,306,116
1,367,828,540
not applicable
not applicable
not applicable
1,367,828,540
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
1
0
1
0
0
0
0
0
0
0
0
0
1
0
1
5,531
0
5,531
0
not available
not available
0
not available
not available
0
not available
not available
0
not applicable
not applicable
Public Facilities
2.
3.
Private For-Profit Facilities
4.
5.
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
6
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
2,368
2,335
2,252
2,154
2,257
15,859,930
15,795,451
16,285,032
14,502,141
16,726,553
32,968
34,166
37,811
41,729
42,569
4,303,236
6,107,316
7,345,702
8,269,002
8,946,688
Insured Hospital Services Provided Outside Canada
not available
not available
not available
not available
not available
623,896
678,205
1,495,313
727,586
1,257,620
12. Total number of claims, out-patient (#).
not applicable
not applicable
not available
not available
not available
13. Total payments, out-patient ($).
not applicable
not applicable
not available
not available
not available
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
5. $’s are paid to acute care facilities/DHAs only.
6. $’s paid to physicians working out of private for-profit facilities are included in indicator #18—total fee for service payments.
Canada Health Act Annual Report, 2007–2008
61
Chapter 3 — Nova Scotia
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
904
1,198
14
2,116
905
1,235
27
2,167
948
1,270
2
2,220
944
1,333
5
2,282
943
1,341
6
2,290
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
9,199,462
434,000,386
9,290,207
464,685,571
9,599,128
540,495,196
9,569,146
581,817,423
9,591,989
555,659,788
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
6,560,930
254,670,965
6,353,382
246,724,107
6,553,774
254,621,655
6,357,622
255,007,711
6,223,067
258,751,069
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
180,897
188,118
198,262
205,237
212,404
5,747,516
5,866,887
6,619,938
7,091,572
7,606,977
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
2,667
3,111
2,981
2,931
2,701
120,977
151,175
151,414
153,937
134,729
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
62
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
28
25
33
29
27
3,780
4,343
5,169
5,321
5,831
904,283
995,966
1,060,006
1,122,126
1,215,333
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
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 2007–2008.
As an example, New Brunswick’s commitment
to accessibility has long included the provision
of health services to individuals in either French
or English, reflecting the province’s standing as
Canada’s only officially bilingual province. While
maintaining this commitment, the 2007–2008
fiscal year also saw New Brunswick assuring access
to French language services in the Acadian Peninsula,
through continuing to implement recommendations
made following the previous year’s Dialogue Santé
consultations.
Significant investments and improvements were made
in 2007–2008 across the range of health services. The
governance structure of New Brunswick’s ambulance
services was overhauled, to ensure equity and accessibility. Investment proceeded in a variety of e-health
initiatives, improving both the quality and accessibility
of services. Both comprehensiveness and accessibility
improved with enhancements to palliative care —
both in home health care and institutional settings,
and with significant investments in regional chemotherapy delivery.
Some of the most important work of 2007–2008,
however, was preparatory — and was not revealed
until the fiscal year had changed over. April 2008
Canada Health Act Annual Report, 2007–2008
saw the introduction of a new Provincial Health
Plan. Some of the plan’s pillars (e.g. Enhancing
Access) explicitly mirror the CHA principles. Others
(e.g. Enhancing Efficiency, Harnessing Innovation,
and Making Quality Count) implicitly speak to
other CHA principles (e.g. comprehensiveness).
The transformed governance structure expresses
New Brunswick’s ongoing commitment to health
care’s public administration, while exploring options
to improve 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.
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.
63
Chapter 3 — New Brunswick
1.2 Reporting Relationship
The Medicare Services Branch and the Medicare
Operations 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
Regional Health Authorities (“RHA(s)”) 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 2007–2008, 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 2007–2008, the Auditor General also
reported on the state of program evaluation in
the Department and followed up on prior recommendations regarding psychiatric hospitals and
units, and the Prescription Drug Program.
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
64
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 2007–2008, the Office of the
Comptroller performed routine audits of new
computer systems and specific payments made
by the Department.
3) Department of Health Internal Audit Branch:
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 2007–08, the
Branch reported on Continuing Medical Education
(CME) payments, Information Technology (IT)
outsourcing, and examined Medicare card usage.
2.0Comprehensiveness
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.
During fiscal 2007–08, there were eight Regional
Health Authorities (RHAs), established under the
authority of the Regional Health Authorities Act.
Each RHA includes a regional hospital facility 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, 2007–2008
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 anesthetic
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:
Canada Health Act Annual Report, 2007–2008
the provision of any proprietary medicines;
the provision of medications for the patient
to take home;
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.
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
2007–2008.
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 number of physicians with an active status as of
March 31, 2008, was 1,453.
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
65
Chapter 3 — New Brunswick
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.
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.
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.
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.
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, 2008, 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 includes certain surgical-dental procedures
66
During fiscal 2007–2008, the following physician
services were added:
Intra tympanic injection of medication
Meniscal Allograph Transplantation
Insertion of Pessary
CT Angiography of Coronary Arteries
Repair of Femoral False Aneurysm
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
examinations. The array of services include, those
performed in an outpatient setting.
removal of minor skin lesions, except where the
lesions are, or are suspected to be, pre-cancerous;
The conditions that an OMS and a dental practitioner
must meet to participate in the medical plan are:
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;
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, 2008, there were 87 OMSs and
dentists registered with the Plan.
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.
Services are not insured if provided to those entitled
under other statutes.
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:
elective surgery or other services for cosmetic
purposes;
correction of inverted nipple;
breast augmentation;
otoplasty for persons over the age of 18;
Canada Health Act Annual Report, 2007–2008
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;
vaccines, serums, drugs and biological products
listed in sections 1006 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 that are provided in conjunction with,
or in relation to, the services referred to above;
testimony in a court or before any other tribunal;
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;
electrocardiogram (ECG) where not performed
by a specialist in internal medicine or paediatrics;
67
Chapter 3 — New Brunswick
laboratory procedures not intended as part of an
examination or consultation fee;
not compromise reasonable access to insured services.
Intraocular lenses are now provided by the hospitals.
refractions;
services provided within the province by medical
practitioners, OMS or dental practitioners for
which the fee exceeds the amount payable under
this Regulation;
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.
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;
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
68
In 2007–2008 the code for “mileage for house calls
to patients on home dialysis, per kilometre in excess
of 5 km, one way” was removed from the insured
service list.
3.0Universality
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
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.
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.
Canada Health Act Annual Report, 2007–2008
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.
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
are legally married to, or living in a common-law
relationship with, an eligible New Brunswick resident and still possess a valid immigration permit.
69
Chapter 3 — New Brunswick
At the time of renewal, they are required to provide
an updated immigration document.
4.0Portability
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,
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.
70
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.
There were 213,710 physician services provided
to New Brunswick residents in other provinces and
territories during 2007–2008. The total amount
paid for these services was $11,998,933.
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,
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
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,
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.
Exception for Temporary 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);
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.
“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 Services 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;
the worker’s permanent residence must remain
in New Brunswick; and
do not establish permanent residence outside
New Brunswick; and
the worker must return to New Brunswick
during their off-time.
do not receive health coverage elsewhere.
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.
Canada Health Act Annual Report, 2007–2008
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.
71
Chapter 3 — New Brunswick
New Brunswick residents may be eligible for
reimbursement if they receive elective medical
services outside the country, provided they fulfill
the following requirements:
5.0 Accessibility
the required service, or equivalent or alternate
service, must be unavailable in Canada;
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.
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.
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.
72
5.1 Access to Insured Health Services
5.2 Access to Insured Hospital Services
The following measures were taken in 2007–2008
to improve access to hospital services:
A provincial surgical patient registry was implemented. This ensures that there is an accurate
and standardized list of patients who are waiting
for surgery in New Brunswick. Utilizing this
wait time information has resulted in ongoing
improvements to surgical wait times resulting
in more timely access to surgery.
Each of the 16 facilities that perform surgery
is implementing recommended changes to its
processes and resources which is resulting in
improving efficiencies and increasing capacity,
thereby improving timely access to surgery.
Electrophysiology services are now being
offered at the New Brunswick Heart Centre.
New Brunswickers previously had to travel
out-of-province to obtain these services.
An additional fixed Magnetic Resonance
Imaging unit (MRI) is now in operation at
the Dr. Everett Chalmers Regional Hospital
in Fredericton. There are now 6 MRI units
(2 mobile and 4 fixed) in the province.
Cardiac rehabilitation services have been
enhanced throughout the province. Existing
programs were enhanced and new programs
were implemented in areas where this service
was previously unavailable.
Six nurse practitioners were added in order to
improve access to primary care services.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
Three new oncology clinics were established
in the northern rural part of the province.
Patients can now receive their treatment
closer to home.
Radiation therapy treatment capacity was
increased in Moncton in order to address
a growing patient load.
The maximum number of annual PET
examinations was increased from 300 to 600.
A new 70 bed hospital began operating
in Waterville, New Brunswick during fiscal
2007–08. Following the opening of this new
facility, 2 facilities were closed (total of 52 beds).
This increased the maximum bed capacity by 18.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2008, there were 708 general practitioners, 745 specialists, and 87 OMSs and dentists
registered with the plan.
In fiscal 2007–2008, the Department continued
to work on its recruitment and retention strategy,
aimed at attracting newly licensed family practitioners
and specialists. This strategy includes a contingency
fund to allow the Department to 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.
Canada Health Act Annual Report, 2007–2008
Fiscal 2007–2008 marked the third and final year
of an agreement with fee-for-service physicians that
provides for a 13 percent increase in fees over a
three-year period (2005–2006 to 2007–2008 for
4.0%, 4.5% and 4.5% respectively).
There is no formal negotiation process for dental
practitioners in New Brunswick.
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.
5.5 Payments to Hospitals
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.
There were no changes during the 2007–2008 fiscal
affecting the hospital payment process.
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 main
patient-care delivered services as follows:
tertiary services (cardiac, dialysis, 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.
Added to this are non-patient care support services
(e.g., general administration, laundry, food services,
energy).
73
Chapter 3 — New Brunswick
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 Regional Health Authority staff.
6.0Recognition 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 18, 2008;
the 2006–2007 Public Accounts presented by the
Minister of Finance on September 28, 2007;
New Brunswick does not produce promotional documentation on its insured medical and hospital benefits.
7.0Extended Health Care
Services
7.1 Nursing Home Intermediate Care
and Adult Residential Care Services
The New Brunswick Long-Term Care program,
a non-insured service, was transferred to the
Department of Family and Community Services
on April 1, 2000. Nursing home care, also a noninsured 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 entrepreneur’s
open and close residential facilities. Clients are
admitted after going through the same evaluation
process used for nursing home admissions.
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.
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 18, 2008.
74
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
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
nurses, licensed practical nurses, social workers,
dieticians, respiratory therapists, physiotherapists,
occupational therapists, speech language pathologists
and pharmacists, where funded.
A demonstration project is now providing screening,
assessment and appropriate community intervention
Canada Health Act Annual Report, 2007–2008
to prevent unnecessary hospital admissions when
it is possible for seniors to be living at home safely
supported and secure. These services, although not
covered by the Canada Health Act, are considered
insured services under the provincial Hospital
Services Plan.
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 it is available in hospitals,
health centres and Community Health Centres. This
is considered an insured service under the provincial
Hospital Services Plan.
75
Chapter 3 — New Brunswick
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
741,353
741,726
740,759
738,651
740,845
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Private For-Profit Facilities
4.
5.
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
27
0
1
22
50
27
0
1
22
50
23
0
1
26
50
23
0
1
26
50
22
0
1
27
50
not available
not available
not available
not available
1,001,055,724
not available
not available
not available
not available
1,118,701,200
not available
not available
not available
not available
1,205,197,000
not available
not available
not available
not available
1,290,887,880
not available
not available
not available
not available
1,372,911,800
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
1
Payments to private for-profit facilities for
insured health services ($): 1
a. surgical facilities
b. diagnostic imaging facilities
c. total
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
4,785
5,464
5,418
3,740
4,363
$26,995,076
$33,743,005
$38,017,578
$32,494,834
$42,267,067
38,090
34,422
45,911
44,941
51,406
$5,391,831
$5,887,128
$9,561,558
$10,022,287
$11,316,103
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
211
191
215
211
209
$497,715
$587,632
$374,035
$741,599
$726,650
1,058
1,170
1,453
1,122
1,073
$266,167
$337,337
$321,202
$358,594
$441,575
1. There are no private for-profit facilities operating in New Brunswick.
76
Canada Health Act Annual Report, 2007–2008
Chapter 3 — New Brunswick
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
647
682
0
1,329
658
707
0
1,365
667
714
0
1,381
693
706
0
1,399
708
745
0
1,453
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
$327,618,344
not available
$351,888,988
not available
$373,500,994
not available
$400,481,139
not available
$420,718,463
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
5,488,314
$216,599,016
5,540,170
$229,403,104
5,721,352
$240,841,117
5,746,248
$244,907,268
5,714,676
$254,610,350
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
2
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
200,718
175,528
202,555
192,544
213,710
$9,909,950
$9,789,304
$11,353,739
$11,125,487
$11,998,933
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
5,459
5,339
6,707
6,047
5,999
$428,473
$409,132
$449,689
$417,942
$487,961
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists
(#). 3
24. Number of services provided (#).
25. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
23
22
21
25
21
1,986
2,422
2,890
2,472
2,962
$486,105
$537,679
$621,491
$502,913
$598,383
2. These are the number of physicians with an active status on March 31 of each year.
3. These are the number of Dentists and Oral Maxillofacial Surgeons participating in New Brunswick’s Medical Services Plan during each
of the fiscal years.
Canada Health Act Annual Report, 2007–2008
77
78
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Quebec
2.0Comprehensiveness
Quebec
1.0Public Administration
1.1 Health Care 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) [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) [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, 2007–2008
2.1 Insured Hospital Services
Insured in-patient services include: standard ward
accommodation and meals; necessary nursing services;
routine surgical supplies; diagnostic services; use
of operating rooms, delivery rooms and anesthetic
facilities; medications, prosthetic 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.
Out-patient services include: 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: mechanical,
hormonal or chemical contraception services; surgical
sterilization services (including tubal ligation or
vasectomy); reanastomosis of the fallopian tubes
or vas deferens; and ablation of a tooth or root
when the health status of the person 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
79
Chapter 3 — Quebec
prostheses; hearing aids, assistive listening devices
and visual aids for people with a visual or auditory
disability; and permanent ostomy appliances.
Since January 1, 1997, in terms of drug insurance,
the Régie covers, over and above its regular clientele
(employment assistance recipients and persons 65 years
of age or older), individuals who otherwise would
not have access to a private drug insurance plan.
Currently (2007), the drug insurance plan covers
3.29 million insured persons.
2.2 Insured Physician Services
The services insured under this plan include medical
and surgical services that are provided by physicians
and are required from a medical standpoint.
2.3 Insured Surgical-Dental Services
Services insured under this plan include oral surgery
performed in a hospital centre or university institution determined by regulation, by dental surgeons
and specialists in oral and maxillo-facial surgery.
2.4 Uninsured Hospital, Physician
and Surgical-Dental Services
Uninsured hospital services include: plastic
surgery; in vitro fertilization; a private or semiprivate 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
an institution authorized for this purpose by
the Minister of Health and Social Services; any
service rendered solely for aesthetic purposes;
80
any refractive surgery, except in cases where there
is documented failure in astigmatism of more than
3.00 diopters or for anisometropia of more than
5.00 diopters, measured at the cornea, when corrective
lenses or corneal lenses are worn; 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 a contract with
an employer, an association or an organization;
any adjustment of eye glasses or contact lenses;
any surgical ablation of a tooth or tooth fragment
performed by a physician, except where the service
is provided in a hospital in certain cases; all acupuncture procedures; injection of sclerosing substances
and the examination done at that time; mammography
used for screening purposes, unless this service is
delivered on a doctor’s orders in a place designated
by the Minister, in either case, to a recipient who is
35 years of age or older, on condition that such an
examination has not been performed on the recipient
in the previous 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 a radiology service, if required
by a person other than a physician or dentist; any
sex-reassignment surgical service, unless it is provided
on the recommendation of a physician specializing
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Quebec
in psychiatry and is provided in a hospital centre
recognized for this purpose; and any services that
are not associated with 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 card, for colour blindness or a refraction
problem, in order to provide or renew a prescription
for eyeglasses 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.
day they arrive, 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
[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
3.2 Registration Requirements
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.
Registration with the hospital insurance plan is
not required. Registration with the Régie or proof
of residence is sufficient to establish eligibility.
4.2 Coverage During Temporary Absences
Outside Quebec (in Canada)
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.
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
Canada Health Act Annual Report, 2007–2008
If living outside Quebec in another province or
territory for 183 days or more, students and fulltime
unpaid trainees may retain their status as residents
of Quebec. In the first case, they retain it for four
calendar years at most, and in the second, for two
consecutive calendar years at most.
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.
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
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Chapter 3 — Quebec
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 the 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 became effective 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, since
November 1, 1995, the Government of Quebec
reimburses a maximum of $450 per day of hospitalization when an Outaouais inhabitant is hospitalized
in an Ottawa hospital for non-urgent care or services
available in the Outaouais.
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.
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4.3 Coverage During Temporary Absences
Outside Quebec (outside Canada)
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 ascertain their eligibility. If the Régie recognizes
them as having special status, they receive full
reimbursement of hospital costs in case of emergency
or sudden illness, and 75 percent reimbursement
in other cases.
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 inhabitant of the province, provided their families
remain in Quebec or they retain a dwelling there.
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. In
such cases, the Régie provides reimbursement for
the associated professional services. The services
must be dispensed 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Quebec
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.
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.
5.0 Accessibility
5.3 Access to Insured Physician
and Surgical-Dental Services
5.1 Access to Insured Health 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 2008,
there were 160 accredited FMGs in Quebec.
Everyone has the right to receive adequate health
care services without any kind of discrimination.
There is no extra-billing by Quebec physicians.
5.2 Access to Insured Hospital Services
On March 31, 2008, Quebec had 117 institutions
operating as hospital centres for a clientele suffering
from acute illnesses. There were 20,400 beds for persons
requiring care for acute physical or psychiatric ailments
allotted to these institutions. From April 1, 2007 to
March 31, 2008, Quebec hospital institutions had
nearly 716,191 admissions for short stays (including
births) 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,
Canada Health Act Annual Report, 2007–2008
The Conseil médical du Québec 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
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Chapter 3 — Quebec
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 practice outside the
plan, with no reimbursement from the Régie going
to either them or their patients.
In 2007–2008, the Régie paid an amount estimated
at $3,654,700 to doctors in the province, while the
amount for medical services outside the province
reached an estimated $9.7 million.
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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 2006–2007 to institutions
operating as hospital centres for insured health services provided to inhabitants of Quebec were more
than $8.2 billion. Payments to hospital centres
outside Quebec were approximately $118.9 million.
7.0 Extended Health Care
Services
Intermediate care, adult residential care and home
care services are available. Admission is coordinated
locally or regionally and based on a single assessment
tool. The CSSSs 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.
Quebec insures long-term care establishments 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
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.
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 $37.9 billion
(including capital) in spending for 2007–2008.
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.
Fourteen Local Health Integration Networks
(LHINs) have been established by the Ministry
to plan, integrate and fund health services in their
local area for the health service providers. While
the LHINs are responsible for managing the local
health care system, the Ministry is responsible
for establishing overall strategic direction and
provincial priorities for the health system.
1.0Public 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
Canada Health Act Annual Report, 2007–2008
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
MOHLTC is audited annually by the Office of
the Auditor General of Ontario. The Auditor
General’s 2007 Annual Report was released on
December 11, 2007.
MOHLTC’s accounts and transactions are
published annually in the Public Accounts
of Ontario. The 2007–2008 Public Accounts
of Ontario were released on August 25, 2008.
1.4 Designated Agency
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.
LHINs are not-for-profit Crown Agencies that
plan, integrate and fund local health 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 before the Legislative Assembly.
For fiscal 2007–08, the MOHLTC entered into
an accountability agreement with each LHIN that
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Chapter 3 — Ontario
includes performance goals and objectives for the
networks as well as the allocations for health service
providers. The Act also provides the LHINs with
the authority to fund health service providers and
to enter into service accountability agreements with
these providers.
The Local Health System Integration Act reaffirms
the principles of the French Languages Services Act
to ensure equitable access to services in French for
French-speaking Ontarians.
2.0Comprehensiveness
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 services include medically
required: use of operating rooms, obstetrical delivery
rooms and anaesthetic facilities; necessary nursing
services; laboratory, radiological and other diagnostic
procedures; 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
86
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 2007–2008, there were 150 public hospital
corporations (excluding specialty mental health
hospitals, private hospitals, federal hospitals and
long-term care homes) staffed and in operation
in Ontario. This includes 132 acute care hospital
corporations, 14 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 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 cover the cost of the
premises, equipment, supplies, and personnel used
to render an insured service. Under the Independent
Health Facilities Act, patient charges 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
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
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 2007–2008, 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 specified in
section 15 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
Canada Health Act Annual Report, 2007–2008
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 23,900 physicians who
submitted claims to OHIP in 2007–2008. This
figure includes physicians submitting both feefor-service claims and physicians included in an
alternative payment plan who submitted tracking
or shadow-billed 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 315 dentists and dental/oral surgeons
provided insured surgical-dental services in Ontario
in 2007–2008.
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
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Chapter 3 — Ontario
visits solely for administering drugs, subject to
certain exceptions.
Section 24 of Regulation 552 details those physician
services that are specifically prescribed as uninsured.
Uninsured physician services include: services that are
not medically necessary; toll charges for long-distance
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.
3.0Universality
3.1 Eligibility
To be considered a resident of Ontario for the
purpose of obtaining Ontario health insurance
coverage, a person must:
Hold Canadian citizenship or an immigration
status as prescribed in Regulation 552 of the
Health Insurance Act;
Be ordinarily resident in Ontario, which includes:
Making his or her permanent and principal
home in Ontario;
Subject to some limited exceptions, being
physically present in Ontario for at least
153 days in any 12-month period; and
88
For most new and returning residents, be
physically present in Ontario for 153 of the
first 183 days following the date residency 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 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 threemonth 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 born in Ontario and
insured residents from another province or territory
who move to Ontario and immediately become
residents of approved charitable homes, municipal
homes for the aged or nursing homes in Ontario.
The Fairness for Military Families Act (Employment
Standards and Health Insurance), 2007, was passed
on December 3, 2007, and amended the Health
Insurance Act, exempting eligible military family
members (spouses and dependent children of active
members of the Canadian Forces) from the waiting
period for Ontario health insurance coverage upon
establishing residency 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.
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
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 MOHLTC review the
denial of their OHIP eligibility by making a request
in writing to the General Manager of OHIP.
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 permanent and principal home
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 provincewide 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.
Registration is done through local Service Ontario
Health Card Services — OHIP offices. 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 residency in
Ontario and their identity. Eligible applicants over
the age of 15.5 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, 2007–2008
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).
Approximately 12.7 million Ontario residents were
registered with OHIP and held valid and active
health cards as of April 1, 2008.
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 residency in Ontario, and their identity
in the same manner as Canadian citizen or Permanent Resident/Landed Immigrant applicants.
The individuals listed below, who ordinarily reside in
Ontario, may be eligible for Ontario health insurance
coverage in accordance with Regulation 552 and
prevailing MOHLTC policy. Clients applying
for coverage under any of these categories should
contact their local Service Ontario Health Card
Services — OHIP office 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) and have passed CIC’s medical
requirements.
Convention Refugees and Protected Persons: These
are persons who are determined to be Convention
Refugees or Protected Persons under the terms of the
Immigration and Refugee Protection Act. Members of
this group are exempt from the three-month waiting
period.
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Chapter 3 — Ontario
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 hold a permit
with a case type of 86, 87, 88, 89 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, 90, 91,
92, 93, 94, 95 and 96 are not eligible for Ontario
health insurance coverage.
Clergy, Foreign Workers and their Accompanying
Family Members: An eligible foreign clergy is a
person who is sponsored by a religious organization
or denomination and has finalized an agreement
to minister full-time to a religious congregation
in Ontario for a period of at least six consecutive
months.
A foreign worker is a person who has a finalized
contract of employment or an agreement of
employment with a Canadian employer located
in Ontario, and has been issued a Work Permit/
Employment Authorization by CIC that names the
Canadian employer, states the person’s prospective
occupation, and has been issued for a period of at
least six months.
Spouses, same-sex partners and/or dependant children
(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 are also eligible for Ontario health
insurance coverage if the member of the clergy or the
foreign worker is to be employed in Ontario for at
least three consecutive years and if the family member
will be ordinarily a resident of Ontario.
90
Live-in Caregivers: Eligible Live-in Caregivers are
persons who hold a valid Work Permit/Employment
Authorization under the Live-in Caregivers in Canada
Program (LCP) or the former Foreign Domestic
Movement (FDM) administered by CIC, and
ordinarily reside in Ontario. The Work Permit/
Employment Authorization for LCP or FDM
workers does not have to list the three specific
employment conditions required by all other
foreign workers.
Migrant Farm Workers: Migrant farm workers
are persons who have been issued a Work Permit/
Employment Authorization under the Caribbean,
Commonwealth and Mexican Seasonal Agriculture
Workers Program administered by CIC. Due to
the special nature of their employment, migrant
farm workers are exempt from the three-month
waiting period and are not required to be ordinarily
resident in Ontario (may be resident for less than
the required five month period and not have a
permanent and principal home in Ontario) and
still qualify for OHIP.
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.
4.0Portability
4.1 Minimum Waiting Period
In accordance with subsection 3(3) of Regulation 552
under the Health Insurance Act, individuals who move
to Ontario are typically entitled to OHIP coverage,
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
three months after establishing residency in the province, unless listed as an exception in section 3(4).
In accordance with 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 on
the first day of the third month following the date
residency is established.
4.2 Coverage During Temporary Absences
in Canada
Insured out-of-province services are prescribed
under sections 28, 29 to 32 of Regulation 552 of
the Health Insurance Act.
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 and hospital services.
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.
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
Canada Health Act Annual Report, 2007–2008
territory are also eligible for continuous OHIP eligibility while accompanying students for the duration
of their studies.
In accordance with MOHLTC policy, 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 the Hospital Reciprocal
Billing agreements with all other provinces and
territories for insured hospital in- and out-patient
services. Payment is at the in-patient rate of the
plan in the province or territory where hospitalization 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.
4.3 Coverage During Temporary Absences
Outside Canada
Health insurance coverage for insured Ontario
residents during extended absences outside Canada
is governed by sections 28.1 through 29 (inclusive)
and section 31 of Regulation 552 of the Health
Insurance Act.
In accordance with sections 1.1(3), 1.1(4), 1.1(5) and
1.1(6) of Regulation 552 of the Health Insurance Act,
MOHLTC may provide 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.
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Chapter 3 — Ontario
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 ordinarily 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 accredited
academic program (unlimited)
Work
Five-year terms
Missionary Work
Duration of missionary activities (unlimited)
Vacation/Other
Up to two years in a lifetime
Certain family members may also qualify for continuous Ontario health insurance coverage while
accompanying the primary applicant on an extended
absence outside Canada and should contact their
local OHIP office for details.
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;
a maximum $50 (CAD) for out-patient services
(except dialysis); and
the actual cost incurred by the patient per dialysis
treatment.
92
During 2007–2008, 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 a licensed
or approved hospital or a licensed 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. 2007–08 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, approval from MOHLTC
is required for payment for non-emergency health
services provided outside of Canada prior to the
medical services being rendered. Where medically
accepted treatment is not available 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 health services.
Under section 28.5 of Regulation 552 of the
Health Insurance Act, laboratory tests performed
outside Canada are paid for, with prior approval
from MOHLTC, if the following conditions
are met:
the kind of service or test is not performed
in Ontario;
the service or test is generally accepted in
Ontario as appropriate for a person in the
same circumstances as the insured person;
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
the service or test is not experimental; and
the service or test is not performed for
research purposes.
person or entity from paying, conferring or receiving
a payment or other benefit in exchange for preferred
access to an insured service.
In 2007–2008, Ontario’s total payments for
prior-approved treatment outside Canada were
$101.4 million.
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.
There is no formal prior-approval process required
for services provided to Ontario residents outside
the province, but within Canada, if the insured service is covered under the Hospital Reciprocal Billing
System. All uninsured or approved for clinical usage
(experimental) devices and drugs are the costs of the
patient or must have prior approval from their home
province. As detailed above in section 4.2, 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.
5.0Accessibility
MOHLTC implemented Health Number/Card
Validation to aid health care providers and patients
with access to health services and claim 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 health 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.
5.1 Access to Insured Health Services
5.2 Access to Insured Hospital Services
All insured hospital, physician and surgical-dental
services are available to Ontario residents on uniform
terms and conditions.
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.
All insured persons are entitled to all insured physician,
surgical-dental and hospital services, as defined in
the Health Insurance Act and Regulations.
In 2007–2008, there were 150 public hospital
corporations staffed and in operation in Ontario,
which included chronic, general and special
rehabilitation units. There were 6,947,381 acute
patient days, 1,929,221 chronic patient days and
775,379 rehabilitation patient days delivered by
public hospitals.
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
more or accepting payment or other benefit for
more than the amount payable by OHIP. In addition, the CFMA prohibits physicians, practitioners
and hospitals from refusing to provide an insured
service if an insured person chooses not to pay for
an uninsured service. The Act further prohibits any
Canada Health Act Annual Report, 2007–2008
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.
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Chapter 3 — Ontario
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 and
Dental-Surgical Services
In 2007–2008, MOHLTC conducted the below
initiatives to improve access to physician 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 underserviced.
UAP works closely with underserviced 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 139 communities
in Ontario designated as underserviced for general/
family practitioners and 14 northern Ontario communities designated as underserviced for medical
specialists.
Northern Physician Retention Initiative (NPRI):
NPRI provides eligible family practitioners and
specialists who maintain practices in northern
Ontario for at least four years with a retention
incentive as well as access to funding for continuing medical education.
94
Northern Health Travel Grant Program (NHTG):
NHTG helps defray transportation-related costs for
residents of northern Ontario who must travel long
distances to access insured hospital 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 2007–2008, 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 after-hours coverage
and preventive care initiatives that enhance health
promotion, disease prevention, and chronic disease
management. As of March 31, 2008, there were
approximately 8.2 million patients rostered to
6,918 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). There are negotiated agreements
in place to address other special needs populations
such as: the homeless, remote First Nations communities, palliative care patients, and maternity centre
patients. Another model is currently being developed
to recognize and compensate physicians for the
uniqueness of practicing within speciality areas such
as HIV, oncology, palliative care 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
5.4 Physician Compensation
Physicians are paid for the services they provide
through a number of mechanisms. Some physician
payments are provided through fee-for-service arrangements. Remuneration is based on the Schedule of
Benefits under the Health Insurance Act. Other physician payment models include 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 36 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 payment rates, incentives
and other changes to the Schedule of Benefits
for Physician Services with the Ontario Medical
Association. A new Physician Services’ Agreement
with the Ontario Medical Association was negotiated for a four-year term, from April 2004 to
March 2008. The Agreement provided for an
across-the-board fee increase of 2 per cent for specialists and 2.5 per cent for general practitioners/
family physicians, effective April 1, 2004. Further
increases in specific fee codes were implemented
on various dates from October 1, 2005, through
to June 1, 2008.
Canada Health Act Annual Report, 2007–2008
The Agreement eliminated payment thresholds,
effective April 1, 2005. This Agreement expands
access to care in rural communities by introducing
new funding to support hospital-based specialists in
the north; enhances care for seniors by introducing
new on-call fees in long-term care homes, home
care and palliative care; supports hospital care by
expanding hospital on-call coverage and in-hospital
care fees for specialists and by introducing new fees
for family doctors caring for their own patients in
emergency departments; supports health promotion
and disease prevention by introducing special fees
for managing specific chronic diseases; promotes
access to primary health care services by introducing
special fees for enrolling unattached patients or patients
without family physicians; invests in initiatives to
recruit physicians to Ontario; and, makes quality of
life improvements for physicians such as expanding
pregnancy and parental leave benefits.
Under the Agreement, the parties began meeting
in April 2007, to undertake a performance review
of the degree to which the objectives under the
Agreement have been met.
A new agreement has been negotiated and is
currently in the implementation stage.
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
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Chapter 3 — Ontario
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 negotiate the
Hospital Service Accountability Agreements (HSAAs)
with the hospitals and are the lead for the Hospital
Annual Planning Process (HAPP). 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.
Each year, public hospitals submit Hospital Annual
Planning Submissions (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.
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.
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.
96
6.0Recognition Given
to Federal Tranfers
The Government of Ontario publicly acknowledged
the federal contributions provided through the Canada
Health Transfer in its 2007–2008 publications.
7.0Extended 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 new Long-Term Care Homes Act, 2007, received
Royal Assent on June 4, 2007. When proclaimed
into force, this legislation would replace the three
existing pieces of legislation and provide a legislative
framework to enable improved management of,
and quality of services to, a growing and rapidly
changing sector. Regulations to support the implementation of the new Act are under development.
The new Act would also enable better planning for
the needs of the population requiring appropriate
residential services provided in a LTC home.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
As of July 31, 2008, there were 622 LTC homes
with 75,972 beds in operation, of which 268
were not-for-profit facilities (including municipal,
charitable and not-for-profit nursing homes) and
354 were for-profit nursing homes.
Long-Term Care 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 Long-Term Care 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.
On August 1, 2005, new regulations were introduced to ensure that at least one registered nurse
is on site and on duty in all LTC homes 24 hours
a day, seven days a week. Effective January 1, 2006,
all LTC homes were required to implement two
new standards: Skin Care and Wound Management,
and Continence Care. As of April 1, 2006, Ministry
inspectors began monitoring compliance with the
new standards.
The Ministry’s public Reports on Long-Term Care
Homes website 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 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
Canada Health Act Annual Report, 2007–2008
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.
The Minister publicly supported in principle the
recommendations provided by Ms. Sharkey. In
addition, the Ministry announced:
Ms. Sharkey has agreed to chair an Implementation
Team to facilitate implementation of recommendations from her staffing and care report as well
as provide advice on key resident care areas
which require regulations under the Long-Term
Care Homes Act, 2007; and
The Ontario Health Quality Council (OHQC)
has been tasked to measure and publicly report
quality of care and resident satisfaction in longterm care homes.
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 care/homemaking,
physiotherapy, occupational therapy, speechlanguage pathology, social work, dietetics,
medical supplies and dressings, hospital and
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Chapter 3 — Ontario
sickroom equipment, assistance in obtaining a
drug card and laboratory and diagnostic services,
and transportation to medical appointments and
hospitals;
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 receiving home schooling, and for
personal support services for children/youth in
private schools or receiving home schooling;
developing plans of service;
re-assessing the individual’s needs and revising
the service plan when the individual’s needs
have changed;
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; Health Insurance Act;
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 service agencies provide support services that include: respite, volunteer hospice services,
Alzheimer services, homemaking, attendant care,
adult day services, caregiver support, meal services,
home maintenance and repair, friendly visiting,
security checks and reassurance, social and recreational services, volunteer transportation, palliative
care consultation and education, and services for
98
persons with physical disabilities such as attendant
outreach, direct funding and special services for
the blind and hearing impaired. 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 legislated 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 MOHLTC.
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 are transfer payment
agencies governed by incorporated non-profit community boards of directors that include members
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
work within a population health framework that
places an equal emphasis on providing comprehensive primary care, preventing illness, and health
promotion.
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.
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.
Historically, Community Health Centres have been
developed based on expressions of interest from
sponsoring groups. This has resulted in an uneven
distribution and some significant gaps in coverage
across the province. Between 2004 and 2008, the
government is expanding the network of Community Health Centres by adding 22 new centres and
27 satellite centres. This expansion will be targeted
to communities with at-risk populations facing
barriers to access. Once implemented, it is expected
that many of the most critical gaps in coverage will
be addressed.
Service is provided through 54 Community Health
Centres operating from more than 80 full-service
Canada Health Act Annual Report, 2007–2008
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Chapter 3 — Ontario
Registered Persons
2003–2004
1.
Number as of March 31st (#).
2004–2005
2005–2006
12,500,000
12,400,000
12,200,000
2006–2007
1
12,600,000
2007–2008
1
12,700,000
1
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Private For-Profit Facilities
4.
5.
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
135
13
4
3
155
135
13
4
3
155
134
14
4
4
156
132
14
4
4
154
132
14
4
4
154
not available
not available
not available
not available
10,300,000,000
2
3
3
3
3
2003–2004
not available
not available
not available
not available
12,300,000,000
2
3
3
3
3
2004–2005
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not available
not available
not available
4
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not available
not available
not available
4
4
4
4
4
not available
not available
not available
not available
12,700,000,000
2
3
3
3
3
2005–2006
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
not available
not available
not available
not available
13,500,000,000
2
3
3
3
3
2006–2007
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
not available
not available
not available
not available
14,032,000,000
2
3
3
3
3
2007–2008
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
1. These estimates represent the number of Valid and Active Health Cards (have current eligibility and resident has incurred a claim in the
last 7 years).
2. Provincial Psychiatric Hospitals are excluded and Specialty Mental Health Hospitals are reported under 2(d) — Other.
3. Facilities in Ontario tend to be mixed (acute/chronic, chronic/rehabilitative beds) with only a minority having one type of bed. Separating
by facility type gives a small sample size and significantly understates the amount actually spent on chronic and rehabilitative beds.
4. Data are not collected in a single system in MOHLTC. Further, the MOHLTC is unable to categorize providers/facilities as “for-profit”
as MOHLTC does not have financial statements detailing service providers’ disbursement of revenues from the Ministry.
100
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Ontario
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
9,023
8,184
8,374
8,037
7,130
63,000,000
52,000,000
54,000,000
49,870,000
45,712,000
167,143
154,460
174,848
139,036
166,373
20,000,000
23,000,000
29,100,000
25,576,000
31,052,000
not available
Insured Hospital Services Provided Outside Canada
21,458
21,710
23,845
20,800
32,000,000
42,466,826
66,916,271
76,828,432
5
not available
5
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
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 ($).
not available
7
not available
7
not available
7
not available
7
not available
7
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
10,611
10,703
not available
21,314
10,660
11,016
not available
21,676
10,774
11,460
not available
22,234
11,114
12,087
not available
23,201
11,288
12,571
not available
23,859
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
15
114
not available
129
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not available
not available
not available
not available
8
8
9
9
9
9
14
62
not available
76
not available
not available
not available
not available
8
8
9
9
9
9
12
39
not available
51
not available
not available
not available
not available
8
8
9
9
9
9
13
36
not available
49
not available
not available
not available
not available
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
192,572,601 10
5,945,003,300 10
200,825,265 10
6,424,329,400 10
215,980,656 10
7,072,813,000 10
222,632,480
7,791,581,966
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
182,000,000
4,973,000,000
191,451,200
5,312,085,618
203,656,000
5,642,049,000
204,545,656
5,962,775,787
8
8
9
9
9
9
10
10
10
31
not available
40
not available
not available
not available
not available
230,383,956
8,410,478,000
8
8
9
9
9
9
10
10
206136644
6,155,422,172
5. Information was not available as of time of printing.
6. Included in #24.
7. Included in #26.
8. All physicians are categorized as general practitioner or specialist.
9. Ontario has no non-participating physicians, only opted-out physicians who are reported under item #8.
10. Number of services includes services provided by Ontario physicians through Fee-for-Service, Primary Care, Alternate Payment Programs,
and Academic Health Science Centres. Total Payments includes payments made to Ontario physicians through Fee-for-Service, Primary
Care, Alternate Payment Programs, and Academic Health Science Centres and the Hospital On Call Program. Services and payments related
to Other Practitioner Programs, Out-of-Country/Out-of-Province Programs, and Community Labs are excluded.
Canada Health Act Annual Report, 2007–2008
101
Chapter 3 — Ontario
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
557,720
534,179
573,830
627,375
759,570
18,600,000
20,300,000
21,164,600
23,754,500
25,180,900
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
180,395
179,410
200,723
182,693
211,323
9,900,000
11,635,998
13,211,381
19,351,944
37,901,297
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
102
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
323
335
330
316
317
72,900
86,000
87,111
92,264
91,540
9,200,000
11,786,600
12,546,397
14,229,896
13,423,384
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
Manitoba
Introduction
Providing Disaster Management through intense
operational support and guidance in emergencies
such as the Selkirk ice jam, flood evacuation of
April 2007, and the Elie tornado of June 2007.
Advancing Public Health through extensive implementation planning for Human Papillomavirus
(HPV) immunization, addressing emerging
diseases, such as West Nile Virus and Lyme
disease and implementation of a multi-media
prevention awareness campaign for diabetes
and chronic disease.
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.
Strengthening efforts in Health Human Resources
that resulted in the total number of Manitoba
physicians being 2,325 as of April 30, 2008
(a net gain of 290 physicians since 1997). As
of December 2007, 973 nurses have received
relocation assistance to work in Manitoba and
496 have received funding for program refresher
programs to re-enter the nursing workforce.
Manitoba Health and Healthy Living remains committed to sustaining our universal, comprehensive
and accessible health care system and improving the
health status of all Manitobans. In support of these
commitments, a number of activities were initiated
in 2007/08:
Healthy Schools
Manitoba has made significant improvements
to patient access through the reduction of wait
lists and wait times in the five federal priority
areas of: cardiac surgery, sight restoration,
cancer, diagnostic imaging and hip and knee
joint replacements and four provincial priority
areas: pain services, sleep disorders, paediatric
dental surgery and mental health.
Emergency Medical Services (EMS) together with
the Regional Health Authorities (RHAs) completed
Phase 1 and Phase 2 of the implementation strategy
for the Medical Transportation Coordination
Centre (MTCC).
Canada Health Act Annual Report, 2007–2008
The Ministry of Healthy Living continued to lead
and shape the Department’s focus on promoting
healthful practices and preventing disease and
injury through:
Supporting school divisions, RHAs and local
resources in activities
Strengthening the “Food for Thought Healthy
Eating Campaign”
Introducing the school nutrition policy
Manitoba in Motion
The “Get In Motion” physical activity campaign
55 new schools registered as “Healthy Schools”
in motion bringing the total to 480 schools
Injury Prevention
Prevent injury by providing 12,884 low cost
bicycling helmets to Manitoba children to a
total of 44,000 provided to Manitobans in
the past three years.
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Chapter 3 — Manitoba
The SafetyAid home safety and falls prevention
program for seniors was supported in conjunction
with Manitoba Justice and Manitoba Seniors and
the Healthy Aging Secretariat.
Supportive funding was provided for the Falls
Prevention and Vision Screening pilot project,
“Focus on Falls,” at Misericordia Health Centre.
Healthy Sexuality
Funding for three additional teen clinics.
Launching rapid HIV testing at Nine Circles
Health Centre.
Funding to address sexual health promotion
needs of Aboriginal youth in the north.
Manitoba introduced a $155 million Five Point Plan
in 2005 to improve access to quality care and reduce
wait times in the five federal priority areas as well as
four additional Manitoba areas. The Plan involves
more diagnostic testing, more surgeries, more health
professionals, system innovation and better wait time
management, prevention and health promotion.
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 will open in 2008. The stateof-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
104
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.
MIPS continues to steer the Manitoba Node for the
Safer Healthcare Now! campaign and chairs the
Annual Provincial Patient Safety Workshops and
other professional and public forums. 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, Professional
Services and Drug Management Policy — to facilitate
comprehensive, coordinated and proactive drug benefit
program management for the publicly-funded 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. Specifically, the Drug Management Policy
Unit develops and leads the implementation of policies
and strategies to increase drug supply chain efficiencies
and to enhance prescribing practices and drug utilization to maximize health outcomes; develops drug
benefit plan design enhancements to manage pharmaceutical expenditures; and develops capacity and
implements cost-effective communication strategies
aimed at, firstly, transferring knowledge and increasing
awareness among prescribers, providers, and patients
about appropriate drug use and, secondly, facilitating
consultation and dialogue with stakeholders. In
2007–08, Manitoba Health and Healthy Living continued to develop goals/objectives for the Operational
Program Management and Professional Services
units to augment the established mission, goals and
objectives of the Drug Management Policy Unit.
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
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:
Considerable health capital investments in acute care
facilities have been made: the Pediatric Opthalmology
Clinic Redevelopment at the Health Sciences Centre,
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. 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 stateof-the-art maternity, newborn and women’s medical
and surgical care.
Capital investments in long term care facilities
included a new 80-bed personal care home, River
Park Gardens, located in St. Vital (Winnipeg).
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.
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
Reconfiguration 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.
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.
In addition, significant capital investments include
the following ongoing projects in construction during
2007/08: Emergency Department Renovations at
Concordia General Hospital, Emergency Room
Redevelopment at Seven Oaks General Hospital,
the first stage of the Emergency Department and
Outpatient Redevelopment of the Victoria General
Hospital, Emergency Room Redevelopment at the
Portage District General Hospital, Sleep Lab at the
Misericordia Health Centre, North End Wellness
Safety and security — living with reduced
risks in the home
Flexibility — adjusting services to meet
changing needs
Choice — freedom to choose among options
Equity — equal access for all seniors
Dignity — Ability to maintain sense of self
worth, self esteem and humanness
Canada Health Act Annual Report, 2007–2008
105
Chapter 3 — Manitoba
Centre – Primary Health Care Office, a 100-bed
personal care home in Neepawa, redevelopment
of the Selkirk Mental Health Centre, a 24-bed residential addictions treatment facility — Thompson
Residential Care and Outreach Facility.
The introduction of a new province-wide program
to enhance screening for colorectal cancer in targeted
age groups was announced in January 2007. The
Colorectal Cancer Screening Program project,
Phase 1 of a provincial program, was approved to
begin April 1, 2007 and is due for completion in
October 2009. Phase 1 involves the targeted population of individuals aged 50–74 years old in Manitoba
who reside in the Assiniboine and Winnipeg regional
health authorities. A total of 25,000 individuals
with an equal combination of rural and urban residents will be invited to participate. By June 30,
2008, a total of 18,656 people were invited to
participate and testing was complete for 1811 of
those. The participation rate was higher in the rural
area than in the urban area. Further expansion of
this program is underway.
It is the mission of Manitoba Health and Healthy
Living to lead a publicly administered sustainable
health system that meets the needs of Manitobans
and promotes their health and well-being. This is
accomplished through a structure of comprehensive
envelopes encompassing program, policy and fiscal
accountability; by the development of a healthy
public policy; and by the provision of appropriate,
effective and efficient health and health care services.
Services are provided through regional delivery
systems, hospitals and other health care facilities.
The Department also makes payments on behalf
of Manitobans for insured health benefits related
to the costs of medical, hospital, personal care,
pharmacare and other health services.
It is also the role of Manitoba Health and Healthy
Living to foster innovation in the health care system.
This is accomplished by developing mechanisms
to assess and monitor quality of care, utilization
and cost-effectiveness; fostering behaviours and
environments that promote health; and promoting
responsiveness and flexibility of delivery systems
and alternative, less expensive services.
The Role and Mission of Manitoba
1.0Public Administration
Health and Healthy Living
The Department of Health (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
Ministers of Health and 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.
Manitoba Health and Health Living’s vision is healthy
Manitobans through an appropriate balance of prevention and care.
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.
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.
106
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
The MHSIP is administered under this Act for insurance in respect of the costs of hospital, personal
care and medical and other health services referred
to in acts of the Legislature or regulations there under.
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.
Canada Health Act Annual Report, 2007–2008
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
imposed upon the Minister under the Act or under
the regulations.
There were no legislative amendments to the Act
or the regulations in the 2007–2008 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 2007–2008 fiscal
year and is contained in the Manitoba Health and
Healthy Living Annual Report, 2007–2008. It will
also be available on the Province’s website in late
October 2008.
107
Chapter 3 — Manitoba
2.0Comprehensiveness
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, 2008, there were 96 facilities
providing insured hospital services to both inand 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; 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, 2008, there were
108
2,293 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.
The range of physician services insured by Manitoba
Health and Healthy Living is listed in the Payment 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 2007–2008, 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
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, 2008,
594 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, 2008.
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.
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
Canada Health Act Annual Report, 2007–2008
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 is continuing
to address the issue of patient charges for medical
supplies, or “tray fees” and remains committed to
taking the necessary steps to prevent this practice.
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 2007–2008.
3.0Universality
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
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Chapter 3 — Manitoba
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-of-country 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
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Canadian Mounted Police (RCMP) and federal inmates. These residents become eligible for Manitoba
Health and Healthy Living coverage upon discharge
from the 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, 2008, there were 1,186,386 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
and be legally entitled to be in Canada before receiving Manitoba Health and Healthy Living coverage.
Province of Saskatchewan for Saskatchewan residents
who receive care in Manitoba border communities.
As of March 31, 2008, there were 5,697 individuals
on work permits covered under the MHSIP.
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.
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 2007–2008 fiscal year affected
universality.
4.0Portability
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
Canada Health Act Annual Report, 2007–2008
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 2007–2008, Manitoba Health and Healthy Living
made payments of approximately $25.6 million for
hospital services and $9.9 million for medical services
provided in Canada.
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
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Chapter 3 — Manitoba
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 $4,609,1602 for hospital care provided in hospitals outside Canada in the 2007–2008
fiscal year. In addition, Manitoba Health and Healthy
Living made payments of approximately $701,829 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 2007–2008 fiscal year had an effect
on portability.
5.0Accessibility
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.
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
2. Please note that the above totals are actual payments in 2007/08 and do not include any adjustments for accruals (current or prior year).
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Chapter 3 — Manitoba
ensuring that a surgical facility cannot perform
procedures requiring overnight stays and thereby
function as a private hospital.
Manitoba Health 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’s nursing supply has improved gradually
but there are ongoing distribution challenges, especially in rural and northern regions and in specialty
areas in Winnipeg. The improvement to the supply
of nurses is primarily due to an investment in nursing education. Enrolment in all nursing education
programs continues to be fully subscribed. The
Nurses Recruitment and Retention fund (NRRF)
has also contributed significantly to improving nursing supply in Manitoba through initiatives such as
relocation assistance, personal care home grants,
funding for continuing education for nurses, and
special project grants, and the Conditional Grant
Program to encourage new graduates to work in
rural and northern regions (outside Winnipeg and
Brandon). 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 52 as of March 31, 2008.
In addition, Manitoba has a wide range of other
health care professionals. Significant shortages in
midwifery are being addressed through a new degree
Canada Health Act Annual Report, 2007–2008
program, student enrolment is fully subscribed, and
through partnership with other jurisdictions on the
development of a bridging program for midwifery.
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 19 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,
Selkirk Regional Health Centre and Portage District
General Hospital.
There are a total of 100 diagnostic ultrasound
scanners in Manitoba. Seventy-four are in
Winnipeg health facilities and 26 are in the rural
and northern regional health authorities.
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Chapter 3 — Manitoba
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.
The 16th rural Manitoba Community Cancer
Program (CCP) opened in Deloraine in February
2008. CCPs are oncology out-patient units within/
juxtaposed to rural acute-care hospitals that are
developed under the direction and support of
CancerCare Manitoba. The CCPs deliver a variety
of treatments including chemotherapy for most
cancer diagnoses, as well as supportive and followup care, and strive to minimize the need for patients
to travel to Winnipeg. Services are delivered by
health professionals specially trained in oncology
and include the preparation and administration
of chemotherapy.
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 to mid 2009 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 Pan Am Clinic, formed in 1979, has evolved
from a sports medicine clinic into a comprehensive
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musculo-skeletal specialty centre. The Pan Am Clinic
came under the ownership of the Winnipeg Regional
Health Authority (WRHA) on September 1, 2001.
Services offered at Pan Am Clinic include primary
care, orthopedics, rheumatology, physiotherapy,
imaging services, lab services, surgical procedures,
a walk-in clinic, a Prehabilitation Program to address
the patient population awaiting joint replacement
surgery, and a minor injury clinic for children. In
January 2007 a satellite pain clinic was opened at
the Pan Am Clinic in Winnipeg to address the
needs/wait times in pain management services.
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.
In March 2005, the expansion of paediatric
dental surgery services to Misericordia Health
Centre (MHC) was initiated to reduce waiting
times. Further, 100 surgeries were added to
Thompson General Hospital at the beginning
of August 2005, and an additional 200 annual
surgeries at the Maples Surgical Centre beginning
in January 2007.
The WRHA Emergency Care Task Force concluded in January 2006. During its two years of work,
a total of 46 recommendations for short and long
term improvements in emergency care in Winnipeg
emergency departments was identified and plans for
implementation defined. The majority of the recommendations have now been fully implemented.
Progress is evident on those recommendations that
involve broad, system-wide issues: enhanced education for Emergency Department staff, redevelopment
of physical space and improved IT support.
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
and as a result, short and medium to long-term
strategies to enact system changes were developed.
Action on these strategies has begun. Strategies
include (but are not limited to) the provision of
enhanced physician education opportunities in the
specialty and the development of system supports
for Emergency Departments including diagnostics,
mental health and allied health.
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,
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. The
Patient Access Registry (PART), is an information
system being implemented to capture data on all
patients waiting for hospital-based medical consultation and/or surgical services within Manitoba.
The Wait Time Task Force established the Manitoba
Patient Access Network in 2006 which is charged with
developing new approaches to patient navigation
through better system integration and coordination,
improving patient access to services, and ensuring
sustainability of initiatives.
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.
Canada Health Act Annual Report, 2007–2008
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 health
authorities with the logistics of recruiting foreigntrained 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 supports many initiatives aimed at
recruiting and retaining physicians. There are initiatives that facilitate the entry of eligible foreign
medical graduates into the physician workforce;
one that provides training leading to licensure, and
one that provides assessment leading to licensure.
Through the training program, foreign-trained physicians can achieve conditional licensure to practice
family medicine in return for agreeing to work in a
sponsoring rural regional health authority. Eligible
applicants 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
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Chapter 3 — Manitoba
in a rural or northern community of Manitoba. The
new assessment leading to licensure was introduced
in the fall of 2006. Eligible applicants undergo a
pre-employment interview, 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. In late 2008, an additional
month of orientation will be added to the assessment
process in an effort to better prepare candidates for
practice in a rural/northern environment. Another
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.
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. 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. Since 2001, Manitoba has supported
an expansion in medical school class sizes, which
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continues in 2008 with the first year enrollment
reaching 110 students. In 2008, the Province introduced the Rural/ Remote Physician Placement
Initiative pilot. The pilot 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.
By the end of 2007-08, the Manitoba Telehealth
Network had grown to 55 Telehealth sites across
the province, 15 in Winnipeg and 40 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.
5.4 Physician/Dentist Compensation
Manitoba continues to employ the following methods
of payment for physicians: fee-for-service, and alternate
funding, which includes salaried, contract, 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 2007–2008 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
remain vital to the province. As well, physicians may
receive sessional payments for providing medical services, as well as stipends for on-call responsibilities.
Representatives from the Manitoba Medical
Association (MMA) and Manitoba Health and
Healthy Living typically negotiate compensation
agreements for physicians.
The existing Master Agreement between Manitoba
Health and Healthy Living expires on March 31, 2008.
It is anticipated that an extensive settlement will be
achieved with the MMA that will continue to place
Manitoba in a position to compete for scarce physician resources.
While the majority of time has been dedicated to the
renegotiation of the Master Agreement, a number of
smaller contracts have been re-opened to address on
going issues within Manitoba’s health system. Of
note was the renegotiation of the contract governing
Manitoba’s emergency room physicians which successfully addressed shortages in physician coverage.
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, 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 Authority for 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.
Canada Health Act Annual Report, 2007–2008
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
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 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 Authorities’ regional health
plans, which the 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 an
Authority, the Authority is required to pay each
hospital in accordance with any agreement reached
between the Authority and the hospital operator.
No legislative amendments to the Act or the regulations
in 2007–2008 had an effect on payments to hospitals.
6.0Recognition 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 Expenditures and
Revenue (Manitoba Budget) document and in the
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Chapter 3 — Manitoba
Public Accounts of Manitoba. Both documents are
published annually by the Manitoba government.
In addition, the Department of Health and Healthy
Living of Manitoba 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.
7.0Extended 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 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 that is led by the community, coordinated by regional health authorities
and supported by the provincial and federal governments. As well, a comprehensive Regional Diabetes
Program is delivered by multidisciplinary teams
throughout the province. A screening pilot has been
initiated in partnership with the Brandon Regional
Health Authority to identify prediabetes / undiagnosed
type 2 diabetes and validate a national screening tool.
A chronic disease self-management program — Get
Better Together! Manitoba — is providing workshops
to assist people living with chronic disease to learn
ways to take control of their health. An innovative
Manitoba Retinal Screening Vision Program has been
implemented to reduce wait times and improve access
to ophthalmology services for northern residents.
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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
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 2007, the minimum daily charge was $28.80
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Chapter 3 — Manitoba
and the maximum was $67.60. There is an application process for requesting a reduction in charges.
Funding in 2007/08 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 177 chronic
care beds, and 149 rehabilitation beds.
One new personal care home was opened in south
Winnipeg, providing 80 additional beds for the city.
A total of 79 Interim personal care beds were closed
to allow for renovations in two facilities for a Program
for the Intergrated Management for the Elderly
(PRIME) and for the amalgamated and enhanced
sleep testing laboratory.
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, facilitybased 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.
Mental Health, Addictions and Spiritual Health
Care Services: Regional health authorities provide
inpatient, outpatient and community mental health
services. Community Mental Health Workers provide
assessment, service planning, short-term counselling
Canada Health Act Annual Report, 2007–2008
interventions, rehabilitation and recovery planning,
crisis intervention, community consultation and in
some cases education. Some regions have a variety of
intensive and supportive programs such as Intensive
Case Management, Supported Employment, Supported
Housing, Program for Assertive Community Treatment teams, and the Early Psychosis Prevention and
Intervention Service. Burntwood RHA provides a
transitional living residence for individuals with an
acquired brain injury.
Selkirk Mental Health Centre (SMHC) is a directoperating unit of Manitoba Health and Healthy
Living and is the designated provincial mental
health facility which provides inpatient treatment
and rehabilitation services. It also provides acute
inpatient psychiatric services to RHAs that do
not have acute psychiatric services. SMHC also
provides treatment and rehabilitation to medicallystable individuals impacted by a brain injury.
Mental health self-help is also funded by Manitoba
Health and Healthy Living. Self-help agencies include
the Manitoba Schizophrenia Society, Mood Disorders
Association of Manitoba, Anxiety Disorders Association
of Manitoba, the Obsessive Compulsive Disorder
Centre, the Canadian Mental Health Association
(Manitoba) and the Manitoba Health Education
Resource Centre. These agencies provide public
education and support to individuals and families
affected by mental illness.
In the last two years, spiritual health care has become
a part of the Mental Health and Addictions Branch.
This reflects the ever-growing awareness that health
is made up of the physical, mental, social and spiritual
aspects of being.
Addictions services and supports are provided
through provincially-funded agencies. They include
the Addictions Foundation of Manitoba (AFM),
the Behavioural Health Foundation, the Salvation
Army-Anchorage Program, the Native Addictions
Council of Manitoba, Tamarack Rehab, the Laurel
Centre, Esther House, Addictions Recovery Inc.,
Two Ten Recovery, St. Raphael Wellness Centre,
119
Chapter 3 — Manitoba
Main Street Project, the Youth Addictions
Stabilization Facility at Marymound, the Youth
Addictions Centralized Intake at the Manitoba
Adolescent Treatment Centre, the Addictions
Unit at the Health Sciences Centre, Rosaire House
and Resource Assistance for Youth. These agencies
work to reduce the harm associated with alcohol
and other drugs. Programs include education,
prevention, rehabilitation and follow-up supports
such as second-stage housing. In addition to the
provincially-funded agencies, Winnipeg RHA
funds two detox programs and NOR-MAN RHA
funds a residential treatment agency for adults.
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, sponsorship
of Physician Manager Institutes, support for the use
of Electronic Medical Records, the development
of a Peer to Peer Network, the introduction of
Registered Nurses (Extended Practice) (RN-EPs)
and midwives, the expansion of the Physician
Integrated Network, hosting customer care workshops and establishing a provincial Maternal and
Child HealthCare Services Task Force (MACHS).
A provincial initiative to introduce and implement
Advanced Access is proceeding with sixteen clinics
(10 Winnipeg, 5 rural and 1 northern) from four
regional health authorities committing their clinics
120
to participate in a 19 month initiative to reengineer
office processes so that patients will be able to see
a health care provider at a time and date that is
convenient to them.
The intent of the initiative is to introduce and
implement the concept of Advanced Access in
‘early adopter clinics’ and then to incrementally
spread its acceptance and implementation across
the province through a variety of mechanisms.
One Physician Manager Institute (PMI), developed
and sponsored by the Canadian Medical Association,
was hosted by the Primary Health Care Branch.
Forty participants attended this session on facilitating
effective teamwork in health care organizations.
As part of the Primary Care Information System
Strategy, Manitoba is conducting a competitive
process to qualify 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.
At the time of writing this process is in progress,
with an expected completion date of the end of
October 2008.
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
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. 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 into primary
care supports primary care renewal and interdisciplinary practice. The Registered Nurse (Extended
Practice) Regulation was enacted in 2005, and 32
were registered by the end of 2006 and 49 by the
end of 2007. Most work in primary care settings.
An RN (EP) 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 RN (EP) 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
develop 40 RN(EP) positions, provide a bursary
for nurse practitioner study and to provide regional
health authorities support to successfully integrate
this new practitioner.
Manitoba introduced regulated and funded midwifery
services in 2000; integrating midwifery services with
primary care. Midwives provide comprehensive,
community-based maternal, newborn and (in some
communities) well-woman care. They can prescribe
Canada Health Act Annual Report, 2007–2008
medications, order and manage the results of
diagnostic and screening tests, perform minor
surgical and invasive procedures, admit to hospital
and attend births. The province provides funding
for midwifery services to 6 of 11 regional health
authorities. There are now 41.5 funded midwifery
positions across the province; 25.5 outside the
Winnipeg including rural, northern and remote
communities. In some, midwives attend up to
30% of births; provincially 5% of births. Service is
focused on priority populations, which represents
over 65% of midwifery clients; including those at
high social risk such as substance abusers. A database of midwifery outcomes was initiated in 2001,
and shows lower rates of pre-term birth, high and
low birth weights and birth interventions for midwifery clients. 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.
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
121
Chapter 3 — Manitoba
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
“Showing We Care” is a customer service program
designed to focus on excellent service delivery in the
health care system. Manitoba Health staff participated
in the first of a series of 1-day workshops on how
individuals can impact their person job satisfaction,
the well-being of their “customers” and the department’s success by delivering excellent service in
an environment of rising customer expectations.
Interested regional health authorities will host the
next workshops.
The Maternal and Child Healthcare Services
(MACHS) Task Force was established by the
Minister of Health in March 2007 to address
122
the needs, challenges and opportunities facing
Manitoba in regards to maternal and child health
care services in a comprehensive manner.
The expectation is that the Task Force will provide
advice and make recommendations regarding:
Maternal/newborn and child health-care service
delivery
Provincial planning and co-ordination of human
resources in maternal and child health services
Working toward closing the gap in services for
Aboriginal child health and maternal/newborn
services
Promoting best practices, health promotion and
disease prevention
Service needs for children with disabilities and
chronic illness
Strategies for reducing health care service wait
times for children
The Task Force will focus on initiatives for improving
care, access and outcomes with due consideration
given of the broader determinants of care (i.e. poverty,
education). This includes short, intermediate and
long term strategies within three areas that will support
access to services closer to home; address service
gaps and support and promote promising practices
across Manitoba.
A report is expected to be released in early fall of 2008.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Manitoba
Registered Persons
1.
Number as of June 1st (#).
3
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
1,159,784
1,169,667
1,173,815
1,178,457
1,186,386
2006–2007
2007–2008
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Private For-Profit Facilities
4.
5.
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2003–2004
2004–2005
2005–2006
92
5
not available
not available
97
98
3
not available
not available
98
1,220,253,362
117,642,127
not available
not available
not available
1,400,448,441
96,364,992
not available
not available
not available
1,488,094,835
71,117,677
not available
not available
not available
1,515,237,203
75,250,507
not available
not available
not available
1,605,095,309
76,373,042
not available
not available
not available
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
1
0
1
1
0
1
1
0
1
1
0
1
1
0
1
1,252,657
0
1,252,657
1,290,989
0
1,290,989
1,305,132
0
1,305,132
1,292,830
0
1,292,830
1,289,964
0
1,289,964
4
5
98
3
not available
not available
98
4
5
95
2
2
1
97
4
5
5
6
95
2
2
1
97
4
5
5
6
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
2,928
3,036
2,995
2,806
2,823
16,290,426
15,393,378
19,153,208
19,431,036
18,731,739
31,100
24,057
29,685
30,357
31,329
4,369,889
3,896,789
5,670,133
6,306,240
6,933,920
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
418
540
569
589
549
1,348,148
1,085,650
1,455,908
1,294,963
1,791,864
6,069
6,170
6,690
7,673
8,796
1,216,073
1,112,466
1,325,062
1,695,844
2,692,096
3. The population data is based on records of residents registered with Manitoba Health as of June 1.
4. 95 submitting Acute facilities includes 22 Nursing Stations and 2 Federal Hospitals
5. One Acute facility has been given a rehab institution submitting number: Riverview Health Centre. Deer Lodge is no longer a submitting acute
care facility, and therefore only counted as rehab and chronic.
6. Manitoba Adolescent Treatment Centre
Canada Health Act Annual Report, 2007–2008
123
Chapter 3 — Manitoba
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
959
980
not applicable
1,939
979
1,008
not applicable
1,987
981
1,035
not applicable
2,016
971
997
not applicable
1,968
1,041
1,009
not applicable
2,050
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
559,271,513
not available
601,240,469
not available
653,290,519
not available
700,465,401
not available
721,552,291
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
16,268,844
384,547,781
16,578,401
415,749,772
17,466,368
442,485,124
16,794,320
438,813,332
16,959,865
459,573,573
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
210,294
209,152
228,090
248,900
290,775
7,579,028
8,109,229
8,966,703
9,997,409
9,985,987
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
5,324
5,714
6,138
6,486
6,414
519,782
426,937
608,524
541,403
701,829
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
124
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
102
114
115
122
120
3,498
3,774
3,863
4,205
4,616
750,122
875,657
936,091
984,621
1,107,357
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
Saskatchewan
Introduction
The Ministry of Health has a mandate to provide
leadership in defining and implementing a vision for
health care and a framework for health systems. The
Ministry assesses, promotes, and protects the health
and well-being of the Saskatchewan population.
During the 2007–08 fiscal year, a new Saskatchewan
government was elected resulting in a revised set of
priorities. The new strategic direction can be found
within the Minister’s Mandate Letter and the
December 2007 Throne Speech:
http://www.gov.sk.ca/cabinet/mcmorris/
http://www.gov.sk.ca
Some examples of this new direction included:
developing the framework for undertaking a Patient
First Review of the health care system with input
from health care stakeholders to improve frontline care for patients, direct dollars away from
bureaucracy to front-line care and create quality
work environments for health care professionals.
The Ministry improves publicly funded health care
in Saskatchewan and delivers publicly funded and
administered health care in a manner consistent
with the principles of the Canada Health Act. The
Ministry works with a range of stakeholders to
ensure adequate recruitment, retention and regulation of health care providers, including nurses and
physicians. In addition to these roles, the Ministry
will implement measures in the Saskatchewan health
care system to ensure that the system maintains a
patient-centered focus.
The Ministry of Health is committed to encouraging
and assisting Saskatchewan residents in achieving
their best possible health and well-being. We do this
by overseeing a complex, multi-faceted health care
system. In this regard, the Ministry carries out the
following responsibilities:
manages approximately 50 pieces of healthrelated legislation;
strengthening cancer care in Saskatchewan by
instituting a colorectal screening program in
the province and providing additional funding
for the approved cancer drug Avastin;
maintains relationships with the regulated health
professional groups;
that children up to age 14 would have their
prescription drug costs capped at $15 per
prescription;
establishes goals and objectives for the provision
of health services;
working with regional health authorities to
develop a 10-year capital plan for health care,
including investment in new emergency medical
equipment such as an air ambulance helicopter,
while making construction of an integrated
health sciences facility and a children’s hospital
a priority;
participating in inter-provincial western
Canadian partnerships related to the issue
of pharmaceuticals; and
Canada Health Act Annual Report, 2007–2008
provides leadership on strategic policy and program policy proposals;
provides provincial oversight for programs and
services, including acute and emergency care,
community services, and long-term care;
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;
125
Chapter 3 — Saskatchewan
administers and maintains a province-wide system
for registering births, deaths, marriages, stillbirths,
divorces, adoptions and changes of name;
delivers a number of services including the
Saskatchewan Prescription Drug Plan and the
Saskatchewan Disease Control Laboratory;
provides leadership on health human resource
issues;
provides leadership and support in the area of
information technology, including development
and delivery of strategic information technology
solutions in support of front line health delivery
and health system management; and
leads financial planning for the health system and
administers the allocation of available resources.
The Ministry works closely with its many partners
in the health sector to deliver high quality services.
Internally, the Ministry is organized into 18 branches,
each working to ensure the health system remains
accountable to the people of the province and sustainable into the future.
The Ministry and the health care system provide a
wide range of services through a complex delivery
system that includes regional health authorities,
the Saskatchewan Cancer Agency (SCA), affiliated
health care organizations and a range of professionals,
many of whom are in private practice.
The health system employs over 37,000 individuals,
including approximately 26 self-regulated health
professions, and operates 269 health facilities. The
range and number of services provided is partially
illustrated by the following examples of activity:
128,700 annual inpatient admissions or
2,100 acute, psychiatric and rehabilitation
patients in hospital beds on any given day;
74,000 operating room surgeries (surgical
patient registry) per year or 205 per day;
4.6 million visits/year or 12,600 family
physician visits per day;
2,500 visits to specialists per day;
126
400,000 immunizations per year; and
more than 40,000 mammograms per year.
Recruitment and retention of our healthcare professionals remains a top priority, and the Government
of Saskatchewan has committed to a number of
initiatives to ensure that we have the right number
and mix of professionals in the system. The following are a few examples of these types of initiatives.
The appointment of a Legislative Secretary
responsible for nursing recruitment and
retention, who will be providing a report and
recommendations on nursing recruitment and
retention issues in March 2009.
The signing of a partnership agreement
between the Saskatchewan Union of Nurses
(SUN) and the Provincial Government in
February 2008. The partnership agreement
acknowledges the need to fill 600 nursing
vacancies and hire 200 additional registered
nurses over the next four years. The government has committed an investment of
$60 million to help increase the nursing
workforce in Saskatchewan;
Implementing a $5 million dollar provincial
nursing mentorship program and a $7.4 million
job guarantee for new nursing graduates.
Saskatchewan continued to enhance its selfsufficiency by increasing our training capacity.
The numbers of education seats in nursing and
medicine and medical diagnostic programs have
all seen an increase in 2008.
The Saskatchewan Bursary Program provides
over $6M to support approximately 600 new
and continuing return-in-service bursaries annually. Saskatchewan students who are awarded
bursaries agree to work in Saskatchewan’s publiclyfunded health system after graduation.
In addition, the Saskatchewan Government has
committed to the development of a new 10-year
Health Human Resource Plan that will provide
further guidance and direction to the system.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
In 2007–08, the Government of Saskatchewan’s health
expense budget was $3.445 billion. This represents
an increase of 8.4 per cent or $266.7 million over the
previous year. Within context of the broad health system plan, regional health authorities are responsible
for planning, organization, delivery and evaluation
of health services within their region. To carry out
these responsibilities, the regional health authorities
receive about two-thirds of the Ministry of Health’s
budget.
In Canada, both the federal and provincial governments play a major role in the provision of health
care. The federal government provides funding to
support health through the Canada Health Transfer.
It also provides health service to certain members of
the population (e.g. veterans, military personnel and
First Nations people living on reserve). Provincial
governments are responsible for most other aspects
of health care delivery.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
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 for 2007–08 are outlined in the Department
of Health Act, the Regional Health Services Act and
the Cancer Agency Act.
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:
1.2 Reporting Relationship
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;
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.
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;
Canada Health Act Annual Report, 2007–2008
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.
The Regional Health Services Act prescribes that
a regional health authority shall submit to the
Minister of Health:
127
Chapter 3 — Saskatchewan
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 departmental payments to regional health authorities, the
Saskatchewan Cancer Agency and to physicians and
dental surgeons for insured physician and surgicaldental 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.
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, 2007.
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.
128
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
The Regional Health Services Act was proclaimed
on August 1, 2002, to replace the Health Districts
Act as the authority to amalgamate the existing
32 health districts into 12 regional health authorities. 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 Health Services Act permits the Minister to designate facilities including
hospitals, special-care 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, 2007–2008
Chapter 3 — Saskatchewan
Funding for hospitals is included in the funding
provided to regional health authorities.
As of March 31, 2008, 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.
The Action Plan for Saskatchewan Health Care
established new hospital categories and outlined a
standard array of services that should be available
in each hospital. Hospitals are grouped into the
following five categories: Community Hospitals;
Northern Hospitals; District Hospitals; Regional
Hospitals; and Provincial Hospitals.
One of the elements of the Action Plan is to provide
reliable, predictable hospital services, so people know
what they can expect 24 hours a day, 365 days a year.
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.
Canada Health Act Annual Report, 2007–2008
This service delivery framework will ensure quality,
predictable hospital services and help guide decisions
about where to invest new funds.
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
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’s Newsletter:
www.health.gov.sk.ca/physican-information
The Saskatchewan Health Medical Services Branch
2007–2008 Annual Statistical Report is available on
the website:
www.publications.gov.sk.ca/deplist.cfm?d=13&c=256
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.
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Chapter 3 — Saskatchewan
As of March 31, 2008, there were 1,795 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
opted-out 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, 2008, 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.
There were approximately 3,300 different insured
physician services as of March 31, 2008.
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.
130
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, 2008,
82 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 the advice given by the
dentist is also required.
There were no opted-out dentists in Saskatchewan
as of March 31, 2008.
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.
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.
Although formal public consultations are not
held, any member of the public may recommend
that surgical-dental services be added to the Plan.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
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
cataract surgery, MRIs and bone 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 problems including the Workers’
Compensation Act, the federal Department of Veteran
Affairs and the Mental Health 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, 2007–2008
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.
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.
Formal public consultations about de-insuring
hospital, physician or surgical-dental services may
be held if warranted.
No health services were de-insured in 2007–08.
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-in-Council 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.
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Chapter 3 — 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.
registration can be carried out either in person
in Regina or by mail;
The following persons are not eligible for insured
health services in Saskatchewan:
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 and
over living in the parental home or on their own
must self-register.
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).
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 2008.)
The number of persons registered for health services
in Saskatchewan on June 30, 2007 was 1,014,649.
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, 2007, there were 6,159 such temporary
residents registered with Saskatchewan Health.
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;
132
4.0Portability
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
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
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 2007–08, expenditures for insured physician
services in other provinces were $25.44 million.
Insured hospital services in other provinces were
$48.81 million.
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 2007–08.
4.3 Coverage During Temporary Absences
Outside Canada
Continued coverage during a period of temporary
absence is conditional upon the registrant’s intent to
return to Saskatchewan residency immediately on
expiration of the approved absence period as follows:
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.
education: for the duration of studies at
a recognized educational facility (written
confirmation by a Registrar of full-time
student status is required annually);
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:
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
out-side 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.
Canada Health Act Annual Report, 2007–2008
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 open-ended
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).
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Chapter 3 — Saskatchewan
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 2007–08, $2.29 million was paid for in-patient
hospital services and $970,500 was spent on out-patient
hospital services outside Canada. In 2007–08, expenditures for insured physician services outside Canada
were $637,600.
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:
wan 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
Prior approval from the Ministry must be obtained
by the patient’s specialist.
As of March 31, 2008, Saskatchewan had 2,957 staffed
hospital beds in 66 acute care hospitals, including
2,374 acute care beds, 208 psychiatric beds and
375 other beds. The Wascana Rehabilitation Centre
had 48 rehabilitation beds and 204 extended care
beds. Rehabilitation services are also provided in
a Geriatric Rehabilitation Unit in one acute care
hospital and in two special care facilities.
Out-of-Country
Supply of Health Providers
Prior approval is required for the following services
provided outside Canada:
Saskatchewan is committed to ensuring that its
residents have access to the health providers and
services they require. As previously mentioned,
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 of a new
10-year health human resource plan that will be
developed in the coming months.
alcohol and drug, mental health and problem
gambling services; and
cataract surgery services, bone densitometry
and non-urgent MRI.
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, Saskatche-
134
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
Table 1: Number of Selected Health Professionals, Saskatchewan and Canada
Saskatchewan
Occupations
Canada
2002
2003
2004
2005
2006
Audiologists
n/a
33
35
30
34
1,294
Chiropractors
183
182
182
184
184
7,318
Dental Hygienists
307
334
336
347
355
19,389
Dentists
348
378
376
364
368
18,925
Dietitians
229
242*
251*
251
262
8,422
58
63
63
64
80
1,375
214
221
230
246
294
3,216
2,011
2,056
2,131
2,194
2,224
67,300
962
938
949
984
977
19,784
10
10
10
9
12
322
451
445
429
453
479
16,464
Midwives
5
5
8+
10+
10+
626
Nurse Practitioners
-
-
42
75
91
1,303
Occupational Therapists
202
211
214
217
232
11,786
Optometrists
107
108
113
117
117
4,238
Pharmacists
1,080
1,142
1,170
1,177
1,027
27,094
Physicians~
1,778
1,751
1,745
1,770
1,818
70,870
Family Medicine
1,016
1,007
913
930
952
34,038
Specialists
762
744
832
840
866
36,832
Physiotherapists
516
530
526
534
551
16,108
Psychologists
387
374
404
418
431
15,751
8,257
8,503
8,481
8,549
8,480
252,948
930
939
935
933
900
5,051
99
97
103
97
116
7,886
1,050
1,004
1,019
1,161
1,118
30,970
n/a
213
216
240
234
6,661
Environmental Public
Health Professionals
Health Information
Management Professionals
Licensed Practical Nurses
Medical Laboratory Technologists
Medical Physicists
Medical Radiation Technologists
Registered Nurses
Registered Psychiatric Nurses
Respiratory Therapists
Social Workers
Speech-Language Pathologists
n/a
Not available.
*
Represents active registered dietitians.
+
Represents registered midwives.
-
Separate NP licensure did not exist for that registration year.
~
Includes Residents.
2006
Source: Canada’s Health Care Providers, 1997 to 2006, A Reference Guide: Canadian Institute for Health Information (CIHI), 2008.
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.
Canada Health Act Annual Report, 2007–2008
135
Chapter 3 — Saskatchewan
In looking at the trend of selected health professionals,
the majority of Saskatchewan’s health professionals
have increased between 2002 and 2006 (Table 1).
Regarding the availability of selected diagnostic,
medical, surgical and treatment equipment and
services in facilities providing insured hospital
services, Saskatchewan Health notes the following:
MRI machines are located in Saskatoon (2) and
Regina (2).
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).
Renal dialysis is provided at Saskatoon, Regina,
Lloydminster, Prince Albert, Tisdale, Yorkton,
Swift Current, North Battleford, and Moose Jaw.
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 2007,
approximately 5,000 new patients began treatment
for cancer. Both centres provided approximately
39,000 radiation therapy treatments and over
15,000 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 2007, over 1,200 patients
made approximately 5,200 visits to COPS
centres for treatment.
Approximately 73 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 22 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.
136
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 2007–08
to improve access to insured hospital services:
Access and use of specialized medical
imaging services, including MRI, CT and
bone mineral density testing, has grown
steadily in Saskatchewan. In 2007–08,
approximately 15,728 patients received MRI
services and approximately 74,947 patients
received CT services.
Telehealth Saskatchewan has proven to be
an effective tool for clinical consultation and
continuing education in northern Saskatchewan.
Saskatchewan Health continues to support the
network. There are a total of 26 Telehealth
Saskatchewan sites in the Province.
The Chronic Renal Insufficiency (CRI) Clinics
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.
As of March 31, 2005, 817 patients were being
supported through CRI clinics. By March 31, 2008
this was just over 1,100.
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 37,000 women annually.
The Prevention Program for Cervical Cancer
is a Cancer Agency program that has the goal
of increasing participation in regular pap testing
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
and tracking follow-up of unsatisfactory and
abnormal test results. In 2007 the program sent
out over 112,000 result notices and 265,000 notification/information letters.
The Provincial Malignant Haematology/Stem
Cell Transplant Program continues to provide
transplants to Saskatchewan residents. In 2007–08,
33 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.
Capital equipment purchases by regional health
authorities are consistent with the criteria established
under the February 2003 Health Accord. Regional
health authority acquisitions are reviewed to ensure
consistency with provincial health strategies and
priorities and Health Accord principles. Capital
equipment acquisitions in 2007–2008 supported
enhanced access to diagnostic imaging and surgical
services.
Saskatchewan Health continues to place priority
on promoting surgical access and improving the
province’s surgical system. Saskatchewan Health,
with advice from the Saskatchewan Surgical Care
Network (SSCN), is leading the country in implementing key surgical care system initiatives.
Saskatchewan has already developed and implemented a Patient Assessment Process, a Surgical
Patient Registry and Target Time Frames for
Surgery as part of Saskatchewan Health’s Action
Plan.
The Patient Assessment Process increases
consistency and fairness by standardizing the
factors physicians use to assess their patients’
level of need for surgery. This will help to
ensure those with the greatest need for surgery
will receive it first.
The Surgical Patient Registry tracks patients
needing surgery in the province. Information
from this comprehensive database supports
Canada Health Act Annual Report, 2007–2008
the surgical care system in improving the management of surgical access, determining system
capacity and resource requirements, and reducing
wait times for patients.
Target Time Frames for Surgery support the
health regions to better monitor and track
patients and to help ensure they receive care
according to their level of need. In March 2004,
Target Time Frames for Surgery were announced
as performance goals for the surgical care system.
On the recommendation of the Saskatchewan
Surgical Care Network (SSCN), the number of
Priority Levels for surgery was reduced from the
initial six levels to four levels (plus emergency
surgery which is to be recorded and reported
separately) as of April 2006, to give surgeons
and regions more flexibility in managing wait
lists to shorten maximum wait times.
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
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Chapter 3 — Saskatchewan
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 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.
Development 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.
Developed and implemented a Provincial Waiting
Time Definition, Urgency Classifications, and
Waiting Time Benchmarks for MRI and CT:
These guidelines standardize diagnostic imaging
procedure waiting times for MRI and CT, and
establish waiting time performance goals.
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 evidencebased guidelines for radiology into a quick, user
friendly electronic order entry tool.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2008, there were 1,795 physicians
licensed to practice in the province and eligible to
participate in the Medical Care Insurance Plan. Of
these, 1,029 (57.3 percent) were family practitioners
and 766 (42.7 percent) were specialists.
138
As of March 31, 2008, there were approximately
369 practising dentists and dental surgeons located
in all major centres in Saskatchewan. Eighty-two provided services insured under the Medical Services Plan.
A number of new or continuing initiatives were
underway in 2007–08 to recruit and retain physicians thereby enhancing access to insured physician
services and reducing waiting times.
Specialist Programs
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.
A Specialist Emergency Coverage Program
compensates specialist physicians who make
themselves available to provide emergency
coverage to acute care facilities.
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.
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.
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 Canadian-trained or
landed immigrant physicians who establish new
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
practices in rural Saskatchewan for a minimum
of 18 months.
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.
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 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 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.
Canada Health Act Annual Report, 2007–2008
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.
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.
139
Chapter 3 — Saskatchewan
The latest three-year agreement with the Saskatchewan
Medical Association, which expires 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;
$42 million to improve patient access
to specialists;
$42 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.
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 2007–08 amounted
to $613.7 million: $373.1 million for fee-for-service
billings; $22.0 million for Emergency Coverage
Programs; $190.7 million in non-fee-for-service
expenditures; and $27.8 million for Saskatchewan
Medical Association programs as outlined in
the agreement.
140
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.
6.0Recognition Given to
Federal Transfers
The Government of Saskatchewan publicly acknowledged the federal contributions provided through the
Canada Health Transfer (CHT) in the Ministry of
Health 2007–08 Annual Report, the Government of
Saskatchewan 2007–08 Annual Budget and related
budget documents, its 2007–08 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
Federal contributions have also been acknowledged
on the Saskatchewan Health website, news releases,
issue papers, in speeches and remarks made at various conferences, meetings and public policy forums.
7.0Extended Health Care
Services
As of March 31, 2007, 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 and drug benefit programs.
Nursing Home Intermediate 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 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
of charge to regional public health services and
other health care providers for administration
to residents in the facilities.
Home Care Services
The Home Care Program provides an option for
people with varying degrees of short and long-term
illness or disabilities to remain in their own homes
rather than in a care facility. The Program is designed
Canada Health Act Annual Report, 2007–2008
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 so they can 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.
Ambulatory Health Care Services
Saskatchewan regional health authorities provide
a full range of mental health and alcohol and drug
services in the community. Mental health services
are governed by the Mental 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 Hearing Aid Program. Services
include hearing testing, assessments for at-risk infants, and the selling, fitting and maintenance of
hearing aids. The Hearing Aid Act and regulations
and the Regional Health Services Act govern these
programs.
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.
141
Chapter 3 — Saskatchewan
Adult Residential Care Services — Mental Health Services
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.
Alcohol and Drug Services
The provision of Alcohol and Drug services generally
falls under the Regional Health Services Act. Facilities
that provide residential alcohol and drug services are
licensed as listed below. Saskatchewan Health or the
regional health authorities contract with communitybased and non-profit organizations governed by the
Non-profit Corporations Act to provide services.
142
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Saskatchewan
Registered Persons
1.
Number as of June 30th (#).
1
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
1,007,753
1,018,057
1,021,080
1,003,231
1,014,649
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
5.
2004–2005
2005–2006
2006–2007
2007–2008
66
0
1
0
67
65
0
1
0
66
66
0
1
0
67
66
0
1
0
67
66
0
1
0
67
811,561,671
not applicable
not available
not applicable
811,561,671
2
867,261,000
not applicable
not available
not applicable
867,261,000
2
922,675,000
not applicable
not available
not applicable
922,675,000
2
2
1,173,115,000
not applicable
not available
not applicable
1,173,115,000
2
2
1,277,632,000
not applicable
not applicable
not applicable
1,277,632,000
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4.
2003–2004
2
2
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
4,561
4,307
4,566
4,627
4,212
30,528,100
30,461,943
33,671,100
36,828,100
31,569,400
45,510
51,678
55,067
52,591
81,787
6,405,900
9,345,190
11,044,200
11,573,400
17,240,900
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
231
254
248
242
245
728,400
730,849
2,033,300
2,473,400
2,291,200
875
1,002
1,194
1,454
1,381
373,300
251,957
1,486,500
1,019,500
970,500
1. Saskatchewan’s numbers are for June 30.
2.
This number includes estimated government funding to Regional Health Authorities (RHAs) based on total projected expenditures
less non-government revenue, as provided to Saskatchewan Health through the RHA annual operational plans.
– Acute care funding includes: acute care services, specialized hospital services, and in-hospital specialist services.
– Does not include inpatient rehabilitative care, inpatient mental health, or addiction treatment services.
– Does not include payments to Saskatchewan Cancer Agency for outpatient chemotherapy and radiation.
Canada Health Act Annual Report, 2007–2008
143
Chapter 3 — Saskatchewan
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
946
716
0
1,662
967
718
0
1,685
990
729
0
1,719
1,003
750
0
1,753
1,029
766
0
1,795
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
449,108,573
not available
491,805,817
not available
528,759,380
not available
554,193,389
not available
585,863,285
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
9,933,689
304,538,785
9,970,606
337,816,629
10,033,881
362,884,810
9,944,187
369,664,529
10,289,448
401,172,658
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
509,784
513,694
542,651
603,687
561,415
19,477,300
20,379,200
20,541,894
24,239,622
25,442,417
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
not available
not available
not available
not available
not available
583,200
510,600
695,900
692,600
637,600
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
144
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
94
84
78
74
82
18,300
19,400
18,511
18,203
16,347
1,345,900
1,442,800
1,539,420
1,511,882
1,577,176
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
and food-borne, drug and environmental hazards,
3) providing appropriate information to prevent
the onset of disease and injury and 4) promoting
healthy choices.
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 Alberta Ministry of Health and Wellness
provides strategic direction and leadership to the
provincial health system. This role includes developing
the overall vision for the health system, defining provincial goals, objectives, standards and policies,
encouraging innovation, setting priorities and
allocating resources. The Ministry’s role is to assure
accountability and balance health service needs
with fiscal responsibility. The Ministry of Health
and Wellness also has a major role in protecting
and promoting public health. This role includes:
1) monitoring the health status of the population,
2) identifying and working toward reducing or
eliminating risks posed by communicable diseases
Canada Health Act Annual Report, 2007–2008
The Regional Health Authorities Act makes regional
health authorities responsible to the Minister of
Health and Wellness for ensuring the provision
of health services that are responsive to the needs
of individuals and communities. Regional health
authorities ensure the provision of acute care
hospital services, community and long-term care
services, mental health services, public health protection and promotion services and other related
services. The Cancer Programs Act makes the
Alberta Cancer Board responsible to the Minister
for providing cancer prevention and treatment
services, education and research. The Alcohol
and Drug Abuse Act makes the Alberta Alcohol
and Drug Abuse Commission responsible to
the Minister for providing services to address
alcohol, other drug and gambling problems, and
to conduct related research. The Alberta Mental
Health Board advises the Minister on strategic and
policy matters related to mental health programs
and services. The Health Quality Council of Alberta
promotes patient safety and health service quality
on a province-wide basis. The council assists in the
implementation and evaluation of strategies designed
to improve patient safety and health service quality
and surveys Albertans on their experience and
satisfaction with health services. Regional health
authorities, provincial health boards and agencies
are also responsible for assessing needs, setting
priorities, allocating resources and monitoring
performance for the continuous improvement of
health service quality, effectiveness and accessibility.
Alberta’s health legislation can be accessed at:
http://www.health.alberta.ca/about/
health_legislation.html
145
Chapter 3 — Alberta
Significant Events in 2007/2008
1.0Public Administration
In 2007/2008 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:
1.1 Health Care Insurance Plan and
Public Authority
The Tobacco Reduction Act was legislated, providing
a province-wide smoking ban in public places
and workplaces.
The Mental Health Amendment Act was legislated,
providing additional care measures for the intervention and treatment of those with mental
illness. This change serves to strengthen mental
health services in communities.
A provincial infection prevention and control
strategy with clear standards for patient safety
was launched in January 2008.
Access to immunization was planned through
a new 10-year strategy to minimize the risk of
vaccine-preventable diseases.
A new stroke network improved the ability of
health regions to work together on prevention,
diagnosis and treatment of after-stroke care.
A new Health Workforce Plan was implemented
to recruit and retain physicians, nurses and healthcare workers; to increase training capacity; and to
look at the skills assessment of foreign healthcare
workers began in earnest.
The number of Primary Care Networks, involving
about 1,400 doctors who serve over 1.4 million
Albertans, was increased by seven, for a total of
26 networks across the province.
High priority long-term care projects were funded
to increase bed capacity in order to address growth
pressures in the health system.
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 May 22, 2008, and indicated
that the statements fairly present, in all material
respects, the financial position and results of
operations for the year ended March 31, 2008.
There was a refocus on the health system to promote
wellness. Healthy U, Healthy Workplaces, Diabetes
Atlas, and Create a Movement initiatives have
brought about a new emphasis on active living
and healthy eating.
146
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
2.0Comprehensiveness
2.1 Insured Hospital Services
In Alberta, regional health authorities are responsible
to the Minister for ensuring the provision of insured
hospital services with the exception of cancer hospitals,
which are the responsibility of the Alberta Cancer
Board. 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:
http://www.health.alberta.ca/regions/
Hospital_directory.pdf
During 2007/2008 no amendments were made to
the legislation regarding insured hospital services.
Alberta’s Health Care Protection Act governs the
provision of surgical services through non-hospital
surgical facilities. Ministerial approval of a contract
between the facility operator and a regional health
authority 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. According
to the College, there are currently 63 non-hospital
surgical facilities with accreditation status. Of these,
26 facilities have contracts with regional health
authorities to provide a variety of insured surgical
services.
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;
the regional health authority has an acceptable
business plan to pay for the services;
the proposed agreement contains performance
expectations and measures; and
the physicians providing the services will comply
with the conflict of interest and ethical requirements of the Medical Profession Act and bylaws.
The publicly funded services provided by approved
hospitals in Alberta range from the most advanced
levels of diagnostic and treatment services for inpatients 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/about/
health_legislation.html
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.
2.2 Insured Physician Services
the insured surgical services are consistent with
the principles of the Canada Health Act;
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.
there is a current and likely future need for the
services in the geographical area;
As of March 31, 2008, 6,058 practitioners were
enrolled in the Alberta Health Care Insurance Plan.
According to the Health Care Protection Act,
Ministerial approval for a contractual agreement
shall not be given unless:
Canada Health Act Annual Report, 2007–2008
147
Chapter 3 — Alberta
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, 2008, 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
in the Schedule of Medical Benefits, which can be
accessed at:
http://www.health.alberta.ca/professionals/somb.html
The Schedule of Medical Benefits is continuously
revised and updated. In 2007/2008 the Schedule
was revised to include the Body Mass Index (BMI)
modifier to support an additional payment of 25%
for selected procedures, obstetrical services and
anesthesia for adult patients with a BMI of 35 or
more and pediatric patients above the 97th percentile for BMI on an approved pediatric growth
curve. Other changes included: formal scheduled
family conferences relating to a deceased child,
examination of a stillborn, botulinum toxic
injection for treatment of sialorrhea, laparoscopic
partial nephrectomy, laparoscopic pyeloplasty,
laparoscopic radical hysterectomy and bilateral
radical lymph node dissection, photodynamic
therapy and acne surgery.
With the introduction of the new Advanced
Ambulatory Care Services and Urgent Care
Services guidelines, schedule amendments were
made to compensate physicians providing services,
including surcharges and call-backs at regionally
administered, community based Advanced Ambulatory Care and Urgent Care Centers in Alberta.
148
To improve access to services provided through
the residential Alberta Alcohol and Drug Abuse
Commission facilities the schedule implemented
the comprehensive visit and admission form health
service code. The Clinical Stabilization Initiative
Business Cost Program was introduced to provide
additional payment to physicians for specified
services provided in an office or diagnostic facility
registered with Alberta Health and Wellness.
Insured physician services and any changes to the
Schedule of Medical Benefits are negotiated among
the Alberta Ministry of Health and Wellness, the
Alberta Medical Association (AMA) and the regional
health authorities. All changes to the Schedule of
Medical Benefits require ministerial approval.
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
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, 2008, 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.html
In 2007/2008, 207 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
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/regions/PrefAcc.pdf.
The policy describes the province’s expectations
of regional health authorities and guides their decision-making with respect to provision of preferred
accommodation and enhanced or non-standard
goods and services. This policy framework requires
regional health authorities to provide 30 days
advance notice to other regional health authorities
and the Minister’s designate regarding the categories
of preferred accommodation offered by the health
region and the charges associated with each category.
Regional health authorities are also required to provide 30 days advance notice to other regional health
authorities and 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, each regional health authority 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 the regional
health authorities.
Canada Health Act Annual Report, 2007–2008
3.0Universality
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:
members of the Canadian Forces;
members of the Royal Canadian Mounted Police
(RCMP) who are appointed to a rank in it; and
persons serving a term in a federal penitentiary.
During 2007/2008 no amendments were made to
the legislation regarding eligibility.
3.2 Registration Requirements
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 for
premium billing purposes. New residents in Alberta
should apply for coverage within three months of
arrival. For persons moving from outside Canada
their registration is effective as of the day they become
an Alberta resident. However they are not eligible
for subsidized premiums for the first 12 months
of residence in Alberta. The Alberta Health Care
149
Chapter 3 — Alberta
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, 2008,
3,473,996 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, 2008, 292 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 45,531 people covered under these
conditions as of March 31, 2008.
3.4 Premiums
The majority of Alberta residents are required
to pay premiums. Exceptions include:
dependants (residents, however, are required to
pay premiums on behalf of their dependants);
members of the Canadian Forces;
members of the Royal Canadian Mounted Police
(RCMP) who are appointed to a rank in it;
persons serving a term in a federal penitentiary;
seniors aged 65 and older, their spouses and
dependants;
individuals enrolled in special groups such as
Alberta Widows’ Pension or income support
programs;
anyone eligible for full premium assistance; and
any resident who elects to opt-out of the plan.
150
Although Albertans are required to pay premiums,
no resident is denied service due to an inability to
pay. Two programs help lower-income, non-senior
Albertans with the cost of their premiums: the
Premium Subsidy Program and the Waiver of
Premiums Program.
4.0Portability
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 full-time
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
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 2007/2008 no amendments were made to the
legislation regarding in-Canada portability. During
2007/2008 Alberta paid $69.31 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/ahcip_travel.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 2007/2008.
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 full-time
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
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/ahcip_travel.html
During 2007/2008, Alberta paid $72 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 2007/2008.
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
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.
2. Ibid.
Canada Health Act Annual Report, 2007–2008
151
Chapter 3 — Alberta
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.
5.0Accessibility
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,
nine regional health authorities, the Alberta Cancer
Board, the Alberta Mental Health Board and the
Health Quality Council of Alberta cooperate with
each other to ensure that all Albertans have access
to needed health services. There are two major
metropolitan regions, Calgary Health Region
and Capital Health (Edmonton), 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.
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, 2008
there were approximately 54,514 health workforce
practitioners in Alberta.
Health authorities are required to develop capital
equipment plans as part of their annual business
plan submissions to the Minister of Health and
Wellness. Funding for regional health authorities
and provincial boards in 2007/2008 (which includes
health services, hospitals, medical equipment and
province-wide services) was $6.7 billion.
The Ministry’s 2007–2010 capital plan provided
funding to renovate and expand existing health
care facilities and to construct new facilities. Major
expansions of existing health facilities are occurring
in Calgary, Medicine Hat, Lethbridge, Rimby,
Barrhead and Viking. New hospitals are being
constructed in Calgary, Sherwood Park, Fort
Saskatchewan and High Prairie. Funding was also
announced for a new hospital in Grande Prairie.
As well, older long-term care facilities are being
replaced in Red Deer, High Prairie, Vermilion
and Vegreville.
5.2 Access to Insured Hospital Services
Work was initiated on the new Edmonton Clinic
which will increase access to health care, educate
health care providers in new ways and foster a patientcentred approach. It will also create a new model for
out-patient care, health sciences, inter-professional
education, and interdisciplinary research. Work continues on the construction of the new Mazankowski
Alberta Heart Institute in Edmonton. The new facility
will enhance treatment options available to Albertans
and advance priority research and innovation initiatives for both Capital Health and the University
of Alberta.
The Ministry of Health and Wellness, regional health
authorities, the Alberta Cancer Board, and the Alberta
Mental Health Board actively participate in a health
workforce planning process to ensure an adequate
supply of key personnel. The key professions utilized
Access to stroke and cancer care are being improved.
A new provincial stroke network improved the ability
of health regions to work together on prevention and
after-stroke care and treatment programs. Methods
to improve the efficiency of hip and knee joint
152
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
replacement surgery, including central assessment and
referral, were tested in a pilot project completed in
2007, and the new care path is being implemented in
all regions.
To enhance access to radiation therapy services,
a strategy was developed to create a north-south
“Capacity Corridor for Cancer Radiation Therapy”
that will create three new sites for radiation therapy
in Lethbridge, Red Deer and Grande Prairie. The
capacity corridor project is partially funded through
a wait time guarantee agreement with Health Canada.
5.3 Access to Insured Physician and
Dental-Surgical Services
A new Health Workforce Action Plan (2007 to 2016)
was released in September 2007. The plan outlines
19 key initiatives to address Alberta health workforce
issues. In 2007/2008, $30 million went toward eight
key actions, which included creating a health career
and skills assessment network, increasing clinical
training capacity, implementing a number of policies
and ongoing consultations with stakeholder groups
on creative approaches to attract and retain personnel
to the domestic health workforce and attracting health
professionals working abroad. A ninth recommended
action, the purchasing of equipment to reduce and
avoid injuries while lifting, was funded with an additional $27.5 million for Alberta’s health authorities.
Some of the actions taken to improve access to
physician and dental services include:
Seven additional Primary Care Networks were
launched, bringing the total across Alberta to 26.
These networks involve approximately 1400 physicians providing care to over 1.4 million Albertans.
Family physicians working in these networks partner with health regions and use a team approach
to improve access and to provide coordinated
and comprehensive primary health care services
to patients.
Canada Health Act Annual Report, 2007–2008
The government invested more than $5 million
to assess internationally educated registered nurses
and increase the number of registered nurses
working in Alberta. The College and Association
of Registered Nurses of Alberta (CARNA) received
more than $500,000 to support the college’s
assessment of applications from internationallyeducated nurses who want to practice in Alberta.
Grant MacEwan College received $750,000 to
reimburse nurses enrolled in the nursing refresher
program. A total of 216 nurses received funding
and 44 nurses have completed this program.
Mount Royal College received almost $4 million
to expand its assessment program for internationallytrained registered nurses seeking to be licensed in
Alberta. After receiving this funding, Mount Royal
College assessed 114 nurses and built a new office
in Edmonton to increase assessment capacity.
The Aboriginal Health Careers Bursary program
provided assistance and awards to 50 First Nations
and Métis students to study in a degree or diploma
program in a health field at a university, college,
or technical institute. The amounts ranged from
$3,000 to $10,000 per student. Areas of study
among recipients this year included biochemistry,
medicine, dentistry, nursing, physical therapy,
kinesiology and occupational therapy.
The Alberta International Medical Graduate
Program received $3.4 million in funding. This
funding allowed 48 residency positions to be
available for international medical graduates
to enter Canadian residency training to become
registered as a doctor in Alberta. The government
also invested $1.2 million for the Calgary and
David Thompson Health Regions to give international medical graduates more opportunities
to work under supervision as clinical assistants.
153
Chapter 3 — Alberta
Funding support was provided for 1,106 physician
residency positions in Alberta and will be supporting
1,165 in 2008/2009. This represents a 31 per
cent increase in residency positions in Alberta
from five years ago. An additional 48 flexibility
training seats were also funded in 2007/2008 to
facilitate dual certification, upgrading, spousal
recruitment, transfers and remediation of medical
residents and existing Alberta physicians. These
increases reflect Alberta Health and Wellness’s
commitment to help ensure that physicians are
trained to match the need for services in Alberta.
Fourteen innovative clinical Telehealth initiatives
proceeded in 2007/2008. These initiatives expanded
the diverse range of health care services that can be
provided to residents in rural and remote locations
and allow more people to remain in their communities and receive needed treatment and services.
The funded projects included management of
intravenous chemotherapy, pediatric surgery consultation, asthma and allergy education, telemental
health outreach services, and care for HIV patients.
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 fee-for-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 regional health authorities. The agreement also contains provisions to improve access to
physician services. Under this agreement, Alternate
Relationship Plans (ARPs) have been established
to enhance specialist physician recruitment and
retention, team-based approaches to service delivery,
154
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 will manage 24-hour 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.
5.5 Payments to Hospitals
The Regional Health Authorities Act governs the
funding of regional health authorities and provincial
boards. Most insured hospital services in Alberta are
funded through a population-based funding formula
for regional health authorities. Regional health
authorities also receive a mental health funding
grant for insured services provided in mental health
hospitals and for community mental health services.
Capital Health and the Calgary Health Region receive
funding to provide highly specialized province-wide
services to all Alberta residents. The Alberta Cancer
Board receives grant funding to provide insured
services in cancer hospitals and to pay for cancer
services that patients receive in regional hospitals.
The regional health authorities and the Alberta
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
Cancer Board are responsible for planning the
allocation of funds for insured hospital services in
accordance with regional needs assessments and
health plans.
6.0Recognition Given
to Federal Transfers
The Government of Alberta publicly acknowledged
the federal contributions provided through the Canada
Health Transfer in its 2007–2008 publications.
Canada Health Act Annual Report, 2007–2008
7.0Extended 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 long-term
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.
155
Chapter 3 — Alberta
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
3,165,157
3,210,035
3,275,931
3,384,625
3,473,996
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
5.
2004–2005
2005–2006
2006–2007
2007–2008
102
107
1
3
213
101
106
1
3
211
101
103
1
3
208
102
98
1
3
204
102
98
1
3
204
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
2006–2007
2007–2008
2003–2004
2004–2005
2005–2006
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
Private For-Profit Facilities
4.
2003–2004
3
3
3
not available
not available
not available
3
3
3
not available
not available
not available
26
not available
not available
3
3
not available
not available
not available
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
4,651
4,550
4,508
4,608
5,334
19,411,517
20,139,919
21,080,232
22,005,293
27,481,524
68,469
72,495
77,438
82,710
101,455
7,982,851
11,473,142
12,820,959
14,305,024
18,004,246
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
3,319
4,266
4,124
3,698
4,014
300,233
381,217
379,710
336,859
378,043
3,405
4,089
3,918
3,816
3,934
212,949
227,609
222,896
224,761
214,162
3. These data are available from the College of Physicians and Surgeons of Alberta at http://www.cpsa.ab.ca/home/home.asp
156
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Alberta
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
2,937
2,426
not applicable
5,363
3,026
2,475
not applicable
5,501
3,122
2,463
not applicable
5,585
3,237
2,613
not applicable
5,850
3,361
2,697
not applicable
6,058
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
not available
not available
not available
not available
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 ($)
30,044,400
1,272,779,982
31,683,660
1,348,724,184
33,428,098
1,472,634,054
34,031,123
1,558,128,163
35,054,154
1,718,717,023
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
485,841
444,884
479,029
463,410
548,423
15,139,409
15,871,755
17,745,928
17,450,377
20,899,683
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
20,753
26,017
24,944
22,909
22,055
963,299
1,208,422
1,049,384
1,054,544
1,105,831
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
Canada Health Act Annual Report, 2007–2008
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
216
216
230
220
207
14,802
14,658
17,007
16,783
16,769
2,404,042
2,843,638
3,275,978
3,637,243
3,913,975
157
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Chapter 3 — British Columbia
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. The British Columbia Ministry of Health
Services has overall responsibility for ensuring that
quality, appropriate and timely health services are
available to British Columbians. The Ministry works
with six health authorities, care providers, agencies
and other groups to provide access to care. The
Ministry provides leadership, direction and support
to service delivery partners and sets province-wide
goals, standards and expectations for health service
delivery by health authorities.
The Ministry directly manages a number of provincial
programs and services. The directly-managed programs
include the Medical Services Plan, which covers most
physician services; PharmaCare, which provides prescription drug insurance; and the Emergency Health
Services Commission, which provides ambulance services. The Ministry is also responsible for health and
information programs, including the BC HealthGuide
and NurseLine programs and the BC Vital Statistics
Agency.
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
Canada Health Act Annual Report, 2007–2008
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 Provincial Renal Agency, BC Transplant Society, BC Women’s Hospital & Health Centre,
Forensic Psychiatric Services Commission, Provincial
Cardiac Services and Riverview Hospital.
The delivery of health services and the health of the
population are continuously monitored and evaluated
by the Ministry. These activities inform the Ministry’s
strategic and policy direction to ensure the delivery
of health services continues to meet the needs of
British Columbians.
Activities for 2007–2008
In 2007–2008, the Government of British Columbia
invested more than $13.1 billion to meet the health
needs of British Columbians. This investment was
made across a wide spectrum of programs and services
aligned with the Ministry’s goals to improve health
and wellness, deliver high quality patient care, and
make the publicly-funded health system sustainable
over the long term.
British Columbians enjoy some of the best health
status in Canada; nevertheless, nation-wide trends
are creating unprecedented demands on the province’s health system. Rising rates of obesity, a
lack of physical activity, injuries, tobacco use
and problematic substance use all affect the health
status of individuals and increase demands for
health services. In addition, the province’s aging
population is exhibiting a high incidence of
chronic illness, resulting in increased demand
for more complex and expensive health services.
Significant reforms and new initiatives have continued
across the health system as the Ministry has worked
with health authorities and health professionals to build
a system that meets the needs of British Columbians
and is sustainable.
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In 2007–2008, the Ministry introduced, continued
or enhanced a number of strategies across the span
of health services. These include: population health
and safety, 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 Ministry also
continued to ensure that an adequate supply of skilled
health providers is available to deliver services across
the continuum of care.
British Columbia also completed the Conversation
on Health, an unprecedented, year-long discussion
with and among British Columbians about how to
strengthen and improve the province’s health system.
The Conversation invited British Columbians to
send in their ideas, solutions and recommendations
for the health system by email, website, letter, toll-free
phone line, local MLA or by registering for one of a
series of community meetings which took place in
16 communities between February and July 2007.
The Summary of Input report on the Conversation
on Health was released in fall 2007. The input
gathered through the Conversation will be used
to direct and inform British Columbia’s development of health policies and initiatives to ensure
the long-term sustainability of British Columbia’s
publicly-funded health system.
Significant Achievements in 2007–2008
Health and Wellness
Launched the Primary Health Care Charter to
steer the transformation of primary health care.
The Charter established seven health priorities,
three of which tackle the growing prevalence of
chronic disease by improving care for individuals
with chronic conditions and preventing their
onset among those at risk.
Began to collaborate with the new Ministry of
Healthy Living and Sport on innovative program
delivery strategies to nurture wellness and augment
health literacy and physical activity.
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Reduced the poor health effects of tobacco by
restricting the promotion and sale of tobacco
products through the Tobacco Sales Act.
Banned smoking in all indoor public spaces
and workplaces.
Granted $6 million to the Canadian Mental
Health Association to integrate strategies aimed
at physical conditions that accompany mental
health conditions.
Because the British Columbia government dearly
wants to close the gap in First Nations health status,
the Ministry also:
Signed the Tripartite First Nations Health Plan,
which champions local health plans for all British
Columbia First Nations and recognizes the fundamental importance of community solutions
and approaches.
Appointed Dr. Evan Adams as the first-ever
Aboriginal Health Physician Advisor.
Provided $6.3 million towards the new health
centre under construction in Lytton, which will
bolster the First Nations Health Plan and the
broader Pacific Leadership Agenda.
Provided $500,000 to increase Aboriginal communities with high-quality nursing care, and
Aboriginal nurses working in British Columbia.
High Quality, Patient Centred Care
Reduced wait times for hip and knee surgeries
through initiatives such as the Centre for Surgical
Innovation. Compared to 2006–2007, this year’s
median wait times have been reduced for hip
surgeries from 13 to 11 weeks and, for knee
replacement surgeries, from 20 to 17 weeks.
Invested $18.8 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — British Columbia
Continued to meet targets for 5,000 net
new residential care, assisted living and
supportive housing units by the end of 2008.
As of March 2008, British Columbia had
built 4,538 net new beds and a total of
10,135 new and replacement beds and
units since June 2001.
Streamlined procedures in the Emergency
Departments at Kelowna General Hospital
and opened a Fast-Track clinic at St. Paul’s
Hospital in Vancouver, both of which have
reduced ER wait times.
A Sustainable, Affordable, Publicly Funded
Health System
Invested $14.2 million in the eDrug project to
enhance PharmaNet — a step forward in using
electronic health records to improve patient
safety and reduce medication errors.
Launched the $10 million Family Physicians for
BC (FP4BC) program in June 2007, to attract
family physicians to designated rural and urban
communities through targeted funding.
Reached an agreement with the British Columbia
Medical Association securing CHA-insured physician services through 2012.
Opened the newly renovated areas of the BC
Cancer Agency’s Fraser Valley Centre, where
approximately $12.5 million provided new
radiation therapy equipment and increased
chemotherapy capacity.
Opened a state-of-the-art Intensive Care Unit
at the Royal Columbian Hospital to enhance
the critical care facilities at the trauma centre
and major Fraser Health Authority tertiary
referral centre.
Invested $28 million in British Columbia’s
Nursing Strategy to help increase the number
of practising nurses. The government has now
provided British Columbia’s Nursing Strategy
with $174 million since 2001 to help educate,
retain and recruit the best qualified nurses.
Canada Health Act Annual Report, 2007–2008
Inaugurated a fast-track assessment service
for internationally-educated nurses.
Doubled undergraduate first-year medical
student spaces at the province’s medical school
from 128 in 2003 to 256 in September, 2007.
This — together with expanded postgraduate
training positions from 128 in 2001 to 224 in
2007 — will make it easier for patients to see
General Practitioners and specialists.
Invested $75.1 million in the expansion and
distribution of medical education, including
$4.2 million in postgraduate training for internationally-educated physicians.
Continued investing in medical education infrastructure, for example, in the planned University
of British Columbia medical school expansion
at Kelowna General Hospital and in Dawson
Creek and District Hospital.
Provided $30 million to the new Terry Fox
Research Institute in Vancouver, where translational research will morph new technology
and practices into practical solutions for
cancer patients.
Learning from British Columbia Citizens
Successfully concluded the unprecedented
year-long Conversation on Health. After over
12,000 submissions, 5.9 million website hits
and thousands more British Columbians taking
part in 78 forums and meetings, the Conversation
recommended priority actions to improve
and renew the province’s health services for
the future.
Conducted patient satisfaction surveys on Emergency Departments and Ambulatory Oncology,
to find out how patients experience health services.
Information on health and health services in
British Columbia is available at:
www.gov.bc.ca/healthservices
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1.0Public 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 sets provincewide goals, standards and performance agreements
for health service delivery and works together with
British Columbia’s 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 of this Act 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, in the manner
provided for in this Act, reasonable access throughout British Columbia to quality medical care, health
care and diagnostic facility services for residents of
British Columbia under MSP.
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 to represent MSP beneficiaries.
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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, and
is available in September for the prior fiscal year.
The Ministry provides extensive information in its
Annual Service Plan Report 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
Ministry reports through various publications, including:
Vital Statistics Annual Report;
Report on Health Authority Performance
(annual); and
Provincial Health Officer’s Annual Report
(on the health of the population).
1.3 Audit of Accounts
The Ministry is 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.
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Chapter 3 — British Columbia
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 Ministry has 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.
The monies are collected by the Ministry of Small
Business and Revenue.
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 governmentadministered 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.
Canada Health Act Annual Report, 2007–2008
Effective April 1, 2005, the Ministry 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). This new organization
is called Health Insurance BC (HIBC). Policy and
decision-making functions remain with the Ministry
of Health Services.
The contract with MAXIMUS BC is enabled
through the Medical Services Commission (MSC
is empowered to manage MSP on behalf of the
Government of British Columbia).
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 approves all payments before they are released.
2.0Comprehensiveness
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 or Hospital
Insurance Act or their regulations in 2007–2008.
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In 2007–2008, there were a total of 139 facilities
designated as hospitals. This included:
80 acute care hospitals (community hospitals,
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,
non-standard 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, division 5,
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 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
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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.
No new hospital services were added during the fiscal
year 2007–2008.
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Chapter 3 — British Columbia
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,
but 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
2007–2008, 8,772 physicians (includes only GPs
and Medical Specialists who billed fee-for-service
(FFS) in 2007–2008) were enrolled with MSP and
billed fee-for-service. In addition, some physicians
practice solely on salary, receive sessional payments,
Canada Health Act Annual Report, 2007–2008
or are on contract (service agreements) to the health
authorities. Physicians paid by these alternative
mechanisms may also practice on a FFS basis.
Non-physician healthcare practitioners who can be
enrolled to provide insured services under MSP are
midwives and supplementary benefit practitioners
(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 2007–2008, there were 126 midwives
and 4,635 supplementary benefits practitioners 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. MSP currently
has 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.
During fiscal year 2007–2008 physician services
which were added as MSP insured benefits included
fee items which reflect current practice standards,
for example:
video capsule endoscopy using M2A capsules;
recognition of sections previously designated
under Internal Medicine listings;
compensation of general practitioners who do not
have full hospital privileges for hospital care; —
increased remuneration for community based
general practitioners with full hospital privileges
for providing hospital care;
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GP age differentials for patients age 50–59;
GP management of labour and transfer to
higher level of care facility for delivery;
GP mental health planning and management fees;
revised oximetry procedures;
compensation of pediatricians for complex
consultations and procedures;
new techniques for laboratory, interventional radiology and interventional cardiology procedures;
insertion/removal of permanent pleural drainage
catheters; and
cardiac surgery Automatic Implantable Cardioverter
Defibrillator procedures.
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. 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.
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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 245 dentists (includes only Oral Surgeons,
Dental Surgeons, Oral Medicine and Orthodontists
who billed FFS in 2007–2008) enrolled with MSP
and billing FFS in 2007–2008.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
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 the
Workers’ Compensation Board, the Department of
Veterans Affairs or any other agency is responsible:
services solely for the alteration of appearance; and
reversal of sterilization procedures.
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.
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.
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Chapter 3 — British Columbia
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 Ministry responds to complaints made by
patients and takes appropriate actions to correct
situations identified to the 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
2007–2008.
3.0Universality
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. A person must be a
resident of British Columbia to qualify for provincial
health care benefits.
The Medicare Protection Act, in section 1, defines a
resident as a person who:
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
6 months in a calendar year; and
is deemed under the regulations to be a resident.
Canada Health Act Annual Report, 2007–2008
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.
Beneficiaries may cover their dependents, provided the
dependents are residents of the province. Dependents
include a spouse (either married to or living and co-
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habiting 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.
4.0Portability
The number of MSP registrants in 2007–2008
was 4,409,732. 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 appropriate Election to Opt Out (ETOO)
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.
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. New residents from other
parts of Canada are advised to maintain coverage with
their former medical plan during the waiting period.
3.3 Other Categories of Individual
4.2 Coverage During Temporary Absences
in Canada
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 percent to 100 percent 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).
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4.1 Minimum Waiting Period
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 2007–2008, 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
that exceed 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.
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Chapter 3 — British Columbia
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 2007–2008, the amount
paid to physicians in other provinces and territories
was $25.5 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 will probably
be required to pay for medical services and seek
reimbursement later from MSP.
British Columbia pays host provincial rates for
insured services according to 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. These changes were effective
March 18, 2005.
Canada Health Act Annual Report, 2007–2008
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 that exceed 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 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 InterProvincial Agreements for the Reciprocal Processing
of Out-of-Province Medical Claims are: surgery for
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Chapter 3 — British Columbia
alteration of appearance (cosmetic surgery); genderreassignment 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.
All non-emergency procedures performed outside
Canada require approval from the Commission
before the procedure.
5.0Accessibility
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
income, the Medicare Protection Act, sections 17 and
18, prohibits extra-billing by enrolled practitioners.
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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, 2008 was 32,225.
British Columbia hospitals also employ Registered
Psychiatric Nurses (RPNs) and Licensed Practical
Nurses (LPNs). On March 31, 2008, there were
2,202 RPNs and 7,019 LPNs licensed to practice
in the province.
In 2007–2008, 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 $174 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,
Canada Health Act Annual Report, 2007–2008
Chapter 3 — British Columbia
promoting nursing as a career of choice to ensure
the future of a quality British Columbia health
care system.
Some of the programs funded in 2007–2008
included: expansion of recruitment initiatives
for internationally-educated 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
front-line leadership positions, and enhancing
specialty and continuing education.
In 2007–2008, 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, 2008, there
are 66 practicing NPs in British Columbia.
In addition, the Ministry of Health Services has
partnered with the Ministry 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 has initiated
changes that encourage strategic investment in capital
infrastructure and innovative approaches to meeting
health service delivery needs, now and in future.
The Ministry has introduced a longer capital planning
cycle and has gathered better data on current capital
assets to support improved decision-making and better
forecasting of needs. The Ministry is now working to
extend the capital planning horizon to coincide with
Canada Health Act Annual Report, 2007–2008
longer term acute care and complex care planning
which is particularly beneficial in planning for major
infrastructure such as hospitals that have life-cycles
encompassing several decades. It also gives the health
authorities more time to explore creative ways of
addressing capital requirements.
The Province committed $42.5 million for the
expansion and upgrading of academic space in
teaching hospitals around British Columbia to
support increased enrolment of medical students.
Medical and Diagnostic Equipment
The 2003 First Ministers’ Accord on Health Care
Renewal established a $1.5 billion national diagnostic
and medical equipment fund, of which $200.1 million
was apportioned to British Columbia, over three years.
Health authorities spent this fund on a wide variety
of equipment for diagnostic/therapeutic and medical/
surgical purposes, and to enhance comfort and safety
for patients and staff.
The Province invested $35 million in leading-edge
medical technologies, using $25 million of the
federal funding as well as provincial capital and
foundation dollars. A committee of representatives
from the Ministry, the health authorities and various
health care fields provided expertise and advice in
identifying investments to improve patient access
and most strategically serve the needs of British
Columbians.
The funding was used by health authorities for
equipment such as:
the province’s first publicly-funded PET unit
located at the Vancouver Cancer Agency, which
will improve the management of cancer patients
by providing accurate pre-treatment detection
of cancerous tumours and monitoring therapy
response to improve recovery;
new CT scanners in the Lower Mainland and
Victoria that will improve cardiac care in British
Columbia and increase provincial capacity for
diagnosing heart and brain disease as well as
handling trauma cases;
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Chapter 3 — British Columbia
a mobile MRI scanner for the Kootenays and
South Okanagan and a CT scanner at Kelowna
that will significantly improve access for patients
with wide ranging needs in the province’s interior
regions; and
were selected as they demonstrated considerable
success during HIF and had the greatest potential
for immediate impact.
a Picture Archiving Communication System and
a Radiology Information System for the Northern
Health Authority that will enhance access to care
and treatment in many small communities by
allowing sharing of digital images between hospitals/
regions and radiologists across the north.
BC HealthGuide Handbook: A free 400+ page
handbook that covers over 200 health topics and
includes information on how to recognize and
manage common health concerns; tips on home
treatment; care options; and when to see a doctor.
The handbook was delivered free to every household
in British Columbia in spring 2001. The updated
version, published in November 2005, is available
free to, all British Columbians at Government
Agents’ Offices and local pharmacies. The updated
handbook contains new information on seniors’
health including healthy aging and tips for caregivers.
The September 2004 First Ministers’ Agreement
committed an additional $66 million in medical
equipment funding for British Columbia to be
spent by 2007–2008.
Health Innovation Fund
The $100 million Health Innovation Fund (HIF)
was developed by the Government of British Columbia
as a means of introducing new and innovative ideas
to address challenges to British Columbia’s health
care system. In 2007–2008, the Fund provided seed
money to enable health authorities to explore new
options by encouraging dynamic but managed risktaking in the provision of health services. Funding
was targeted towards sustainable health system change
with a particular focus on strategies that would have
a systemic effect on: Emergency Department Decongestion, Primary Care, and Pay for Performance-based
Patient Outcome concepts.
The Health Innovation Fund provided a venue for
community and regionally-driven proposals designed
to improve both patient and provider experiences
while reducing wait times and increasing access
to services. Communities throughout the province
continue to benefit from these innovative practices,
as rigorous monitoring and evaluation provide an
evidence base for improving service delivery and
replicating successful projects. In 2007–2008, three
of the Fund’s initiatives — iCare, Streaming/Rapid
Assessment Zones and Lean Design — were targeted
for funding through the Province’s three-year
$300 million Transformation Fund. These initiatives
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Ongoing Innovations
A BC First Nations Health Handbook, developed
in partnership with the BC First Nations Chiefs’
Health Committee, was released in June 2003
and a French version, Guide-santé — ColombieBritannique, was released in June 2004. Translated
and culturally-focused versions in Chinese and
Punjabi were available in April 2007.
BC HealthGuide OnLine: a comprehensive public
website (www.bchealthguide.org) with current, medically approved information on over 3,500 health
topics, tests, procedures and resources. The website
expands on the information in the BC HealthGuide
handbook with more than 35,000 medically
reviewed pages covering over 3,000 health topics.
BC HealthGuide OnLine provides information
on the BC HealthGuide Program components in
French, Chinese, Punjabi and Farsi. Annual hits
(page views) to the BC HealthGuide OnLine have
more than tripled since implementation in 2002.
BC NurseLine: a 24-hour, toll-free contact centre
service providing access to registered nurses specially
trained to provide confidential health information
and advice on the telephone. Registered nurses are
specially trained to use medically approved protocols
to provide confidential health information and
Canada Health Act Annual Report, 2007–2008
Chapter 3 — British Columbia
advice on acute and chronic health symptoms and
conditions and when to see a health professional.
Health information and advice are available in over
130 languages to anyone in British Columbia with
access to a telephone.
BC HealthFiles: a series of over 200 easy-to-understand
fact sheets with British Columbia-specific information
on a wide range of public and environmental health
and safety topics. Translated versions of a number
of the BC HealthFiles are available. Fact sheets are
available to residents and as a resource to health care
professionals by download from the BC HealthGuide
OnLine website and from public health units.
Launched in January 2005, the BC NurseLine provides
after-hours triage and support to Hospice Palliative
Care (HPC) patients in the Fraser Health Authority.
HPC patients are able to contact the BC NurseLine
for after-hours support from 9:00 p.m. to 8:00 a.m.
September 2005 to March 2006, the BC NurseLine
in partnership with Fraser Health Authority and
Northern Health Authority launched the demonstration phase of the Chronic Disease Management
(CDM) Project. The Project provides primary health
care teams with an opportunity to refer patients
with diabetes or congestive heart failure with selfmanagement support. Those patients with complex
medication issues are referred the BC NurseLine
to a pharmacist coach. The effectiveness of the
demonstration phase of the CDM Project will be
evaluated and leveraging the CDM Project as part
of the existing CDM support available in BC will
be considered.
July 2006 to December 2006, the BC NurseLine
and Interior Health Authority piloted a telehomecare monitoring project in the East Kootenays to
determine the effectiveness of expanding the project
across the authority. Congestive heart failure patients
used monitoring equipment set up in their home to
record their vitals daily. The information was then
securely transferred to a central monitoring station.
The information was monitored by a registered
nurse, in the Interior Health Authority on weekdays
Canada Health Act Annual Report, 2007–2008
and BC NurseLine on weekends, who would follow
up with the patient as required based on the vitals
that were recorded.
Dial-A-Dietician: A free nutrition information service
that provides easy-to-use nutrition information for
self-care, based on current scientific sources, by a
registered dietician over the telephone. Registered
dieticians are available from 9:00 a.m. to 5:00 p.m.,
Monday to Friday. Referrals are provided to hospital
out-patient dieticians, community nutritionists and
other local services. Translation services are available
in over 130 languages. In addition to nutrition
information over the telephone, the Dial-ADietitian service includes a comprehensive website
(www.dialadietitian.org) with nutritional information and useful links.
The Ministry’s 2005–2006 to 2007–2008 Service
Plan contained a number of objectives and strategies
designed to reach the Province’s goals for a sustainable health system. This includes Priority Strategy 3:
Effective Management of Acute Care Services in
Hospitals: Plan for and manage the demand on
emergency health services and surgical and procedural services.
While most of the strategies under this objective
focus on providing services outside the hospital, this
strategy focuses on ensuring needed hospital services
are provided in a timely and high-quality manner.
Under this strategy, the Ministry and all five health
authorities have participated in two province-wide
projects to improve access to, and effectiveness of,
emergency room and surgical services in hospitals
across the province.
5.3 Access to Insured Physician and
Dental-Surgical Services
In 2007–2008, approximately 2,800 general practitioners and specialists received all or part of their
income through British Columbia’s Alternative
Payments Program (APP).
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Chapter 3 — British Columbia
APP funds regional health authorities to hire salaried
physicians or contract with physicians, in order to
deliver insured clinical services.
The Ministry 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
2,404 visits in 2007–08 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 28 days of paid
locum coverage per year. This program assisted
physicians in approximately 58 small communities to attend continuing medical education
and also provided vacation relief.
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.
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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 Medical On-call/
Availability Program, call-back, or Doctor of
the Day payments are not available.
Rural Loan Forgiveness Program which decreases
British Columbia student loans by 20 percent 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 and physicians
continue to work together to develop incentives
aimed at helping to support and sustain full service
family practice. In 2007–2008 new fees were introduced to support GP care of complex patients,
management of community based patients living
with depression, cardiovascular risk assessment,
and fees to support case management of patients
living in the community and in facilities.
The University of British Columbia’s (UBC) medical
school is expanding in collaboration with the University
of Northern British Columbia, the University of
Victoria and British Columbia’s health authorities
to double the number of medical students. In 2002,
the government announced $134 million to build a
new Life Sciences Centre at UBC in Vancouver and
other distributed sites for medical programs in Prince
George and Victoria. British Columbia’s annual
intake for medical students was 128 in 2003. The
expanded program doubled the number of first-year
seats to 256 in 2007. In addition, British Columbia
is planning to further expand the medical program
to British Columbia’s southern Interior, adding
another 32 first-year medical school spaces to the
province’s medical program.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — British Columbia
In addition to the medical school expansion, the
Ministry has begun to expand postgraduate medical
education (residency positions) to keep pace with
undergraduate MD program growth. In 2003, the
Ministry funded 128 entry-level residency positions for
Canadian medical graduates (CMGs). Since July 2003,
this has increased by 96 to 224 entry-level positions.
With the further expansion of medical education to
the province’s southern Interior, postgraduate medical
education is expected to increase to 256 entry-level
residency positions for CMGs.
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.
Funding in 2007–2008 for physicians accounted
for $3,053 million, or 23.6% of the Ministry’s
budget in 2007–2008.
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.
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 was signed on November 1, 2007, and
it remains in effect until 2012. Provisions of the
now expired 2004 Working Agreement and the
2006 Letter of Agreement were incorporated into
the new Agreement.
Effective April 1, 2007, physician compensation
rates were increased by 2%. The PMA also prescribes
increases in 2008–2009 and 2009–2010 of 2% and
3%, respectively. Between April and January 2010,
there is provision within the PMA to re-open and
revisit compensation clauses. Any adjustments will
be reflected in compensation rates for 2010–2011
and 2011–2012.
In addition to the PMA, the Province and the
BCMA also signed 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.
As of 2007–2008 the PMA also provided for targeted
compensation increases (market adjustments) for:
specialist fee disparities; creating new emergency
physician contract rates; and other service and salary
rate adjustments.
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.
Canada Health Act Annual Report, 2007–2008
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.
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Chapter 3 — British Columbia
The Province and the BC Dental Association (BCDA)
negotiated a Memorandum of Understanding (MOU) in
August 2007. The MOU is effective from July 2007,
through March 2010 and covers the following services:
dental surgery; oral surgery; orthodontic services;
oral medicine; and dental technical procedures. Fee
schedules for these services will increase as follows:
3.5% in October 2007; 3% in April 2008; and 3%
in April 2009. Both the Province and the BCDA
agree to meet through a Joint Dental Surgery Policy
Committee for the duration of the Agreement.
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.
Legislation
Annual funding allocations to health authorities are
determined as part of the Ministry’s annual budget
process in consultation with the Ministry of Finance
and Treasury Board. The final funding amount is
conveyed to health authorities by means of an annual
funding letter.
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. There were no significant
amendments to the Act or Regulations in 2007–2008.
Medical practitioners are licensed under the Medical
Practitioners Act and dentists under the Dentists Act.
Compensation Methods for Physicans 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 percent of payments were distributed as fee-for-service
payments and nearly 11 percent were distributed as
alternative payments. Of the alternative payments,
75 percent are distributed through contracts, 21 percent
as sessions (3.5-hour units of service) and 4 percent
as salaried arrangements. The government funds
health authorities for alternative payments, but does
not pay physicians directly. In British Columbia,
MSP pays only for medically required dental services;
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
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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.
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 Ministry of Health Services’ broad
expectations for health authorities and explain how
performance in relation to these expectations will
be monitored.
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 2007–2008 to
legislation or regulations concerning payments for
insured hospital services.
Insured hospital services are included within the annual
funding allocations to regional 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — British Columbia
Needs-Based Funding Formula and other funding
allocation methodologies (to reflect specific program
delivery requirements within health authorities).
In 2007–2008, 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.
6.0Recognition 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.
In 2007–2008, these documents included:
2008/09 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
2008/09 Budget and Fiscal Plan available at
http://www.bcbudget.gov.bc.ca/2008/
estimates/2008_Estimates.pdf
Public Accounts 2007–2008 available at
http://www.fin.gov.bc.ca/OCG/pa/07_08/
Pa07_08.htm
 Balanced Budget 2008 available at
http://www.bcbudget.gov.bc.ca/2008/
Canada Health Act Annual Report, 2007–2008
7.0Extended Health Care
Services
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 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.
177
Chapter 3 — British Columbia
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 percent 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
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 psychosocial, 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.
178
Community Residential Care Facilities
These facilities provide 24-hour care, intensive treatment and support services, including psychosocial
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 psychosocial
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 psychosocial rehabilitation and home support
services, such as assistance with meal preparation,
personal care, home management, medication support,
socialization, and crisis management. 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — British Columbia
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
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,
Canada Health Act Annual Report, 2007–2008
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 be independent. They provide supportive group programs and activities that give clients
a chance to be more involved in their community
and offer care providers a break. Services vary with
each centre, but may include personal care, social
activities, meals and transportation.
Centres usually charge a small 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 are also providing home care
services such as home care nursing, community
rehabilitation, nutrition and social work, sometimes
in partnership with primary health care, in a variety
of ambulatory settings including wellness clinics,
ambulatory home care nursing clinics, and community health clinics for the frail elderly.
179
Chapter 3 — British Columbia
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
4,099,076
4,182,682
4,216,199
4,279,734
4,409,732
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Payments for insured health services ($): 2
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Private For-Profit Facilities
4.
5.
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
92
18
3
24
137
92
18
4
23
137
82
19
4
32
137
82
18
4
35
139
80
19
3
37
139
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
11
0
11
17
1
18
18
1
19
22
0
22
18
not available
not available
1,470,370
not available
1,470,370
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
Number (#): 1
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
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 Canada 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.
180
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.
Canada Health Act Annual Report, 2007–2008
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 ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
7,294
7,467
6,517
7,172
7,160
45,318,174
51,869,175
49,899,859
65,678,542
55,309,733
81,911
80,386
77,537
81,878
95,677
11,105,322
13,574,737
14,089,042
17,937,647
19,088,368
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
1,970
2,294
2,345
1,858
1,603
2,365,051
3,811,717
4,248,649
3,452,739
14,486,341
611
761
1,247
960
1,215
294,712
741,617
770,215
453,698
553,661
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
4,573
3,510
0
8,083
4,629
3,642
0
8,271
4,681
3,773
0
8,454
4,756
3,870
0
8,626
4,806
3,966
0
8,772
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
3
2
0
5
4
2
0
6
4
2
0
6
3
2
0
5
3
2
0
5
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
1
0
0
1
1
0
0
1
1
0
0
1
1
0
0
1
2
0
0
2
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
63,758,925
1,967,031,496
65,944,973
1,956,374,356
70,083,943
2,032,708,002
72,660,315
2,074,806,490
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
3
75,659,148
2,149,229,722
3
3. The MSP Fee-for-Service Payments listed in 18b included partial retroactive rate increases applied to the 2006/2007 and 2007/2008
medical expenditure.
Canada Health Act Annual Report, 2007–2008
181
Chapter 3 — British Columbia
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
604,748
628,099
674,497
673,886
706,044
22,516,419
23,624,476
25,781,441
26,928,627
25,512,690
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
52,673
65,134
69,741
55,527
34,444
2,281,820
2,767,854
3,121,999
2,551,760
6,652,374
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
182
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
243
228
238
234
245
36,809
38,310
41,965
44,015
43,262
5,170,348
5,268,900
5,833,105
6,087,395
6,305,343
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Yukon
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 33,423 eligible persons registered with
the Yukon health care plan on March 31, 2008.
Other insured services provided to eligible Yukon
residents include the Travel for Medical Treatment
Program; the Chronic Disease and Disability Benefits
Canada Health Act Annual Report, 2007–2008
Program; the Pharmacare and Extended Benefits
Programs; and the Children’s Drug and Optical
Program. Non-insured health service programs
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:
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 two years for the
processing of Health Care Registration, Medical
Claims, Hospital Claims and Drug Claims. The
Medical Travel Claims component is planned for
implementation 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;
 the establishment of a pace maker clinic in
February 2007 that services approximately
60 Yukon residents—as a result, residents
with pacemakers no longer have to leave
the territory for medical check-ups on
their pacemaker;
 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:
183
Chapter 3 — Yukon
 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 hightechnology diagnostic and treatment equipment.
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 2007–2008.
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 2007–2008.
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;
184
 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 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Yukon
1.2 Reporting Relationship
1.4 Designated Agency
The Department of Health and Social Services is
accountable to the Legislative Assembly and the
Government of Yukon through the Minister.
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.
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
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, 2008.
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.
Canada Health Act Annual Report, 2007–2008
2.0Comprehensiveness
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 2007–2008.
In 2007–2008, 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. 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.
185
Chapter 3 — Yukon
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 facilities, including
186
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.
In 2007–2008, additional funds were provided to
increase the number of knee replacements performed
in Yukon.
A Satellite Specialist Clinic was established in
Whitehorse to accommodate the increase in
visiting specialist services.
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 2007–2008.
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Yukon
The estimated number of resident physicians participating in the Yukon Health Care Insurance Plan
in 2007–2008 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 2007–2008, no
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 2007–2008, two dentists 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 2007–2008, 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
surgical-dental procedures listed in Schedule B
of the Regulations and require the unique capabillities 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;
Canada Health Act Annual Report, 2007–2008
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Chapter 3 — Yukon
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.
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
188
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 2007–2008.
 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, 2008, 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.
 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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Yukon
3.0Universality
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;
 members of the Canadian Forces;
 convention refugees;
Canada Health Act Annual Report, 2007–2008
 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, 2008, there were 33,423 residents
registered with the Yukon Health Care Insurance
Plan. There were no residents who notified Insured
Health Services of their decision to opt out of the
Yukon Health Care Insurance Plan in 2007–2008.
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Chapter 3 — Yukon
3.3 Other Categories of Individual
4.0Portability
The Yukon Health Care Insurance Plan provides
health care coverage for other categories of individuals, as follows:
4.1 Minimum Waiting Period
 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 2007–2008 under the following conditions is:
 Returning Canadians — 97
 Permanent Residents — 480
 Minister’s Permit — 0
 Convention Refugees — 0
 Armed Forces — 6
 RCMP — 12
The estimated number of individuals receiving
coverage in 2007–2008 under the following
conditions is:
 Foreign Workers — 95
 Clergy — 0
3.4 Premiums
The payment of premiums by Yukon residents was
eliminated on April 1, 1987.
190
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.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Yukon
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.
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 2007–2008.
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 2007–2008:
 In-patient services — $10,742,393
 Out-patient services — $2,155,225
Canada Health Act Annual Report, 2007–2008
These figures are by date of service and may be subject
to adjustment.
In 2007–2008 payments to out-of-territory physicians
totalled $1,977,052.
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.
No amendments were made to these sections of
the legislation in 2007–2008. 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, 2007 was $1,382. This rate
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Chapter 3 — Yukon
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 Out-Patient
Procedures Regulation. The out-patient rate is currently
$169 and is established through Order-in-Council
and derived by the Inter-provincial Health Insurance
Agreements Coordinating Committee (IHIACC).
The following amounts were paid in 2007–2008 for
elective and emergency services provided to eligible
Yukon residents outside Canada:
 In-patient services — $32,075
 Out-patient services — $11,782
These figures are by date of service and may be subject to adjustment.
4.4 Prior Approval Requirement
There is no legislated requirement that eligible
residents must seek prior approval before seeking
elective or emergency hospital or physician services
outside Canada.
5.0Accessibility
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.
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Access to hospital or physician services not available
locally are provided through the Visiting Specialist
Program, Telehealth Program or the Travel for
Medical Treatment Program. These programs ensure
that there is minimal or no delay in receiving medically necessary services.
There is no extra-billing in the Yukon for any services
covered by the Plan.
5.2 Access to Insured Hospital Services
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 fulltime equivalent (FTEs)
nurses and other health care professionals working
in facilities providing insured hospital services in the
Yukon as of March 31, 2008, is:
Profession
Whitehorse
General
Hospital
Watson Lake
Cottage
Hospital
# of FTEs
# of FTEs
Registered Nurses
74.75
7.50
Licensed Practical
8.00
0
Nurse Practitioner
0
0
Social Worker
1.00
0
Pharmacist
2.27
0
Physiotherapist
4.55
9.00
Occupational Therapist
1.40
0
Psychologist
0
0
Medical Lab/X-Ray
31.99
0
Dietician
4.50
0
Public Health
0
2.00
Home Care
0
1.00
Canada Health Act Annual Report, 2007–2008
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.
Emergency surgery patients at the Whitehorse General
Hospital are normally seen within 24 hours.
Recruitment and Retention
Surgical services provided include:
Recruitment and retention initiatives include:
 minor orthopaedics;
 selected major orthopaedics;
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:
 competitive salaries;
 recruitment and retention bonuses;
 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.
Canada Health Act Annual Report, 2007–2008
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).
 gynecology/obstetrical;
 paediatrics;
 general abdominal;
 mastectomy;
 emergency trauma;
 ear/nose/throat/otolaryngology; and
 ophthalmology including cataracts.
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.
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Chapter 3 — Yukon
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.
Measures to Improve Access
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:
 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.
194
5.3 Access to Insured Physician and
Surgical-Dental Services
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.
The following resident physicians, specialists and
dentists provided services in the Yukon as of
March 31, 2008, (see Statistical Table item #14):
 General/Family Practitioners — 58
 Specialists — 9
 Dentists — 2
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Yukon
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:
 Ophthalmology — 2
 Oncology — 3
 Internal Medicine — 2
 Otolaryngology — 1
 Neurology — 2
 Rheumatology — 1
 Dermatology — 1
 Dental Surgery — 2
 Infectious Disease — 1
 Psychiatry — 3
 Orthopaedics — 4
 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 March 31, 2008, the waitlist for
non-emergency specialist services was estimated at:
 Ophthalmology — 12 to 18 months
 Orthopaedics — 2 to 24 months
 Otolaryngology — 1 to 3 months
 Rheumatology — 3 to 5 months
 Dental Surgery — 2 to 6 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,
2008, the waitlist for non-emergency specialist services
was estimated at:
 Neurology — 1 to 4 months
 Gastroenterology — 1 to 6 months
 Internal Medicine — 1 to 2 months
Canada Health Act Annual Report, 2007–2008
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.
 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.
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Chapter 3 — Yukon
 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.
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, 2004, ending March 31, 2008. That MOU
established the terms and conditions for payment
of physicians and established two new programs: the
New Patient Program, and the Physician Retention
Program.
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 2007–2008.
The fee-for-service system is used to reimburse the
majority of physicians and dentists providing insured
services to residents. In 2007–2008, 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.
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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
2007–2008.
6.0Recognition Given to
Federal Transfers
The Government of Yukon has acknowledged
the federal contributions provided through the
Canada Health and Social Transfer (CHST) in
its 2007–2008 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, 2007–2008
Chapter 3 — Yukon
7.0Extended Health Care
Services
There is no legislated requirement for home care
services in Yukon. No other major changes were
made in the administration of these services in
2007–2008.
7.1 Nursing Home Intermediate Care
and Adult Residential Care
7.3 Ambulatory Health Care Services
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 138 continuing care beds in
the Territory in 2007–2008.
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.
Canada Health Act Annual Report, 2007–2008
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)
 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)
197
Chapter 3 — Yukon
 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.
198
 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, 2007–2008
Chapter 3 — Yukon
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
30,917
31,505
32,226
33,103
33,423
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other 1
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
5.
2004–2005
2005–2006
2006–2007
2007–2008
2
0
0
13
15
2
0
0
13
15
2
0
0
13
15
2
0
0
13
15
2
0
0
13
15
24,877,479
not applicable
not applicable
6,318,565.00
31,196,044
26,255,596
not applicable
not applicable
6,509,897.00
32,765,493
26,867,501
not applicable
not applicable
6,862,368.00
33,729,869
36,330,706
not applicable
not applicable
7,718,344
44,049,050
33,825,619
not applicable
not applicable
10,748,019
44,573,638
2
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4.
2003–2004
2
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
783
674
714
738
976
7,587,906
5,857,725
8,698,387
8,808,130
10,742,393
6,938
7,412
8,450
8,735
9,027
936,376
1,306,531
1,735,520
2,168,964
2,155,225
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
8
14
15
11
15
13,536
30,566
43,454
20,257
32,075
46
64
55
42
74
5,994
9,965
8,372
7,101
11,782
1. 13 Health Centres ( Beaver Creek, Destruction Bay, Carcross, Carmacks, Dawson, Faro, Haines Junction, Mayo, Old Crow, Pelly Crossing,
Ross River, Teslin and Whitehorse )
2. Added Whitehorse Health Centre expenditures for 2007/08
Canada Health Act Annual Report, 2007–2008
199
Chapter 3 — Yukon
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
55
8
0
63
54
8
0
62
55
9
0
64
57
9
0
66
58
9
0
67
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
235,642
11,769,018
238,797
12,892,522
248,646
13,752,251
254,170
13,788,028
280,718
16,342,282
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
200,462
8,321,114
219,031
9,201,579
225,815
9,847,991
245,069
11,076,701
255,143
12,003,059
27,274
1,840,478
13,035
1,495,701
17,127
1,886,289
32,272
2,232,060
17,936
2,124,340
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Visiting Specialists, Locum Doctors and
Member Reimbursements: 3
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
34,037
35,401
35,781
39,669
38,512
1,833,654
1,921,260
1,873,508
2,139,805
1,977,052
Insured Physician Services Provided Outside Canada
not available
21. Number of services (#).
22. Total payments ($).
not available
not available
not available
not available
not available
not available
not available
not available
not available
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
4
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
6
6
6
2
2
104
30
24
2
2
25,093
29,712
25,072
941
587
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.
200
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Northwest Territories
Northwest Territories
Introduction
The Northwest Territories (NWT) 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, school health programs, and
educational programs. Physicians and some
specialists routinely visit communities without
resident physicians. Services also include early
intervention and support to families and children,
mental health, and addictions.
As of April 1, 2008, there were more than 42,000
people living in the Northwest Territories, of which
half were Aboriginal. The NWT continues to have
a relatively young population and a high birth rate.
According to 2007 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:
the implementation of the new Pharmacy Act,
which was passed in November 2006. This Act
reflects a number of differences from the previous
Pharmacy Act, ensuring the public receives quality
pharmaceutical service and care. The new Act
recognizes health care professionals and the
National Association of Pharmaceutical Regulatory Authorities’ drug schedules, permits
pharmacists to accept faxed prescriptions,
and allows for discipline provisions such as
an alternative dispute resolution process; and
the passing of the new Public Health Act in
August of 2007. The new Public Health Act
reflects provisions of the Charter of Rights and
modernizes provisions regarding privacy and
information management, management of
pandemics, and the independent powers of
the Chief Medical Health Officer.
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.
1.0Public 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, 2007–2008
201
Chapter 3 — Northwest Territories
1.2 Reporting Relationship
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.
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.
The Minister also appoints 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 service facilities. The Boards’ chairpersons hold
office indefinitely, while other members hold office
for a term of three years. With respect to the TCSA,
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 the term.
An annual audit of accounts is performed on each
Board of Management. The Minister has regular
meetings with Board of Management chairpersons.
This forum allows the chairperson to provide nonfinancial reporting.
1.3 Audit of Accounts
The Hospital Insurance Plan and the Medical Care
Plan are administered by the Department of Heath
and Social Services. The Office of the Auditor General
of Canada (OAG) audits the payments made under
each plan, as part of the GNWT annual audit.
202
2.0Comprehensiveness
2.1 Insured Hospital Services
Insured hospital services are provided under the
authority of the HIHSSA and the Regulations.
During 2007–2008, four hospitals and 28 health
centres delivered insured hospital services to both
in- and out-patients.
The NWT provides coverage for a full range of
insured hospital services. 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, 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.
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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Northwest Territories
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 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, residents travel to hospitals or clinics
in other jurisdictions. 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.
2.2 Insured Physician Services
The NWT Medical Care Act and the NWT Medical
Care Regulations provide for insured physician services.
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, 2008,
there were approximately 300 licensed physicians,
most of whom provide locum services.
A physician may opt-out and collect her or his fees
otherwise than under the Medical Care Plan by
delivering to the Director of Medical Insurance a
Canada Health Act Annual Report, 2007–2008
written notice to that effect. There were no physicians who opted-out of the Medical Care plan as
of March 2008.
A wide range of medically necessary services are provided in the NWT. No limitation is applied if
a service has been deemed an insured service. 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 from
an approved medical practitioner are provided.
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.
2.3 Insured Surgical-Dental Services
Insured services and those related to oral surgery,
injury to the jaw or disease of the mouth/jaw are
eligible. 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.
203
Chapter 3 — Northwest Territories
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
3.0Universality
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.
3.1 Eligibility
In the NWT, prior approval applications 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.
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 2008, there were 46,177 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.
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.
204
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Northwest Territories
3.3 Other Categories of Individuals
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.
4.0Portability
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
Canada Health Act Annual Report, 2007–2008
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 2007–2008
fiscal year, over $15 million was paid for in- and
out-patient hospital services received in other provinces and 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 infor-
205
Chapter 3 — Northwest Territories
mation 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.
In an effort to maximize the effectiveness of recruitment
for all allied health professionals, the Government
of the Northwest Territories (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
5.0Accessibility
the creation of economies of scale, thereby
reducing costs.
5.1 Access to Insured Health Services
5.3 Access to Insured Physician and
Surgical-Dental 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.
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 that
residents will have access to necessary services not
available in NWT facilities. Through the use of
medical travel arrangements, access to services
was maintained throughout the year.
During 2007–2008, Telehealth services were
expanded to include 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.
206
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 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 made to hospitals are 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
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Northwest Territories
government budget and level of services provided
by the hospital.
grams and services operate according to HIHSSA
and the Hospital Standards Regulations.
Payments to facilities providing insured hospital
services are governed under the HIHSSA and the
Financial Administration Act. No amendments were
implemented in 2007–2008 to provisions involving
payments to facilities. A comprehensive budget is
used to fund hospitals in the NWT.
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.
6.0Recognition 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 2007–2008, these documents included:
2007–2008 Budget Address;
2007–2008 Main Estimates;
2006–2007 Public Accounts; and
2005–2008 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.
7.0Extended Health Care Services
Continuing Care programs and services offered in
NWT communities may include: supported living,
adult group homes, long-term care facilities, and
extended care facilities. Where applicable, these pro-
Canada Health Act Annual Report, 2007–2008
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,
post-hospital 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.
207
Chapter 3 — Northwest Territories
Registered Persons
2003–2004
1.
Number as of March 31st (#).
43,202
2004–2005
2
44,504
2005–2006
2
44,082
2006–2007
2
45,551
2007–2008
2
46,177
2
Insured Hospital Services Within Own Province or Territory
2003–2004
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
4
not applicable
not applicable
28
32
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
not available
not applicable
not applicable
not available
51,285,446
Private For-Profit Facilities
4.
5.
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
56,143,626
2005–2006
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
56,388,405
2006–2007
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
64,875,012
2007–2008
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
69,114,573
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2004–2005
3
3
4
3
3
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
1,338
1,248
1,198
1,051
1,256
8,737,798
9,020,790
11,482,462
11,429,716
12,484,198
9,591
10,251
10,662
11,922
11,743
2,110,818
2,572,333
2,633,322
2,688,223
2,626,107
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
1
2
9
8
13
216
165
14,868
16,970
27,516
21
19
54
43
28
20,735
4,972
7,280
9,635
4,773
All data are subject to future revisions. 2007/08 information current to September 2008.
2. The 2003–2004 figure is as of August 25, 2004, 2004–05 figure as of September 1, 2005, 2005–06 figure as of September 6, 2006, the 2006–07
figure as of September 6, 2007, and the 2007–08 figure as of September 5, 2008.
3. Northwest Territories does not have facilities that provide these services as their primary type of care. Instead, the 4 hospital acute care facilities
provide long term care, extended care, day surgery, out-patient services, diagnostic services and rehabilitative care.
4. Includes Health Centres and Public Health Units.
208
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Northwest Territories
Insured Physician Services Within Own Province or Territory
2003–2004
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
44
15
169
228
2004–2005
5
5
6
7
56
21
139
216
2005–2006
5
5
6
7
56
21
155
232
2006–2007
5
57
21
175
253
5
6
7
2007–2008
5
57
21
222
300
5
6
7
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
200,865
28,991,000
213,424
29,447,633
196,131
30,081,020
183,697
31,589,882
180,281
33,534,000
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
26,326
1,513,440
28,509
1,570,686
28,845
1,576,444
28,413
1,696,962
28,247
1,789,554
5
5
6
7
Insured Physician Services Provided to Residents in Another Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
41,607
43,244
51,201
62,898
53,734
2,968,136
3,137,444
3,985,029
3,592,314
4,137,351
19. Number of services (#).
20. Total payments ($).
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
77
88
85
94
78
8,515
19,417
3,611
4,142
5,356
Insured Surgical-Dental Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
23. Number of participating dentists (#).
not available
not available
not available
not available
not available
24. Number of services provided (#).
not available
not available
not available
not available
not available
25. Total payments ($).
not available
not available
not available
not available
not available
All data are subject to future revisions. 2007/08 information current to September 2008.
5. The 2003/04 numbers are estimates from NWT Department of Health and Social Services. 2004/05 to 2007/08 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.
Canada Health Act Annual Report, 2007–2008
209
210
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nunavut
Nunavut
Introduction
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. The Territory 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 31,152 as of April 1, 20081.
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. Pinasuaqtavut
2004–2009 describes the Government’s commitment
to building Nunavut’s future by achieving healthy
communities, simplicity and unity, self-reliance and
continuous learning. All Government of Nunavut
departments and agencies also strive to incorporate
traditional Inuit knowledge and values, known as
Inuit Qaujimajatuqangit, into program and policy
development as well as in service design and delivery.
The delivery of health services in Nunavut is based
on a primary health care model. There are local
health facilities in 24 communities across Nunavut,
including new regional facilities in Rankin Inlet and
Cambridge Bay (with in- and out-patient capacity)
and one hospital in Iqaluit. The Qikiqtani General
Hospital, 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. It is connected to the old hospital
(46,000 square feet) and repurposing plans are
underway for that facility. 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.
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 when necessary,
accesses specialist services from health centres
in Ottawa, Toronto, Winnipeg, Yellowknife
and Edmonton. A Nunavut physicians’ website
and incentives such as flexible work contracts,
have assisted the Department in its physician
recruitment efforts.
The management and delivery of health services in
Nunavut were integrated into the overall operations
of the Department on March 31, 2000, when the
1. Statistics Canada, Demography Division, CANSIM #051-0005
2. Statistics Canada, 2006 Census
3. Ibid.
Canada Health Act Annual Report, 2007–2008
211
Chapter 3 — Nunavut
former regional boards (Baffin, Keewatin 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. A continued emphasis on
support to front-line service delivery has remained
an integral part of this amalgamation.
The Territorial budget for health care and social
services in 2007-2008 was $299,615,000, which
includes $50,333,000 allocated for capital projects4.
This represents an increase of $22,091,000 from
2006–2007 funding levels.
In 2007–2008, 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 has experienced new usage
for a wider range of services such as: discharge
planning, tele-psychiatry, geriatrics, occupational
therapy, and patient post-operation follow-up.
In 2007-2008, use of the Telehealth network
totalled 3,999 hours, of which 1,812 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. In
November 2007, the Department tabled its Nunavut
Nursing Recruitment and Retention Strategy in the
Legislative Assembly. 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 our workforce; and preparing Inuit for
careers in the nursing profession. The Department
is developing an implementation plan to support
the Strategy. Recruitment and retention of other
health care professionals such as social workers,
dental therapists and physiotherapists continues
to be a challenge.
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 (equipment
and health human resources), 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.
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 Qiqiktani General
Hospital during working hours. At present, the
Clinic is staffed by two nurse practitioners (with
consult visits from doctors of the hospital), and
there are approximately 500 patient visits per
month. The Department continues to try to
recruit physician resources and an additional
nurse practitioner for the Clinic.
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 two
priority areas: healthy children and families;
and addiction reduction. The Strategy outlines
specific measures to promote and protect health
and to prevent disease and injury. To build upon
4. Government of Nunavut. 2007–2008 Main Estimates and 2007–2008 Supplementary Appropriations
212
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nunavut
the Public Health Strategy, the Department also
released Nutrition in Nunavut — A Framework for
Action. This framework is a proactive approach
to dealing with nutrition from a clinical, public
health and foodservices perspective with the goal
of finding solutions to achieve healthy eating.
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.
1.0 Public Administration
1.3 Audit of Accounts
1.1 Health Care Insurance Plan and
Public Authority
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 has the
mandate to audit the activities of the Department.
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
2007–2008.
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
Canada Health Act Annual Report, 2007–2008
The Auditor General is required to conduct an
annual audit of the transactions and consolidated
financial statements of the Government. The 2005
Report of the Auditor General of Canada to
the Legislative Assembly of Nunavut was tabled
in February, 2005. There were no references to
the operation of the health care insurance plan
or to the principles of the Canada Health Act
in the report. As of March 31, 2008, the 2006
Report of the Auditor General of Canada had
not been issued.
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 2007–2008.
In 2007–2008, insured hospital services were delivered
in 28 facilities across Nunavut, including a general
hospital located in Iqaluit, two regional health facilities
(located in Rankin Inlet and Cambridge Bay), as
well as 22 community health centres and as well as
a public health unit and a separate family practice
213
Chapter 3 — Nunavut
clinic (both located in Iqaluit). There is also rehabilitative treatment available through the Timimut
Ikajuksivik Centre located in Iqaluit. The Qikiqtani
General Hospital in Iqaluit is currently the only
acute care facility in Nunavut providing a range of
in- and out-patient hospital services as defined by
the Canada Health Act. However, as the two regional
facilities in 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.
214
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 Nunavut Financial Management Board.
No new services were added in 2007–2008 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 the Act or regulations in 2007–2008.
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 23 fulltime 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
one surgeon and one anaesthetist 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. As of
March 31, 2008, Nunavut had 156 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 2007–2008, no
physicians provided written notice of this election.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nunavut
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, Yellowknife
and Edmonton. These are the out-of-territory sites
to which Nunavut 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 2007–2008.
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 2007–2008, three 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.
Canada Health Act Annual Report, 2007–2008
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 2007–2008.
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 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 $1,396
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
215
Chapter 3 — Nunavut
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 and
Yellowknife), 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 Inter-Provincial Agreement on Eligibility
and Portability as well as internal guidelines. No
amendments were made to the Act or regulations
in 2007–2008.
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.
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
216
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.
As of March 31, 2008, 31,412 individuals were
registered with the Nunavut Health Care Plan,
up by 1,308 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)
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nunavut
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.
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 2007–2008 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
Canada Health Act Annual Report, 2007–2008
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 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 Territory, 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.
Out-of-territory hospitals were paid $18,786,899 in
the fiscal year 2007–2008.
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,
217
Chapter 3 — Nunavut
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 nonreferred or non-emergency services, the payment for
hospital services is $1,396 per diem and $158 for
out-patient care. No changes were made to these
rates in 2007–2008.
In 2007–2008 there were no payments for insured
emergency in-patient and out-patient health services
to eligible residents temporarily outside 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 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.
218
Interpretation services are also provided to patients
in any health care setting.
5.2 Access to Insured Hospital Services
The Qikiqtani General Hospital, which opened in the
fall of 2007, is located in Iqaluit and is currently 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 six day surgery beds and four recovery
beds. The facility provides in-patient, out-patient
and 24-hour emergency services. Local 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 2007–2008.
Outside the Qiqiktani General Hospital, out-patient
and 24-hour emergency nursing services are provided
by all 24 health centres located in the 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 Nunavut greater access to
a broader range of service options and allowing
service providers and communities to use existing
resources more effectively.
Nunavut has special arrangements with facilities in
Ottawa, Toronto, Churchill, Winnipeg, Edmonton
and Yellowknife to provide insured services to
referred patients.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nunavut
5.3 Access to Insured Physician and
Surgical-Dental Services
In addition to the medical travel assistance and
Telehealth initiatives, Nunavut has in place, agreements with a number of health regions or facilities
to provide medical and visiting specialists and other
visiting health practitioner services. For services and
equipment unavailable in Nunavut, patients are
referred to other jurisdictions. The Telehealth
network, linking all 25 communities, allows for
the delivery of a broad range of services: specialist
consultation services such as dermatology, psychiatry and internal medicine; rehabilitation
services; regularly scheduled counselling sessions;
family visitation; and continuing medical education. In 2007–2008, Nunavut had 156 physicians
registered.
The following specialist services were provided 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.
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,
the two new regional facilities in Rankin Inlet
and Cambridge Bay, and the 22 community
health centres, is part of the Department’s
budget. No payments are made directly to
hospitals or community health centres.
Canada Health Act Annual Report, 2007–2008
6.0Recognition Given to
Federal Transfers
The Government of Nunavut recognized the
Canada Health Transfer in the Director of Medical
Insurance Annual Report for Fiscal Year 2006–2007
which was tabled in the Legislative Assembly on
February 19, 2008.
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
thereafter 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 four (4) and five (5) on a 24/7 basis.
The facility employs Licensed Practical Nurses and
acute care needs are provided by the Chesterfield
219
Chapter 3 — Nunavut
Inlet Health Centre. The facility is often able to
provide Respite Care for levels 4 & 5 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 acute care (levels IV and level V) services. Acute
care cases are transferred to the closest hospital.
No legislation currently exists in Nunavut to
formally enable the extended health care services
described above.
Home Care Services
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
or community, thereby allowing individuals to remain
in familiar surroundings close to loved ones and to
maintain their sense of independence and wellbeing.
The guiding objectives of the program are to respect
the traditional and contemporary Inuit approach to
health and wellbeing, 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 2007–2008, 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 and fiscal constraints.
220
The HCC program is coordinated through three
regional centers with service delivery by: Home &
Community Care Workers; Home & Community
Care Representatives; Home Care Nurses; and
Physiotherapists and Occupational Therapists. HCC
program standards are developed by a Territorial
Home and Community Care Coordinator, in
consultation with the three Regional Home and
Community Care Managers.
No legislation currently exists in Nunavut to
formally enable the HCC services described above.
Ambulatory Health Care Services
In 2007-2008, 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 population aging facing
Nunavummiut 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 underway in
2007–2008. 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 will be offering a 6-month
Home and Community Care Worker Program.
Canada Health Act Annual Report, 2007–2008
Chapter 3 — Nunavut
Registered Persons
1.
Number as of March 31st (#).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
31,660
31,525
31,172
30,104
31,412
Insured Hospital Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
1
not available
not available
25
not available
1
not available
not available
25
not available
1
not available
1
26
28
1
not available
1
26
28
1
not available
1
26
28
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
Public Facilities
2.
3.
5.
5
5
5
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4.
5
5
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2003–2004
2004–2005
2005–2006
2006-2007
2006–2007
2007–2008
2,526
2,544
2,721
2,644
1,790
17,202,646
15,851,159
17,909,264
20,572,287
15,741,704
12,112
14,492
16,939
14,540
13,204
1,552,418
2,521,841
3,596,878
3,335,111
3,045,194
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
2
1
1
0
0
6,300
6,345
954
0
0
2
1
16
5
0
400
433
2,637
1,105
0
5. This includes 22 community health centres and two regional health centres located in communities throughout the Territory, as well as a public
health unit and family practice clinic (both located in Iqaluit). The family practice clinic currently has 2 nurse practitioners on staff offering
primary health care, as it would if located in one of the communities and operating as a community health centre.
Canada Health Act Annual Report, 2007–2008
221
Chapter 3 — Nunavut
Insured Physician Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
75
64
0
139
86
82
0
168
74
61
0
135
60
67
0
127
91
65
0
156
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
18. Services provided by physicians paid
through fee-for-service: 6
a. number of services (#)
b. total payments ($)
60,561
3,548,457
59,542
3,112,661
57,363
2,863,075
46,368
2,380,746
17,068
911,254
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
51,050
45,334
57,332
59,121
53,022
2,955,996
2,816,282
3,471,307
3,623,163
3,845,570
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
19
0
36
5
15
1,519
0
2,459
1,105
796
Insured Surgical-Dental Services Within Own Province or Territory
2003–2004
2004–2005
2005–2006
2006–2007
2007–2008
23. Number of participating dentists (#).
not available
not available
not available
not available
not available
24. Number of services provided (#).
not available
not available
not available
not available
not available
25. Total payments ($).
not available
not available
not available
not available
not available
7
6. 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.
7. In Nunavut, oral surgeries are only performed at the Qiqiktani General Hospital in Iqaluit. The 3 oral surgeons permitted to bill Nunavut
Medical Care Insurance Plan in 07–08 for insured dental services are reflected in reporting numbers contained under 14b (specialists).
222
Canada Health Act Annual Report, 2007–2008
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
Canada Health Act Annual Report, 2007–2008
of extra-billing and user charges prior to the
beginning of 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 2008.
223
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
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.
AVERTISSEMENT
La présente codification administrative n’est
préparée que pour la commodité du lecteur et
n’a aucune valeur officielle.
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:
— 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,
— 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;
–
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,
— 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;
–
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 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;
Considérant que le Parlement du Canada reconnaît :
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,
227
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
2. In this Act,
Definitions
“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;
228
Titre abrégé
2. Les définitions qui suivent s’appliquent à la présente
loi.
« 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 :
Définitions
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,
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 :
(h) use of physiotherapy facilities, and
a) les soins intermédiaires en maison de repos;
(i) services provided by persons who receive
remuneration therefor from the hospital,
b) les soins en établissement pour adultes;
but does not include services that are excluded by
the regulations;
“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;
Chap. C–6
c) les soins à domicile;
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;
“medical practitioner” means a person lawfully entitled
to practise medicine in the place in which the
practice is carried on by that person;
c)
les actes de laboratoires, de radiologie ou autres
actes de diagnostic, ainsi que les interprétations
nécessaires;
“Minister” means the Minister of Health;
d) les produits pharmaceutiques, substances
biologiques et préparations connexes administrés à l’hôpital;
229
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]
L.R. (1985), ch. C-6, art. 5; 1995, ch. 17, art. 36.
6. [Abrogé, 1995, ch. 17, art. 36]
230
Objectif premier
Raison d’être de
la présente loi
Contribution
pécuniaire
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
:
(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;
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;
(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.
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.
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.
Règle générale
l’universalité;
1984, c. 6, s. 7.
Gestion publique
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
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.
231
Chap. C–6
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.
Universality
1984, c. 6, s. 10.
11.(1) In order to satisfy the criterion respecting portability, the health care insurance plan of a province
Portability
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
232
(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.
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.
233
Chap. C–6
Canada Health Act
CONTRIBUTION PÉCUNIAIRE
ASSUJETTIE À DES CONDITIONS
CONDITIONS FOR CASH CONTRIBUTION
13.In order that a province may qualify for a full cash
contribution referred to in section 5, the government of the province
Conditions
(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
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.
234
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.
1984, ch. 6, art. 14.
Impossibilité
de consultation
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
(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.
Notice of order
(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.
Commencement
of order
(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.
235
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 extra-billing 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.
236
Surfacturation
Frais modérateurs
Réserve
Déduction en cas
de surfacturation
Déduction en
cas de frais
modérateurs
Consultation
de la province
Comptabilisation
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 :
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.
Application
aux exercices
ultérieurs
L.R. (1985), ch. C-6, art. 22; 1995, ch. 17, art. 40.
237
Chap. C–6
Annual report
by Minister
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.
1984, c. 6, s. 23.
238
Canada Health Act
1984, ch. 6, art. 23.
Rapport annuel du
ministre
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
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.
AVERTISSEMENT
La présente codification administrative n’est
préparée que pour la commodité du lecteur et
n’a aucune valeur officielle.
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.
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.
241
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.
(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.
242
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) 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.
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, 2007–2008
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 public
facility that provides acute, rehabilitative or chronic
care. Thus, when a provincial/territorial health insu­
rance 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.
243
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 physical and 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 population and strive to develop health promotion strategies and health
care delivery alternatives.
244
Canada Health Act Annual Report, 2007–2008
Annex B — Policy Interpretation Letters
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.
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 bona-fide 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 bona-fide 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.
Canada Health Act Annual Report, 2007–2008
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Annex B — Policy Interpretation Letters
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 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 inter-provincial 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 co-ordinated 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.
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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.
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 information 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
Canada Health Act Annual Report, 2007–2008
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Annex B — Policy Interpretation Letters
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].
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.
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Annex B — Policy Interpretation Letters
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
Canada Health Act Annual Report, 2007–2008
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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 subsidization 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 pro­vision 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
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Annex B — Policy Interpretation Letters
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 “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 technologically 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.
Canada Health Act Annual Report, 2007–2008
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Annex B — Policy Interpretation Letters
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.
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
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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.
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.
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
Canada Health Act Annual Report, 2007–2008
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.
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.
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.
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Annex C — Dispute Avoidance and Resolution Process Under the Canada Health Act
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Canada Health Act Annual Report, 2007–2008
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.
Canada Health Act Annual Report, 2007–2008
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Annex C — Dispute Avoidance and Resolution Process Under the Canada Health Act
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.
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.
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Annex C — Dispute Avoidance and Resolution Process Under the Canada Health Act
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, 2007–2008
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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
undertake government-to-government information
exchange, discussions and clarification on issues
as they arise.
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.
As a first step, governments involved in the dispute
will, within 60 days of the date of the letter initiating
the process, jointly:
258
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.
The panel 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 noncompliance 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.
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.
Canada Health Act Annual Report, 2007–2008
Annex D — Glossary
ANNEX D
Glossary of Terms Used in the Annual Report
The terms described in this glossary are defined within the context of the Canada Health Act. In other
situations, these terms may have a different definition or interpretation.
Term
Description
Acute care
Acute care includes health services provided to persons suffering from
serious and sudden health conditions that require ongoing professional
nursing care and observation.
Examples of acute care include post-operative observation in an intensive
care unit, and care and observation while waiting for emergency surgery.
Admission
The official acceptance into a health care service facility and the assignment
of a bed to an individual requiring medical or health services on a timelimited basis.
Block Fee
Block fees are flat fees usually charged on an annual basis to patients to
cover the cost of a predetermined set of services provided by a physician
that are not covered by the provincial or territorial health insurance plan.
These services can include, for example, telephone advice, the provision
of medical certificates and the renewal of prescriptions by telephone.
Chronic Care
Chronic care includes care required by a person who is chronically ill or has
a functional disability (physical or mental) whose acute phase of illness is over,
whose vital processes may or may not be stable and who requires a range of
services and medical management that can only be provided by a hospital.
Diagnostic Imaging
A procedure that detects or determines the presence of various diseases
or conditions with the use of medical imaging equipment. Medical imaging
equipment may include bone mineral densitometry, mammography, magnetic
resonance imaging (MRI), nuclear medicine, ultrasound, computed
tomography (CT), and X-ray/fluoroscopy.
Canada Health Act Annual Report, 2007–2008
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Annex D — Glossary
Term
Description
Eligibility
and Portability
Agreement
The original Interprovincial/Territorial Agreement on Eligibility and
Portability was approved by provincial and territorial Ministers of Health
in 1971 and was implemented in 1972. The Agreement sets minimum
standards with respect to interprovincial and territorial eligibility
and portability of health insurance programs. Provinces and territories
voluntarily apply the provisions of this agreement, thereby facilitating
the mobility of Canadians and their access to health services throughout
Canada. Officials meet periodically to review and revise the Agreement.
Enhanced Medical
Goods and Services
These are medical goods or services provided in conjunction with insured
services. They are usually a higher-grade service or product that is not
medically necessary and provided to a patient for personal choice and
convenience.
Fee-for-service This is a method of physician payment based on a fee schedule that itemizes
each service and provides a fee for each service rendered.
General Practitioner
This is a licensed physician in a province or territory who practises
community-based medicine and refers patients to specialists when the
diagnosis suggests it is appropriate. Some services a general practitioner
may provide are: consultation, diagnosis, reference, counselling, advice
on health care and prevention of illness, minor surgeries, and prescribing
medicines.
Health Insurance
Supplementary Fund
(HISF)
This is a fund, administered by the Canada Health Act Division to assist eligible
individuals who, through no fault of their own, have lost or been unable to
obtain provincial or territorial coverage for insured health services under the
Canada Health Act. The fund was first established in 1972, when the portability
of insurance between provinces varied and allowed for discrepancies in eligibility
rules whereby a resident of Canada could become temporarily ineligible for
health insurance in a province or territory following a change of province or a
change of health care eligibility status (e.g., discharge from RCMP or Canadian
Forces). The passage of the Canada Health Act in 1984 eliminated the discrepancies in interprovincial eligibility periods that were the source of most concerns
for which the fund was established. There is currently $28,387 in the fund.
There have been five applications for claims to the HISF since 1986; however,
none of these have qualified under the terms and conditions for reimbursement.
Hospital Reciprocal
Billing Agreement
This is a bilateral agreement between two provinces, or a province and a
territory, or two territories that allows for the reciprocal processing of outof-province or out-of-territory claims for hospital in- and out-patient services
from either jurisdiction. Under such an agreement, insured hospital services
are payable at the approved rates of the host province or territory or as
otherwise agreed upon by the parties involved or by the Interprovincial
Health Insurance Agreements Coordinating Committee (IHIACC).
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Canada Health Act Annual Report, 2007–2008
Annex D — Glossary
Term
Description
In-patient
This is a patient who is admitted to a hospital, clinic or other health care
facility for treatment that requires at least one overnight stay.
Medical Necessity
Under the Canada Health Act, the provincial and territorial governments
are required to provide medically necessary hospital and physician services
to their residents on a prepaid basis, and on uniform terms and conditions.
The Act does not define medical necessity. The provincial and territorial health
insurance plans, in consultation with their respective physician colleges or
groups, are responsible for determining which services are medically necessary
for health insurance purposes. If it is determined that a service is medically
necessary, the full cost of the service must be covered by the public health
insurance plan to be in compliance with the Act. If a service is not considered
to be medically required, the province or territory need not cover it through
its health insurance plan.
Medical Reciprocal
Billing Agreement
This is a bilateral agreement between two provinces, or a province and
a territory, or two territories that allows the reciprocal processing of outof-province/territory claims for medical services provided by a licensed
physician to residents of the other jurisdiction. Where a reciprocal billing
agreement exists, an insured medical service is payable at the approved
rate of the host province or territory.
Non-Participating
Physician This is a physician operating completely outside provincial or territorial
health insurance plans. Neither the physician nor the patient is eligible
for any cost coverage for services rendered or received from the provincial
or territorial health insurance plans. A non-participating physician may
therefore establish his or her own fees, which are paid directly by the patient.
Opted-out Physician
These are physicians who operate outside the provincial or territorial health
insurance plans, and who bill their patients directly at provincial or territorial
fee schedule rates. The provincial or territorial plans reimburse patients of
opted out physicians for charges up to, but not more than the amount paid
by the plan under fee schedule agreement.
Out-patient
This is a patient admitted to a hospital, clinic or other health care facility
for treatment that does not require an overnight stay.
Out-patient Surgical Facility
This is a health care facility providing short-term (day only) surgical services.
Participating Physician These are licensed physicians who are enrolled in provincial or territorial
health insurance plans.
Primary Health Care
Primary health care forms the foundation of the Canadian health care
system. In general, it is the direct provision of first-contact health care
services by a physician, nurse or other health care professional, where
patients’ health care services are coordinated to ensure continuity of
care and ease of movement across the health care system should more
specialized services be required (e.g., from specialists or in hospitals).
Canada Health Act Annual Report, 2007–2008
261
Annex D — Glossary
Term
Description
Private Diagnostic Facility
This is a privately owned health care facility providing laboratory tests,
radiological services and other diagnostic procedures.
Private Surgical Facility
This is a privately owned health care facility providing surgical health services.
Rehabilitative Care
Rehabilitative care includes health care services for persons requiring
professional assistance to restore physical skills and functionality following
an illness or injury. An example is therapy required by a person recovering
from a stroke (e.g., physiotherapy and speech therapy).
Specialist
A specialist is a licensed physician in a province or territory whose practice of
medicine is primarily concerned with specialized diagnostic and treatment
procedures. Specialties include anaesthesia, dermatology, general surgery,
gynaecology, internal medicine, neurology, neuropathology, ophthalmology,
paediatrics, plastic surgery, radiology, and urology.
Surgery The treatment of disease, injury or other types of ailment by using the
hands or instruments to mend, remove or replace an organ, tissue, or
part, or to remove foreign matter in the body.
Temporarily Absent Under the portability criterion of the Canada Health Act (section 11(1)(b)),
the term “temporarily absent” is used to denote when a person is absent
from their home province or territory of residence for reasons of business,
education, vacation or other reasons, without taking up permanent residence
in another province, territory or country.
Third-Party Payers These are organizations such as workers’ compensation boards, private
health insurance companies and employer-based health care plans that
pay for insured health services for their clients and employees.
262
Canada Health Act Annual Report, 2007–2008
Contact Information for Provincial and Territorial Departments of Health
Newfoundland and Labrador
Department of Health and Community Services
Confederation Building
P.O. Box 8700
St.John’s, NL A1B 4J6
(709) 729-5021
www.gov.nl.ca/health
Prince Edward Island
Department of Health
P.O. Box 2000
Charlottetown, PE C1A 7N8
(902) 368-6130
www.gov.pe.ca/health
Nova Scotia
Department of Health
P.O. Box 488
Halifax, NS B3J 2R8
(902) 424-5818
www.gov.ns.ca/health/
New Brunswick
Manitoba
Manitoba Health
300 Carlton Street
Winnipeg, MB R3B 3M9
1-800-392-1207
www.gov.mb.ca/health
Saskatchewan
Saskatchewan Health
3475 Albert Street
Regina, SK S4S 6X6
1-800-667-7766
www.health.gov.sk.ca
Alberta
Alberta Health and Wellness
P.O. Box 1360, Station Main
Edmonton, AB T5J 2N3
(780) 427-1432
www.health.gov.ab.ca/
British Columbia
Department of Health
P.O. Box 5100
Fredericton, NB E3B 5G8
(506) 457-4800
www.gnb.ca/
Ministry of Health
1515 Blanshard Street
Victoria, BC V8W 3C8
Toll free in B.C.: 1-800-465-4911
In Victoria: (250) 952-1742
www.gov.bc.ca/health
Quebec
Yukon
Ministry of Health and Social Services
1075 Sainte-Foy Road
Québec, QC G1S 2M1
(418) 266-7005
www.msss.gouv.qc.ca
Ontario
Ministry of Health and Long-Term Care
10th Floor, Hepburn Block
80 Grosvenor Street
Toronto, ON M7A 1R3
1-800-268-1153
www.health.gov.on.ca
Health and Social Services
204 Lambert Street, 4th Floor
Financial Plaza
Whitehorse, YT Y1A 2C6
1-867-667-5202
www.hss.gov.yk.ca/
Northwest Territories
Department of Health and Social Services
P.O. Box 1320
Yellowknife, NWT X1A 2L9
1-800-661-0830 or 1-867-777-7413
www.hlthss.gov.nt.ca
Nunavut
Department of Health and Social Services
P.O. Box 1000, Station 1000
Iqaluit, NU X0A 0H0
1-867-975-5700
www.gov.nu.ca/health/
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