2006–2007 Canada Health Act Annual Report

2006–2007 Canada Health Act Annual Report
Canada Health Act
Annual Report
2006–2007
2006–2007
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 2006–2007
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 2006-2007
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, 2007
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.: 1257
Cat.: H1-4/2007E-PDF
ISBN: 978-0-662-47169-1
Minister of Health
Ministre de la Santé
The Honourable/L’honorable Tony Clement
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, 2007.
Tony Clement
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Canada Health Act Annual Report, 2006–2007
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
Yukon Department of 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, 2006–2007
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Canada Health Act Annual Report, 2006–2007
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 2006–2007 _________________________ 15
Newfoundland and Labrador __________________________________________________________________________________ 17
Prince Edward Island __________________________________________________________________________________________ 33
Nova Scotia_____________________________________________________________________________________________________ 45
New Brunswick_________________________________________________________________________________________________ 63
Quebec__________________________________________________________________________________________________________ 79
Ontario _________________________________________________________________________________________________________ 85
Manitoba ______________________________________________________________________________________________________ 103
Saskatchewan__________________________________________________________________________________________________ 123
Alberta _________________________________________________________________________________________________________ 145
British Columbia______________________________________________________________________________________________ 159
Yukon__________________________________________________________________________________________________________ 185
Northwest Territories_________________________________________________________________________________________ 203
Nunavut _______________________________________________________________________________________________________ 213
Annex A — Canada Health Act and Extra-Billing and User Charges Information Regulations_____________ 227
Annex B — Policy Interpretation Letters _______________________________________________________________________ 249
Annex C — Dispute Avoidance and Resolution Process under the Canada Health Act _____________________ 259
Annex D — Glossary of Terms __________________________________________________________________________________ 265
Provincial and Territorial Departments of Health Contact Information ____________________________ inside back cover
Canada Health Act Annual Report, 2006–2007
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Canada Health Act Annual Report, 2006–2007
Introduction
Introduction
Canada has a predominantly publicly financed and
administered health care system. The Canadian health
insurance system is achieved through 13 interlocking
provincial and territorial health insurance plans, and is
designed to ensure that all eligible residents of Canada
have reasonable access to medically necessary hospital
and physician services on a prepaid basis, without
direct charges at the point of service.
The Canadian health insurance system evolved
into its present form over more than five decades.
Saskatchewan was the first province to establish
universal, public hospital insurance in 1947 and,
ten years later, the Government of Canada passed
the Hospital Insurance and Diagnostic Services Act
(1957) to share in the cost of these services. By
1961, all the provinces and territories had public
insurance plans that provided universal access to
hospital services. Saskatchewan again pioneered
in providing insurance for physician services,
beginning in 1962. The Government of Canada
adopted the Medical Care Act in 1966 to costshare the provision of insured physician services
with the provinces. 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
Canada Health Act Annual Report, 2006–2007
that extra-billing by doctors and user fees levied
by hospitals were creating a two-tiered system that
threatened the accessibility of care. This report, and
the national debate it generated, led to the enactment
of the Canada Health Act in 1984.
The Canada Health Act, Canada’s federal health
insurance legislation, defines the national principles
that govern the Canadian health insurance system,
namely, public administration, comprehensiveness,
universality, portability and accessibility. These
principles are symbols of the underlying Canadian
values of equity and solidarity.
The roles and responsibilities for Canada’s health care
system are shared between the federal and provincial/
territorial governments. The provincial and territorial governments have primary jurisdiction in the
administration and delivery of health care services.
This includes setting their own priorities, administering their health care budgets and managing their
own resources. The federal government, under the
Canada Health Act, sets out the criteria and conditions that must be satisfied by the provincial and
territorial health insurance plans for them to qualify
for their full share of the cash contribution available
under the federal Canada Health Transfer.
On an annual basis, the federal Minister of Health
is required to report to Parliament on the administration and operations of the Canada Health Act,
as set out in section 23 of the Act. The vehicle for
so doing is the Canada Health Act Annual Report.
While the principal and intended audience for the
report is parliamentarians, it is a readily accessible
public document that offers a comprehensive report
on insured services in each of the provinces and
territories. The annual report is structured to address
the mandated reporting requirements of the Act—its
scope does not extend to commenting on the status
of the Canadian health care system as a whole.
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Introduction
Health Canada’s approach to the administration of
the Act emphasizes transparency, consultation and
dialogue with provincial and territorial health care
ministries. The application of financial penalties
through deductions under the Canada Health
Transfer is considered only as a last resort when
all options to resolve an issue collaboratively have
been exhausted. Pursuant to the commitment made
by premiers under the 1999 Social Union Framework Agreement, federal, provincial and territorial
governments agreed through an exchange of letters,
in April 2002, to a Canada Health Act Dispute
Avoidance and Resolution (DAR) process. The
DAR process was formalized in the First Ministers’
2004 Accord. Although the DAR process includes
dispute resolution provisions, the federal Minister
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of Health retains the final authority to interpret and
enforce the Canada Health Act.
For the most part, provincial and territorial health
care insurance plans not only meet the criteria and
conditions of the Canada Health Act, in many cases
they restate the principles of the Act in provincial
and territorial laws and regulations.
Currently, the most prominent concerns with respect
to compliance under the Canada Health Act relate
to 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, 2006–2007
Chapter 1 – Canada Health Act Overview
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.
CHAPTER 1
Key Definitions Under the Canada Health Act
Canada Health
Act Overview
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.”
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.
Persons excluded under the Act include serving
members of the Canadian Forces or Royal Canadian
Mounted Police and inmates of federal penitentiaries.
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).
Canada Health Act Annual Report, 2006–2007
Insured health services are medically necessary
hospital, physician and surgical-dental services
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, radio-logical 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.
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Chapter 1 — Canada Health Act Overview
Insured surgical-dental services are services provided
by a dentist in a hospital, where a hospital setting is
required to properly perform the procedure.
Extended health care services as defined in the
Act are certain aspects of long-term residential
care (nursing home intermediate care and adult
residential care services), and the health aspects
of home care and ambulatory care services.
Requirements of the
Canada Health Act
The Canada Health Act contains nine requirements
that the provinces and territories must fulfill in order
to qualify for the full amount of their cash entitlement under the CHT. They are:
2. Comprehensiveness (section 9)
The comprehensiveness criterion of the Act requires
that the health care insurance plan of a province
or territory must cover all insured health services
provided by hospitals, physicians or dentists (i.e.,
surgical-dental services that require a hospital setting) and, where the law of the province so permits,
similar or additional services rendered by other
health care practitioners.
3. Universality (section 10)
Under the universality criterion, all insured residents
of a province or territory must be entitled to the
insured health services provided by the provincial
or territorial health care insurance plan on uniform
terms and conditions. Provinces and territories generally require that residents register with the plans
to establish entitlement.
two conditions that apply to insured health
services and extended health care services; and
Newcomers to Canada, such as landed immigrants or
Canadians returning from other countries to live in
Canada, may be subject to a waiting period by a province or territory, not to exceed three months, before
they are entitled to receive insured health services.
extra-billing and user charges provisions that
apply only to insured health services.
4. Portability (section 11)
five program criteria that apply only to insured
health services;
The Criteria
1. Public Administration (section 8)
The public administration criterion, set out in
section 8 of the Canada Health Act, applies to provincial and territorial health care insurance plans.
The intent of the public administration criterion
is that the provincial and territorial health care
insurance plans be administered and operated on
a non-profit basis by a public authority, which is
accountable to the provincial or territorial government for decision-making on benefit levels and
services, and whose records and accounts are
publicly audited.
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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.
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.
Canada Health Act Annual Report, 2006–2007
Chapter 1 — Canada Health Act Overview
The portability criterion does not entitle a person
to seek services in another province, territory or
country, but is intended to permit a person to
receive necessary services in relation to an urgent
or emergent need when absent on a temporary
basis, such as on business or vacation.
If insured persons are temporarily absent in another
province or territory, the portability criterion requires
that insured services be paid at the host province’s
rate. If insured persons are temporarily out of the
country, insured services are to be paid at the home
province’s rate.
Prior approval by the health care insurance plan
in a person’s home province or territory may also
be required before coverage is extended for elective
(non-emergency) services to a resident while temporarily absent from his/her province or territory.
5. Accessibility (section 12)
The intent of the accessibility criterion is to ensure
that insured persons in a province or territory have
reasonable access to insured hospital, medical and
surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or
indirectly, by charges (user charges or extra-billing)
or other means (e.g., discrimination on the basis of
age, health status or financial circumstances).
In addition, the health care insurance plans of the
province or territory must provide:
reasonable compensation to physicians and
dentists for all the insured health services they
provide; and
payment to hospitals to cover the cost of insured
health services.
Reasonable access in terms of physical availability
of medically necessary services has been interpreted
under the Canada Health Act using the “where and
as available” rule. Thus, residents of a province or
territory are entitled to have access on uniform terms
and conditions to insured health services at the setting
“where” the services are provided and “as” the services
are available in that setting.
Canada Health Act Annual Report, 2006–2007
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 determined 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).
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
surgical-dentist providing insured health 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 were to charge patients
any amount for an office visit that is insured by
the provincial or territorial health insurance plan,
the amount charged would constitute extra-billing.
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Chapter 1 — Canada Health Act Overview
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 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
definition of “extended health care services”;
prescribing which services to exclude from
hospital services;
prescribing the types of information that the
federal Minister of Health may reasonably
require, and the times at which and the manner
in which that information may be provided; and
prescribing how provinces and territories are
required to recognize the CHT in their documents, advertising or promotional materials.
To date, the only regulations in force under the Act
are the Extra-billing and User Charges Information
Regulations. These regulations require the provinces
and territories to provide estimates of extra-billing
and user charges before the beginning of a fiscal year
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so that appropriate penalties can be levied. They
must also provide financial statements showing
the amounts actually charged so that reconciliations
with the actual deductions 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, 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.
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:
Canada Health Act Annual Report, 2006–2007
Chapter 1 — Canada Health Act Overview
services that fall outside the definition of insured
health services; and
Excluded Persons
certain services and groups of persons are excluded
from the definitions of insured services and
insured 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.
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.
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.
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.
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.
A number of services provided by hospitals and
physicians are not considered medically necessary,
and thus are not insured under provincial and
territorial health insurance legislation. Uninsured
hospital services for which patients may be charged
include preferred hospital accommodation unless
prescribed by a physician, private duty nursing
services and the provision of telephones and televisions. Uninsured physician services for which
patients may be charged include telephone advice,
the provision of medical certificates required for
work, school, insurance purposes and fitness clubs,
testimony in court and cosmetic services.
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.
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,
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.
Canada Health Act Annual Report, 2006–2007
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Chapter 1 — Canada Health Act Overview
Minister Epp’s letter followed several months of
consultation with his provincial and territorial
counterparts. The letter sets forth statements of
federal policy intent that clarify the Act’s criteria,
conditions and regulatory provisions. These clarifications have been used by the federal government
in assessing and interpreting compliance with the
Act. The Epp letter remains an important reference
for interpreting the Act.
A copy of Minister Epp’s letter is included in Annex B
of this report.
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 provincial/territorial health insurance
plan pays the physician fee for a medically necessary
service delivered at a private clinic, it must also
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pay the facility fee or face a deduction from federal
transfer payments.
A copy of Minister Marleau’s letter is included in
Annex B of this report.
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, 2006–2007
Chapter 2 — Administration and Compliance
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 six regional
offices of the Department, and by lawyers with
the Department of Justice.
Health Canada works with the provinces and territories to ensure that the principles of the Act are
respected and always strives to resolve issues through
consultation, collaboration and cooperation.
The Canada Health Act Division
The Canada Health Act Division is part of the
Intergovernmental Affairs Directorate of the Health
Policy Branch at Health Canada and is responsible
for administering the Act. Officers of the Division
located in Ottawa and in regional Health Canada
offices fulfill the following ongoing functions:
monitoring and analysing provincial and territorial health insurance plans for compliance with
the criteria, conditions and extra-billing and user
charges provisions of the Act;
working in partnership with the provinces and
territories to investigate and resolve compliance
issues and pursue activities that encourage compliance with the Act;
informing the Minister of possible non-compliance and recommending appropriate action to
resolve the issue;
Canada Health Act Annual Report, 2006–2007
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
billing of hospital and medical services as well as
issues related to registration and eligibility for health
insurance coverage. It oversees the application of
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Chapter 2 — Administration and Compliance
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 (previous to April 1, 2004, the cash contribution
was payable under the Canada Health and Social
Transfer). 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
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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 administering 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 Interpretation Unit, Canada Health Act Division, assess
issues of concern and complaints on a case-by-case
basis. The assessment process involves compiling
all facts and information related to the issue and
taking appropriate action. Verifying the facts with
provincial and territorial health officials may reveal
issues that are not directly related to the Act, while
others may pertain to the Act but are a result of
misunderstanding or 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.
Canada Health Act Annual Report, 2006–2007
Chapter 2 — Administration and Compliance
Compliance Issues
For the most part, provincial and territorial health
care insurance plans meet the criteria and conditions
of the Canada Health Act. However, some issues and
concerns remain. The most prominent of these relate
to patient charges and queue jumping for medically
necessary health services at private clinics.
The Act requires that all medically necessary
physician and hospital services be covered by the
provincial and territorial health insurance plans,
whether the services are provided in a hospital or
in a facility providing hospital care. There are concerns about queue jumping and charges to insured
persons at private surgical clinics in 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 2006–2007, some outstanding concerns
under the Act were resolved. In September 2006, the
British Columbia Health Minister ordered certain
hospitals in British Columbia to “cease and desist”
from the practice of allowing queue-jumping for
insured diagnostic services.
In January 2007, Quebec took action to discourage
certain clinics from charging patients for insured
health services.
In February 2007, a private clinic in Manitoba
which had been charging patients for insured
MRI services contracted with its Regional Health
Authority to deliver these services until February
2010, thus resolving the issue for the duration of
the contract.
As well, in March 2007, Nova Scotia confirmed
that a physician had stopped charging patients as
a condition of receiving insured services.
Canada Health Act Annual Report, 2006–2007
History of Deductions and Refunds
Under the Canada Health Act
The Canada Health Act, which came into force
April 1, 1984, reaffirmed the national commitment
to the original principles of the Canadian health
care system, as embodied in the previous legislation,
the Medical Care Act and the Hospital Insurance
and Diagnostic Services Act. By putting into place
mandatory dollar-for-dollar penalties for extrabilling and user charges, the federal government
took steps to eliminate the proliferation of direct
charges for hospital and physician services, judged
to be restricting the access of many Canadians to
health care services due to financial considerations.
During the period 1984 to 1987, subsection 20(5)
of the Act provided for deductions in respect of
these charges to be refunded to the province if
the charges were eliminated before April 1, 1987.
By March 31, 1987, it was determined that
all provinces, which had extra-billing and user
charges, had taken appropriate steps to eliminate
them. Accordingly, by June 1987, a total of
$244.732 million in deductions were refunded
to New Brunswick ($6.886 million), Quebec
($14.032 million), Ontario ($106.656 million),
Manitoba ($1.270 million), Saskatchewan
($2.107 million), Alberta ($29.032 million)
and British Columbia ($84.749 million).
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.
11
Chapter 2 — Administration and Compliance
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 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 million was deducted from British Columbia’s cash
contribution for extra-billing that occurred in
the province between 1992–1993 and 1995–1996.
These deductions and all subsequent deductions
are non-refundable.
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
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 million were made to Alberta’s cash contribution 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 Newfoundland and Labrador's cash contribution before
these fees were eliminated, effective January 1, 1998.
12
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 its abortion 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, a total deduction
of $372,135 was 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 Extrabilling 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.
Canada Health Act Annual Report, 2006–2007
Chapter 2 — Administration and Compliance
Deductions were taken from the March 2005 CHT
payments 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 for deductions that had
already 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.
Canada Health Act Annual Report, 2006–2007
Deductions were taken from the March 2007 Canada
Health Transfer (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.
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.
Since the enactment of the Canada Health Act, from
April 1984 to March 2007, deductions totaling
$8,977,386 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
Chapter 2 — Administration and Compliance
14
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2006–2007
CHAPTER 3
Provincial and
Territorial Health
Care Insurance Plans
in 2006–2007
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 2006–2007.
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, 2006–2007
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 2006–2007: A Guide for Updating
Submissions (User’s Guide). This guide was developed
through discussion with provincial and territorial
officials and 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 2006–2007 was launched late spring 2007
with bilateral tele-conferences 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 2006–2007
This narrative description also includes information
on how each jurisdiction met the Canada Health Act
requirement for the recognition of federal contributions that support insured and extended health care
services and a section outlining 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.
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, 2007. 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.
Insure 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, 2006–2007
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 public health, community services, acute and long-term care services.
The provincial government appoints Boards of
Trustees who serve as volunteers. 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 stakeholders to determine
health needs. The regional authorities receive their
funding from the provincial government, to which
they are accountable. The Department of Health
and Community Services provides the regional
authorities with policy direction 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).
In May 2006, the Department announced a reregistration of the province’s Medical Care Plan
(MCP) to enhance the security for beneficiaries
and tighten controls over the administration of
the program. This measure will ensure that only
eligible beneficiaries permanently residing in the
province are able to avail themselves of coverage
under the MCP. All residents of the province were
Canada Health Act Annual Report, 2006–2007
required to complete a re-registration form in order
to receive a new MCP card. Each new card will have
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
is the first major overhaul of the program since it
began in 1969.
Other key initiatives during the year included:
A new Pharmaceutical Services Act was passed by
the House of Assembly on December 12, 2006
and proclaimed in force on January 31, 2007.
This new statute provides support for the
Newfoundland and Labrador Prescription Drug
Plan (NLPDP) and other associated programs.
As part of the province’s Poverty Reduction
Strategy, the government extended eligibility for
the Newfoundland and Labrador Prescription
Drug Program (NLPDP) to more low-income
residents. This initiative will increase the number
of eligible residents by an estimated 85,000.
Investments in health infrastructure included
new projects for long-term care facilities in the
Eastern, Western and Labrador/Grenfell regions.
Construction has begun on a new addictions
centre in the Western Region.
HealthLine, the province’s new telehealth service, was officially launched in September 2006,
providing residents of the province with toll-free
health information and advice 24 hours a day,
seven days a week.
Budget 2006 allocated $4.1 million for improvements to the Children’s Dental Health Plan by
significantly increasing the fees under the provincial fee schedule bringing them more in line with
the levels of fees charged by dentists.
Budget 2006 allocated $15.6 million as part of the
new cancer control strategy for new cancer screening and treatment. This included $3.3 million for
the construction of two bunkers to house radiation
treatment machines, $2.2 for cervical and breast
screening programs, and $10 million for new
treatment therapies and medications.
17
Chapter 3 — Newfoundland and Labrador
Medications for Alzheimer’s Disease became
eligible for the Newfoundland and Labrador
Prescription Drug Program under special
authorization in September 2006.
The Department continues to address the challenges
of delivering quality health and community services
to the people of the province while recognizing the
challenges of an aging population, fiscal resource constraints, diverse geography and human resource issues.
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.
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
18
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 2006–2007.
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 2006–2007
Annual Report in the House of Assembly in Fall
2007. The four regional health authorities and
some health agencies will also table their reports.
The Department’s Annual Report highlights the
accomplishments of 2006–2007 and provides an
overview of the initiatives and programs that will
continue to be developed in 2007–2008. The
report is a public document and is circulated to
stakeholders. It will be posted on the department’s
website at:
www.health.gov.nl.ca/health
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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
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 36 facilities (14 hospitals and 22
community health centres) and 14 nursing stations.
Insured services include: accommodations and
meals at the standard 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 physician
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 2006–2007.
Canada Health Act Annual Report, 2006–2007
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 2006–2007,
there were 985 physicians 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.
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.
19
Chapter 3 — Newfoundland and Labrador
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 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, 2007, there were no physicians who
had opted out of the MCP.
Ministerial direction is required to add to or to deinsure a physician service from the list of insured
services. This process is managed by the Department
in consultation with various stakeholders, including
the provincial medical association and the public.
There were no services added or deleted during
20
the 2006–2007 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 dentist
are covered by MCP if the treatment is specified
in the Surgical-Dental Services Schedule.
All 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
Dental Board. In 2006–07, there were 27 dentists
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.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Hospital services not covered by MCP include:
preferred accommodation at the patient’s request;
cosmetic surgery and other services deemed to be
medically unnecessary; ambulance or other patient
transportation before admission or upon discharge;
private duty nursing arranged by the patient; nonmedically required x-rays or other services for
employment or insurance purposes; drugs (except
anti-rejection and AZT drugs) and appliances
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
issued for use after discharge from hospital; bedside
telephones, radios or television sets for personal,
non-teaching use; fibreglass splints; services covered
by the Workplace Health, Safety and Compensation
commission or by other federal or provincial legislation; and services relating to therapeutic abortions
performed in non-accredited facilities or facilities
not approved by the College of Physicians and
Surgeons of Newfoundland and Labrador.
The use of the hospital setting for any services
deemed not insured by the Medicare Plan are also
uninsured under the Hospital Insurance Plan.
For purposes of the Medical Care Insurance Act
(1999), the following is a list of non-insured
physician services:
examinations not necessitated by illness or at
the request of a third party except as specified
by the appropriate authority;
plastic or other surgery for purely cosmetic
purposes, unless medically indicated;
testimony in a court;
visits to optometrists, general practitioners
and ophthalmologists solely for determining
whether new or replacement glasses or contact
lenses are required;
the fees of a dentist, oral surgeon or general
practitioner for routine dental extractions
performed in hospital;
fluoride dental treatment for children under four
years of age;
any advice given by a physician to a beneficiary
by telephone;
excision of xanthelasma; circumcision of newborns;
hypnotherapy;
the dispensing by a physician of medicines, drugs
or medical appliances and the giving or writing
of medical prescriptions;
medical examination for drivers;
alcohol/drug treatment outside Canada;
the preparation by a physician of records, reports
or certificates for, or on behalf of, or any communication to, or relating to, a beneficiary;
any services rendered by a physician to the
spouse and children of the physician;
any service to which a beneficiary is entitled
under an Act of the Parliament of Canada,
an Act of the Province of Newfoundland and
Labrador, an Act of the legislature of any
province of Canada, or any law of a country
or part of a country;
the time taken or expenses incurred in travelling
to consult a beneficiary;
ambulance service and other forms of patient
transportation;
acupuncture and all procedures and services
related to acupuncture, excluding an initial
assessment specifically related to diagnosing the
illness proposed to be treated by acupuncture;
Canada Health Act Annual Report, 2006–2007
consultation required by hospital regulation;
therapeutic abortions performed in the province
at a facility not approved by the College of
Physicians and Surgeons of Newfoundland
and Labrador;
sex reassignment surgery, when not recommended
by the Clarke Institute of Psychiatry;
in vitro fertilization and OSST (ovarian stimulation and sperm transfer);
reversal of previous sterilization procedure;
surgical, diagnostic or therapeutic procedures not
provided in facilities other than those listed in the
Schedule to the Hospitals Act or approved by the
appropriate authority under paragraph 3(d); and
other services not within the ambit of section 3
of the Act.
The majority of diagnostic services (e.g., laboratory
services and x-ray) are performed within public
facilities in the province. Hospital policy concerning
access ensures that third parties are not given
priority access.
21
Chapter 3 — Newfoundland and Labrador
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.
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
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 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
22
Registration under the MCP and possession of a
valid MCP card are 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 began in 2006. All residents of the province
were required to complete a re-registration form
in order to receive a new MCP card. The original
deadline of March 3/07 was extended to July 31/07.
Almost 450,000 residents (or 90% of the total population) had registered by March 31/07.
It is the parent’s responsibility to register a newborn
or adopted child. The parents of a newborn child
will be given a registration application upon discharge
from hospital. Applications for newborn coverage
will require, in most instances, a parent’s valid
MCP number. A birth or baptismal certificate
will be required where the child’s surname differs
from either parent’s surname.
Applications for coverage of an adopted child require
a copy of the official adoption documents, the birth
certificate of the child, or a Notice of Adoption
Placement from the department. Applications for
coverage of a child adopted outside Canada require
Permanent Resident documents for the child.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
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. There
are approximately 550 beneficiaries covered under
a work permit, only 1 under a Minister’s permit and
approximately 5 dependents of NATO personnel.
Clergy are included under the work permit or other
category and numbers are not readily available.
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 released
inmates of federal penitentiaries. For coverage to be
effective, however, registration is required under the
MCP. Immediate coverage is provided to persons
from outside Canada authorized to work in the
province for one year or more.
4.2 Coverage During Temporary Absences
in Canada
Newfoundland and Labrador is a party to the
Agreement on Eligibility and Portability regarding
matters pertaining to portability of insured services
in Canada.
Sections 12 and 13 of the Hospital Insurance
Regulations (1996) define portability of hospital
coverage during temporary absences both within
and outside Canada. Portability of medical coverage
Canada Health Act Annual Report, 2006–2007
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:
Before leaving the province for extended periods,
a resident must contact the MCP to obtain an
out-of-province coverage certificate.
Beneficiaries leaving for vacation purposes may
receive an initial out-of-province coverage certificate of up to 12 months. Upon return, beneficiaries are required to reside in the province for a
minimum four consecutive months. Thereafter,
certificates will only be issued for up to eight
months of coverage.
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
school 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 the entire cost of any medical or
hospital bills 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 2006/2007, the total amount paid by MCP for
physician services received by residents in another
province or territory was $6,290,000.
4.3 Coverage During Temporary Absences
Outside Canada
The Province provides coverage to residents during
temporary absences outside Canada. Out-of-country
insured hospital in- and out-patient services are
covered for emergencies, sudden illness and elective
procedures at established rates. Hospital services are
considered under the Plan when the insured services
are provided by a recognized facility (licensed or
24
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 by MCP in 2006/2007 for
insured physician services provided outside Canada
was $130,000.
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.
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.
Prior approval is not required for physician services;
however, it is suggested that physicians obtain prior
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
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
In Newfoundland and Labrador there is a health care
workforce of nearly 19,000 individuals. Half of this
workforce belongs to regulated professional groups.
The supply of health professionals is a high-priority
issue in the province, especially in rural areas.
In 2006–2007, the Department of Health and
Community Services maintained its commitment
to health human resource planning in the province.
The Physician Resource Planning Committee was
formed in March 2005 to develop a human resource
plan for physicians and continued the work throughout the year. The Department participated in the
Provincial Nursing Network, and formed a Diagnostics Workforce Network and an Allied Health
Workforce Network to ensure system stakeholders
have an opportunity to contribute to workforce
planning. Networks have representation from
employers, educators, unions, government, and
professional associations.
Canada Health Act Annual Report, 2006–2007
In addition to the workforce networks, vice-presidents
of human resources in regional health authorities met
regularly and formed sub-committees with representation from their organizations and government.
One sub-committee was formed for human resource
planning in the Fall 2006 and has met several times
to develop recommendations to address key workforce issues. Planning staff participated on several
National expert working groups and committees as
well as the Atlantic Advisory Committee on Health
Human Resources. Several targeted initiatives
addressed current and projected workforce issues,
including the recruitment and retention of clinical
pharmacists and diagnostics personnel, and projected
needs for social work and nursing graduates.
The Department continued to offer recruitment
incentives for physicians, registered nurses, audiologists, speech language pathologists, pharmacists,
and other health professionals in 2006–2007.
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.
Federal funding through the 2004 Health Accord
enabled Newfoundland and Labrador to continue
with investments to improve access to key services
by purchasing new medical equipment, modernizing
diagnostic and medical equipment and expanding
select services in all of the province’s major health care
centres. The government has invested $28.6 million
in the past two budget years to reduce wait times
for select health services; purchase new equipment
to increase capacity and support a new wait time
management team.
25
Chapter 3 — Newfoundland and Labrador
Newfoundland and Labrador is making progress
in reducing wait times for select health services.
The province is already at, or near, the national
benchmarks in the five priority areas identified
in the 2004 Health Accord. The Department has
begun planning for a patient wait time guarantee
for cardiac surgery in order to access funding from
the federal government. The guarantee will be
implemented by March 2010.
In late 2005–2006, Newfoundland and Labrador
announced a $14.5 million investment in a provincewide Picture Archiving and Communications System
(PACS) by 2007. Steady progress in meeting project
milestones in 2006/07 is being made with implementation planned for 2007/2008.
The provincial Primary Health Care (PHC) framework, “Moving Forward Together: Mobilizing
Primary Health Care,” is providing 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 6000 to maximum population of 25,000) from primary prevention through
to, and including, acute and episodic illness at the
PHC service delivery level.
The framework supports four goals: (1) enhanced
access to, and sustainability of, primary health care;
(2) an emphasis on self-reliant and healthy citizens
and communities; (3) promotion of a team-based,
interdisciplinary and evidenced-based approach to
services provision; and (4) enhanced accountability
and satisfaction of health professionals. Provincial
supports have included a number of Departmental
staff linkages with local college and university programs and professional associations, and developing
provincial working groups to support learning/
problem-solving and provider capacity-building.
Eleven interdisciplinary team-based PHC team areas
have initiated changes to service delivery based on
the provincial framework, including the development
26
of Community Advisory Committees (CACs) and
enhanced activities support health promotion and
illness prevention. In addition, two PHC team areas
have completed proposals and have been provided
with funding for implementation, and two other
areas have been provided funds for proposal development. Registration processes for PHC services have
commenced in one of the PHC team areas. Formal
evaluation of these changes was completed by external evaluators in the Fall of 2006 and a report is
completed.
Primary health care working groups, with associations,
university, PHC team area and other partnerships,
have developed processes and tools for scope of
practice shifts, physician funding and payment
models and information management. Scope of
practice processes have been implemented in the
eight initial PHC team areas, with the development
of action plans to assist in shifting scope of practices.
This continues to be the practice for new sites.
A discussion document has been developed for
physician funding and payment models, and a
research project has been initiated at Memorial
University regarding a funding and payment model.
Physician networks are in development in the initial
eight PHC team areas, and a physician network
contract (for signing by the Department of Health
& Community Services, the region, and the physician network for medical services to the PHC team
area) is in the latter stages of completion.
In the spring of 2005, a Chronic Disease Prevention
and Management (CDPM) Collaborative program,
with diabetes as the first collaborative, was funded
provincially on an operational basis, and initiated in
8 PHC team areas. These collaboratives will support
CDPM from primary prevention through to management, and include provincial Learning Sessions to
promote professional development regarding chronic
diseases. In addition, a software application is being
supported through Eastern Health Authority that will
provide information regarding adherence to clinical
practice guidelines, and also for service planning at
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
the individual client, PHC team area, regional and
provincial levels. Plans to move forward with collaboratives for mental health and arthritis are in the
early stages.
Newfoundland and Labrador is currently involved in
two Atlantic Canada projects. The Building a Better
Tomorrow Initiative (BBTI) has been supporting
team and inter-professional development and change
management in PHC team areas through a variety
of training modules (team development, conflict
resolution, adult learning, understanding PHC,
community development, and program planning
and evaluation). In partnership with New Brunswick,
a Memorandum of Understanding has been completed for a 24/7 toll-free health advice telephone service.
Three sites are currently operational in this province:
St. Anthony, Stephenville and Corner Brook.
5.3 Access to Insured Physician and
Surgical-Dental Services
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, 2007, there were 481 general practitioners and 504 specialists in practice, compared
with 471 general practitioners and 500 specialists
as of March 31, 2006. This represents a two percent
increase in general practitioners and a one percent
increase in specialists.
The Department has several measures to ensure 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
Canada Health Act Annual Report, 2006–2007
an annual bursary program valued at $1.2 million
for medical residents and students (matched to
FP in CARMS) willing to commit to provide
medical services in areas of need within the province. During fiscal year 2006–2007, 37 bursaries
and travelling fellowships were funded.
5.4 Physician Compensation
The legislation governing payments to physicians
and dentists for insured services is the Medical Care
Insurance Act (1999).
The current methods of remuneration to compensate physicians for providing insured health services
include fee-for-service, salary, contract and sessional
block funding.
Compensation agreements are negotiated between
the provincial government and the Newfoundland
and Labrador Medical Association (NLMA), on
behalf of all physicians. Representatives from the
regional health authorities play a significant role
in this process. In 2005, a four-year agreement was
negotiated with the provincial medical association
effective October 1, 2005.
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.
27
Chapter 3 — Newfoundland and Labrador
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 when
costs are rising, staff workloads are increasing,
patient expectations are higher and new technology
is introducing new demands for time, resources and
funding. Regional health authorities continue to
work with the Department to address these issues and
provide effective, efficient and quality health services.
6.0 Recognition Given to
Federal Transfers
Funding provided by the federal government through
the Canada Health Transfer (CHT) and the Canada
Social Transfer (CST) has been recognized and
reported by the Government of Newfoundland and
Labrador in the annual provincial budget, through
press releases, government websites and various other
documents. For fiscal year 2006–2007, these documents included:
the 2006–2007 Public Accounts;
the Estimates 2006–2007; and
the Budget Speech 2006.
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.
28
7.0 Extended Health
Care Services
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 requiring high levels of
nursing care in 22 community health centres
19 nursing homes, a psychiatric facility, and a
rehabilitation facility. There are approximately
2,730 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.
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 3,637 beds located
in 105 homes across the province. These homes
are operated by the private for-profit sector.
Residents are subsidized to a maximum of $1,500
per month, based on an individual client assessment using standardized financial criteria.
Home Care Services including professional and
non-professional 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
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 2006–2007 was $2,707 for seniors
and $3,875 for persons with disabilities.
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
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.
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.
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.
Canada Health Act Annual Report, 2006–2007
Services are available to recipients of Income
Support 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 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 Benefit
List. These approved benefits are supplied as part
of the Income Support, Senior Citizens, Special
Needs and Low Income Drug Components for
eligible residents.
The Income Support Component 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 Senior Citizens Component 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 Senior Citizens
Component covers defined ingredient cost
only for identified benefits. Any additional
cost, such as dispensing fees, is the client’s
responsibility.
29
Chapter 3 — Newfoundland and Labrador
Ostomy Subsidy benefits are available to
those senior citizens who qualify for a drug
card under the Senior Citizens’ Drug Subsidy
or the Income Support Components. 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 Component provides
universal coverage for patients with Cystic
Fibrosis and Growth Hormone Deficiency.
The Special Needs Component covers the
full cost for identified benefits — diseaserelated prescription drugs, enzymes, foods,
medical supplies, and equipment — supplied
through the Health Sciences Central Supply
and Pharmacy.
30
The Low Income Drug Component 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 Low
Income Drug Component covers a percentage
of drug costs (ranging from 30–80%) dependant upon family income.
The Government of Newfoundland and Labrador
recently approved legislation governing the
Newfoundland and Labrador Prescription Drug
Program. The Pharmaceutical Services Act which
came into effect on January 31, 2007 states that
the NLPDP will be the payer of last resort. This
means that if a patient has private insurance, they
are required to bill their private insurance first.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Newfoundland and Labrador
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
560,644
599,907
569,835
545,160
545,629
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.
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
36
0
0
0
36
36
0
0
0
36
36
0
0
0
36
36
0
0
0
36
36
0
0
0
36
666,773,382
0
0
0
666,773,382
679,024,717
0
0
0
670,024,717
740,235,437
0
0
0
740,235,437
743,680,905
0
0
0
743,680,905
666,472,833
0
0
0
666,472,833 2
2
2
2
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
1
0
1
1
0
1
1
0
1
1
0
1
1
0
1
286,425
0
286,425
280,250
0
280,250
264,575
0
264,575
285,475
0
285,475
288,800
0
288,800
2
Insured Hospital Services Provided to Residents in Another Province or Territory
809
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
2006–2007
1,588
1,640
1,699
1,809
1,736
10,817,595
12,397,072
12,248,758
15,130,363
15,157,341
26,464
25,762
26,467
29,628
34,349
3,488,186
3,232,235
4,321,173
5,132,112
6,755,412
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
61
62
50
54
60
269,963
363,153
76,981
112,039
92,683
278
283
301
261
345
18,432
167,588
60,159
24,265
934,295
3
1.
Newfoundland and Labrador is in the process of re-registering residents and issuing new cards with expiry dates, to ensure that only permanent
residents are eligible for health care services under the provincial plan. The 2006–2007 number represents re-registered residents plus individuals
currently holding valid cards who have yet to re-register.
2.
New Methodology for 2002–2003. Operating costs only: does not include capital, deficit or non-government funding. Payments represent the
final provincial plan funding provided to regional health care boards for the purposes of delivering insured acute care services
3.
Increase attributable to patients who were granted prior approval to receive insured services outside the country.
Canada Health Act Annual Report, 2006–2007
31
Chapter 3 — Newfoundland and Labrador
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
437
477
not applicable
914
451
499
not applicable
950
460
494
not applicable
954
471
500
not applicable
971
481
504
not applicable
985
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
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 ($)
4,353,000
129,118,000
3,953,889
153,352,000
4,019,000
175,910,000
4,234,000
180,263,000
4,295,000
182,730,000
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
4
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
116,000
139,000
113,000
136,000
139,000
4,231,000
4,518,000
4,770,000
5,197,000
6,290,000
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
2,400
1,800
2,400
2,300
2,100
172,000
199,000
136,000
135,000
130,000
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
6
24. Number of services provided (#).
25. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
33
25
31
26
27
3,522
3,609
3,022
2,633
2,044
419,000
462,000
329,000
313,000
123,000
4. Excludes inactive physicians. Total Salaried and Fee-for-service.
32
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Prince Edward Island
of the Department of Health and Community
Hospital Authorities were established to manage the
rural hospitals.
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 under a centralized management model.
The ministry is responsible for 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.
Under the Health and Community Services
Reorganisation Act (2006) and the Community
Hospitals Reorganisation Act (2006) all health regions
were dissolved and the general administration of
health services was brought under the authority
Canada Health Act Annual Report, 2006–2007
A Minister of the Crown is ultimately accountable
to the rest of government and the citizens of PEI
for the Department of Health and its performance
and results. The Department is managed by a
Departmental Management Committee comprised
of the Deputy Minister and eight 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 the 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.
For each of the five community hospitals, a governing
board has been put in place. 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.
Primary Care: Provides primary health services
to citizens of PEI. Programs and facilities include:
Community Mental Health and Addictions
33
Chapter 3 — Prince Edward Island
including the Provincial Addictions Treatment
Facility, 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
Population Health: Provides Public Health and
Regulatory Services to the citizens of PEI. Programs
and services include the Office of Chief Health
Officer, Emergency Health Services, Communicable
Disease Control and Immunization, Epidemiology,
Environmental Health, Vital Statistics, Community
Care / Nursing Home Inspection, and Dietic Services.
Administratively, the Director of Population Health
is responsible for this division and is a member of
the Departmental Management Committee.
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
1.0 Public 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 Commission hires physicians, nurses and
other health related workers.
34
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: necessary nursing services;
laboratory; radiological and other diagnostic procedures; accommodations and meals at a standard
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Prince Edward Island
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 2007, 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
who billed the Insurance Plan as of March 31, 2007,
was 314.
Under section 10 of the Health Services Payment Act,
a physician or practitioner who is not a participant
in the Insurance Plan is not eligible to bill the Plan
for services rendered. When a non-participating
physician provides a medically required service,
section 10(2) requires that physicians advise patients
that they are not participating physicians or practitioners and provide the patient with sufficient
information to enable recovery of the cost of services
from the Minister of Health.
Canada Health Act Annual Report, 2006–2007
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, 2007, 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.
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
35
Chapter 3 — Prince Edward Island
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.
A surgical-dental service (post-operative removal
of mandibular wires in an office setting) has been
added as a result of negotiations between the Dental
Association and the Department.
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 2006/2007 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, 2006–2007
Chapter 3 — Prince Edward Island
3.0 Universality
3.1 Eligibility
The Health Services Payment Act and Regulations,
section 3, define eligibility for the health care
insurance plans. The plans are designed to provide
coverage for eligible Prince Edward Island residents.
A resident is anyone legally entitled to remain in
Canada and who makes his or her home and is
ordinarily present on an annual basis for at least
six months plus a day, in Prince Edward Island.
All new residents must register with the Department
in order to become eligible. Persons who establish
permanent residence in Prince Edward Island from
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, 2006–2007
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, 2007, was 145,047.
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 2006/2007 was
$25,850,500.
The payment rate currently ranges from $748 at
the community hospitals to $755 at Prince County
Hospital and $959 at the Queen Elizabeth Hospital
per day for hospital stays. The standard interprovincial outpatient rate is $164. The methodology
used to derive these rates is as if the patient had
the services provided in Prince Edward Island.
between the full amount charged and the amount
paid by the Department. In 2006–2007, the total
amounts paid for in-patient claims was $105,268
and $16,179 for out-patient claims.
4.4 Prior Approval Requirement
Prior approval is required from the Department
before receiving non-emergency, out-of-province
medical or hospital services. Island residents seeking
such required services may apply for prior approval
through a Prince Edward Island physician. Full
coverage may be provided for (Prince Edward Island
insured) non-emergency or elective services, provided
the physician completes an application to the
Department. Prior approval is required from the
Medical Director of the Department to receive
out-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.
5.1 Access to Insured Health Services
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 for paying the difference
38
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) longterm care nursing beds, Islanders have access to an
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Prince Edward Island
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.
A $50 million health facility, the Prince County
Hospital, was opened in April 2004 in Summerside.
Phase I of a $52 million multi-phase redevelopment
plan to upgrade the 24-year-old Queen Elizabeth
Hospital is underway and construction is expected
to begin in early 2008. This redevelopment will ultimately result in the major redesign of the emergency
department and enhancements to ambulatory care
among other improvements.
The public sector health workforce has approximately
4,500 employees. There is ongoing recruitment to
address vacancies in the physician complement in
this province. This challenge is being met in part
by developing 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 is researching the viability of
putting in place a Medical Residency Program to
better integrate our medical students so that they
will want to stay 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);
wait Times Strategy;
youth Addictions Strategy;
clinical Information System interoperable
Electronic Health Record;
patient Safety Strategy; and
pandemic Planning.
Canada Health Act Annual Report, 2006–2007
In the Provincial Budget for 2006–2007 the
Government announced the reinstatement of
the Registered Nurse Recruitment and Retention
Strategy. Thirty-two BN students received sponsorships while in their final year of study.
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
included establishment of family health centres;
innovations and improvements in the areas of
pharmacare, home care, and wait times being
developed and implemented; and the Clinical
Information System /Electronic Health Record to
improve health care provider access to timely and
accurate information. This 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;
the PEI Strategy for Healthy Living, which
focuses on tobacco reduction and promoting
exercise and good nutrition; and the
39
Chapter 3 — Prince Edward Island
PEI Active Living Alliance, which promotes physical
activity through a variety of community activities.
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. To help
assist recruitment efforts and stabilize physician services in rural emergency rooms the Rural Physician
Stabilization Initiative was announced. This initiative
established a new daily on-call fee structure for
physicians providing emergency on-call services
in rural hospitals. This has continued to be a focus
for our health system.
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, 2007 there were the following
vacancies in the physician complement: Family
Medicine, Internal Medicine, Emergency Medicine,
Psychiatry, Radiology, Pathology, Hospitalists,
40
Ophthalmology and Plastic Surgery, overall totalling
16 vacancies. Recruitment to find suitable placements
for these positions is ongoing.
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 one meeting was
held in January, 2007. 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
50 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, 2006–2007
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 2006–2007
Annual Budget and related budget documents
and its 2005–2006 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 longterm care facilities in the province, nine public
manors and nine licensed private nursing homes,
with a total of 968 beds, including respite and
temporary beds. Nursing home admission is for
individuals who require 24 hour registered nurse
(nursing care) supervision and care management.
The standardized Seniors Assessment Screening
Canada Health Act Annual Report, 2006–2007
Tool is used to determine service needs of residents
for all admissions to nursing homes.
Significant changes were made to long-term nursing
care funding and subsidization in Janurary, 2007.
First, self-paying 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
72 percent of residents in nursing homes. The federal
government subsidizes approximately 8.7 percent of
nursing home residents through Veterans Affairs
Canada. The remaining 18.4 percent finance their
own care.
In addition to nursing home facilities, there are
38 licensed community care facilities in Prince
Edward Island. As of March 31, 2007, the total
number of licensed community care facility beds
was 938. 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.
41
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
42
by regional Home Care staff. The overall purpose
of adult day programs, is to allow clients to remain
in their homes as long as possible, provide respite
for care givers, monitor client’s health and provide
social interaction. There are Adult Day Programs
located across Prince Edward Island.
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, 2006–2007
Chapter 3 — Prince Edward Island
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
141,031
142,022
143,261
144,159
145,047
Insured Hospital Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 appliciable
not appliciable
not appliciable
7
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
115,697,000
not applicable
not applicable
not applicable
115,697,000
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
Public Facilities
2.
3.
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
Private For-Profit Facilities
4.
5.
1
1
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
2,059
2,006
2,163
2,187
2,003
11,713,751
14,208,471
15,325,267
16,463,548
17,510,188
16,790
15,638
14,368
15,547
15,675
2,879,064
2,578,895
2,667,968
3,225,803
3,345,624
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
1.
23
37
30
25
35
79,577
155,922
95,719
69,391
105,268
152
130
93
91
96
25,954
24,366
16,304
17,084
16,179
Figures are budget estimates, not actuals.
Canada Health Act Annual Report, 2006–2007
43
Chapter 3 — Prince Edward Island
Insured Physician Services Within Own Province or Territory
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
97
92
not applicable
189
96
94
not applicable
190
98
96
not applicable
194
113
98
not applicable
211
120
108
not applicable
228
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
1,264,991
1,330,946
2,504,320
1,387,070
36,475,710
36,732,119
40,012,026
40,027,386
9,795,812
1,312,506
41,778,719
1,079,216
1,181,548
1,197,935
1,052,167
32,984,220
33,289,335
34,423,393
35,226,215
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. number of records
b. total payments ($)
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. number of records
b. total payments ($)
2
3
4
5
937,707
794,706
34,543,095
Insured Physician Services Provided to Residents in Another Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
48,369
45,255
48,928
54,269
73,399
58,284
3,778,171
3,795,244
4,122,725
4,674,004
5,221,586
19. Number of services (#).
Number of Records
20. Total payments ($).
Insured Physician Services Provided Outside Canada
21. Number of services (#).
Number of Records
22. Total payments ($).
521
706
627
534
746
681
30,076
37,100
21,849
15,844
27,899
Insured Surgical-Dental Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
2
2
2
3
3
312
393
410
303
442
332
88,443
90,851
96,490
115,918
106,708
23. Number of participating dentists (#).
24. Number of services provided (#).
Number of records provided
25. Total payments ($).
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, 2006–2007
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 community health plans with primary health care and
health promotion as their foundation. DHAs draw
two thirds of their board nominations from CHBs.
Their community health plans are part of the DHAs
annual business planning process. In addition to the
nine DHAs, the IWK Health Centre continues to
have separate board, administrative and service
delivery structures.
Canada Health Act Annual Report, 2006–2007
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.
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 2006–2007 accountability
report will be available in late 2007.
Nova Scotia faces a number of challenges in the
delivery of health care services. Nova Scotia’s
population is aging. Approximately 14.1% of the
Nova Scotian population is sixty-five or over and
this figure is expected to nearly double by 2026.
In response to the needs of our aging population,
Nova Scotia has expanded its basket of publicly
insured services to include home care long-term
care, and enhanced pharmaceutical coverage. Nova
Scotia also has much higher than average rates of
chronic diseases such as cancers and diabetes which
contribute to the rising costs of health care delivery
in Nova Scotia.
Other major cost drivers are a highly competitive
labour market for health human resources, the
increasing costs of pharmaceuticals and aging facility
infrastructure.
45
Chapter 3 — Nova Scotia
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
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
Two plans cover insured health services in Nova
Scotia: the Hospital Insurance Plan (HSI) and
the Medical Services Insurance Plan (MSI). The
Department of Health administers the HSI Plan,
which operates under the Health Services and
Insurance Act, Chapter 197, Revised Statutes of
Nova Scotia, 1989: sections 3(1), 5, 6, 10, 15,
16, 17(1), 18 and 35.
The MSI is administered and operated by an
authority consisting of the Department of Health
and Medavie Blue Cross (formerly called Atlantic
Blue Cross), under the above-mentioned Act
(sections 8, 13, 17(2), 23, 27, 28, 29, 30, 31, 32
and 35).
Section 3 of the Health Services and Insurance Act
states that subject to this Act and the Regulations,
all residents of the province are entitled to receive
insured hospital services from hospitals on uniform
terms and conditions. As well, all residents of
the province are insured on uniform terms and
conditions in respect of the payment of insured
professional services to the extent of the established
46
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 Department under various Statement of Requirements
for each Business Service Description as listed in
the contract.
Section 17(1)(i) of the Health Services and Insurance
Act, and sections 11(1) and 12(1) of the Hospital
Insurance Regulations, under this Act, set out the
terms for reporting by hospitals and hospital boards
to the Minister of Health.
1.3 Audit of Accounts
The Auditor General’s office 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
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nova Scotia
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, 2006 Report of the Auditor General of
Nova Scotia contained audits with respect to:
District Health Authorities — Colchester East
Hants and Cumberland & Pictou County
Payments to Physicians
The December 2006 Report of the Auditor General
of Nova Scotia contained audits with respect to collection of wait time information.
1.4 Designated Agency
Medavie Blue Cross Care administers and has
the authority to receive monies to pay physician
accounts under a new service level agreement with
the Department of Health, effective August 1, 2005.
Medavie Blue Cross Care receives written authorization from the Department for the physicians to
whom it may make payments. The rates of pay and
specific amounts depend on the physician contract
negotiated between Doctors Nova Scotia and the
Department of Health.
All Medavie Blue Cross Care system development
for MSI and Pharmacare is controlled through a
joint committee. All MSI and Pharmacare transactions are subject to a review by the Office of the
Auditor General.
1.
2.0 Comprehensiveness
2.1 Insured Hospital Services
Nine District Health Authorities and the IWK
Health Centre (Women and Children’s Tertiary
Care Hospital) deliver insured hospital services
to both in- and out-patients in Nova Scotia in a
total of 35 facilities.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, case room and anaesthetic
facilities;
use of radiotherapy and physiotherapy services,
where available; and
blood or therapeutic blood fractions.
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, 2006–2007
47
Chapter 3 — Nova Scotia
Out-patient services include:
laboratory and radiological examinations;
diagnostic procedures involving the use of
radio-pharmaceuticals;
electroencephalographic examinations;
use of occupational and physiotherapy facilities,
where available;
necessary nursing services;
drugs, biologicals and related preparations;
blood or therapeutic blood fractions;
hospital services in connection with most minor
medical and surgical procedures;
day-patient diabetic care;
services other than medical services provided
by and within the Nova Scotia Hearing and
Speech Clinics;
ultrasonic diagnostic procedures;
home parenterel nutrition; and
haemodialysis and peritoneal dialysis.
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 Proposal 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.
48
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 2006–2007,
2,282 physicians and 29 dentists were paid through
the MSI Plan.
Physicians retain the ability to opt into or out
of the MSI Plan. In order to opt out, a physician
notifies MSI, relinquishing his or her billing
number. Patients who pay the physician directly
due to opting out are reimbursed for these services
by MSI. As of March 31, 2007, no physicians had
opted out.
Insured services are those medically necessary to
diagnose, treat, rehabilitate or otherwise alter a
disease pattern. There are no limitations on medically necessary insured services.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nova Scotia
No new large-scale services were added to the list
of insured physician services in 2006–2007. On an
as needed basis, new specific fee codes are approved
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,
2007, no dentists had opted out. In 2006–2007,
29 dentists were paid through the MSI Plan for
providing insured surgical-dental services.
Canada Health Act Annual Report, 2006–2007
Insured surgical-dental services must be provided in
a health care facility. Insured services are listed in the
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) immunocompromised patients, and 4) radiation patients.
Routine extractions for these patients will be provided at public expense when and only when, the
following criteria have been met. These patients must
be undergoing active treatment in a hospital setting
and the attendant medical procedure must require
the removal of teeth that would otherwise be considered routine extractions and not paid at public
expense. It is critical/vital to the claims approval
process that the dental treatment plans include the
name of the Medical Specialist providing the care
and that he/she has indicated in writing in the
patient’s medical treatment plan that the routine
dental extractions are required prior to performing
the medical treatment/procedure.
Other newly approved service includes coverage for
all precancerous or cancerous dental surgical biopsies.
49
Chapter 3 — Nova Scotia
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;
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
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, except because of
medical necessity; and
services not deemed medically necessary that
are required by third parties, such as insurance
companies.
Uninsured physician services include:
those a person is eligible for under the Workers’
Compensation Act or under any other federal or
provincial legislation;
mileage, traveling 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, Canadian Force and
RCMP.
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 a fiberglass cast can be purchased,
it is required to fully inform patients about the cost.
They are not to be 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 Medical Society of Nova Scotia and
the Department of Health representatives, who
jointly evaluate a procedure or process to determine
its medical necessity. 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, 2006–2007
Chapter 3 — Nova Scotia
3.0 Universality
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 “Permanent Resident” status as defined by Citizenship and
Immigration Canada.
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.
Members of the RCMP, members of the Canadian
Forces and federal inmates are ineligible for MSI
coverage. When their status changes, they immediately become eligible for provincial Medicare.
In 2006–2007, the total number of residents registered with the health insurance plan was 965,044.
There were no changes to eligibility requirements
in 2006–2007.
The following persons may also be eligible for
insured health care services in Nova Scotia, once
they meet the specific eligibility criteria for their
situations:
Canada Health Act Annual Report, 2006–2007
3.3 Other Categories of Individual
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
the Immigration Department 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 the Immigration Department stating that they
have applied for Permanent Residence.
In 2006–2007, there were 23,886 Permanent Residents registered with the health care insurance plan.
Work Permits: Persons moving to Nova Scotia
from outside the country who possess a work permit
can apply for coverage on the date of arrival in
Nova Scotia, providing they will be remaining in
Nova Scotia for at least one full year. A declaration
must be signed to confirm that the worker will not
be outside Nova Scotia for more than 31 consecutive
days, except in the course of employment. MSI
coverage is extended for a maximum of 12 months
at a time. Each year a copy of their renewed immigration document must be presented and a declaration
signed. Dependants of such persons, who are legally
entitled to remain in Canada, are granted coverage
on the same basis.
52
Once coverage has terminated, the person is to be
treated as never having qualified for health services
coverage as herein provided and must comply with
the above requirements before coverage will be
extended to him/her—or their dependents.
In 2006–2007, there were 1,560 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 maximum of 12 months at a time
and only for services received within Nova Scotia.
Each year, a copy of their renewed immigration
document must be presented and a declaration
signed. Dependants of such persons, who are legally
entitled to remain in Canada, will be granted
coverage on the same basis, once the student has
gained entitlement.
In 2006–2007, there were 804 individuals with
Student Authorizations covered under the health
care insurance plan.
Refugees: Refugees are eligible for MSI if they
possess either a work permit or study permit.
4.0 Portability
4.1 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nova Scotia
4.2 Coverage During Temporary Absences
in Canada
There were no changes made in Nova Scotia in
2006–2007 regarding in-Canada portability.
The Agreement of Eligibility and Portability is
followed in all matters pertaining to portability
of insured services.
4.3 Coverage During Temporary Absences
Outside Canada
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 Eligibility and Portability Agreement.
Students, and their dependants, who are temporarily
absent from Nova Scotia and in full-time attendance
at an educational institution, may remain eligible
for MSI on a yearly basis. To qualify for MSI, the
student must provide, to MSI, a letter directly from
the educational institution, which states that they
are registered as full-time students. MSI coverage
will be extended on a yearly basis pending receipt
of this letter.
Workers who leave Nova Scotia to seek employment
elsewhere will still be covered by MSI for up to
12 months, provided they do not establish residence
in another province, territory or country. Services
provided to Nova Scotia residents in other 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 2006–2007, for inand out-patient hospital services received in other
provinces and territories was $22,771,143. Nova
Scotia pays the host province rates for insured services in all reciprocal-billing situations.
Canada Health Act Annual Report, 2006–2007
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 2006–2007 for insured in-patient services provided outside Canada was $153,937.17.
There were no changes made in Nova Scotia in
2006–2007 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.
5.0 Accessibility
5.1 Access to Insured Health Services
Insured services are provided to Nova Scotia residents
on uniform terms and conditions. There are no user
charges or extra charges under the plan.
Nova Scotia continually reviews access situations
across Canada to ensure that it is not falling behind.
In areas where improvement is deemed necessary,
depending on the Province’s financial situation,
extra funding is generally allocated to that area.
The Department of Health accepted 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. In fiscal 2002–2003, an
additional $5 million was allocated to the Capital
District Health Authority to increase cardiac surgery
and cardiac catheterization capability to decrease wait
54
times. In Fiscal 2004/05, $7 million was added to the
Capital District budget to address the issue of ever
increasing orthopedic wait lists. In fiscal 2004–2005
approval and funding was approved for the purchase
of four MRIs to be located in four rural areas:
Antigonish, New Glasgow, Kentville, and Yarmouth.
In fiscal 2006–2007, MRI services were introduced
at the Yarmouth, Kentville, New Glasgow and
Antigonish Regional Hospital to increase rural
access and reduce provincial wait times. The two
MRIs at the Capital District Health Authority in
Halifax were also replaced. Capital Health also
received approval and funding to establish a Positron
Emission Tomography Program (PET/CT). In addition to the PET/CT project that will be operational
in February 2008, the province has approved funding
for a Cyclotron project to complete access to PET/CT
services and the required manufacture of the FDGs
(2-[flourine-18]-flouro-2-deoxy-D-glucose) on site
to be operational in fiscal 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 2006–2007, a total of $11.0 million in funding
was provided to train, recruit and retain nurses.
Eighty percent of the nurses from the class of 2002
renewed their licenses, compared with only 51 percent in 2001. This is the highest retention ratio
since 1999.
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nova Scotia
Table 1: Health Personnel in Nova Scotia
Health Occupation
Registered/Licensed
to Practice 3
Physicians
Dentists
5.3 Access to Insured Physician and
Surgical-Dental Services
2
4
2,282
510
Registered Nurses
9,526
Licensed Practical Nurses
3,274
Medical Radiation
Technolologists
537
Respiratory Therapists
186
Pharmacists
In 2006–2007, 2,282 physicians and 29 dentists
actively provided insured services under the Canada
Health Act or provincial legislation. Innovative funding
solutions such as block funding and personal services
contracts have enhanced recruitment.
1,145
Occupational Therapists
234
Speech-Language
Pathologists
155
Chiropractors
107
Opticians
173
Optometrists
97
Denturists
61
Dietitians
447
Psychologists
450
Physiotherapists
390
5
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.
In 2006–2007 the province has also taken the
following measures to improve access to insured
physician services:
Nova Scotia invested $11.5 million to upgrade
Inverness Hospital. The upgrades will allow
residents of Inverness and the surrounding
area to have improved access to community
health-care services.
Nova Scotia invested $5.3 million in renovating the Cape Breton Regional Hospital. The
renovations will include the addition of cardiac
examination and observation rooms, a patient
transfer entrance, changes to the nursing station,
trauma area improvements, more observation
beds, consultation rooms for mental health
services, a revised triage area and changes to
the emergency ambulance entrance.
2.
Data are current (2006–2007) except where mentioned.
3.
Not all professionals licensed to practise actually work.
4.
A limited number of licensed dentists are approved for insured dental services.
5.
Data is for year 2002.
Canada Health Act Annual Report, 2006–2007
55
Chapter 3 — Nova Scotia
Nova Scotia introduced a new Registered Nurses
Act. This legislation will better define the scope
of practice and how registered nurses work with
other health professionals.
The Act will eliminate the barriers facing nurse
practitioners, while following national standards.
This will enable them to work in collaboration
with other health-care professionals, allowing
them to make a diagnosis, order tests and prescribe medications.
A second piece of legislation, the Licensed
Practical Nurses Act, clarifies the definition of
their scope of practice. This allows them to
work more independently with their patients.
About 9,526 registered nurses are licensed by the
College of Registered Nurses of Nova Scotia and
3,058 licensed practical nurses are licensed by the
College of Licensed Practical Nurses of Nova Scotia.
5.4 Physician Compensation
The Health Services and Insurance Act, RS Chapter 197
governs payment to physicians and dentists for insured
services. Physician payments are made in accordance
with a negotiated agreement between Doctors Nova
Scotia and the Nova Scotia Department of Health.
Doctors Nova Scotia is recognized as the sole bargaining agent in support of physicians in the province.
When negotiations take place, representatives from
Doctors Nova Scotia and the Department of Health
negotiate the total funding and other terms and conditions. The current master agreement is effective
from April 1, 2004 through March 31, 2008. 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.
56
Fee-for-service is still the most prevalent method of
payment for physician services. However, there has
been significant growth in the number of alternative
payment arrangements in place in Nova Scotia.
Over the past number of years, we have seen a
significant shift toward alternative payment. In
the 1997–1998 fiscal year, about 9 percent of our
doctors were paid solely through alternative funding.
In 2006–2007 it is estimated that over 30 percent
of physicians continue to be remunerated through
alternative funding. They can be broken down into
three groups:
1) Academic Specialists — (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
and Ophthalmology.
2) District Specialists — (Obstetrics/Gynecology,
Anaesthesiology, Pediatrics).
3) General Practice (including General Practice/
Nurse Practitioner Contracts).
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 2006–2007 total payments to physicians for
insured services in Nova Scotia were $581,817,423.
The Department paid an additional $7,091,572 for
insured physician services provided to Nova Scotia
residents outside the province, but within Canada.
Payment rates for dental services in the province are
negotiated between the Department of Health and
the Nova Scotia Dental Association and follow a
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nova Scotia
process similar to physician negotiations. Dentists
are paid on a fee-for-service basis. The current agreement, which was reached in April 2004, expires on
March 31, 2008.
6.0 Recognition Given to
Federal Transfers
5.5 Payments to Hospitals
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 Department of Health establishes budget targets
for health care services. It does this by receiving business plans from the nine District Health Authorities
(DHAs), the IWK Health Centre and other nonDHA 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
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 April 2001.
The DHAs 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 2006–2007, there were 2,891 hospital beds in
Nova Scotia (3.0 beds per 1,000 population). The
Department of Health’s direct expenditures for
insured hospital services operating costs were
increased to $1.12 Billion.
Canada Health Act Annual Report, 2006–2007
The Government of Nova Scotia also recognized
the federal contribution under the CHT in various
published documents including the following documents released in 2006–2007:
Public Accounts 2006–2007; and
Budget Estimates 2006–2007.
7.0 Extended Health
Care Services
The Nova Scotia Department of Health’s Continuing
Care branch offers home care and long-term care
services. These services promote independence, fairness, equity, and choice for people with care needs.
The Department of Health provides a Single Entry
Access to its continuing care services. Nova Scotians
can connect with Continuing Care through a single
toll-free number.
In 2006, the Department of Health released a
broad based, multi-year Continuing Care strategy
that will see the addition of long-term care beds
and the expansion and enhancement of community
and home based services over the ensuing five to
ten years.
57
Chapter 3 — Nova Scotia
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 the availability of a registered nurse on-site at all times;
Residential Care Facilities which provide supervisory care and/or personal care in a residential
setting; and
Community Based Options which provide
accommodation, minimal supervision and the
development of self-care skills 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.
Long-term care accommodation charges are based on
the type of facility and the resident’s income, up to a
daily maximum. 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 prolong independent living in
the community. Both chronic care services over the
longer term and short-term acute services are provided through home care. Home care services can be
provided to people who are chronically ill, convalescent, palliative, disabled or to individuals with an
acute illness. The services available to individuals
through home care include professional nursing care,
assistance with personal care, nutritional care, aid
58
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, volunteer services, meals on wheels and
community rehabilitation services.
In December 2005, the Department of Health introduced a Self-Managed Care service component to
assist physically disabled Nova Scotians to increase
control over their lives. The 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 user charges
of 33 percent of the total cost to a maximum
of $30 for each drug and supply with an annual
maximum of $360. General information regarding Pharmacare can be found at:
www.gov.ns.ca/health/pharmacare/default.htm
Special Funding for Drugs for Specific Disease
States — The Province provides special funding
for drug therapies for a few specific disease states
including cystic fibrosis, diabetes insipidus, cancer
and growth hormone deficiency. There are no
user charges for this coverage. General information regarding Drug Programs and Funding can
be found at:
www.gov.ns.ca/health/pharmacare/default.htm
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nova Scotia
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:
http://www.gov.ns.ca/health/pharmacare/dap/
default.htm
Emergency Health Services — Pre-hospital
Emergency Care — Emergency Health Services
Nova Scotia (EHS) is responsible for the continual development, implementation, monitoring
and evaluation of pre-hospital emergency health
services in Nova Scotia. EHS integrates various
pre-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), EHS 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 America.
Residents in Nova Scotia are levied a user charge
of $120, to be transported to hospital by ambulance (regardless of distance). There is no charge
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. All eligible children are entitled to one dental
examination and two radiographs per year.
Canada Health Act Annual Report, 2006–2007
Special Dental Plans — The program covers
all dental services required, including prosthetics
and orthodontics required by persons diagnosed
as having a cleft palate cranofacial disorder; inhospital dental services provided to the severely
mentally challenged who, because of their
condition, require the services to be provided
in hospital; and a full range of diagnostic, preventive and restorative procedures to residents
of the Nova Scotia School for the Blind. There
are no user charges for these services. Eligible
residents include the following: 1) patients registered with the Cleft Palate Cranofacial Clinic
at the IWK Health Centre; 2) registered students
at the School for the Blind; and 3) patients with
a signed statement to the effect that they are
severely mentally challenged and require hospitalization for dental treatment.
Community Mental Health Program — All
of the DHAs and the IWK Health Centre offer
acute psychiatric treatment. Services are provided
across the life span of a person. Specialized services
are offered and are in-patient, day treatment, and
community-based (e.g. forensic, eating disorders,
psychogeriatrics and psychosocial rehabilitation).
There are early intervention programs for children with Autism Spectrum Disorder (0–6 yrs).
Intensive Community Based Treatment teams
in two DHAs and one provincial Mental Health
residential/rehabilitation program for children
and youth exists to enhance the continuum of
mental health services. Youth Forensic services,
including a treatment program for Sexually
Aggressive Youth, exist under the authority
of the IWK Health Centre. There are no user
charges for these services. They are available to
all residents in the province.
59
Chapter 3 — Nova Scotia
Nova Scotia Addiction Services — A range of
treatment and rehabilitation options are provided,
including withdrawal management (detoxification and treatment orientation) programs and
community-based structured treatment, outpatient and extended care services. Treatment
options are tailored to individual needs and are
based on an ongoing assessment. Short-term
and long-term treatment goals are identified
with each client. Programs and services may
be available on a residential, day or out-patient
basis, and may include individual, group and/
or family programming. Targeted programming
is offered where appropriate and may include
programming for adolescents, women, families
or impaired drivers. There are no user charges
for these services except for the program for
Driving While Impaired Offenders.
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, 2006–2007
Chapter 3 — Nova Scotia
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
955,475
956,820
961,089
963,993
965,044
Insured Hospital Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($): 6
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
1,021,934,504
not applicable
not applicable
not applicable
1,021,934,504
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
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
1
0
1
1
0
1
0
1
1
0
1
1
0
1
1
11,714
0
0
5,531
0
5,531
0
not available
not available
0
not available
not available
0
not available
not available
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
2,300
2,368
2,335
2,252
2,154
12,685,659
15,859,930
15,795,451
16,285,032
14,502,141
34,425
32,968
34,166
37,811
41,729
4,447,816
4,303,236
6,107,316
7,345,702
8,269,002
Insured Hospital Services Provided Outside Canada
not available
not available
not available
not available
not available
938,092
623,896
678,205
1,495,313
727,586
12. Total number of claims, out-patient (#).
not applicable
not applicable
not applicable
not available
not available
13. Total payments, out-patient ($).
not applicable
not applicable
not applicable
not available
not available
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
6.
$’s are paid to acute care facilities/DHAs only.
Canada Health Act Annual Report, 2006–2007
61
Chapter 3 — Nova Scotia
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
875
1,142
9
2,026
904
1,198
14
2,116
905
1,235
27
2,167
948
1,270
2
2,220
944
1,333
5
2,282
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
9,023,272
398,328,665
9,199,462
434,000,386
9,290,207
464,685,571
9,599,128
540,495,196
9,569,146
581,817,423
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
6,243,934
241,362,772
6,560,930
254,670,965
6,353,382
246,724,107
6,553,774
254,621,655
6,357,622
255,007,711
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
187,390
180,897
188,118
198,262
205,237
5,562,125
5,747,516
5,866,887
6,619,938
7,091,572
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
2,748
2,667
3,111
2,981
2,931
121,780
120,977
151,175
151,414
153,937
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
62
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
36
28
25
33
29
5,188
3,780
4,343
5,169
5,321
939,004
904,283
995,966
1,060,006
1,122,126
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
New Brunswick
Introduction
New Brunswick’s ongoing commitment to the
principles of public administration, comprehensiveness, universality, portability and accessibility
in health care services — the principles that form
the foundation of the Canada Health Act — was
reaffirmed during the 2006–2007 fiscal year as
the Government of New Brunswick implemented
the health portions of the Charter for Change.
The Charter is a key priority of New Brunswick’s
new provincial government, which took office in
September 2006, and will guide The Department of
Health in setting its key goals, principles, strategies
and priorities to guide the health care investments
and improvements.
Total funding for the Department of Health in
2006–2007 was a record $1.927 billion, representing
an increase of $154 million over the previous year.
Investments have increased in all areas of health
care, including hospital services, Medicare, the
Prescription Drug Program and ambulance services.
As New Brunswick is Canada’s only officially bilingual province, the Department has engaged in
consultation sessions to determine the needs of
Francophone communities. The recommendations
from this Dialogue Santé are currently being implemented. In 2007, the Government released its Rural
Health Framework, which is designed to improve
health care services in rural areas. Initiatives under
this program include the recruitment, retention,
and continuing education of rural health providers,
and increasing the level of primary care services in
rural areas. Emergency medical services are being
Canada Health Act Annual Report, 2006–2007
enhanced with the creation of a single ambulance
service for the province. The Government of New
Brunswick is moving toward the development of
electronic health records and is in the process of
updating its health information privacy legislation.
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, whose
authority rests under the Medical Services Payment
Act and its Regulations, which were proclaimed on
January 1, 1971.
The 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 Act.
1.2 Reporting Relationship
The Medicare Services Branch and the Medicare
Operations Branch of the Department of Health 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.
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Chapter 3 — New Brunswick
The Regional Health Authorities Act, which came
into force on April 1, 2002, sets out the relationship
between the eight Regional Health Authorities (RHAs)
and the Department. Under the Act, RHAs must
prepare regional health and business plans that are in
harmony with the Provincial Health Plan developed
by the Department. The business and affairs of the
RHA are to be controlled and managed by a board
of directors, appointed or elected in accordance with
the Act and its regulations. The chief executive officer of each RHA reports to the Deputy Minister of
Health. Under sections 7(1) and 7(2) of the Act, the
Minister of Health shall establish an accountability
framework, drafted in consultation with RHAs, to
specify the responsibilities that each party has to the
other in the provincial health system.
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 of Health. For 2006–2007, 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.
2) The Office of the Comptroller: The Comptroller
is the chief internal auditor for the Province of
New Brunswick and provides accounting, audit
and consulting services in accordance with responsibilities and authority set out in the Financial
Administration Act. The Comptroller’s internal
audit objectives cover Appropriations Audits,
Information Systems Audits, Statutory Audits
64
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 2006–2007, the Office of the
Comptroller continued to gather risk assessment
data on programs offered by the Department and
reviewed common services in the Department
and other selected departments.
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.
2.0 Comprehensiveness
2.1 Insured Hospital Services
Legislation providing for insured hospital services includes the Hospital Services Act, 1973, and section 9 of
Regulation 84-167 and the Hospital Act, assented to
on May 20, 1992, and its Regulation 92-84.
There are 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 other facilities or health
facilities or health centres, without designated beds,
that provide a range of services to entitled persons.
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
In-patient services in a hospital facility operated by
an approved RHA as follows:
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, as
provided for under Schedule 2;
use of operating room, case room and anaesthetic
facilities, including necessary equipment and
supplies, and routine surgical supplies;
use of radiotherapy facilities, where available;
use of physiotherapy facilities, where available; and
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.
During fiscal 2006–2007, the Department added
PET/CT services for oncology patients, who meet
pre-determined criteria, to the list of insured services.
The process for adding a hospital service to the
list of insured services involves the Department
of Health receiving a proposal from a Regional
Health Authority or other stakeholder, which is
then screened for eligibility against the criteria
for insured hospital services described under the
Hospital Services Act and its regulations.
services rendered by persons who receive remuneration therefore from the RHA.
2.2 Insured Physician Services
Out-patient services in a hospital facility operated by
an approved RHA as follows:
The enabling legislation providing for insured physician services is the Medical Services Payment Act.
laboratory and diagnostic procedures, together
with the necessary interpretations, when referred
by a medical practitioner or nurse practitioner,
when approved facilities are available;
The Act was given Royal Assent on December 6,
1968. Regulation 84-20 was filed on February 13,
1984. Regulation 93-143 was filed on July 26, 1993.
Regulation 96-113 was filed on November 29, 1996,
since repealed and replaced with 2002-53, filed on
June 28, 2005, and Schedule 4 (surgical-dental services) Regulation 84-20 was filed on April 13, 1999.
laboratory and diagnostic procedures, together
with the necessary interpretations, where approved
facilities are available, when performed for the
purpose of a mammography screening service that
has been approved by the Minister of Health;
the hospital component of available outpatient services when prescribed by a medical
practitioner or nurse practitioner and provided
in an out-patient facility of an approved RHA,
for maintaining health, preventing disease and
helping diagnose and treat any injury, illness
or disability, excluding the following services:
the provision of any proprietary medicines;
the provision of medications for the patient
to take home;
Canada Health Act Annual Report, 2006–2007
No changes pertaining to physician services were
introduced to this Act and regulations during fiscal
2006–2007.
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;
65
Chapter 3 — New Brunswick
hold privileges in an RHA; and
have signed the Participating Physicians
Agreement.
The physician must obtain a signed waiver from the
patient on the specified form and forward that form
to Medicare.
The number of practitioners participating in
New Brunswick’s Medical Services Plan as of
March 31, 2007, was 1,411.
As of March 31, 2007, no physicians rendering
health care services had elected to completely opt
out of the New Brunswick Medical Services Plan.
Physicians in New Brunswick have the option to opt
out totally or for selected services. Totally opted-out
practitioners are not paid directly by Medicare for the
services they render and must bill patients directly in
all cases. Patients are not entitled to reimbursement
from Medicare for services rendered by totally optedout physicians.
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
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,
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 cases, the following procedure must be
adhered to in every instance. 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 by 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.
66
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.
During fiscal 2006–2007, the following physician
services were added:
Repair Closure of Abdominal Wall
Sacral Afferent Nerve Stimulation (SANS)
Paediatric Chemotherapy
Evaluation of Child Abuse
Paediatric Coloscopy
Suburethral Prosthetic Sling — TVT, SPARC
Pelvic Ultrasound
Narrow Band UV Therapy
Heidelberg Retinal Tomography (HRT)
Mohs Micrographic Surgery
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
Capsule Endoscopy
PET-CT scans
Surgical Prioritization Tool Completion
2.3 Insured Surgical-Dental Services
Schedule 4 of Regulation 84-20 (filed June 23, 1998,
under the Medical Services Payment Act) identifies
the insured surgical-dental services that can be provided by a qualified dental practitioner in a hospital,
if 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.
The conditions that a dental practitioner must meet
to participate in the medical plan are maintaining
current registration with the New Brunswick Dental
Society and completing the Participating Physician’s
Agreement (included in the New Brunswick
Medicare Dental registration form).
As of March 31, 2007, there were 85 dentists registered with the Plan.
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.
New Brunswick expanded the role of Oral Maxillofacial Surgeons (OMS) in the province by amending
the Medical Services Payment Act and Regulations
to provide payment for entitled services when they
admit and discharge patients and perform physical
examinations. The range of services and procedures
was expanded and includes those done in an outpatient setting.
The conditions that an OMS must meet to participate in the New Brunswick Medical Services Plan
are maintaining current registration with the New
Brunswick Dental Society and completing the Participating Physician’s Agreement (included in the New
Brunswick Medicare Dental registration form).
Canada Health Act Annual Report, 2006–2007
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;
removal of minor skin lesions, except where the
lesions are, or are suspected to be, pre-cancerous;
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;
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;
67
Chapter 3 — New Brunswick
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;
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
oral maxillofacial surgeons to members of their
immediate family;
psychoanalysis;
electrocardiogram (ECG) where not performed
by a specialist in internal medicine or paediatrics;
laboratory procedures not intended as part of an
examination or consultation fee;
refractions;
services provided within the province by medical
practitioners or dental practitioners for which
the fee exceeds the amount payable under this
Regulation;
the fitting and supplying of eyeglasses or
contact lenses;
transsexual surgery;
radiology services provided in the province by
a private radiology clinic;
acupuncture;
complete medical examinations when performed
for a periodic check-up and not for medically
necessary purposes;
68
circumcision of the newborn;
reversal of vasectomies;
second and subsequent injections for impotence;
reversal of tubal ligations;
intrauterine insemination;
bariatric surgery unless the person (i) has a body
mass index of 40 or greater, (ii) has obesity-related
comorbid 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 preformed as a stand-alone procedure in
a facility that is not an approved hospital facility.
Dental services not specifically listed in Schedule 4
of the Dental Schedule are not covered by the Plan.
Those listed in Schedule 2 are considered the only
non-insured medical services.
There are no specific policies or guidelines, other
than the Act and regulations, to ensure that charges
for uninsured medical goods and services (i.e.,
enhanced medical goods and services such as intraocular lenses, fibreglass casts, etc.), provided in
conjunction with an insured health service, do not
compromise reasonable access to insured services.
Intraocular lenses are now provided by the hospitals.
The decision to de-insure physician or surgicaldental 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 of Health to furnish advice and
make recommendations has expired. Subsequent to
receiving their input and resolution of any issues,
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
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.
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
No medical or surgical-dental services were removed
from the insured service list in fiscal 2006–2007.
non-Canadians who are issued certain types of
Canadian authorization permits (e.g., a Student
Authorization).
3.0 Universality
3.1 Eligibility
Sections 3 and 4 of the Medical Services Payment
Act and its Regulation 84-20, define eligibility for
the health care insurance plan in New Brunswick.
Residents are required to complete a Medicare application and to provide proof of Canadian citizenship,
Native status or valid Canadian immigration document. A resident is defined as a person lawfully
entitled to be, or to remain, in Canada, who makes
his or her home and is ordinarily present in New
Brunswick, but does not include a tourist, transient,
or visitor to the province.
All persons entering or returning to New Brunswick
(excluding children adopted from outside Canada)
have a waiting period before becoming eligible for
Medicare coverage. Coverage commences on the first
day of the third month following the month of arrival.
Residents who are ineligible for Medicare coverage
include:
regular members of the Canadian Armed Forces;
members of the Royal Canadian Mounted Police
(RCMP);
inmates of federal prisons;
persons moving to New Brunswick as temporary
residents;
a family member who moves from another
province to New Brunswick before other family
members move;
Canada Health Act Annual Report, 2006–2007
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 that they are
residing in New Brunswick at the time, these
persons are eligible for coverage on the date of
their release. They must complete an application,
provide the official date of release and provide
proof of citizenship.
3.2 Registration Requirements
A beneficiary who wishes to become eligible to receive entitled services shall register, together with any
dependants under the age of 19, on a form provided
by Medicare for this purpose, or be registered by a
person acting on his or her behalf.
Upon approval of the application, the beneficiary
and dependants are registered and a Medicare card
with an expiry date is issued to the beneficiary and
each dependent.
A Notice of Expiry form providing all family
information currently existing on the Medicare
files is issued to the beneficiary two or three
months before the expiry date of the Medicare
card or cards. A beneficiary who wishes to remain
eligible to receive entitled services is required to
confirm the information on the Notice of Expiry,
69
Chapter 3 — New Brunswick
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.
At the time of renewal, they are required to provide
an updated immigration document.
4.0 Portability
4.1 Minimum Waiting Period
There is a three-month waiting period to obtain
eligibility for Medicare coverage in New Brunswick.
Coverage commences the first day of the third
month following the month of arrival.
70
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 that they do 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 that they do the following:
do not establish residence in another province;
do not receive coverage in another province; and
intend to return to New Brunswick.
If absent longer than 12 months, residents should
apply for coverage in the province or territory
where they are employed and should be entitled
to receive coverage there 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. As well, 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
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 192,544 physician services provided
to New Brunswick residents in other provinces and
territories as of March 31, 2007. The total amount
paid for these services was $11,125,487.
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
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
Canada Health Act Annual Report, 2006–2007
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);
the worker’s permanent residence must remain
in New Brunswick; and
the worker must return to New Brunswick
during their off-time.
“Mobile Worker” status is assigned for a maximum
of two years, after which the New Brunswick resident must reapply and resubmit documentation to
confirm continuing “mobile worker” status.
Contract Workers
Any New Brunswick resident accepting a contract
out-of-country must supply the following information
and documentation:
letter of request from the New Brunswick resident with their signature, detailing their absence
including Medicare number, New Brunswick
address, date of departure, destination and forwarding address, reason for absence and date of
return; and
copy of contractual agreement between employee
and employer which defines a start date and end
date of employment.
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Chapter 3 — New Brunswick
“Contract Worker” status is assigned for up to a
maximum of two years. Any further requests for
contract worker status must be forwarded to the
Director of Medicare 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;
do not establish permanent residence outside
New Brunswick; and
do not receive health coverage elsewhere.
4.4 Prior Approval Requirement
Medicare will cover out-of-country services that are
not available in Canada on a prior approval basis
only. Residents may opt to seek non-emergency outof-country services; however, those who receive such
services will assume responsibility for the total cost.
New Brunswick residents may be eligible for
reimbursement if they receive elective medical
services outside the country, provided they fulfill
the following requirements:
the required service, or equivalent or alternate
service, must be unavailable in Canada;
it must be rendered in a hospital listed in
the current edition of the American Hospital
Association Guide to the Health Care Field
(guide to United States hospitals, health care
systems, networks, alliances, health organizations, agencies and providers);
the service must be 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.
5.0 Accessibility
5.1 Access to Insured Health Services
New Brunswick charges no user fees for insured
health services as defined by the Canada Health
Act. Therefore, all residents of New Brunswick
have equal access to these services.
the services must be rendered by a medical
doctor; and
72
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
5.2 Access to Insured Hospital Services
The new $28 million Stan Cassidy Centre for
Rehabilitation, a facility for treating patients with
complex neurological disabilities, was officially
opened in Fredericton in June 2006. The new
centre has 25 per cent more in-patient beds and
almost 30 more clinical and non-clinical staff than
the old facility, which was founded in 1957.
Capital investments in hospital services for
2006–2007 included:
A new mobile MRI unit for patients served by
the Restigouche Health Authority, the AcadieBathurst Health Authority and the Miramichi
Regional Health Authority. This service will
enhance the quality of diagnostic images and
the ability to offer more services within the
regions, including cardiac and advanced breast
imaging, services for which patients previously
had to travel to other areas to receive.
New investment totalling $13.723 million in
priority medical equipment and technology for
hospitals across New Brunswick to provide better
access to quality health care and services, including:
Regional Health Authority 1 (Beauséjour) —
a new cardiac monitoring system, a lowtemperature plasma-gas sterilizer, a new CO2
surgery laser. The replacement of this equipment will shorten the wait list, minimize
surgical complications and shorten hospitalization.
Regional Health Authority 1 (South-East) —
a new surgical aspiration system, a lowtemperature plasma-gas sterilizer, a magnetic
resonance imaging (MRI) monitoring system.
Regional Health Authority 2 — 12 new
machines used to provide anesthesia and
monitor surgical patients, a holmium laser,
and eight hemodialysis machines.
Canada Health Act Annual Report, 2006–2007
Regional Health Authority 3 — three new
ultrasound machines, and enhancements to
a radiographic unit. The upgrade will reduce
wait times for radiology assessment.
Regional Health Authority 4 — a new general
echography unit and a second echography unit
to reduce waits time for specialized diagnostic
examinations.
Regional Health Authority 5 — a new medical
transcription and dictation system, and a new
cardiac-monitoring system.
Regional Health Authority 6 — a new digital
radiographic/fluoroscopic unit and an additional ultrasound machine. The additional
unit will have an immediate positive impact
on the wait time for examinations.
Regional Health Authority 7 — a new mobile
c-arm radiology unit and a new surgical table
for urology. This new unit will provide better
access to diagnostic images during urological
procedures.
A third catheterization lab was added to the New
Brunswick Heart Centre. This has reduced wait
times to meet and exceed nationally recommended
wait times.
The addition of a PET/CT scanner for certain
oncology patients. This has improved access;
patients previously had to go out-of-province
to get this test.
Chemotherapy services were added for Regional
Health Authorities 5 and 6, serving communities
in north-eastern New Brunswick.
A surgical operational review was completed.
Implementation of a Provincial Surgical Registry
was underway. This is part of an ongoing initiative
to improve efficiencies for surgical procedures in
order to reduce wait times.
New Brunswick does not have a system to capture
in real time the number of nursing positions or staff
working in the RHAs. Global budgets are allocated
by the Department of Health and managed by the
RHAs, and the number and types of nurses are hired
73
Chapter 3 — New Brunswick
to meet the needs of their clientele. The available
data includes the number of nurses and licensed
practical nurses that were registered in 2006 as
employed in New Brunswick. These include insured and non-insured services: 8,041 registered
nurses, 22 nurse practitioners, and 2,653 licensed
practical nurses.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2007, there were 694 general practitioners, 717 specialists, and 85 dentists registered with
the plan.
In fiscal year 2006–2007, the Department continued to work on its recruitment and retention
strategy, aimed at attracting newly licensed family
practitioners and specialists. This strategy, announced
in 1999–2000, included a contingency fund to
allow the Department to more effectively respond to
potential recruitment opportunities; the provision
of location grants for $25,000 for family practitioners
and $40,000 for specialists willing to practice in
under-serviced areas of the province; and the purchase of five additional seats at the University
of Sherbrooke’s medical school, which began in
September 2002. The recruitment and retention
strategy also provides for increased government
involvement in post-graduate training of family
physicians; the maintenance of 300 weeks in
summer rural preceptorship training for medical
students; and moving physician remuneration
toward relative parity with other Atlantic provinces.
Working with Dalhousie University Medical School
and the Regional Health Authority, the Department
of Health established an internal medicine residency
training program in Saint John. This new program is
part of the government’s efforts to improve training
opportunities for physicians in New Brunswick.
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.
Fiscal year 2006–2007 marked the second year of
an agreement with fee-for-service physicians that
provide 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, which provides for the
delivery and administration of health services in
defined geographic areas within the province,
came into force on April 1, 2002.
There were no changes during the 2006–2007
fiscal year affecting the hospital payment process.
The Department uses two components to distribute
available funding to New Brunswick’s eight 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);
74
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
community-based services (Extra-Mural Program;
health service centres); and
the Budget Papers presented by the Minister of
Finance on March 13, 2007;
general patient care.
the 2005-2006 Public Accounts presented by the
Minister of Finance on August 16, 2006
Added to this are non-patient care support services
(e.g., general administration, laundry, food services,
energy).
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.
6.0 Recognition Given to
Federal Transfers
New Brunswick routinely recognizes the federal role
regarding its contributions under the Canada Health
Transfer (CHT) in public documentation presented
through legislative and administrative processes.
These include the following:
Canada Health Act Annual Report, 2006–2007
the 2006-2007 Public Accounts presented by the
Minister of Finance on September 28, 2007; and
the Main Estimates presented by the Minister of
Finance on March 13, 2007.
New Brunswick does not produce promotional
documentation on its insured medical and hospital
benefits.
7.0 Extended Health
Care Services
7.1 Nursing Home Intermediate Care and
Adult Residential Care Services
The New Brunswick Long-Term Care program,
a 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. 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, except for one facility that is owned by
the Province. 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 constantly as private
entrepreneurs open and close residential facilities.
75
Chapter 3 — New Brunswick
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
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 eight RHAs
according to provincial policies and standards.
76
Service providers include nurses, social workers,
dieticians, respiratory therapists, physiotherapists,
occupational therapists, speech language pathologists and pharmacists, where funded. 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 are delivered
by New Brunswick’s eight RHAs according to
provincial policies and standards, and include
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — New Brunswick
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
740,843
741,353
741,726
740,759
738,651
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
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
27
0
1
20
48
27
0
1
22
50
27
0
1
22
50
23
0
1
26
50
23
0
1
26
50
not available
not available
not available
not available
954,198,600
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
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
4,558
4,785
5,464
5,418
3,740
24,236,513
26,995,076
33,743,005
38,017,578
32,494,834
40,823
38,083
34,422
45,907
44,941
5,674,627
5,391,061
5,887,128
9,560,931
10,022,287
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
1.
180
211
191
215
211
420,660
497,715
587,632
374,035
741,599
1,001
1,058
1,170
1,453
1,122
244,218
266,167
337,337
321,202
358,594
There are no private for-profit facilities operating in New Brunswick.
Canada Health Act Annual Report, 2006–2007
77
Chapter 3 — New Brunswick
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
611
649
0
1,260
647
681
0
1,328
659
706
0
1,365
668
714
0
1,382
694
717
0
1,411
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
305,027,451
not available
327,618,344
not available
351,888,988
not available
373,500,994
not available
400,481,139
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
5,693,054
215,626,099
5,488,314
216,599,016
5,540,170
229,403,104
5,721,352
240,841,117
5,750,695
245,133,979
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
178,533
200,718
175,516
202,555
192,544
9,302,399
9,909,950
9,789,130
11,353,739
11,125,487
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
4,978
5,459
5,339
6,707
6,048
389,584
428,473
409,132
449,689
417,969
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
78
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
28
23
22
21
25
2,301
1,986
2,422
2,890
2,510
499,769
486,105
537,679
621,491
505,466
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Quebec
2.0 Comprehensiveness
2.1 Insured Hospital Services
Quebec
1.0 Public Administration
1.1 Health Insurance Plan and
Public Authority
Quebec’s hospital insurance plan, the Régime
d’assu rance 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
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, 2006–2007
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;
79
Chapter 3 — Quebec
external breast prostheses; ocular prostheses; hearing
aids, assistive listening devices and visual aids for
people with a visual or auditory disability; and
permanent ostomy appliances.
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, the drug insurance plan covers
3.17 million insured persons.
2.2 Insured Medical 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, Medical and
Surgical-Dental Services
Uninsured hospital services include: plastic surgery;
in vitro fertilization; a private or semi-private room
at the patient’s request; televisions; telephones; drugs
and biologics ordered after discharge from hospital;
and services for which the patient is covered under
the Act Respecting Industrial Accidents and Occupational
Diseases or other federal or provincial legislation.
The following services are not insured: any examination or service not related to a process of cure
or prevention of illness; psychoanalysis of any kind,
unless such service is rendered in an institution
authorized for this purpose by the Minister of
Health and Social Services; any service rendered
solely for aesthetic purposes; any refractive surgery,
except in cases where there is documented failure
80
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 in psychiatry and is provided in a
hospital centre recognized for this purpose; and
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Quebec
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.
3.2 Registration Requirements
Registration with the hospital insurance plan is
not required. Registration with the Régie or proof
of residence is sufficient to establish eligibility.
3.3 Other Categories of Individual
Services received by regular members of the Canadian
Forces, members of the Royal Canadian Mounted
Police (RCMP) and inmates of federal penitentiaries
are not covered by the Plan. There are no health premium charges.
Certain categories of residents, notably permanent
residents under the Immigration Act and persons
returning to live in Canada, become eligible under
the Plan following a waiting period of up to three
months. Persons receiving last resort financial assistance are eligible upon registration. Members of the
Canadian Forces and RCMP who have not acquired
the status of inhabitant of Quebec become eligible
the day they arrive, and inmates of federal penitentiaries become eligible the day they are released.
Canada Health Act Annual Report, 2006–2007
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
Persons settling in Quebec after moving from
another province of Canada are entitled to coverage
under the Quebec Health Insurance Plan when
they cease to be entitled to benefits from their
province of origin, provided they register with
the Régie.
4.2 Coverage During Temporary Absences
Outside Quebec (in Canada)
If living outside Quebec in another province or
territory for 183 days or more, students and 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
federal government and posted outside Quebec, also
81
Chapter 3 — Quebec
retain their status as an inhabitant of the province,
provided their families remain in Quebec or they
retain a dwelling there.
4.3 Coverage During Temporary Absences
Outside Quebec (outside Canada)
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.
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.
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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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 $100 (CDN)
per day if the patient was hospitalized (including
in the case of day surgery) or to a maximum of
$50 (CDN) per day for out-patient services.
However, hemodialysis treatments are covered to a
maximum of $220 (CDN) 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Quebec
province is reimbursed at the Quebec rate, usually
in Canadian funds, when they are incurred abroad.
An insured person who moves permanently from
Quebec to another country ceases to be a recipient
as of the day of departure.
4.4 Prior Approval Requirement
Insured persons requiring medical services in hospitals abroad, in cases where those services are not
available in Quebec or elsewhere in Canada, are
reimbursed 100 percent if prior consent has been
given for medical and hospital services that meet
certain conditions. Consent is not given by the
Plan’s officials if the medical service in question
is available in Quebec or elsewhere in Canada.
5.0 Accessibility
5.1 Access to Insured Health Services
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, 2007, Quebec had 118 institutions
operating as hospital centres for a clientele suffering
from acute illnesses. There were 21,400 beds for
persons requiring care for acute physical or psychiatric ailments allotted to these institutions. From
April 1, 2005 to March 31, 2006, Quebec hospital
institutions had nearly 713,732 admissions for short
stays (including births) and 302,448 registrations
for day surgeries. These hospitalizations accounted
for 5,111,799 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, 2006–2007
the Centre de santé et de services sociaux (CSSS)
[the health and social services centre]. These centres
are the result of the merger of the public institutions
whose mission it was to provide CLSC (local community service centre) services, CHSLD (residential
and long-term care) services, and, in most cases,
neighbourhood hospital services. The CSSSs also
provide the people in their territory with access to
other medical services, general and specialized hospital services, and social services. To do so, they will
have to enter into service agreements with other
health sector organizations. The linking of services
within a territory forms the local services network.
Thus, the aim of integrated local health and social
services networks is to make all the stakeholders
in a given territory collectively responsible for the
health and well-being of the people in that territory.
5.3 Access to Insured Medical and
Surgical-Dental Services
Primary care: In 2003–2004, family medicine
groups (FMGs) were established. These groups
work closely with the CLSCs 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 January 2007, Quebec had 121 accredited FMGs.
The number of such groups has gone from 21 to
121 in four years.
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
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Chapter 3 — Quebec
directly by the patient according to the fee schedule
after the patient has collected from the Régie. Nonparticipating physicians are paid directly by their
patients according to the amount charged.
Provision is made in law for reasonable compensation for all insured health services rendered by health
professionals. The Minister may enter into an agreement with the organizations representing any class
of health professional. This agreement may prescribe
a different rate of compensation for medical services
in a territory where the number of professionals is
considered insufficient. The Minister may also provide for a different rate of compensation for general
practitioners and medical specialists during the first
years of practice, depending on the territory or the
activity involved. These provisions are preceded by
consultation with the organizations representing
the professional groups.
While the majority of physicians practise within the
provincial plan, Quebec allows two other options:
professionals who have withdrawn from the plan and
practise outside the plan, but agree to remuneration
according to the provincial fee schedule; and nonparticipating professionals who practice outside the
plan, with no reimbursement from the Régie going
to either them or their patients.
In 2006–2007, the Régie paid an amount estimated
at $3,410,400 to doctors in the province, while the
amount for medical services outside the province
reached an estimated $9.5 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 2005–2006 to institutions
operating as hospital centres for insured health
services provided to inhabitants of Quebec were
more than $7.8 billion. Payments to hospital centres
outside Quebec were approximately $108.2 million.
6.0 Extended Health
Care Services
Intermediate care, adult residential care and home
care services are available. Admission is coordinated
on a regional level and based on a single assessment
tool. The CLSCs 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.
Residential facilities and long-term care units in
acute-care hospitals focus on maintaining their
clients’ autonomy and functional abilities by
providing them with a variety of programs and
services, including health care services.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
1.0 Public Administration
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 $35.3 billion
(including capital) in spending for 2006–2007.
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 psychiatric
hospital and medical laboratories, and co-ordinates
emergency health services.
The Ministry established 14 Local Health Integration Networks (LHINs) 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, priorities and outcome
measures for the provincial health system.
Canada Health Act Annual Report, 2006–2007
1.1 Health Care Insurance Plan and
Public Authority
The Ontario Health Insurance Plan (OHIP) is
administered on a non-profit basis by Ministry
of Health and Long-Term Care (MOHLTC).
OHIP is established under the Health Insurance
Act, Revised Statutes of Ontario, 1990, c. H-6,
to provide insurance in respect of the cost of
insured services provided in hospitals and health
facilities, and by physicians and other health
care practitioners.
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 (CHA).
1.3 Audit of Accounts
MOHLTC is audited annually by the Office of the
Auditor General of Ontario. The Auditor General’s
2006 Annual Report was released on July 23,2007.
The Auditor General’s 2006 Annual Report on
the Ontario Health Insurance Plan was released
on December 5, 2006.
MOHLTC’s accounts and transactions are
published annually in the Public Accounts of
Ontario. The 2006–2007 Public Accounts of
Ontario were released on August 17, 2007.
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Chapter 3 — Ontario
1.4 Designated Agency
Local Health Integration Networks (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.
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 Local Health System Integration
Act recognizes MOHLTC’s obligations under the
French Languages Services Act, to ensure equitable
access to services in French for French-speaking
Ontarians.
The Local Health System Integration Act, 2006
requires the board of directors of each LHIN to
establish, by by-law, the committees of the board
that the Minister specifies by regulation. Regulation
417/06, which came into force on September 16,
2006, prescribes two LHIN Board Committees and
their responsibilities: an Audit Committee; and, a
Community Nominations Committee.
On April 1, 2007, the LHINs assumed full
responsibilities for funding, planning, and integrating health care services at the local level.
The Act requires LHINs to prepare an Annual
Report for the Minister who is required to table
the reports before the Legislative Assembly. The
2006/07 annual reports were received by the
Ministry on June 29, 2007, and tabled in the
provincial legislature on August 23, 2007.
For fiscal 2007–08, the Ontario Ministry of Health
and Long-Term Care will enter into an accountability agreement with each LHIN that will include
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.
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2.0 Comprehensiveness
2.1 Insured Hospital Services
Insured in-patient and out-patient hospital services
in Ontario are prescribed under the Health Insurance
Act, and Regulation 552 under that Act.
Insured in-patient hospital 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, anesthetic facilities, surgical
supplies, necessary nursing service, and supplying of
drugs, biologicals, and related preparations (subject
to some exceptions), including vaccines, anti-cancer
drugs, biologicals and related preparations (subject to
some exceptions); provision of equipment, supplies
and medication to haemophiliac patients for use at
home; and the following drugs for take-home use:
cyclosporine to transplant patients; zidovudine,
didanosine, zalcitabine and pentamidine to patients
with HIV infection; biosynthetic human growth
hormone to patients with endogenous growth hormone deficiency; drugs for treating cystic fibrosis
and thalassemia; erythropoeitins to patients with
anaemia of end-stage renal disease; alglucerase to
patients with Gaucher disease; and clozapine to
patients with treatment-resistant schizophrenia.
In 2006–2007, there were 150 public hospital
corporations (excluding specialty mental health
hospitals, private hospitals, provincial psychiatric
hospitals, federal hospitals and long-term care
homes) staffed and in operation in Ontario. This
includes 132 acute care hospital corporations,
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
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.
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.
When insured physician services are provided
in licensed 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, the Ministry of Health and
Long-Term Care (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.
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.
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 this Act include: surgical/treatment
facilities (e.g., those providing abortions, cataract
surgery, dialysis and non-cosmetic plastic surgery)
and diagnostic facilities (e.g., those providing
x-ray, ultrasound, nuclear medicine, sleep studies
and pulmonary function studies). New facilities
are ordinarily established through a Request for
Proposals process based on an assessment of need
for the service.
2.2 Insured Physician Services
Insured physician services are prescribed under the
Health Insurance Act and regulations under that Act.
Under subsection 37.1(1) of Regulation 552 of
the Health Insurance Act, a service provided by a
physician in Ontario is an insured service if it is
medically necessary; contained in the Schedule
of Benefits for Physician Services; and rendered
in such circumstances or under such conditions
Canada Health Act Annual Report, 2006–2007
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 2006–2007, physicians could submit claims
for all insured services rendered to insured persons
directly to the Ontario Health Insurance Plan (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 “optedout”. 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 re-imbursement by
OHIP. However, the number of physicians who
may opt out was fixed (on a “grandparented” basis)
following proclamation of the Commitment to the
Future of Medicare Act on September 23, 2004.
Physicians must be registered to practice medicine in
Ontario by the College of Physicians and Surgeons
of Ontario.
There were approximately 23,000 physicians who
submitted claims to OHIP in 2006–2007.
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Chapter 3 — Ontario
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 2006–2007.
(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; and, research and experimental
survey programs.
3.0 Universality
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
3.1 Eligibility
Services prescribed by and rendered in accordance
with the Health Insurance Act and regulations under
that Act are insured.
To be considered a resident of Ontario for the
purpose of obtaining Ontario health insurance
coverage, a person must:
Uninsured hospital services include: additional
charges for preferred accommodation unless prescribed by a physician, oral-maxillofacial surgeon
or midwife; telephones and televisions; charges for
private-duty nursing; provision of medications for
patients to take home from hospital, with certain
exceptions; and in-province, out-patient hospital
visits solely for administering drugs, subject to
certain exceptions.
hold Canadian citizenship or an immigration
status as prescribed in Regulation 552 of the
Health Insurance Act;
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 longdistance telephone calls; the preparation or provision
of a drug, antigen, antiserum or other substance,
unless the drug, antigen or antiserum is used to
facilitate a procedure; advice given by telephone
at the request of the insured person or the person’s
representative; an interview or case conference
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make his or her permanent and principal home
in Ontario;
be physically present in Ontario for at least
153 days in any 12-month period; and
in most cases, Ministry of Health and LongTerm Care (MOHLTC) policy requires new
and returning residents applying for health
coverage to 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
Health Insurance Act, are eligible for Ontario health
insurance coverage subject to a three-month waiting
period. MOHLTC assesses whether or not an individual is subject to the three-month waiting period
at the time of their application for health coverage.
Examples of those who are exempt from the threemonth 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, homes for the aged or nursing homes
in Ontario.
In July 2006, MOHLTC amended section 3(4) of
Regulation 552 of the Health Insurance Act to exempt
Canadian citizens and Permanent Residents/Landed
Immigrants from the three-month waiting period for
Ontario Health Insurance Plan (OHIP) coverage, if
they arrive in Ontario after July 20, 2006, from a
foreign country where an evacuation effort is being
undertaken or facilitated by the federal government.
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 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.
When MOHLTC determines 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.
Canada Health Act Annual Report, 2006–2007
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 MOHLTC.
A health card is issued to eligible residents upon
applying to the General Manager of OHIP,
pursuant to sections 2 and 3 of Regulation 552.
Eligible persons should apply for coverage upon
establishing their permanent and principal home
in the province. Registration is done through
local OHIP offices. Applicants for Ontario health
coverage must complete and sign a Registration
for Ontario Health Coverage form and provide
MOHLTC with 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.
MOHLTC mails renewal notices to registrants
several weeks before the card’s renewal date.
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 12.6 million Ontario residents
were registered with OHIP and held valid and
active health cards as of as of April 1, 2007.
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
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Chapter 3 — Ontario
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 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.
Holders of Temporary Resident Permits/Minister’s
Permits: A Temporary Resident Permit/Minister’s
Permit is issued to an individual by Citi-zenship 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. Only individuals who hold a
Temporary Resident Permit/Minister’s 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
90
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 19 years of age) 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.
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 resides
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
3.4 Premiums
There are no premiums payable as a condition of
obtaining Ontario health insurance coverage. The
Ontario Health Premium is collected through the
provincial income tax system and is not connected
to OHIP registration or eligibility in any way.
Responsibility for the administration of the
Ontario Health Premium lies with the Ontario
Ministry of Finance.
4.0 Portability
4.1 Minimum Waiting Period
In accordance with subsection 3(3) of Regulation
552 under the Health Insurance Act, individuals who
move to Ontario are typically entitled to Ontario
Health Insurance Plan (OHIP) coverage, three months
after establishing residency in the province, unless
listed as an exception in section 3(4).
In accordance with Ministry of Health and LongTerm Care (MOHLTC) policy, 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 could use their Ontario health cards to
obtain insured health services.
Canada Health Act Annual Report, 2006–2007
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 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, 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 arrangements with all other provinces and
territories, except Québec (which has not signed
a reciprocal agreement with any other province or
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Chapter 3 — Ontario
territory), for insured physician services. Ontario
residents who may be required to pay for physician
services received in Québec can submit their receipts
to MOHLTC for payment as an insured service at
Ontario rates.
Certain family members may also qualify for continuous Ontario health coverage while accompanying
the primary applicant on an extended absence outside
Canada and should contact their local OHIP office
for details.
4.3 Coverage During Temporary Absences
Outside Canada
Out-of-country services are covered under sections
28.1 to 28.6 inclusive, and sections 29 and 31 of
Regulation 552 of the Health Insurance Act.
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.
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 present 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 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
92
Effective September 1, 1995, out-of-country
emergency hospital costs are reimbursed at
Ontario fixed per diem rates of:
a maximum $400 (CDN) for in-patient services;
a maximum $50 (CDN) for out-patient services
(except dialysis); and
the actual cost incurred by the patient per dialysis
treatment.
During 2006–2007, emergency medically necessary
out-of-country physician and other eligible practitioner 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.
In 2006–2007, Ontario’s payments for out-ofcountry emergency in-patient and out-patient
insured hospital and medical services amounted
to $25.0 million.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
4.4 Prior Approval Requirement
As set out in section 28.4 of Regulation 552 of the
Health Insurance Act, prior approval from MOHLTC
is required for payment for non-emergent health
services provided outside of Canada. 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 irreversible tissue damage,
the patient may be entitled to full funding for outof-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;
the service or test is not experimental; and
the service or test is not performed for
research purposes.
In 2006–2007, Ontario’s total payments for
prior-approved treatment outside Canada were
$70.1 million.
There is no formal prior-approval process required
for services provided to Ontario residents outside the
province, except 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 and 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.
Canada Health Act Annual Report, 2006–2007
5.0 Accessibility
5.1 Access to Insured Health Services
All insured hospital, physician and surgical-dental
services are available to Ontario residents on uniform terms and conditions.
All insured persons are entitled to all insured hospital and physician services, as defined in the Health
Insurance Act.
Accessibility to insured health care services is
protected under the Commitment to the Future
of Medicare Act (CFMA). This Act prohibits
any person or any entity from charging more
or accepting payment or other benefit for more
than the amount payable by the Ontario Health
Insurance Plan (OHIP). In addition, the CFMA
also 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 person or
entity from paying, conferring or receiving any
benefit in exchange for preferred access to an
insured service.
The Ministry of Health and Long-Term Care
(MOHLTC) investigates all possible contraventions
of Part II of the CFMA that come to its attention.
For situations in which it is found that a patient
has made an unauthorized payment, the Ministry
ensures that the amount is repaid to that patient.
MOHLTC implemented Health Number/Card
Validation to aid health care providers and patients
with access to 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
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Chapter 3 — Ontario
for patients who are unable to provide a health
number and require emergency treatment is available
to emergency room facilities through the Health
Number Look Up service.
5.2 Access to Insured Hospital Services
Public hospitals in Ontario are not permitted to
refuse the provision of services in life-threatening
situations because the person is not insured.
In 2006–2007, there were 151 public hospital
corporations staffed and in operation in Ontario,
which included chronic, general and special rehabilitation units. There were 6,781,528 acute
patient days, 1,944,159 chronic patient days and
770,450 rehabilitation patient days delivered by
public hospitals.
Acute care priority services are designated highly
specialized hospital-based services that deal with
life-threatening conditions. These services are often
high-cost and rapidly growing, which has made
access a concern. Generally, these services are
managed provincially, on a time-limited basis.
Acute care Priority services include:
selected cardiovascular services;
selected cancer services;
chronic kidney disease;
critical care services; and
organ and tissue donation and organ
transplantation.
5.3 Access to Insured Physician and
Dental-Surgical Services
Initiatives
Underserviced Area Program (UAP): UAP is one
of a number of 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
94
the UAP’s recruitment and retention benefits, 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 141 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.
Northern Health Travel Grant Program (NHTG):
NHTG helps defray transportation 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 2006–2007,
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, 2007,
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
there were approximately 7.4 million patients
rostered to physicians in the primary care models
that have these features. The Rural & Northern
Physician Group Agreement (RNPGA) has been
implemented in 39 northern Ontario communities since April 2004. In 2007, eight additional
rural northern communities have been identified
as eligible for the agreement, while 14 southern
communities are identified as eligible for a modified version of the agreement. 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, and care of the elderly. As part of
transforming its health care system, Ontario
has approved 150 family health teams since
April 2005, with all expected to be operational
by 2007/08, thereby improving access for
more than 2.5 million Ontario residents in
112 communities.
The 2004 Memorandum of Agreement between
MOHLTC and the Ontario Medical Association
provides for the alignment of the Primary Care
Network (PCN) and Health Service Organization
(HSO) models into one model—the Family
Health Organization (FHO). In May 2007, the
FHO model was offered to all family physicians
in 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.
Canada Health Act Annual Report, 2006–2007
General practitioners paid solely on a fee-for-service
basis represent 39 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
Family Health Teams. Family Health Teams build
upon existing primary care physician funded models
by providing funding for inter-disciplinary health care
professionals, who work as integral members of the
team. Physicians participating in Family Health Teams
are funded by one of three compensation options that
include: Blended Capitation (such as FHN/FHO),
Complement Based Models (RNPGA or other
specialized model agreements) and Blended Salary
Model (for community or mixed governed FHTs).
MOHLTC negotiates payment rates 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
are scheduled for implementation on various dates
from October 1, 2005, through to January 1, 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; invests in
95
Chapter 3 — Ontario
initiatives to recruit physicians to Ontario; and, makes
quality of life improvements for physicians such as
expanding pregnancy and parental leave benefits.
for service volumes and performance targets
that form the contractual basis for the Hospital
Accountability Agreement.
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.
In the Hospital Accountability Agreement, 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 Hospital
Accountability Agreement are conducted between
Ministry staff and hospitals.
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 multiyear funding agreement for dental services, which
became effective on April 1, 2003, and expired
on March 31, 2007. The terms of the agreement
continue until a new contract is negotiated by
the parties.
5.5 Payments to Hospitals
The Ontario budget system is a prospective reimbursement system that reflects the effects of
workload increases, costs related to provincial
priority services, wait time strategies, and cost
increases in respect of above-average growth
in volume of service in specific geographic
locations. Payments are made to hospitals on
a semi-monthly basis.
Transfer 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 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. Hospital Annual Planning
Submissions are based on a multi-year budget and
provide a corresponding multi-year planning forecast. The data submitted in the Hospital Annual
Planning Submissions is used to populate schedules
96
The Interprovincial Hospitals’ Reciprocal billing
agreements are a convenient administrative arrangement in which provincial/territorial governments
reimburse hospitals for insured services from other
provinces/territories.
On April 1 2007, Local Health Integration Networks
(LHINs) assumed funding authority for hospitals in
Ontario. The LHINs are leading the negotiations of
the Hospital Service Accountability Agreements and
the Hospital Annual Planning Submission process.
MOHLTC reviews chronic care co-payment regulations and rates annually, accounting for changes
in the Consumer Price Index and Old Age Security
each year, and determines whether revisions to the
regulations and rates are appropriate.
6.0 Recognition
The Government of Ontario publicly acknowledged the federal contributions provided through
the Canada Health Transfer in its 2006–2007
publications.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
7.0 Extended Health
Care Services
7.1 Nursing Home Intermediate Care and
Adult Residential Care Services
Long-Term Care (LTC) homes provide care and
personal support services and accommodation for
people who are no longer able to live independently.
Nursing care is available on-site 24-hours a day.
Residents may also require on-site supervision, personal care and monitoring to ensure their safety and
well-being. The home-like environment is intended
to foster the best possible quality of life. The Ministry
of Health and Long-Term Care (MOHLTC) currently funds and regulates 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.
The new Long-Term Care Homes Act, 2007, which
received Royal Assent on June 4, 2007, replaces the
three existing pieces of legislation and provides 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 will also enable better planning
for the needs of the population requiring appropriate
residential services provided in a LTC home.
As of April 30, 2007, there were approximately
608 LTC homes with 75,302 beds including
256 not-for-profit (including municipal, charitable
and not-for–profit nursing homes) and 352 forprofit 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
Canada Health Act Annual Report, 2006–2007
Community Care Access Centres (CCACs). Retirement homes are neither regulated nor funded by
the Ministry.
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 Compliance
Advisors 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.
Through the 2007/08 budget, $57.7 million
in annualized funding was approved to create
1,200 new Registered Practical Nurse (RPN) positions to enhance care in Long-Term 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
Community Care Access Centres (CCACs) and
Community Service agencies.
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Chapter 3 — Ontario
CCACs provide simplified access for eligible Ontario
residents, of all ages, to home and community care;
coordinate the delivery of home care services to
people in their homes, schools and communities;
and, authorize admission to long-term care 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. The range of
services includes: nursing, homemaking, personal
support, physiotherapy, occupational therapy,
speech-language pathology, social work, dietetics,
medical supplies and dressings, hospital and
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 and personal
support services for children/youth in schools
and receiving home schooling;
Developing plans of service;
Providing information and referral services
for the public to home and community care
related services;
Managing admission to LTC homes; 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
98
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, services for persons with physical disabilities, 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 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 LongTerm 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, collaborative planning between
all health care sectors, and increased resources. 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 client-centred and interdisciplinary endof-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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
“Community Health Centre” reflects the fact that
the agency is established by the community and
provides programs and services in response to needs
identified in that community. Community Health
Centres deliver services through inter-disciplinary
teams including physicians, nurse practitioners,
nurses, counsellors, dieticians, therapists, community
health workers and health promoters. Services include comprehensive primary care as well as group
and community programs, such as diabetes education, parent/child programs, community kitchens,
and youth outreach services. Community Health
Centres work within a population health framework that places an equal emphasis on providing
comprehensive primary care, preventing illness,
and health promotion.
Community Health Centres identify the priority
populations that they will serve—traditionally
people have experienced barriers to access based on
culture, language, literacy, age, geographic isolation,
socio-economic status, disability, mental health status
and homelessness. Community Health Centres also
Canada Health Act Annual Report, 2006–2007
develop partnerships with other service providers to
improve access to care, promote effective service integration and build community capacity to address the
social determinants of health in their communities.
Service is provided through 54 Community Health
Centres operating from more than 80 full-service
sites across Ontario. Of these, 27 are in large urban
centres, 14 are in smaller urban centres, and 13 are
in either northern or rural communities. There is no
legislation specific to Community Health Centres.
Historically, Community Health Centres 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 2004–2008, 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.
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Chapter 3 — Ontario
Registered Persons
2002–2003
1.
2003–2004
2005–2006
12,500,000
12,400,000
12,200,000
12,100,000
Number as of March 31st (#).
2004–2005
2006–2007
1
12,600,000
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.
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
139
11
4
3
157
135
13
4
3
155
135
13
4
3
155
134
14
4
4
156
132
14
4
4
154
not available
not available
not available
not available
10,300,000,000
2
3
3
3
3
2002–2003
not available
not available
not available
not available
10,300,000,000
2
3
3
3
3
2003–2004
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not available
not available
not available
4
4
4
4
4
not available
not available
not available
not available
12,300,000,000
2
3
3
3
3
2004–2005
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
not available
not available
not available
not available
12,700,000,000
2
3
3
3
3
2005–2006
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
not available
not available
not available
not available
13,500,000,000
3
3
3
3
2006–2007
not available
not available
not available
4
not available
not available
not available
4
4
4
4
4
not available
not available
not available
4
not available
not available
not available
4
1.
These estimates represent the number of Valid and Active Health Cards (have current eligibility and resident has incurred a claims in the last
7 years).
2.
Provincial Psychiatric Hospitals are excluded and Specialty Mental Health Hospitals are reported under 2(d) — Other.
3.
Facilities in Ontario tend to be mixed (acute/chronic, chronic/rehabilitative beds) with only a minority having one type of bed. Separating by
facility type gives a small sample size and significantly understates the amount actually spent on chronic and rehabilitative beds.
4.
Data are not collected in a single system in MOHLTC. Further, the MOHLTC is unable to categorize providers/facilities as “for-profit” as
MOHLTC does not have financial statements detailing service providers' disbursement of revenues from the ministry.”
100
2
4
4
4
4
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Ontario
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
9,306
9,023
8,184
8,374
8,037
48,500,000
63,000,000
52,000,000
54,000,000
49,870,000
140,692
167,143
154,460
174,848
139,036
16,500,000
20,000,000
23,000,000
29,100,000
25,576,000
23,845
20,800
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
23,295
21,458
27,200,000
21,710
32,000,000
12. Total number of claims, out-patient (#).
not available
5
13. Total payments, out-patient ($).
not available
6
42,466,826
not available
5
not available
6
66,916,271
not available
5
not available
6
76,828,432
not available
5
not available
5
not available
6
not available
6
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
10,508
10,724
not available
21,232
10,611
10,703
not available
21,314
10,660
11,016
not available
21,676
10,774
11,460
not available
22,234
11,114
12,087
not available
23,201
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
17
134
not available
151
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not available
not available
not available
not available
8
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
188,309,344
5,420,010,700
9
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
179,100,000
4,798,300,000
7
7
8
8
8
9
15
114
not available
129
7
7
not available
not available
not available
not available
8
192,572,601
5,945,003,300
9
182,000,000
4,973,000,000
8
8
8
9
14
62
not available
76
7
7
not available
not available
not available
not available
8
200,825,265
6,424,329,400
9
8
8
8
9
191,451,200
5,312,085,618
12
39
not available
51
7
7
not available
not available
not available
not available
8
215,980,656
7,072,813,000
9
203,656,000
5,642,049,000
8
8
8
9
13
36
not available
49
7
not available
not available
not available
not available
8
222,632,480
7,791,581,966
9
8
8
8
9
204,545,656
5,962,775,787
5.
Included in #24.
6.
Included in #26.
7.
All physicians are categorized as general practitioner or specialist.
8.
Ontario has no non-participating physicians, only opted-out physicians who are reported under item #8.
9.
Number of services includes services provided by Ontario physicians through Fee-for-Service, Primary Care, Alternate Payment Programs,
and Academic Health Science Centres. Total Payments includes payments made to Ontario physicians through Fee-for-Service, Primary Care,
Alternate Payment Programs, and Academic Health Science Centres and the Hospital On Call Program. Services and payments related to
Other Practitioner Programs, Out-of-Country/Out-of-Province Programs, and Community Labs are excluded.
Canada Health Act Annual Report, 2006–2007
7
101
Chapter 3 — Ontario
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
497,880
557,720
534,179
573,830
627,375
17,700,000
18,600,000
20,300,000
21,164,600
23,754,500
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
200,428
180,395
179,410
200,723
182,693
10,200,000
9,900,000
11,635,998
13,211,381
19,351,944
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
102
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
319
323
335
330
316
75,600
72,900
86,000
87,111
92,264
9,300,000
9,200,000
11,786,600
12,546,397
14,229,896
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
Manitoba
Introduction
Manitoba Health and Healthy Living provides
leadership and support to protect, promote
and preserve the health of all Manitobans. The
Department is organized into five distinct but
related functional areas: Corporate and Provincial
Program Support; Healthy Living and Health
Programs; Health Workforce; Regional Affairs
and Administration; Finance and Accountability.
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.
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 2006/07.
The Ministry of Healthy Living continued to
lead and shape the department’s focus on promoting healthful practices and preventing disease and
injury through the launch of the Healthy Eating
Campaign—a province-wide initiative to promote
healthy eating and good nutrition in our schools
and additional resources to support the Healthy
Aging Strategy to promote healthy living among
older adults.
Canada Health Act Annual Report, 2006–2007
Manitoba introduced a $155 million Five Point
Plan 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 has embarked on major provincial quality
improvement endeavours that include a mandatory
reporting and learning process which is aimed at
enhancing patient safety by reducing the potential
for recurrence of critical incidents. This move from
a voluntary, less comprehensive process signals a
commitment from policy-makers for substantial
improvements to safety with adverse events being
addressed systemically within the healthcare system.
With regard to this commitment, The Regional
Health Authorities Act and The Manitoba Evidence
Amendment Act were proclaimed November 1, 2006.
Regions are now operationalizing legislative requirements including specific critical incident reporting and
investigation requirement processes and procedures.
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 included their health literacy
initiative, It’s Safe to Ask, introduced in several
loca-tions in Manitoba in late 2006. This initiative
consists 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 clinical occurrences.
It’s Safe to Ask will lead to stronger communication
between patients and providers, leading patients
to become more informed about their health and
more active in their healthcare. MIPS continues
to facilitate culture of safety surveys in the regions,
steer the Manitoba Node for the Safer Healthcare
Now! Campaign and Chair the Annual Provincial
Patient Safety Workshops and other professional
and public forums.
103
Chapter 3 — Manitoba
In 2006/07, Manitoba Health and Healthy Living
continued the restructuring of 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 publiclyfunded drug programs in Manitoba. The Operational
Program Management Unit is responsible for operational issues. The Professional Services Unit focuses
on formulary management and implementation of
drug management intervention strategies. The Drug
Management Policy Unit provides for focused policy
and planning capacity on emerging drug management and utilization issues. 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.
A new Long Term Care Seniors’ Strategy based
on the principle of Aging in Place will increase
community living support and provide alternatives
to institutional care. By increasing the opportunity
to remain in one’s community, or “age in place,”
Manitobans will be provided options to continue
to contribute to the social, civic and economic life
of the community.
Significant capital investments were also made in
acute care facilities: the Cardiac Care Centre at
St. Boniface General Hospital, the Critical Services
104
Redevelopment Project at Health Sciences Centre
(HSC), the Burn Unit project at HSC, the Mature
Women’s Program (relocation and expansion of this
program from HSC to Victoria General Hospital),
the new Reproductive Health Centre (Women’s
Health Clinics Satellite), the new Misericordia
Isolation Room, The Winnipeg Regional Health
Authority (WRHA) Laundry Department upgrade
and establishment of a Community Cancer Program.
In addition, significant capital investments included two long term care facilities: an addition
to and renovation of a new 39 bed unit at Foyer
Valade Personal Care Home in Winnipeg; and
a new 35 bed Personal Care Home, Northern
Spirit Manor, located in Thompson, Manitoba.
Further provincial program capital investments
included: the Brandon Regional Health Centre
Medical Transportation Coordination Centre; the
Primary Health Care Transcona Access Centre providing significant tenant improvements, expansions
and/or upgrades to the Swan Valley Health Centre
and the St. Anne and Flin Flon Hospitals; a new
Health Care Centre in Wabowden; and enhancement of rehabilitation services with the initiation of
the WRHA Rehabilitation Reconfiguration Project.
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. This project will occur in three stages
over a 2.5 year period to project completion in
October, 2008/09, for the targeted population of
select 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
The Role and Mission of Manitoba 1.0 Public Administration
Health and Healthy Living
1.1 Health Care Insurance Plan and
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.
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.
1.
Public Authority
The Manitoba Health Services Insurance Plan
(MHSIP) is administered by the Department of
Health under The Health Services Insurance Act,
R.S.M. 1987, c. H35. The Act1 was significantly
amended in 1992, dissolving the Manitoba Health
Services Commission and transferring all assets
and responsibilities to Manitoba Health and
Healthy Living. The dissolution took effect on
March 31, 1993.
The MHSIP is administered under this Act for
insurance in respect of the costs of hospital, personal
care 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;
Where reference is made to “the Act” in the text, this refers to the Health Services Insurance Act as consolidated to March 31, 2007.
Canada Health Act Annual Report, 2006–2007
105
Chapter 3 — Manitoba
to provide a consulting service, exclusive of individual patient care, to hospitals and personal care
homes in the province or to make such arrangements as the Minister considers necessary to
ensure that such a consulting service is provided;
to require that the records of hospitals, personal
care homes and related health facilities are audited
annually and that the returns in respect of hospitals, which are required by the Government of
Canada, are submitted; and
in cases where residents do not have available
medical services and other health services, to
take such measures that are necessary to plan,
organize and develop medical services and other
health services commensurate with the needs
of the residents.
The Minister may also enter into contracts and
agreements with any person or group that he or
she considers necessary for the purposes of the Act.
The Minister may also make grants to any person
or group for the purposes of the Act on such terms
and conditions that are considered advisable. Also,
the Minister may, in writing, delegate to any person
any power, authority, duty or function conferred or
imposed upon the Minister under the Act or under
the regulations.
There were no legislative amendments to the Act
or the regulations in the 2006–2007 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.
106
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 2006–2007 fiscal
year and is contained in the Manitoba Health and
Healthy Living Annual Report, 2006–2007. It will
also be available on the Province’s website in late
October 2007.
2.0 Comprehensiveness
2.1 Insured Hospital Services
Sections 46 and 47 of the Act, as well as the
Hospital Services Insurance and Administration
Regulation (M.R. 48/93), provide for insured
hospital services.
As of March 31, 2007, there were 97 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
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.
the Excluded Services Regulation (M.R. 46/93) of
the Act, rendered to an insured person by a physician.
During fiscal year 2006–2007, 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
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, 2007, there were
2,244 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
Canada Health Act Annual Report, 2006–2007
In order for a physician’s service to be added to
the list of those covered by Manitoba Health and
Healthy Living, physicians must put forward a
proposal to their specific section of the Manitoba
Medical Association (MMA). The MMA will negotiate the item, including the fee, with Manitoba
Health and Healthy Living. Manitoba Health and
Healthy Living may also initiate this process.
2.3 Insured Surgical-Dental Services
Insured surgical and dental services are listed in the
Hospital Services Insurance and Administration
Regulation (M.R. 48/93) under the Act. Surgical
services are insured when performed by a certified
oral and maxillofacial surgeon or a licensed dentist
in a hospital, when hospitalization is required for
the proper performance of the procedure. This
Regulation also provides benefits relating to the
cost of insured orthodontic services in cases of cleft
lip and/or palate for persons registered under the
program by their 18th birthday, when provided by
a registered orthodontist. As of March 31, 2007,
590 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, 2007.
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.
107
Chapter 3 — Manitoba
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
The Excluded Services Regulation (M.R. 46/93)
made under the Act sets out those services that
are not insured. These include: examinations and
reports for reasons of employment, insurance,
attendance at university or camp, or performed
at the request of third parties; group immunization
or other group services except where authorized
by Manitoba Health and Healthy Living; services
provided by a physician, dentist, chiropractor or
optometrist to him or herself or any dependants;
preparation of records, reports, certificates, communications and testimony in court; mileage or
travelling time; services provided by psychologists,
chiropodists and other practitioners not provided
for in the legislation; in vitro fertilization; tattoo
removal; contact lens fitting; reversal of sterilization
procedures; and psychoanalysis.
The Hospital Services Insurance and Administration
Regulation states that hospital in-patient services
include routine medical and surgical supplies, thereby ensuring reasonable access for all residents. The
Regional Health Authorities and Manitoba Health
monitor compliance.
Manitoba Health 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.
108
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 2006–2007.
3.0 Universality
3.1 Eligibility
The Health Services Insurance Act defines the eligibility of Manitoba residents for coverage under the
provincial health care insurance plan. Section 2(1)
of the Act states that a resident is a person who is
legally entitled to be in Canada, makes his or her
home in Manitoba, is physically present in Manitoba
for at least six months in a calendar year, and includes any other person classified as a resident in
the Regulations, but does not include a person
who holds a temporary resident permit under the
Immigration and Refugee Protection Act (Canada),
unless the Minister determines otherwise, or is a
visitor, transient or tourist.
The Residency and Registration Regulation
(M.R. 54/93) extends the definition of residency.
The extensions are found in sections 7(1) and
8(1). Section 7(1) allows missionaries, individuals
with out-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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
The Residency and Registration Regulation, section 6,
defines Manitoba’s waiting period as follows:
“ A resident who was a resident of another Canadian
province or territory immediately before his or her
arrival in Manitoba is not entitled to benefits until
the first day of the third month following the
month of arrival. ”
There are currently no other waiting periods in
Manitoba.
The MHSIP excludes residents covered under the
following federal statutes: Aeronautics Act; Civilian
War-related Benefits Act; Government Employees
Compensation Act; Merchant Seaman Compensation
Act; National Defence Act; Pension Act; Royal Canadian
Mounted Police Act; Veteran’s Rehabilitation Act; or
under legislation of any other jurisdiction (Excluded
Services Regulations subsection 2(2)). The excluded
are residents who are members of the Canadian
Forces, the Royal Canadian Mounted Police (RCMP)
and federal inmates. These residents become eligible
for Manitoba Health and Healthy Living coverage
upon discharge from the 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 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 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
Canada Health Act Annual Report, 2006–2007
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, 2007, there were 1,188,209 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 months, be physically present in
Manitoba and be legally entitled to be in Canada
before receiving Manitoba Health and Healthy
Living coverage.
As of March 31, 2007, there were 6,692 individuals
on work permits covered under the MHSIP.
The definition of “resident” under the Health
Services Insurance Act allows the Minister of Health
or the Minister’s designated representative to provide coverage for holders of a Minister’s permit
under the Immigration Act (Canada). No legislative
amendments to the Act or the regulations in the
2006–2007 fiscal year affected universality.
4.0 Portability
4.1 Minimum Waiting Period
The Residency and Registration Regulation (M.R.
54/93, section 6) identifies the waiting period for
insured persons from another province or territory.
A resident who lived in another Canadian province
109
Chapter 3 — Manitoba
or territory immediately before arriving in Manitoba
is entitled to benefits on the first day of the third
month following the month of arrival.
4.3 Coverage During Temporary Absences
Outside Canada
4.2 Coverage During Temporary Absences
in 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.
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 enrollment at any accredited educational
institution. The additional requirement is that they
intend to return and reside in Manitoba after completing their studies. Manitoba has formal agreements
with all Canadian provinces and territories for
the reciprocal billing of insured hospital services.
Manitoba has a bilateral agreement with the Province
of Saskatchewan for Saskatchewan residents who
receive care in Manitoba border communities.
In-patient costs are paid at standard rates approved
by the host province or territory. Payments for
in-patient, high-cost procedures and out-patient
services are based on national rates agreed to by
provincial or territorial health plans. These include
all medically necessary services as well as costs for
emergency care.
Except for Quebec, medical services incurred in all
provinces or territories are paid through a reciprocal
billing agreement at host province or territory rates.
Claims for medical services received in Quebec are
submitted by the patient or physician to Manitoba
Health for payment at host province rates.
In 2006–2007, Manitoba Health and Healthy Living
made payments of approximately $26.7 million
for hospital services and $9.9 million for medical
services provided in Canada.
Residents on full-time employment contracts outside
Canada will receive Manitoba Health and Healthy
Living coverage for up to 24 consecutive months.
Individuals must return and reside in Manitoba after
completing their employment terms. Clergy serving
as missionaries on behalf of a religious organization
approved as a registered charity under the Income
Tax Act (Canada) will be covered by Manitoba Health
and Healthy Living for up to 24 consecutive months.
Students are considered residents and will continue
to receive health coverage for the duration of their
full-time enrollment at an accredited educational
institution. The additional requirement is that
they intend to return and reside in Manitoba after
completing their studies. Residents on sabbatical or
educational leave from employment will be covered
by Manitoba Health and Healthy Living for up to
24 consecutive months. These individuals also must
return and reside in Manitoba after completing their
leave. Residents on sabbatical or educational leave
from employment will be covered by Manitoba
Health for up to 24 consecutive months. These
individuals 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
110
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
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 $3,834,000 for hospital
care provided in hospitals outside Canada in the
2006–2007 fiscal year. In addition, Manitoba
Health and Healthy Living made payments of
approximately $1,118,800 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.
Canada Health Act Annual Report, 2006–2007
No legislative amendments to the Act or the regulations in the 2006–2007 fiscal year had an effect
on portability.
5.0 Accessibility
5.1 Access to Insured Health Services
Manitoba Health and Healthy Living ensures that
medical services are equitable and reasonably available to all Manitobans. Effective January 1, 1999,
the Surgical Facilities Regulation (M.R. 222/98)
under the Health Services Insurance Act came into
force to prevent private surgical facilities from
charging additional fees for insured medical services.
In July 2001, the Health Services Insurance Act,
the Private Hospitals Act and the Hospitals Act were
amended to strengthen and protect public access to
the health care system. The amendments include:
changes to definitions and other provisions
to ensure that no charges can be made to individuals who receive insured surgical services or
to anyone else on that person’s behalf; and
ensuring that a surgical facility cannot perform
procedures requiring overnight stays and thereby
function as a private hospital.
On February 10, 2004, Manitoba officially opened
the expanded Health Links/Info Santé, a 35-seat,
state-of-the-art call centre with a call capacity of
300,000 per year.
Manitobans now have access to vital health information and assistance in 120 languages 24-hours a
day, seven days a week.
Public demand for Health Links/Info Santé has
increased steadily since it began as a six station call
back service in 1994. Manitobans value the service.
Providing this information source relieves pressure on
other areas of the health care system, particularly
emergency rooms.
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Chapter 3 — Manitoba
Through the Primary Health Care Transition
Fund, multi-jurisdictional envelope funds have
been made available to implement a program
to manage patients with congestive heart failure.
Beginning in November 2004, this 17-month
initiative will evaluate the benefits of using health
lines to manage patients with chronic diseases.
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 significantly
in Winnipeg, with a more gradual improvement
noted in rural and northern regions. The increased
supply of nurses is primarily due to an investment in
nursing education. Enrolment in 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, 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). In June 2005, the Extended Practice
Regulation came to effect to allow 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.
In addition, Manitoba has a wide range of other
health care professionals. Significant shortages in
midwifery are being addressed through a new degree
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
112
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 six 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, and two located at the Health
Sciences Centre. One of the MRIs at the Health
Science Centre was a joint initiative with the National
Research Council (NRC). The sixth MRI was opened
at Brandon Regional Health Centre in June 2004.
This was the first MRI machine to be located
outside Winnipeg. The seventh and newest MRI
opened at Pan AM Clinic and became operational
November 21, 2005.
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
and Selkirk Regional Health Centre. As well, Portage
District General Hospital has purchased a new
scanner and Brandon has replaced a 64 slice scanner.
Dauphin has also replaced a 16 slice CT scanner.
There are a total of 93 diagnostic ultrasound
scanners in Manitoba. Sixty-nine are in Winnipeg
health facilities and 24 are in located the rural and
northern Regional Health Authorities.
In January 2007, the 15th Community Cancer
Program (CCP) became operational in Pinawa.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
CCPs are oncology out-patient units within 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 follow-up 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.
The Manitoba Prostate Cancer Centre became
operational in October 2004. It is located on the
third floor of the new CancerCare building at
675 McDermot Avenue. The Prostate Centre
includes a wide variety of services for Manitoba
men including clinical assessment, information
to help with patient decision-making, linkages
with prostate cancer support groups and research
conducted in the area of prostate disease.
In October 2006, the last of seven cytology laboratories of the laboratory network and laboratory
quality assurance program for the central and
confidential Cervical Cancer Screening Registry
began submitting results electronically. The followup function of the Registry implements follow-up
with Health Care Providers for any Pap test with
a high grade abnormal result and no follow-up
Colposcopy visit within three months of the test,
and provides directions for updating Registry
records. The Manitoba Breast Cancer Screening
Program has a mandate to ensure that the women
in Manitoba aged 18 to 69 years receive organized,
high quality cervical cancer screening services.
Wait time funding has provided for additional
hip and knee joint replacements at several sites in
Winnipeg, 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.
Canada Health Act Annual Report, 2006–2007
A central provincial registry was established in 2006
for all lower extremity joint replacement surgery.
The Pan Am Clinic, formed in 1979, has evolved
from a sports medicine clinic into a comprehensive
musculo-skeletal specialty centre. The Pan Am
Clinic came under the ownership of the Winnipeg
Regional Health Authority (WRHA) on September
1, 2001. In March 2006, a minor injury clinic for
kids was opened in conjunction with the WRHA
Child Health Program.
Consolidation of the Cardiac Surgery Program to
St. Boniface General Hospital occurred on January
15, 2007, as planned in response to the comprehensive external review of the entire cardiac program
in 2003.
Additional cataract procedures to reduce wait lists
have been added at Pan Am Clinic in Winnipeg
and at Brandon Regional Health Centre.
In March 2005, the expansion of paediatric dental
surgery services to Misericordia Health Centre (MHC)
was initiated to reduce waiting times. Further, 200
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 was initiated in January 2004 and concluded its work 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 hospitals were identified and plans for implementation
defined. While some recommendations have been
fully implemented, work continues on others as many
recommendations involve system issues. Highlights
include enhanced diagnostic capabilities, enhanced
education for Emergency Department staff, redevelopment of physical space and improved IT support.
In response to the ongoing challenges with delivery
of Emergency Medical Services and the recognition
that system-based solutions would most effectively
address these challenges, Manitoba Health and
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Chapter 3 — Manitoba
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. As a result, both
short and medium to long-term strategies to enact
system changes were developed. 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 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.
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.
Manitoba Health and Healthy Living announced
a plan in February 2007 to provide increased access
to sleep disorder testing and treatment through
a centralized intake and referral process, and the
expansion of the sleep testing program.
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 Wait Time Task Force established the Manitoba
Patient Access Network 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.
114
5.3 Access to Insured Physician and
Surgical-Dental Services
In 2006–2007, 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 foreign-trained physicians.
The co-ordinated process, administered through the
Physician Resource Coordination Office (PRCO), is
aimed at avoiding duplication of effort, while introducing future physician candidates to opportunities
available in Manitoba.
The province 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 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 assessment, candidates
may be recommended for conditional licensure and
upon commencement of practice are linked with
a physician mentor for a minimum of 12 months.
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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
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 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. Since 2001, Manitoba
has supported an expansion in medical school
class sizes, which continues in 2006 with the first
year enrolment for the fall of this year reaching
101 students.
The Manitoba Telehealth Network under the
leadership of the Winnipeg Regional Health
Authority has implemented the infrastructure to
link 23 Telehealth sites across the province. 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
the north to Winnipeg. In September 2002,
Manitoba Health and Healthy Living launched
the new Manitoba Telehealth site at St. Boniface
General Hospital, officially linking its medical
specialists to patients and colleagues province-wide.
Canada Health Act Annual Report, 2006–2007
5.4 Physician/Dentist Compensation
Manitoba continues to employ the following
methods of payment for physicians: fee-for-service,
salaried, sessional and blended.
The Health Services Insurance Act governs payment
to physicians for insured services. There were no
amendments to the Health Services Insurance Act
(HSIA) related to physician compensation during
the 2006–2007 fiscal year.
Fee-for-service remains the dominant method of
payment for physician services. Notwithstanding,
alternate payment arrangements constitute a significant portion of the total compensation to physicians
in Manitoba. Alternate-funded physicians are those
who receive either a salary (employer-employee relationship) or those who work on an independent
contract basis. Manitoba also uses blended payment
methods to “top-up” the wages of physicians whose
fee-for-service income may not be competitive,
yet whose services remain vital to the province.
As well, physicians may receive sessional payments
for providing medical services, as well as stipends
for on-call responsibilities.
Representatives from the Manitoba Medical
Association (MMA) and Manitoba Health and
Healthy Living typically negotiate compensation
agreements for physicians.
The June 27, 2005, settlement, effective April 1, 2005
to March 31, 2008, maintained the terms of the
June 2, 2002, Arbitration Agreement(subsequently
entrenched in the 2003–2005 MMA-Manitoba
Heath and Healthy Living Agreement), including:
the continuation of a Physician Retention Fund
($5 million per annum over the duration of this
agreement as well as the subsequent agreement);
the continuation of the Professional Liability
Insurance Fund ($5 million per annum for 2006
through to 2011);
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Chapter 3 — Manitoba
the continuation of the Continuing Medical
Education Fund ($2 million per annum from
2006 through 2011);
increased incentives for family doctors to provide
full-service care and to maintain hospital privileges; and,
the continuation of a Maternity/Parental Benefits
Fund ($1 million per annum from 2005 through
to 2011);
increases to the rates for physicians under alternate funding agreements in the amount of
2.5 percent effective April 1, 2005; 2.5 percent
effective April 1, 2006; and 2.5 percent effective
April 1, 2007 (non-compounded); were also
applied over and above the fee-for-service increase.
a mechanism to initiate arbitration proceedings
with respect to a subsequent agreement, if notice
is given by either party by January 1, 2007;
that physicians covered by the Agreement shall
refrain from stopping work or curtailing services
and to continue to provide services without
interruption; and
continuation of the Grievance Arbitration
procedure set forth in the March 8, 1994, FeeFor-Service Agreement between the parties.
The highlights of the June 27, 2005, Negotiated
Settlement include:
a three-year term from April 1, 2005 to
March 31, 2008;
an overall increase of 7.5 percent (non-compounded) to the Fee-For-Service Schedule of
Benefits, as well as alternate-funded agreements
and arrangements);
2.5 percent effective April 1, 2005
2.5 percent effective April 1, 2006
2.5 percent effective April 1, 2007
an additional $10 million was applied to the
schedule of benefits through a Shoring Up Fund
and an additional $5.5 million was applied to
outstanding fee-for-service issues through the
Exceptional Issues Fund;
an additional $5 million was applied to alternate
funding contracts though the Alternate Funding
Shoring Up Fund;
an extension of maternity and parental benefits
to all Manitoba physicians, including interns and
residents continued;
116
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.
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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
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 2006–2007 had an effect on payments
to hospitals.
6.0 Recognition Given to
Federal Transfers
Manitoba routinely recognizes the federal role
regarding the contributions provided under
the Canada Health Transfer (CHT) in public
documents. Federal transfers are identified in the
Estimates of Expenditures and Revenue (Manitoba
Budget) document and in the 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
Canada Health Act Annual Report, 2006–2007
Health Care (the 2004 Health Accord—Wait Time
Reduction Fund) in funding letters to the Regional
Health Authorities and other organizations who are
implementing programs using this funding.
7.0 Extended Health
Care Services
Manitoba has established community-based service
programs as appropriate alternatives to hospital
services. These service programs are funded by
Manitoba Health and Healthy Living through
the Regional Health Authorities. The services
include the following:
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 2 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. Total Manitoba Health and
Healthy Living operating funding during the fiscal
year 2006–07 was $450,638,599. This funding
supported the delivery of insured personal care services in a total of 9,832 personal care home beds
plus a total of 177 chronic care beds, 30 palliative
care beds, and 149 rehabilitation beds. A 35 bed
personal care home servicing the north opened with
5 beds designated for behavioural management of
adult brain injuries. In addition, Manitoba Health
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Chapter 3 — Manitoba
and Healthy Living provided $26,284,000 in capital
funding for approved capital projects and safety and
security upgrades.
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 multidisciplinary
assessment of individual needs. Home Care case
co-coordinators conduct assessments and develop
individual care plans, which may include self or
family Managed Care, personal care assistance,
household maintenance, professional health care,
in-home family relief, facility-based respite care,
some supplies and equipment, access to adult day
programs, and/or access to support services to seniors’
programs that coordinate volunteers, congregate
meal programs, transportation, emergency response
systems and other activities that support continued
independent community living.
Mental Health and Addictions Services: Regional
Health Authorities provide in-patient, out-patient
and community mental health services. The exception to this is that Manitoba Health and Healthy
Living funds and provides mental health self-help
and the provincial mental health centre. Community
Mental Health Workers provide assessment, service
planning, short-term counselling 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 and, the Program for Assertive Community
Treatment teams and the Early Psychosis Prevention
and Intervention Service.
118
Addictions services and supports are provided
through provincially funded agencies. They include
the Addictions Foundation of Manitoba (AFM),
The Behavioural Health Foundation, Salvation
Army—Anchorage, Native Addictions Council of
Manitoba, Tamarack, Laurel Centre, Esther House,
Addictions Recovery Inc., Youth Centralized Intake,
Youth Stabilization and outreach. 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, the Winnipeg Regional
Health Authority funds two detox programs and
the Norman Regional Health Authority funds a
residential treatment agency for adults.
Primary Health Care:
One of Manitoba Health’s strategic priorities is the
need to address primary care renewal. The goals for
the upcoming years are:
improved access to primary care services,
development of multidisciplinary 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.
In order to fulfill these goals, work was accomplished
in the following areas:
Two awareness workshops on Advanced Access were
held to acquaint primary care physicians and their
staff with Advanced Access and its benefits. The
response was significant with the majority of
the participants willing to learn more. Plans are
underway to work with committed clinics in the
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
implementation and spread of Advanced Access
within the province.
Two Physician Manager Institutes (PMI), developed
and sponsored by the Canadian Medical Association,
were hosted by the Primary Health Care Branch and
each were attended by approximately 40 physicians.
The Primary Health Care Transition Fund provided
many lessons for the development and effective
functioning of inter-disciplinary teams. The need
to ensure that practitioners are prepared and ready
to work in teams is essential. Facilitation workshops
were held with regional personnel to give team
managers the skills and tools to facilitate the development of high performance teams. A blueprint or
framework to look at a province wide implementation
of interprofessional collaborative teams is underway.
The Primary Care Information Systems Steering
Committee was struck to provide guidance for
practitioners choosing Primary Care systems, remove
roadblocks to adoption of Primary Care systems,
and reduce the cost and improve the management
of Primary Care System/EHR inter-operability.
Work is ongoing.
Another key strategy includes the development
of Physician Integrated Network (PIN) which has
been evolving under the guidance of an Advisory
Committee with representation from the University
of Manitoba; the Colleges of Registered Nurses and
Physicians & Surgeons of Manitoba; the Manitoba
Medical Association; the Winnipeg and Assiniboine
Regional Health Authorities and other primary care
stakeholders.
The Physician Integrated Network initiative focuses
on the engagement of fee-for-service physician groups.
The objectives of this initiative are to improve access
to primary care, to improve primary care providers’
access to and use of information systems, to improve
the working environment for all primary care providers, and to demonstrate high quality care with a
specific focus on chronic disease management.
Canada Health Act Annual Report, 2006–2007
Through the PIN initiative three clinics—Agassiz
(Morden), Wiebe (Winkler) and Assiniboine
(Winnipeg)—have been identified as demonstration
sites to implement practice changes and are remunerated based on quality targets. One clinic (Steinbach)
will provide data on the same quality indicators, as a
control site.
All four clinics already have EMR systems. However,
system and usage changes are necessary to provide
the required data. Each clinic is expected to provide
information management deliverables, which
include: detailed indicator definitions, extract file
specifications, report specifications, tested extract
and report, data entry procedures, training.
One unique component of the PIN initiative is the
development of Quality Based Incentive Funding
(QBIF). The purpose behind QBIF was the desire
of family physicians and funders to stabilize funding
while also supporting quality primary care. PIN is
addressing this through the exploration of blended
funding (FFS combined with QBIF). PIN QBIF
funding is linked to performance on selected clinical
process indicators.
An additional initiative to support primary care
renewal is supporting the integration of nurse
practitioners into primary care in order to improve
access to primary care services and to support the
implementation of multidisciplinary teams. The
Registered Nurse (Extended Practice) Regulation
was enacted in 2005, and 32 were registered by the
end of 2006. 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
new RN(EP) positions, provide a bursary for
nurse practitioner study and to provide supports
for successful integration of this new practitioner.
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Chapter 3 — Manitoba
Manitoba introduced regulated and funded midwifery services in 2000. Midwives provide primary
care for women and newborns, including wellwoman care. The province provides funding for
midwifery services to 6 of 11 Regional Health
Authorities. Just over half of midwifery services are
provided outside the Winnipeg Region; including
rural, northern and remote communities. In some
rural and northern communities, midwives provide
care for up to 30% of births; provincially for 5%
of births. Homebirth services are provided for 20%
of midwifery clients; 1% of provincial births. Service
120
is focused on priority populations, representing over
65% of midwifery clients; including those at high
social risk such as substance abusers. The program
provides comprehensive, community-based care, and
has significantly lower rates of pre-term birth, high
and low birth weights. Significant human resource
needs in midwifery are being addressed by a new
Bachelor of Midwifery (Aboriginal Midwifery) program through University College of the North, and
participation with other jurisdictions in development
of a bridging program for internationally educated
midwives.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Manitoba
Registered Persons
1.
Number as of March 31st (#).
2
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
1,156,217
1,159,784
1,169,667
1,173,815
1,178,457
2005–2006
2006–2007
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2002–2003
2003–2004
2004–2005
92
5
not available
not available
97
92
5
not available
not available
97
98
3
not available
not available
98
1,148,652,940
107,840,132
not available
not available
not available
1,220,253,362
117,642,127
not available
not available
not available
1,400,448,441
96,364,992
not available
not available
not available
1,488,094,835
71,117,677
not available
not available
not available
1,515,237,203
75,250,507
not available
not available
not available
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
1
0
1
1
0
1
1
0
1
1
0
1
1
0
1
not available
0
not available
1,252,657
0
1,252,657
1,290,989
0
1,290,989
1,305,132
0
1,305,132
1,292,830
0
1,292,830
3
4
98
3
not available
not available
98
3
4
95
2
2
1
97
3
4
4
5
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
2,714
2,928
3,036
2,995
2,806
12,918,117
16,290,426
15,393,378
19,153,208
19,431,036
26,059
31,100
24,057
29,685
30,357
3,783,059
4,369,889
3,896,789
5,670,133
6,306,240
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
569
418
540
569
589
1,847,910
1,348,148
1,085,650
1,455,908
1,294,963
6,025
6,069
6,170
6,690
7,673
914,251
1,216,073
1,112,466
1,325,062
1,695,844
2.
The population data is based on records of residents registered with Manitoba Health as of June 1.
3.
95 submitting Acute facilities includes 22 Nursing Stations and 2 Federal Hospitals
4.
One Acute facility has been given a rehab institution submitting number: Riverview Health Centre. Deer Lodge is no longer a submitting acute
care facility, and therefore only counted as rehab and chronic.
5.
Manitoba Adolescent Treatment Centre
Canada Health Act Annual Report, 2006–2007
121
Chapter 3 — Manitoba
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
954
1,010
not applicable
1,964
959
980
not applicable
1,939
979
1,008
not applicable
1,987
981
1,035
not applicable
2,016
971
997
not applicable
1,968
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
521,611,200
not available
559,271,513
not available
601,240,469
not available
653,290,519
not available
700,465,401
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
15,940,720
365,794,499
16,268,844
384,547,781
16,578,401
415,749,772
17,466,368
442,485,124
16,794,320
438,813,332
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
212,795
210,294
209,152
228,090
248,900
7,691,159
7,579,028
8,109,229
8,966,703
9,997,409
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
5,826
5,324
5,714
6,138
6,486
607,066
519,782
426,937
608,524
541,403
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
122
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
116
102
114
115
122
3,455
3,498
3,774
3,863
4,205
714,590
750,122
875,657
936,091
984,621
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
the development and distribution of a booklet on
depression and suicide in youth, and a brochure
about the children’s mental health services plan;
Saskatchewan
Introduction
In 2006–07, The Action Plan for Saskatchewan
Health Care continued to guide the work of
Saskatchewan Health. Saskatchewan is committed
to strengthening its health care system, retaining
and recruiting health care providers, providing
timely access to quality services and planning for
sustainability of a system that continues to face
increasing demands for services.
The Action Plan provides a clear picture of the
government’s health care priorities and plans and
is available to the public at:
www.health.gov.sk.ca
The following examples highlight key actions that
were accomplished by Saskatchewan Health during
the 2006–07 year.
Infrastructure projects such as the planning for the
Muskeg Lake Cree Nation Diabetes Centre and
the new Saskatchewan Disease Control Laboratory
at the Regina Research Park are underway. In addition the Cypress Regional Hospital, a new 89-bed
regional hospital in Swift Current was completed
in April 2007. Construction continued on the Ile
a la Crosse joint use facility, providing 11 inpatient
rooms, 17 long-term care rooms, community and
public services, as well as a share of community
spaces attached to a high school and day care.
Saskatchewan Health worked with its many partners
to develop a plan for children’s mental health services
in Saskatchewan, as recommended by the Children’s
Advocate. Several initiatives under the plan were
accomplished including:
Canada Health Act Annual Report, 2006–2007
filling positions such as the psychologist position
for distance specialist consultation for southern
Saskatchewan, the social work/psychology positions (3) for family-based therapeutic residential
services for youth with mental disorders in Moose
Jaw, Prince Albert and Lloydminster, and the
social work position to provide children’s mental
health services in the Melfort, Nipawin, Tisdale
region; and
additional mental health outreach and respite
services are being provided.
Substance abuse prevention and treatment options
for youth and families continue to be addressed.
The Youth Drug Detoxification and Stabilization Act
was proclaimed on April 1, 2006. Six interim beds
were opened at the Secure Youth Detoxification
Centre in Regina; youth outreach and associated
services related to the Act are being implemented
in each of the 12 regional health authorities and
the Athabasca Health Authority; and mobile treatment is being delivered in northern Saskatchewan
communities.
Saskatchewan Health continues to put emphasis
on reducing wait times for diagnostic and surgery
services and on ensuring the best possible patient
outcomes are achieved.
A new radiology information system and picture
archiving communication system will securely
schedule, store and quickly transmit digital images
between health facilities, enabling authorized care
givers to view and/or consult on studies without
having to transport patients. The systems will reduce
costs and delays for patients and the health system.
The Saskatoon and Regina Qu’Appelle Regional
Health Authorities will be the first to implement
the Radiology Information System, followed by
mid-sized regions.
Between March 31, 2006 and March 31, 2007,
the number of patients waiting for surgery in
123
Chapter 3 — Saskatchewan
Saskatchewan’s seven largest regional health authorities decreased by more than 2,600, and the number
on the registry who have been waiting longer than a
year for their surgery decreased by more than 1,200.
Working Together: Saskatchewan’s Health Workforce
Action Plan, released in December 2005, set out
a plan to improve health care in Saskatchewan by
keeping and attracting health care professionals.
Recruitment and retention of our healthcare professionals remains a top priority. A $25 million
retention and recruitment fund was put in place
in September 2006 - a three-year initiative to retain
and recruit health professionals in Saskatchewan.
The Health Workforce Steering Committee and
a Provincial Nursing Committee were formed to
advise on the development, implementation and
evaluation of recruitment and retention initiatives.
Included under this fund is a $6 million relocation
and recruitment grant program to encourage health
providers to move to Saskatchewan and work in
rural, northern and hard-to-recruit positions, as well
as a $6 million retention grant program for retention
projects focused on keeping health providers in
Saskatchewan. In addition, Saskatchewan Health
developed and launched a provincial recruitment
agency and website:
www.HealthCareersinSask.ca.
Saskatchewan Health has a mandate to support
Saskatchewan residents in achieving their best
possible health and well-being. It carries out this
mandate by establishing policy direction, setting
and monitoring standards, providing funding,
supporting regional health authorities, and ensuring
the provision of essential and appropriate services
to Saskatchewan residents.
In 2006–07, the government budgeted $3.189 billion
for health care. This represents an increase of 10.2 per
cent or $295.6 million over the previous year.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The provincial government is responsible for
funding and ensuring the provision of insured
hospital, physician and surgical-dental services
in Saskatchewan. Section 6.1 of The Department
of Health Act authorizes that the Minister of
Health may:
pay part of, or the whole of, the cost of providing
health services for any persons or classes of person who may be designated by the Lieutenant
Governor in Council;
make grants or loans or provide subsidies
to regional health authorities, health care
organizations or municipalities for providing
and operating health services or public health
services;
pay part of or the whole of the cost of providing
health services in any health region or part of
a health region in which those services are considered by the Minister to be required;
make grants or provide subsidies to any health
agency that the Minister considers necessary; and
make grants or provide subsidies to stimulate and
develop public health research and to conduct
surveys and studies in the area of public health.
Sections 8 and 9 of The Saskatchewan Medical Care
Insurance Act provide the authority for the Minister
of Health to establish and administer a plan of
medical care insurance for residents. The Regional
Health Services Act provides the authority to establish
12 regional health authorities, replacing the former
32 district health boards.
Sections 3 and 9 of The Cancer Agency Act provide
for establishing a Saskatchewan Cancer Agency
and for the Agency to coordinate a program for
diagnosing, preventing and treating cancer.
124
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
The mandates of the Department of Health, regional
health authorities and the Saskatchewan Cancer
Agency for 2006–07 are outlined in The Department
of Health Act, The Regional Health Services Act and
The Cancer Agency Act.
1.2 Reporting Relationship
The Department 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.
Section 36 of The Saskatchewan Medical Care
Insurance Act prescribes that the Minister of Health
submit an annual report concerning the medical
care insurance plan to the Legislative Assembly.
The Regional Health Services Act prescribes that
a regional health authority shall submit to the
Minister of Health:
a report on the activities of the regional health
authority; and
a detailed, audited set of financial statements.
Section 54 of The Regional Health Services Act
requires that regional health authorities and the
Cancer Agency shall submit to the Minister any
reports that the Minister may request from time
to time. Regional health authorities and the
Cancer Agency are required to submit a financial
and health service plan to Saskatchewan Health.
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.
The Provincial Auditor’s Office of Saskatchewan
also prepares reports to the Legislative Assembly of
Saskatchewan. These reports are designed to assist
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
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
Canada Health Act Annual Report, 2006–2007
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.
125
Chapter 3 — Saskatchewan
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 surgi-cal 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).
Funding for hospitals is included in the funding
provided to regional health authorities.
As of March 31, 2007, 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
126
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.
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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
well as external stakeholder groups such as health
regions, service providers and the public.
Medical Care Insurance Payment Regulations (1994)
of The Saskatchewan Medical Care Insurance Act.
2.2 Insured Physician Services
There were approximately 3,300 different insured
physician services as of March 31, 2007.
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/physician-information
The Saskatchewan Health Medical Services Branch
2006–2007 Annual Statistical Report is available on
the website:
www.health.gov.sk.ca/msb-annual-reports.html
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
Department of Health without extra-billing for
insured services.
As of March 31, 2007, there were 1,753 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, must fully
opt out of all insured physician services. The optedout physician must also advise beneficiaries that the
physician services to be provided are not insured and
that the beneficiary is not entitled to be reimbursed
for those services. Written acknowledgement from
the beneficiary indicating that he or she understands
the advice given by the physician is also required.
As of March 31, 2007, 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 Department of Health and are listed in
the Physician Payment Schedule of The Saskatchewan
Canada Health Act Annual Report, 2006–2007
A process of formal discussion between the Medical
Services Plan and the Saskatchewan Medical Association addresses new insured physician services and
definition or assessment rule revisions to existing
selected services (modernization) with significant
monetary impact. The Executive Director of the
Medical Services Branch manages this process.
When the Medical Services Plan covers a new
insured physician service or significant revisions
occur to the Physician Payment Schedule, a
regulatory amendment is made to the Physician
Payment Schedule.
Although formal public consultations are not held,
any member of the public may make recommendations about physician services to be added to
the Plan.
2.3 Insured Surgical-Dental Services
Dentists registered with the College of Dental
Surgeons of Saskatchewan and designated by the
College as specialists able to perform dental surgery
may provide insured surgical-dental services under
the Medical Services Plan. As of March 31, 2007,
74 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, 2007.
127
Chapter 3 — Saskatchewan
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.
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
128
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 surgicaldental 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 Department of Health.
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 2006–07.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
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.
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.
The following persons are not eligible for insured
health services in Saskatchewan:
members of the Canadian Forces and the Royal
Canadian Mounted Police (RCMP), federal
inmates and refugee claimants; visitors to the
province; and
Canada Health Act Annual Report, 2006–2007
persons eligible for coverage from their home
province or territory for the period of their stay
in Saskatchewan (e.g., students and workers
covered under temporary absence provisions
from their home province or territory).
Such people become eligible for coverage as follows:
discharged members of the Canadian Forces
and the RCMP, if stationed in or resident in
Saskatchewan on their discharge date;
released federal inmates (this includes those
prisoners who have completed their sentences
in a federal penitentiary and those prisoners
who have been granted parole and are living
in the community); and
refugee claimants, on receiving Convention
Refugee status (immigration documentation
is required).
3.2 Registration Requirements
The following process is used to issue a health
services card and to document that a person is
eligible for insured health services:
every resident, other than a dependent child
under 18 years, is required to register;
registration should take place immediately
following the establishment of residency in
Saskatchewan;
registration can be carried out either in person
in Regina or by mail;
each eligible registrant is issued a plastic health
services card bearing the registrant’s unique lifetime nine-digit health services number; and
cards are renewed every three years. (Current
cards expire in December 2008.)
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.
129
Chapter 3 — Saskatchewan
The number of persons registered for health services
in Saskatchewan on June 30, 2006 was 1,003,231.
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, 2006, there were 5,642 such temporary
residents registered with Saskatchewan Health.
4.0 Portability
4.1 Minimum Waiting Period
In general, insured persons from another province
or territory who move to Saskatchewan are eligible
on the first day of the third month following establishment of residency. However, where one spouse
arrives in advance of the other, the eligibility for
the later arriving spouse is established on the earlier
of a) the first day of the third month following
arrival of the second spouse; or b) the first day of
the thirteenth month following the establishment
of residency by the first spouse.
4.2 Coverage During Temporary Absences
in Canada
Section 3 of The Medical Care Insurance Beneficiary
and Administration Regulations of The Saskatchewan
Medical Care Insurance Act prescribes the portability
130
of health insurance provided to Saskatchewan
residents while temporarily absent within Canada.
There were no changes to the in-Canada temporary
absence provisions in 2006–07.
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:
education: for the duration of studies at a
recognized educational facility (written confirmation by a Registrar of full-time student
status is required annually);
employment of up to 12 months (no documentation required); and
vacation and travel of up to 12 months.
Section 6.6 of The Department of Health Act provides
the authority for paying in-patient hospital services
to Saskatchewan beneficiaries temporarily residing
outside the province. Section 10 of The Saskatchewan
Medical Care Insurance Payment Regulations
(1994) provides payment for physician services
to Saskatchewan beneficiaries temporarily residing
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.
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 2006–07, expenditures for insured physician
services in other provinces were $24.24 million.
Insured hospital services in other provinces were
$48.40 million.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
4.3 Coverage During Temporary Absences
Outside Canada
4.4 Prior Approval Requirement
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.
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.
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:
education: for the duration of studies at a recognized educational facility (written confirmation
by a Registrar of full-time student status is
required annually);
Out-of-Province
Prior approval is required for the following services
provided out-of-province:
alcohol and drug, mental health and problem
gambling services; and
cataract surgery services, bone densitometry and
non-urgent MRI.
contract employment of up to 24 months
(written confirmation from the employer is
required); and
Prior approval from the Department must be
obtained by the patient’s specialist.
vacation and travel of up to 12 months.
Out-of-Country
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).
Prior approval is required for the following services
provided outside Canada:
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.
If a specialist physician refers a patient
outside Canada for treatment not available
in Saskatchewan or another province, the
referring specialist must seek prior approval
from the Medical Services Plan of Saskatchewan
Health. The Saskatchewan Cancer Agency is
consulted for out-of-country cancer treatment
requests. If approved, Saskatchewan Health
will pay the full cost of treatment, excluding
any items that would not be covered in
Saskatchewan.
In 2006–07, $2.47 million was paid for in-patient
hospital services and $1.02 million was spent on
out-patient hospital services outside Canada. In
2006–07, expenditures for insured physician
services outside Canada were $692,600.
Canada Health Act Annual Report, 2006–2007
131
Chapter 3 — Saskatchewan
5.0 Accessibility
Aboriginal people fully participate in the
health sector in all health occupations.
5.1 Access to Insured Health Services
The education and training supply of
Saskatchewan health care professionals
is aligned with projected workforce
requirements and health service needs.
To ensure that access to insured hospital, physician
and surgical-dental services are not impeded or
precluded by financial barriers, extra-billing by
physicians or dental surgeons and user charges by
hospitals for insured health services are not allowed
in Saskatchewan.
The Saskatchewan Human Rights Code prohibits
discrimination in providing public services, which
include insured health services on the basis of race,
creed, religion, colour, sex, sexual orientation, family
status, marital status, disability, age, nationality,
ancestry or place of origin.
5.2 Access to Insured Hospital Services
As of March 31, 2007, Saskatchewan had 3,092
staffed hospital beds in 66 acute care hospitals,
including 2,497 acute care beds, 213 psychiatric
beds and 382 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.
Saskatchewan’s Health Workforce Action Plan
Working Together: Saskatchewan’s Health Workforce Action Plan was released in December 2005.
Extensive consultations took place with stakeholders
in developing the plan. The Plan contains 5 goals,
including:
The health care system has a sufficient number
and effective mix of health care professionals who
are used fully to provide safe, high-quality care.
The health system has safe, supportive, and
quality workplaces that help to retain and
recruit health care professionals.
132
The health workforce is innovative, flexible
and responsive to changes in the health system.
A copy of Working Together: Saskatchewan’s
Health Workforce Action Plan can be found at:
www.health.gov.sk.ca. In the last year, significant
recruitment, retention and training initiatives
were undertaken:
A $25 million recruitment and retention fund
was announced in the fall of 2006. $15 million
dollars was targeted at nursing recruitment and
retention programs, while $10 million was earmarked for recruitment and retention programs
focused on allied health professionals.
Two committees were also established to provide
direction and advice related to this funding and
to the actions outlined in the Workforce Action
Plan. These two committees, the Provincial
Health Workforce Steering Committee and the
Provincial Nursing Committee, bring together
the health partners that helped develop the
Workforce Action Plan.
The establishment of HealthCareersInSask,
a provincial recruitment agency supporting
the regional health authorities and the
Saskatchewan Cancer Agency in filling
health professional vacancies.
The establishment of a $6 million Relocation
and Northern/Rural/Hard to Recruit Grant
Program.
The development and implementation of
a $6 million Health Workforce Retention
Program.
An increase in the number of training seats available in Saskatchewan for physicians and nurses
(registered nurses and licensed practical nurses).
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
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 2006,
approximately 5,000 new patients began treatment
for cancer. Both centres provided approximately
39,000 radiation therapy treatments and 18,000
chemotherapy treatments to cancer patients in
Saskatoon and Regina.
Supply of Health Providers
In looking at the trend of selected health professionals,
the majority of Saskatchewan’s health professionals
have increased between 1995 and 2005 (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:
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 2006, over 1,000
patients made approximately 6,200 visits to COPS
centres for treatment.
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.
Table 1: Selected Health Professionals, Saskatchewan and Canada*
Saskatchewan
Canada
Occupations
1997
2000
Chiropractors
14
16
Dental Hygienists
27
2001
2002
2003
2004
2005
2005
16
18
18
18
19
22
27
30
30
34
34
35
57
Dentists
34
34
35
35
38
38
37
58
Dietitians
n/a
n/a
22
23
24
25
25
25
Licensed Practical Nurses
214
151
n/a
199
207
214
221
200
Occupational Therapists
n/a
n/a
n/a
20
21
22
22
35
Optometrists
11
11
11
11
11
11
12
12
Pharmacists
105
109
111
107
115
118
119
91
48
52
52
51
53
53
54
49
7
823 ~
7
n/a
n/a
n/a
41
42
45
838
808
818
855
854
863
776
Physiotherapists
Psychologists
Registered Nurses
*
Rates per 100,000 population.
n/a
Data not available.
~
Datum was for 1998.
Source: Health Care Indicators, Canadian Institute for Health Information (CIHI): 2000 to 2007.
Note: Comparing the number of professionals per 100,000 population may not provide a good comparison,
as it does not recognize the different ways health services are delivered.
Canada Health Act Annual Report, 2006–2007
133
Chapter 3 — Saskatchewan
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.
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 2006–07
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 2006–07, approximately 14,425 patients
received MRI services and approximately 69,240
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, 2007 this had increased to 1,140.
134
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
and tracking follow-up of unsatisfactory and
abnormal test results. In 2006 the program sent
out 112,500 result notices and 260,000 notification/information letters.
The Provincial Malignant Hematology/Stem Cell
Transplant Program continues to provide transplants to Saskatchewan residents. In 2006–07,
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 hematology 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 2006–07 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
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
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.
Canada Health Act Annual Report, 2006–2007
Saskatchewan Health is currently working closely
with members of the health regions, physicians and
other health partners to maximize access to diagnostic imaging services in Saskatchewan. The focus is on
improving access to specialized diagnostic services
(MRI, CT), while at the same time providing a basis
for improved, sustainable health delivery in the future.
On January 31, 2005, the Minister of Health
announced the establishment of a Diagnostic
Imaging Network. This Network is a partnership
among clinicians, service providers, regional health
authorities, regulatory agencies, health training
institutions, community and government representatives, that works toward the goal of ensuring
equitable access to quality diagnostic imaging
services in Saskatchewan. Through collaboration
with participating partners, the Network acts as
a provincial advisory body to assist in provincewide 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.
Development and implementation of 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.
135
Chapter 3 — Saskatchewan
A Provincial Decision Support Tool pilot project:
A decision support tool for diagnostic imaging
will assist the referring physician in ordering
the right test the first time by incorporating
evidence-based guidelines for radiology into a
quick, user friendly electronic order entry tool.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2007, there were 1,753 physicians
licensed to practice in the province and eligible to
participate in the Medical Care Insurance Plan. Of
these, 1,003 (57.2 percent) were family practitioners
and 750 (42.8 percent) were specialists.
As of March 31, 2007, there were approximately
380 practising dentists and dental surgeons located
in all major centres in Saskatchewan. Seventyfour provided services insured under the Medical
Services Plan.
A number of new or continuing initiatives were
underway in 2005–2006 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 practicing 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 return-of-service commitment.
136
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 $18,000 to Canadian-trained or
landed immigrant physicians who establish new
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
The Saskatchewan Medical Association is funded
to provide locum relief to rural physicians through
the Locum Service Program while they take vacation, education or other leave.
The Northern Medical Services Program is a tripartite endeavour of Saskatchewan Health, Health
Canada and the University of Saskatchewan
to help stabilize the supply of physicians in
northern Saskatchewan.
The Rural Extended Leave Program supports
physicians in rural practice who want to upgrade
their skills and knowledge in areas such as anaesthesia, obstetrics and surgery by reimbursing
educational costs and foregone practice income
for up to six weeks.
The Rural Travel Assistance Program provides
travel assistance to rural physicians participating
in educational activities.
The Northern Telehealth Network provides
physicians in remote or isolated areas with
access to colleagues, specialty expertise and
continuing education.
Other Programs:
Support is provided to initiatives for physicians
to use allied health professionals and enhance
the integration of medical services with other
community-based services through the Alternate
Payments and Primary Health Services Program.
A Long-term Service Retention Program rewards
physicians who work in the province for 10 or
more years.
The Parental Leave Program was developed
in 2004 to provide benefits for self-employed
physicians who take a maternity, paternity or
adoption child care leave from clinical practice.
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:
Canada Health Act Annual Report, 2006–2007
a Medical Compensation Review Committee
is established within 15 days of either the
Saskatchewan Medical Association or the
government providing notice to begin
discussing a new agreement;
each party shall appoint no more than six
representatives to the Committee;
the objective of the Committee is to prepare
an agreement respecting insured services that
is satisfactory to both parties;
in the case that a satisfactory agreement cannot
be reached, the matter may be referred to the
Medical Compensation Review Board, consisting
of an appointee by either party who in turn select
a third member; and
the Board has the authority to make a decision
binding on the parties.
The latest three-year agreement with the Saskatchewan
Medical Association, which 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.
137
Chapter 3 — Saskatchewan
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
2006–07 amounted to $586.6 million: $369.3 million for fee-for-service billings; $20.8 million for
Emergency Coverage Programs; $164.2 million in
non-fee-for-service expenditures; and $32.4 million
for Saskatchewan Medical Association programs as
outlined in the agreement.
6.0 Recognition Given to
Federal Transfers
5.5 Payments to Hospitals
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.
In 2006–07, 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.
138
The Government of Saskatchewan publicly
acknowledged the federal contributions provided
through the Canada Health Transfer (CHT) in the
Department of Health 2006–07 Annual Report,
the Government of Saskatchewan 2006–07 Annual
Budget and related budget documents, its 2006–07
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.
7.0 Extended Health
Care Services
As of March 31, 2006, 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
regional health authorities and are governed by The
Housing and Special-care Homes Act and regulations.
Public Health Services of regional health authorities
provide immunization for residents in long-term care
facilities and other similar residential facilities under
the provincial immunization program. Saskatchewan
Health purchases the vaccines and provides them
free of charge to Public Health Services. This applies
to influenza and pneumococcal vaccines.
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 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.
Canada Health Act Annual Report, 2006–2007
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.
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
139
Chapter 3 — Saskatchewan
regional health authorities contract with communitybased and non-profit organizations governed by The
Non-profit Corporations Act to provide services.
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
140
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, 2006–2007
Chapter 3 — Saskatchewan
Registered Persons
1.
Number as of March 31st (#).
1
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
1,024,827
1,007,753
1,018,057
1,021,080
1,003,231
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.
2003–2004
2004–2005
2005–2006
2006–2007
65
0
1
0
66
6
0
1
0
67
65
0
1
66
66
1
1
66
67
67
not available
not applicable
not available
not applicable
not available
811,561,671
not applicable
not available
not applicable
811,561,671
2
4
867,261,000
not applicable
not available
not applicable
867,261,000
2
4
922,675,000
not applicable
not available
not applicable
922,675,000
2
4
2
1,173,115,000
not applicable
not applicable
not applicable
1,173,115,000
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4.
2002–2003
3
4
3
1.
Saskatchewan’s numbers are for June 30.
2.
This number includes estimated government funding to Regional Health Authorities (RHAs) based on total projected expenditures less
non-government revenue, as provided to Saskatchewan Health through the RHA annual operational plans.
– Acute care funding includes: acute care services, specialized hospital services, and in-hospital specialist services.
– Does not include inpatient rehabilitative care, inpatient mental health, or addiction treatment services.
– Does not include payments to Saskatchewan Cancer Agency for outpatient chemotherapy and radiation.
3.
Comparable annual information is not available at this time.
4.
This number is based on audited operating expenditures of Regional Health Authorities (RHAs), as published in Saskatchewan Health’s annual
report. As the majority of funding for actue care is provided by the Ministry, the use of actual expenditures rather than budget (RHA operational
plans) reflects more accurately the funding provided by the Province.
– Acute care funding includes: acute care services, specialized hospital services, and in-hospital specialist services.
– Does not include inpatient rehabilitative care, inpatient mental health, or addiction treatment services.
– Does not include payments to Saskatchewan Cancer Agency for outpatient chemotherapy and radiation.
Canada Health Act Annual Report, 2006–2007
141
Chapter 3 — Saskatchewan
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
4,422
4,561
4,307
4,566
4,627
23,447,100
30,528,100
30,461,943
33,671,100
36,828,100
50,401
45,510
51,678
55,067
52,591
7,144,800
6,405,900
9,345,190
11,044,200
11,573,400
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
287
231
254
248
242
1,891,800
728,400
730,849
2,033,300
2,473,400
1,049
875
1,002
1,194
1,454
359,400
373,300
251,957
1,486,500
1,019,500
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
936
700
0
1,636
946
716
0
1,662
967
718
0
1,685
990
729
0
1,719
1,003
750
0
1,753
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
not available
421,709,330
not available
449,108,573
not available
491,805,817
not available
528,759,380
not available
554,193,389
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
10,269,461
290,471,821
9,933,689
304,538,785
9,970,606
337,816,629
10,033,881
362,884,810
9,944,187
369,664,529
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
142
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Saskatchewan
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
458,100
509,784
513,694
542,651
603,687
16,948,900
19,477,300
20,379,200
20,541,894
24,239,622
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
not available
not available
not available
not available
not available
1,129,300
583,200
510,600
695,900
692,600
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
Canada Health Act Annual Report, 2006–2007
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
94
94
84
78
74
18,500
18,300
19,400
18,511
18,203
1,264,200
1,345,900
1,442,800
1,539,420
1,511,882
143
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Canada Health Act Annual Report, 2006–2007
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, 2006–2007
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/
Minister_legislation.html
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Chapter 3 — Alberta
Significant Events in 2006/2007
In 2006/2007, 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:
The new overarching mental health framework,
entitled Positive Futures — Optimizing Mental
Health for Alberta's Children and Youth: A
Framework for Action (2006–2016), was released.
The Newborn Metabolic Screening Program was
expanded to include screening for 17 additional
disorders such as cystic fibrosis.
The Alberta Provincial Stroke Strategy was
launched. The strategy is a partnership between
the provincial government, regional health
authorities and the Alberta Heart and Stroke
Foundation and gives Albertans enhanced
access to appropriate stroke treatment and
care. The aim of the strategy is to reduce the
rate of strokes and improve treatment and
rehabilitation outcomes.
The Cancer Prevention Legacy Act was proclaimed
in May 2006. The Act helps in building a cancerfree future for Albertans, and demonstrates
Alberta’s commitment to becoming a leader in
the fight against cancer. The Act established a
$500 million Alberta Cancer Prevention Legacy
Fund to support initiatives in cancer prevention,
screening, and education.
Five new Primary Care Networks were established,
bringing the total across Alberta to 19. These
networks involve over 900 physicians and provide services to more than one million Albertans.
The Health Quality Council of Alberta was
granted status as a provincial health board under
the Regional Health Authorities Act on July 1,
2006. The council is a catalyst for change in the
health system, and serves as an independent body
to measure, monitor and assess patient safety and
health service quality throughout the province.
146
The draft Health Policy Framework was released
on February 28, 2006. It outlined Alberta’s policy
directions for reforming the health system to
enhance sustainability, flexibility and accessibility.
The Minister held extensive public consultations
during March 2006, following which a report
entitled What We Heard was made public.
Albertans indicated their support for health
system renewal, but did not agree with allowing
physicians to work in both the public and private
systems, and did not agree with allowing individuals to pay privately for quicker access to services.
Based on this, the Health Policy Framework was
revised and published in August 2006.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The Government Organization Act describes the
departments of government that are to be administered by Ministers in Alberta. Schedule 7 to
this Act sets out the specific powers, duties and
functions to be exercised or performed by the
Minister of Health and Wellness. The Ministry
of Health and Wellness administers the Alberta
Health Care Insurance Plan on a non-profit 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. The Ministry reviews scientific
literature, consults with expert advisors, assesses
policy, and considers the funding and training that
is required when deciding which medical products,
services or devices will be covered under the Alberta
Health Care Insurance Plan.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Alberta
The Ministry of Health and Wellness registers
eligible Alberta residents for coverage under the
Plan and pays practitioners for insured services
listed in the Schedule of Medical Benefits and
the Schedule of Oral and Maxillofacial Surgery
Benefits. The Ministry also provides funding to
regional health authorities and provincial boards
for the provision of insured hospital services.
1.2 Reporting Relationship
The Minister of Health and Wellness is fully
accountable for the Alberta Health Care Insurance
Plan, which is managed by the Minister’s departmental staff. Under the Government Accountability
Act, sections 13 and 14, the Minister must prepare
a business plan and an annual report for each fiscal
year. The Alberta Ministry of Health and Wellness
Three-Year Business Plan 2006 to 2009 was tabled
in the Alberta Legislature on March 22, 2006. The
Ministry’s annual report documents the health care
system’s key activities including the Alberta Health
Care Insurance Plan and provides consolidated
financial statements for the previous fiscal year. It
also provides information about key achievements
and results in response to key performance measures
and targets included in the previous year’s business
plan. The 2006/2007 Annual Report of the Alberta
Ministry of Health and Wellness was publicly
released September 27, 2007 and can be accessed at:
http://www.health.alberta.ca/resources/AR07.html
The Ministry also issues an annual statistical supplement on data related to the Alberta Health Care
Insurance Plan. An announcement will be made when
the 2006/2007 statistical supplement is available.
Under the Government Accountability Act, section 16,
“accountable organizations” (regional health authorities and provincial health boards) must prepare and
provide to the Minister a business plan and annual
report for each fiscal year. In addition, under the
Regional Health Authorities Act, section 9, regional
Canada Health Act Annual Report, 2006–2007
health authorities and provincial health boards must
provide to the Minister a health plan indicating how
the authority will carry out its responsibilities under
section 5 of the Act and how its performance will
be measured. Health plans and business plans must
be provided to the Minister by March 31 of each
year. Health authority annual reports are due to the
Minister by July 31 of each year, and are tabled in
the Alberta Legislature within 15 days of the beginning of the next session.
1.3 Audit of Accounts
The Auditor General of Alberta is the auditor of
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 reports
on the adequacy of regulatory administration,
management structures, accounting systems and
management control systems, including those
designed to ensure economy and efficiency. The
Auditor General of Alberta audits the performance
reporting, records and financial statements of the
Ministry of Health and Wellness as well as regional
health authorities and provincial health boards.
The Ministry was subjected to a complete Financial
Statement audit by the Auditor General of Alberta.
The statements of operations and cash flows as well
as the statement of financial position were audited.
The audit was conducted in accordance with
Generally Accepted Auditing Standards and included
examining evidence supporting the amounts and
disclosures in the financial statements. The audit
also included assessing the accounting principles
used and significant estimates made by the Ministry
of Health and Wellness and the overall financial
statement presentation. The draft auditor's reports,
dated June 11, 2007, indicated that the statements
fairly present, in all material respects, the financial
position and results of operations for the year ended
March 31, 2007.
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Chapter 3 — Alberta
2.0 Comprehensiveness
the proposed surgical services will not have
a negative impact on the province’s public
health system;
2.1 Insured Hospital Services
there will be an expected benefit to the public;
the regional health authority has an acceptable
business plan to pay for the 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,
the Minister must approve all hospitals and surgical
facilities. A directory of approved hospitals in Alberta
can be found at:
http://www.health.alberta.ca/regions/RHA_map.html
During 2006/2007, 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 60 non-hospital
surgical facilities with accreditation status. Of these,
27 facilities have contracts with regional health
authorities to provide insured services.
According to the Health Care Protection Act,
Ministerial approval for a contractual agreement
shall not be given unless:
the insured surgical services are consistent with
the principles of the Canada Health Act;
there is a current and likely future need for the
services in the geographical area;
148
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/
Minister_legislation.html
2.2 Insured Physician Services
The Alberta Health Care Insurance Act governs the
payment of physicians for insured physician services
under the Alberta Health Care Insurance Plan
(section 6). Only physicians who meet the requirements stated in the Alberta Health Care Insurance
Act are allowed to provide insured services under
the Alberta Health Care Insurance Plan. In addition
to physician services, a number of other practitioner
services are covered or partially covered under the
Alberta Health Care Insurance Plan. They include
services provided by chiropractors, denturists,
dentists, opticians, optometrists and podiatrists.
As of March 31, 2007 there were 7,411 practitioners
enrolled in the Alberta Health Care Insurance Plan.
Before being registered with the Alberta Health
Care Insurance Plan, a practitioner must complete
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Alberta
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, 2007 there were no opted-out
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 residents
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 2006/2007, the Schedule
was revised to include an assessment of an unrelated
condition in association with a workers’ compensation or third party payer; ocular ultrasonography
for cataract surgery and diagnosis and measurement
of intraocular lesions; and percutaneous closure for
atrial septal defects. In addition, the schedule was
extensively revised to reimburse physicians for the
anesthetic portion of new podiatric surgery services.
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, but the majority of
procedures can be billed to the Alberta Health Care
Insurance Plan only when performed by a dentist
certified as an oral and maxillofacial surgeon who
meets the requirements stated in the Alberta Health
Canada Health Act Annual Report, 2006–2007
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, 2007 there were no dentists 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 2006/2007, there were 220 dentists/oral surgeons
who provided insured services under the Alberta
Health Care Insurance Plan. Although there is no
formal agreement between dentists and the Alberta
Ministry of Health and Wellness, the department
meets with members of the Alberta Dental Association
and College to discuss changes to the Schedule of
Oral and Maxillofacial Surgery Benefits. All changes
to the benefit schedule require ministerial approval.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Section 12 of the Alberta Health Care Insurance
Regulation defines what 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
Ministry 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
149
Chapter 3 — Alberta
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 charges
for these goods or services, and when applicable,
the criteria or clinical indications that may qualify
patients to receive them 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.
3.0 Universality
3.1 Eligibility
Under the terms of the Alberta Health Care Insurance
Act, all Alberta residents are eligible to receive publicly funded health care services under the Alberta
Health Care Insurance Plan. A resident is defined
as a person lawfully entitled to be or to remain in
Canada, who makes the province his or her home,
and is ordinarily present in Alberta. The term “resident” does not include a tourist, transient or visitor
to Alberta. Persons moving permanently to Alberta
from outside Canada are eligible for coverage if they
are landed immigrants, returning landed immigrants
or returning Canadian citizens. Temporary residents
may also be eligible for coverage, if they intend to
remain in Alberta for 12 months and their Canada
entry documents are in order.
Residents who are not eligible for coverage under the
Alberta Health Care Insurance Plan include:
150
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 2006/2007, 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 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, 2007, there were 3,384,625 Alberta
residents 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, 2007 there were
255 Alberta residents 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 29,477 people covered under these conditions
as of March 31, 2007.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Alberta
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.
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.
4.0 Portability
4.1 Minimum Waiting Period
Under the Alberta Health Care Insurance Act, persons
moving permanently to Alberta from another part
of Canada are eligible for coverage on the first day
of the third month following their arrival, provided
they register within three months of 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); and
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.
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 2006/2007, no amendments were made
to the legislation regarding in-Canada portability.
During 2006/2007, Alberta paid $53.7 million for
emergency 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
Canada Health Act Annual Report, 2006–2007
151
Chapter 3 — Alberta
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); and
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
In 2006/2007, no amendments were made to the
legislation regarding the portability of health insurance. During 2006/2007, Alberta paid $1.6 million
for insured in-patient and out-patient emergency
services provided to Albertans in another country.
152
4.4 Prior Approval Requirement
Prior approval is not required for elective insured
services received in another Canadian province/
territory, except for high-cost items not included in
reciprocal agreements such as gender reassignment
surgery, and gamma knife surgery. Prior approval is
required for elective services received out-of-country
and will only be given for insured services that are
medically required, are not experimental, and are
not available in Alberta or elsewhere in Canada.
Approval must be received before these services
can be covered.
5.0 Accessibility
5.1 Access to Insured Health Services
All Alberta residents have access to provincially
funded and insured health services regardless of
where they live in the province. In the province,
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Alberta
5.2 Access to Insured Hospital Services
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 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, 2007 there were approximately 52,700 health
workforce practitioners in Alberta. These professions
combined comprise approximately half of the total
workforce employed in the province.
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 2006/2007 (which includes
health services, hospitals, medical equipment and
province-wide services) was $6.1 billion.
The Ministry’s 2006–2009 capital plan provided
funding to renovate and expand existing health
care facilities and to construct new facilities. Major
expansions of existing hospitals are occurring in
Calgary, Edmonton, Lethbridge, Rimbey, Edson,
Barrhead and Viking. New hospitals are being
constructed in Calgary, Sherwood Park, Fort
Saskatchewan and High Prairie. As well, older
long-term care facilities are being replaced in
Red Deer, High Prairie, Vermilion and Vegreville.
Work continues on the construction of the new
Mazankowski Alberta Heart Institute in Edmonton.
The new facility, which is nearing completion,
will enhance cardiac treatment options available
to Albertans and advance priority research and
innovation initiatives for both Capital Health and
the University of Alberta. Due to rapidly escalating
construction costs, the budgets for many capital
projects over the past year have increased beyond
what was originally established. To help off-set
these additional costs, the government allocated an
Canada Health Act Annual Report, 2006–2007
additional $221 million to address cost escalation
pressures on health projects for 2007–2010.
Province-wide services funding was provided toallow
for expanded coverage of ocular photodynamic
therapy. This expanded coverage is helping to prevent blindness in older Albertans. Access to mental
health services for children was established as a
top priority for the Ministry. Wait time goals for
children’s mental health services were developed
and distributed to all the health regions in October
2006. The Alberta Mental Health Board and the
regional health authorities have begun planning
towards the achievement of these wait time goals.
5.3 Access to Insured Physician and
Dental-Surgical Services
A draft Health Workforce Action Plan was developed
to address critical labour shortfalls in the health system and has been submitted to government for final
approval. This plan has two parts. The first is about
changing the workforce to support changes in service
delivery, while the second is about expanding the
capacity of the workforce to ensure a future supply
of health workers. As part of the overall Health
Workforce Action Plan, a Rural Workforce Action
Plan was developed to address current and future
rural health workforce shortages through a variety of
province-wide recruitment and retention strategies.
Some of the actions taken to improve access to
physician and dental services include:
Five new Primary Care Networks were added
bringing the total across Alberta to 19. These
networks involve over 900 physicians and provide services to more than one million Albertans.
Primary Care Networks use a team approach to
coordinate care for their patients. Family physicians working in these networks are better able
to integrate and link their service with such
regional services as home care. In so doing,
family physicians work closely with other health
providers such as nurses, dieticians, pharmacists,
physiotherapists and mental health workers.
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Chapter 3 — Alberta
The Aboriginal Health Careers Bursary program
provided assistance to 62 Aboriginal student
recipients. These bursaries are helping Aboriginal
students to continue pursuing careers in healthrelated occupations.
The Ministry allocated $8 million in March 2007
to help support physicians who are teaching
medical residents. This additional funding has
allowed for more medical residents to receive
the training they need to meet clinical practicum
and educational requirements.
The Ministry worked in collaboration with
Alberta Advanced Education and Technology
to help meet future health workforce needs
in Alberta. The government committed
funding to create 467 new spaces for nursing
students, starting September of 2007, to fill
a growing demand for nurses in the province.
In Edmonton, 207 nursing spaces will be added
at Grant MacEwan College. In Calgary, a new
four-year nursing degree program at Mount
Royal College will have room for 260 students.
The new spaces mean there could be 3,200
students enrolled in nursing degree programs
across Alberta by the fall of 2007.
The Provincial Nominee Program filled
37 allocations in 2006/2007. The program
grants international medical graduates permanent citizenship status enabling them to stay
in the country and continue to provide health
services. Since the Provincial Nominee Program
allows for fast-tracking of citizenship, it has
been effective in attracting health care workers
to Alberta.
The Ministry provided a grant to the University
of Alberta, Department of Dentistry to support
the Dental Outreach Program. This program
allowed dental students to refine their skills
while providing greatly needed dental services
to under-served and remote communities
throughout Alberta.
154
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
(ARPs) 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,
ARPs have been established to enhance specialist
physician recruitment and retention, team-based
approaches to service delivery, access to services,
patient satisfaction and value for money. ARPs
provide predictable funding that enables physician
groups to recruit new physicians to their programs
and retain their services. ARPs are unique in that
they offer alternatives to the way government has
traditionally funded health service delivery.
Also under the agreement, family physicians can
partner with their health regions to create Primary
Care Networks that 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Alberta
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 Cancer Board are
responsible for planning the allocation of funds
for insured hospital services in accordance with
regional needs assessments and health plans.
Canada Health Act Annual Report, 2006–2007
6.0 Recognition
The consolidated financial statements in the
Ministry’s annual report recognize the federal
contributions provided under the Canada Health
Transfer (CHT). The 2006/2007 Annual Report
of the Alberta Ministry of Health and Wellness
can be accessed at:
http://www.health.alberta.ca/resources/AR07.html
7.0 Extended Health
Care Services
Alberta also provides full or partial coverage for
health care services not required by the Canada
Health Act. They include: home care and longterm care; mental health services; dental, denturist
and eyeglass benefits for recipients of the Alberta
Widows’ pension and their eligible dependants;
palliative care; immunization programs for children;
allied health services such as optometry (for residents
under 19 and over 64 years), chiropractic and podiatry services; and drugs and other benefits through
Alberta Blue Cross.
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Chapter 3 — Alberta
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
3,124,487
3,165,157
3,210,035
3,275,931
3,384,625
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.
2003–2004
2004–2005
2005–2006
2006–2007
100
110
1
3
214
102
107
1
3
213
101
106
1
3
211
101
103
1
3
208
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
2002–2003
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
not available
not available
not available
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
Private For-Profit Facilities
4.
2002–2003
1
1
1
not available
not available
not available
1
1
1
not available
not available
not available
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
4,275
4,651
4,550
4,508
4,608
15,753,884
19,411,517
20,139,919
21,080,232
22,005,293
67,975
68,469
72,495
77,438
82,710
7,953,195
7,982,851
11,473,142
12,820,959
14,305,024
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
1.
156
3,698
3,319
4,266
4,124
3,698
340,169
300,233
381,217
379,710
336,859
3,739
3,405
4,089
3,918
3,816
206,684
212,949
227,609
222,896
224,761
These data are available from the College of Physicians and Surgeons of Alberta at http://www.cpsa.ab.ca/home/home.asp
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Alberta
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
2,841
2,365
not applicable
5,206
2,937
2,426
not applicable
5,363
3,026
2,475
not applicable
5,501
3,122
2,463
not applicable
5,585
3,237
2,613
not applicable
5,850
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
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 ($)
29,328,923
1,225,626,637
30,044,400
1,272,779,982
31,683,660
1,348,724,184
33,428,098
1,472,634,054
34,031,123
1,558,128,163
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
559,503
485,841
444,884
479,029
463,410
13,880,981
15,139,409
15,871,755
17,745,928
17,450,377
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
21,289
20,753
26,017
24,944
22,909
976,232
963,299
1,208,422
1,049,384
1,054,544
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
Canada Health Act Annual Report, 2006–2007
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
234
216
216
230
220
16,759
14,802
14,658
17,007
16,783
2,394,458
2,404,042
2,843,638
3,275,978
3,637,243
157
158
Canada Health Act Annual Report, 2006–2007
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
has overall responsibility for ensuring 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 for British
Columbians; and the Emergency Health Services
Commission, which provides ambulance services
across the province. The Ministry also operates health
and information programs for British Columbians,
including the BC HealthGuide and NurseLine program 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
Canada Health Act Annual Report, 2006–2007
their respective regions. A sixth health authority, the
Provincial Health Services Authority, is responsible
for managing the quality, coordination and accessibility of selected province-wide health programs and
services. This includes the specialized 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 2006–2007
In 2006–2007, the Government of British Columbia
invested more than $12.1 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.
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Chapter 3 — British Columbia
Significant reforms and new initiatives have continued across the health system as the Ministry of
Health worked with health authorities and health
professionals to build a system that meets the
needs of British Columbians and is sustainable
into the future.
In 2006–2007, 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 an adequate supply of skilled
health providers is available to deliver services across
the continuum of care.
B.C. also launched 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 September
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 the B.C.’s
publicly funded health system.
Significant Achievements in 2006–2007
Keeping People Healthy: In 2006–2007, the
Ministry of Health introduced a number of health
promotion and disease prevention initiatives
designed to improve the health and wellness of
British Columbians.
160
In 2006–2007, the Ministry:
Launched The First Nations Health Plan:
Supporting the Health and Wellness of First
Nations in British Columbia in November of
2006 to outline B.C.’s commitment to close
the gap in health status between First Nations
and other British Columbians. Highlights
include hiring an Aboriginal physician to
advise on Aboriginal issues, improving access
to primary health care services in Aboriginal
health and healing centres, an Aboriginal
Mental Health and Addictions Plan, and a
new $8.5 million health centre in Lytton.
Translated the BC HealthGuide into Chinese and
Punjabi. More than 200,000 BC HealthGuides
are being distributed in communities throughout
the province with the assistance of many multicultural and community organizations, temples
and providers of English language services for
adults.
Implemented early childhood screening programs
for hearing, dental and vision health. The hearing
and dental programs are underway and a phased-in
program for vision screening has begun.
Amended the Tobacco Sales Act to limit the promotion and sale of tobacco products and ban
smoking in all indoor public places, including
schools and on school grounds.
Translated an emergency preparedness kit into
Chinese, Punjabi, Vietnamese, Spanish and
French to help non-English speaking British
Columbians prepare for an influenza (flu)
pandemic.
Increasing Access: Access has been expanded across
the spectrum of care, from BC NurseLine services to
heart surgery and cancer treatment.
In 2006–2007, the Ministry:
Introduced a wait time reduction strategy
focusing on hip/knee joint replacement,
curative radiotherapy, sight restoration
(cataract surgery), coronary artery bypass
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
graft surgery and diagnostic services (mammography and cervical screening).
Began development of a new Surgical Patient
Registry to be operational by early 2008.
Developed initiatives to help reduce congestion
in emergency departments including working
with teams of front-line professionals to generate
innovative emergency department solutions
for patients.
Opened four $4.8m radiation therapy vaults at
the Vancouver Cancer Centre that will improve
access to an innovative treatment that delivers
intense amounts of radiation to a very specific
tumour target, while sparing the surrounding
healthy tissue from radiation damage. More than
850 cancer patients a year will benefit from this
increased system capacity.
Expanded the Screening Mammography Program
of BC and purchased a mobile screening unit. In
January 2007, the program opened a new fixed
location in Smithers, and now has 38 Centres
and three mobile vans.
Opened a $4.1 million Precision Radiotherapy
Centre in Vancouver. The Centre can target
cancers as small as one millimetre using new
image-guided tools, and will provide services
to approximately 600 patients each year.
Improving Quality of Health Services: In
2006–2007, a number of initiatives were undertaken across the health system to improve the
quality of health services provided. Innovations,
integrated services and the application of proven
best practices in treating health conditions are
leading to better health outcomes for British
Columbians.
In 2006–2007, the Ministry:
Granted $500,000 to the Heart and Stroke
Foundation to launch an innovative Stroke
Charter in emergency rooms across the province. The Charter will provide best practices
for stroke prevention and management in
emergency rooms throughout the province.
Canada Health Act Annual Report, 2006–2007
Conducted the first ever provincial ambulatory
oncology survey which showed 97.1 per cent
of respondents felt the quality of their overall
care was good, very good or excellent. Survey
respondents were people who had received
chemotherapy and/or radiation outpatient
therapy in a B.C. facility in 2006.
Reached labour agreements with the British
Columbia Medical Association, British
Columbia Nurses Union, Hospital Employees
Union, Paramedical Professional Bargaining
Association, Hospitalists and the Community
Bargaining Association.
Reached an agreement with the BC Medical
Association to encourage physicians to implement electronic medical records. This will
benefit patients through faster access to health
information, improved patient safety and better
co-ordination of care.
Expanded PharmaNet to all authorized health
professionals in hospitals and designated mental
health facilities. PharmaNet is the province’s
secure electronic network that protects patients
from potentially dangerous medication errors,
duplications and dangerous combinations of
different medications by linking prescriptions
to a central database.
Investing for Future Sustainability: Making the
right strategic investments now will ensure the health
system is sustainable into the future. Investing in
infrastructure and health human resources, independently or with funding partners, is a key priority
for the government.
Launched 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 invites 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
161
Chapter 3 — British Columbia
of community meetings taking place in 16 communities between February and July 2007.
The Province’s $60.5 million wait time management strategy included $25 million for health
authorities to immediately increase the number
of surgeries with a focus on joint replacement
surgery. The strategy also included $25 million
for a new Centre for Surgical Innovation at UBC
Hospital to support dedicated operating rooms to
clear patient backlogs for hip and knee surgery.
Continued to meet our targets to deliver 5,000
new residential care, assisted living and supportive housing units by the end of 2008. Through
June 2007 we have built 3,411 net new beds. In
total, we have built 8,839 new and replacement
beds and units since 2001.
Opened Cottonwood Lodge, a $5.5 million
supportive, homelike environment for mental
health patients in the Fraser Health Authority.
Invested more than $40 million in March 2006
to expand UBC Clinical Academic Campuses
at key teaching hospitals throughout British
Columbia.
Signed a $148-million contract with Sun Microsystems to advance patient care by building the
infrastructure needed for electronic health records
and improving access to laboratory test results.
The program will enable physicians, nurses and
other authorized caregivers involved in clinical
practice to receive lab test results online.
Invested an additional $26 million in B.C.’s
Nursing Strategy. With this investment, the
government has provided a total of $146 million
since 2001 to help educate, retain and recruit the
best qualified nurses in B.C.
Information on health and health services in British
Columbia is available at:
www.gov.bc.ca/healthservices
162
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The British Columbia Medical Services Plan (MSP)
is administered by the BC Ministry of Health; the
Plan insures medically required services provided by
physicians and supplementary health care practitioners, laboratory services and diagnostic procedures.
The Ministry of Health sets province-wide goals,
standards and performance agreements for health
service delivery, and works together with BC’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 BC 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 BC, 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 BC
to quality medical care, health care and diagnostic
facility services for residents of BC 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
1.2 Reporting Relationship
The MSC is accountable to the Government of
BC through the Minister of Health; 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 of Health 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).
The Ministry of Health reports through various
publications, including:
Ministry Annual Service Plan Report;
Report on Health Authority Performance
(annual);
Nationally Comparable Indictors Report; 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.
Canada Health Act Annual Report, 2006–2007
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 BC 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: 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
163
Chapter 3 — British Columbia
Effective April 1, 2005, the Ministry of Health
contracted with MAXIMUS BC to deliver the
operations of the Medical Services Plan and
PharmaCare (including responding to public
inquiries, registering clients, and processing
medical and pharmaceutical claims from health
professionals). This new organization is called
Health Insurance BC. Policy and decision-making
functions remain with the Ministry of Health.
The contract with Maximus BC is enabled
through the Medical Services Commission
(MSC is empowered to manage MSP on
behalf of the Government of BC).
Health Insurance BC submits monthly reports
to the Ministry of Health, reporting performance
on service levels to the public and health care
providers.
Health Insurance BC posts quarterly reports on
its website on performance on key service levels.
Health Insurance BC applies payments against
fee items approved by the Ministry of Health.
The Ministry approves all payments before they
are released.
2.0 Comprehensiveness
2.1 Insured Hospital Services
The Hospital Act and Hospital Act Regulation provide authority for the Minister to designate facilities
as hospitals, to license private hospitals, to approve
the bylaws of hospitals, to inspect hospitals, and
to appoint a public administrator. This legislation
also establishes broad parameters for the operation
of hospitals.
The Hospital Insurance Act provides the authority for
the Minister to make payments to health authorities
for the purpose of operating hospitals, outlines who
is entitled to receive insured services, and defines the
“general hospital services” which are to be provided
as benefits.
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There were no legislative or regulatory amendments
made to the Hospital Act or Hospital Insurance Act or
their regulations in 2006–2007.
In 2006–2007, there were a total of 139 facilities
designated as hospitals. This included:
82 acute care hospitals (community hospitals,
large tertiary care and teaching hospitals);
18 chronic care hospitals;
4 rehabilitation hospitals; and
35 other hospitals (including diagnostic and
treatment centres, free-standing abortion clinics,
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 inpatients: 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
The following out-patient general hospital services
are also insured: day care surgical services; out-patient
renal dialysis treatments in designated hospitals or
other approved facilities; diabetic day-care services in
designated hospitals; out-patient dietetic counselling
services at hospitals with qualified staff dieticians;
psychiatric out-patient and day-care services; rehabilitation out-patient services; cancer therapy and
cytology services; out-patient psoriasis treatment;
abortion services; and 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 service; 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 of Health 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
Canada Health Act Annual Report, 2006–2007
illness or condition excluded by regulation of the
Lieutenant Governor in Council.
No new hospital services were added during the
fiscal year.
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 fiscal year 2006–2007,
8,626 physicians (includes only GPs and Medical
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Chapter 3 — British Columbia
Specialists who billed fee-for-service [FFS] in
2006–2007) were enrolled with MSP and billed
fee-for-service. In addition, some physicians
practice solely on salary, receive sessional payments, or are on contract (service agreements)
to the health authorities. Physicians paid by these
alternative mechanisms may also practice on a
fee-for-service basis.
Non-physician healthcare practitioners who can be
enrolled to provide insured services under MSP are
midwives and supplementary benefit practitioners
(dental surgeons, optometrists, podiatrists). Only
those MSP beneficiaries with premium assistance
status qualify for MSP coverage of physiotherapy,
massage therapy, chiropractic, naturopathy and
non-surgical podiatry services. In 2006–2007 there
were 13,136 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. The Medical
Services Plan of BC currently has five opted-out
physicians and one de-enrolled physician.
schedule, including laboratory and volume discounting. In addition, fee items were added
to encourage general practitioners to return to
hospital work by obtaining admitting privileges.
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 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
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.
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.
During fiscal year 2006–2007 physician services
which were added as MSP insured benefits included
fee items which reflect current practice standards,
for example: new fee items for pædiatric case conferences, laser lead extraction, cytogenic analysis
by fluorescence in situ hybridization (FISH); fee
items to track immunizations; revised fee items for
methadone treatments, laparoscopic splenectomy
and anæsthetic administration for cataract surgery;
and an updated laboratory medicine payment
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 234 dentists (includes only Oral Surgeons,
Dental Surgeons, Oral Medicine and Orthodontists
who billed fee-for-service in 2006–2007) enrolled
with the Medical Services Plan and billing fee-forservice in 2006–2007. None have de-enrolled or
opted out of the Medical Services Plan.
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Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
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; acupuncture; telephone
advice unrelated to insured visits; reversal of sterilization procedures; in vitro fertilization; medico-legal
services; and most cosmetic surgeries.
Medical necessity, as determined by the attending
physician and hospital, is the basis for access to
hospital and medical services.
The Medicare Protection Act, (section 45) prohibits
the sale or issuance of health insurance by private
insurers to patients for services that would be benefits
if performed by a practitioner. Section 17 prohibits
persons from being charged for a benefit or for
“materials, consultations, procedures, and use of
an office, clinic or other place or for any other
matters that relate to the rendering of a benefit”.
The Ministry of Health responds to complaints made
Canada Health Act Annual Report, 2006–2007
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 2006–2007.
3.0 Universality
3.1 Eligibility
Section 7 of the Medicare Protection Act defines
the eligibility and enrolment of beneficiaries for
insured services. Part 2 of the Medical and Health
Care Services Regulation made under the Medicare
Protection Act details residency requirements. 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.
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 BC 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
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Chapter 3 — British Columbia
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 firstday coverage to discharged members of the Royal
Canadian Mounted Police and the Canadian Forces,
and to released inmates of federal penitentiaries.
However, if discharged outside British Columbia,
they must wait the prescribed period.
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 cohabiting in a marriage-like relationship), any
unmarried child or legal ward supported by the
beneficiary, and either under the age of 19 or under
the age of 25 and in fulltime attendance at a school
or university.
The number of MSP registrants in 2006–2007
was 4,279,734. Enrollment 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)
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form. The term of this decision is 12 months from
the first of the month of receipt of the application,
after which each adult must re-apply to remain
opted out of MSP.
3.3 Other Categories of Individual
Holders of Minister’s Permits, Temporary Resident
Permits, study permits, and work permits are eligible
for benefits when deemed to be residents under the
Medicare Protection Act and section 2 of the Medical
and Health Care Services Regulation.
3.4 Premiums
Enrolment in the Medical Services Plan 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 the Medical Services Plan
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)
4.0 Portability
4.1 Minimum Waiting Period
New residents or persons re-establishing residence
in BC 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
the month of July, coverage is available October 1.
If absences from Canada exceed a total of 30 days
during the waiting period, eligibility for coverage
may be affected. New residents from other parts of
Canada are advised to maintain coverage with their
former medical plan during the waiting period.
4.2 Coverage During Temporary Absences
in Canada
Sections 3, 4 and 5 of the Medical and Health Care
Services Regulation of the Medicare Protection Act
define portability provisions for persons temporarily
absent from BC with regard to insured services.
In 2006–2007, there were no amendments to the
Medical and Health Care Services Regulation with
respect to the portability provisions
Individuals who leave 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 BC must be
physically present in Canada at least six months in
a calendar year and continue to maintain their home
in BC in order to retain coverage. When a beneficiary
stays outside BC longer than the approved period,
they will be required to fulfill a waiting period upon
returning to the province before coverage can be
renewed. Students attending a recognized school in
another province or territory on a full-time basis are
entitled to coverage for the duration of their studies.
According to inter-provincial and inter-territorial
reciprocal billing arrangements, physicians, except
in Quebec, bill their own medical plans directly for
services rendered to eligible BC residents, on presentation of a valid MSP Card (CareCard). BC 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,
Canada Health Act Annual Report, 2006–2007
the payment is at the inter-provincial and interterritorial 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 2006–2007, the amount paid to physicians in
other provinces and territories was $26.9 million.
Quebec does not participate in reciprocal billing
agreements for physician services. As a result,
claims for services provided to BC 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.
BC 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 BC Reg. 111/2005. These changes
were effective March 18, 2005.
The relevant issues addressed by the amendments
are as follows:
All provinces, except Quebec, have eliminated
caps on MSP coverage for students studying
abroad, enabling them to finish their undergraduate and graduate studies. The amendment
brings BC 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.
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Chapter 3 — British Columbia
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 BC in line with practice in
other provinces.
BC residents who are temporarily absent from
BC 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.
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 BC physician.
Some treatments (e.g., treatment for anorexia)
may require the approval of the Health Authorities
Division of the Ministry of Health.
All non-emergency procedures performed outside
Canada require approval from the Commission
before the procedure.
5.0 Accessibility
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.
Physician services excluded under the Inter-Provincial
Agreements for the Reciprocal Processing of Out-ofProvince Medical Claims: surgery for alteration of
appearance (cosmetic surgery); gender-reassignment
surgery; surgery for reversal of sterilization; therapeutic abortions; routine periodic health examinations
including routine eye examinations; in vitro fertilization, artificial insemination; acupuncture, acupressure,
transcutaneous electro-nerve stimulation (TENS),
moxibustion, biofeedback, hypnotherapy; services
to persons covered by other agencies; RCMP, Armed
Forces, Workers’ Compensation Board, Department
of Veterans Affairs, Correctional Services of Canada
(Federal Penitentiaries); services requested by a
“Third Party”; team conference(s); genetic screening
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5.1 Access to Insured Health Services
Beneficiaries in BC, 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.
5.2 Access to Insured Hospital Services
Nurses comprise the largest group of professional
staff within the health care sector. The number of
Registered Nurses licensed to practice in British
Columbia (BC) as of December 2006 was 31,960.
BC hospitals also employ Registered Psychiatric
Nurses (RPNs) and Licensed Practical Nurses
(LPNs). In 2006, there were 2,173 RPNs and
5,940 LPNs licensed to practice in the province.
In 2006/07, the BC government provided additional funding to build on successful recruitment,
retention and education nursing strategies. This
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
funding brought the government’s total commitment
to nursing strategies to $146 million since 2001.
British Columbia’s nursing strategies are developed
and implemented annually by the Ministry of Health’s
Nursing Directorate through consultation with stakeholders, input from 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 BC to
address health care needs;
Health Professions Act as the regulatory body for
Registered Nurses and also enables NPs to be regulated by the new College and to practice in British
Columbia. In BC, NPs are Master’s-prepared or
have equivalent clinical experience and education.
The first BC educated NPs graduated in 2005, and
NP programs are currently being offered at the
University of British Columbia, the University of
Victoria, and the University of Northern BC. Due
to the overwhelming success of NP integration in
the province, BC has expanded the implementation
of the role of NPs in both urban and rural settings.
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;
In recent years, the Province of 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.
analyzing nursing data to enhance the Ministry’s
understanding of trends and changing needs in
nursing and health care;
The Ministry of Health 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 extend to capital planning to
coincide with 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.
recruiting students of aboriginal descent into
nursing, supporting those already in nursing
programs, and recruiting/retaining aboriginal
nurses currently practising in BC; and,
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 2006–2007
included: expansion of recruitment initiatives for
internationally educated nurses, aboriginal nursing
strategies, internship/new graduate transition
program, operating room initiative for LPNs,
post-basic acute rural nursing education program
and expansion of Nurse Practitioner (NP) implementation. In addition, the Ministry of Health has
partnered with the Ministry of Advanced Education
to work closely with educational institutions to
increase nursing education spaces.
On August 19, 2005, the Nurses (Registered) and
Nurse Practitioners Regulation came into effect.
The regulation established the new College of
Registered Nurses of British Columbia under the
Canada Health Act Annual Report, 2006–2007
The Province committed $42.5 million for the
expansion and upgrading of academic space in
teaching hospitals around BC to support increased
enrolment of medical students.
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.
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Chapter 3 — British Columbia
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 of Health, 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.
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 of charge 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 funding was used by health authorities for
equipment such as:
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 will be available in April 2007.
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 tumors and monitoring therapy
response to improve recovery;
new CT scanners in the Lower Mainland and
Victoria that will improve cardiac care in BC
and increase provincial capacity for diagnosing
heart and brain disease as well as handling
trauma cases;
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
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.
The September 2004 First Ministers’ Agreement
committed an additional $66 million in Medical
Equipment funding for BC to be spent by
2007–2008
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
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BC HealthGuide OnLine: A comprehensive
public website (www.bchealthguide.org) with
current, medically approved information on
over 3,000 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 with over 30.5 million
hits in 2006–2007.
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
advice on acute and chronic health symptoms and
conditions and when to see a health professional.
Health information and advice is available in over
130 languages to anyone in British Columbia with
access to a telephone.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
Over 1.57 million calls have been received by
the BC NurseLine since the programs launched
in 2001. Specifically in 2006–2007, the BC
NurseLine received over 347,241 calls.
In June 2003 the BC NurseLine was enhanced
to include a pharmacist referral service. Between
5 p.m. and 9 a.m. daily, registered nurses of BC
NurseLine can refer callers direct to a pharmacist
to answer medication-related calls. The pharmacist
service has received over 40,518 medication related
calls transferred from the BC NurseLine. Over
this period, BC NurseLine pharmacists submitted
834 Adverse Drug Reaction (ADRs) reports to
the British Columbia/Yukon Regional ADR Centre.
803 of these ADRs have been approved for submission to Health Canada, Canadian ADR Monitoring
Program. These reports are used to monitor adverse
effects that are unexpected, serious or for newly
marketed medications. The pharmacist service is
responsible for 35 percent of all ADR reports submitted to the British Columbia/Yukon Regional
ADR Centre, making it a large and integral contributor to patient safety in British Columbia.
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 p.m.
to 8 a.m.
From 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
Canada Health Act Annual Report, 2006–2007
Management (CDM) Project. The Project provides
primary health care teams with an opportunity to
refer patients with diabetes or congestive heart failure
with self-management support. Those patients with
complex medication issues are referred by 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.
From 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 and
BC NurseLine on weekends, who would follow
up with the patient as required based on the vitals
that were recorded.
Dial-A-Dietitian: A free nutrition information
service that provides easy-to-use nutrition information for self-care, based on current scientific
sources, by a registered dietitian over the telephone.
Registered dietitians are available 9:00am to 5:00pm,
Monday to Friday. Referrals are provided to hospital
outpatient dietitians, community nutritionists and
other local services. Translation services are available
in over 130 languages.
In addition to nutrition information over the
telephone, the Dial-A-Dietitian service includes
a comprehensive website (www.dialadietitian.org)
with nutritional information and useful links.
In March 2005, Dial-A-Dietitian added an Allergy
Dietitian to team to answer questions about food
allergies and intolerances and in February 2007, an
Oncology Dietitian was added to answer questions
and provide information to individuals who are
173
Chapter 3 — British Columbia
interested in preventing cancer, or have been
diagnosed and/or are recovering from cancer. In
2006–07 Dial-A-Dietitian received 22,553 calls.
The Ministry’s 2004–2005 to 2006–2007 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 2006–2007, approximately 2,653 general
practitioners and specialists received all or part
of their income through British Columbia’s
Alternative Payments Program (APP).
APP funds regional health authorities to hire
salaried physicians or contract with physicians,
in order to deliver insured clinical services.
The Ministry of Health implemented several
programs under the 2002 Subsidiary Agreement
for Physicians in Rural Practice to enhance the
availability and stability of physician services in
smaller urban, rural and remote areas of British
Columbia.
174
These programs include:
the Rural Retention Program, provides eligible
physicians (estimated at 1,300) with fee premiums and is available for resident, visiting
physicians and locums and also provides a flat
fee sum for eligible physicians who reside and
practice in a rural community;
the Northern and Isolation Travel Assistance
Outreach Program, which funded an estimated
2,002 visits by family doctors and specialists to
rural communities;
the Rural General Practitioner Locum Program,
which assisted physicians in approximately 64
small communities to attend continuing medical
education and provided vacation relief;
the Rural Specialist Locum Program, which
provided locum support for core specialists in
15 rural communities to provide vacation relief
and while physician recruitment efforts were
underway;
the Rural Education Action Plan, which
supported training physicians in rural practice
through several components, including rural
practice experience for medical students and
enhanced skills for practicing physicians;
the Isolation Allowance Fund, which provided
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; and
the 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 recently been expanded through the 2007 agreement with physicians and the ministry continues to
establish clinical practice guidelines and protocols to
improve patient care.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
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 B.C.’s southern
Interior, adding another 32 first-year medical school
spaces to the province’s medical program.
In addition to the medical school expansion, the
Ministry of Health has begun to expand postgraduate medical education (residency positions)
to keep pace with undergraduate MD program
growth. In 2003, the Ministry funded 128 entrylevel 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 288 entry-level
residency positions for CMGs.
5.4 Physician Compensation
The Province of British Columbia (BC) negotiates with the BC Medical Association (BCMA)
to establish the conditions, benefits and overall
compensation for physicians.
The BCMA has the sole and exclusive right to
represent the interests of physicians who receive
funding for their services from the government.
Membership in the BCMA is not mandatory.
Funding for physicians accounted for over
$2.87 billion or 24 percent of the Ministry
of Health budget in 2006–2007.
Canada Health Act Annual Report, 2006–2007
The BC government and the BCMA entered into
a Master Agreement governing the relationship
between the province and the provinces’ physicians,
effective December 1993, for a term which was
extended to March 31, 2001. The parties entered
into the Second Master Agreement February 28, 2001,
which was set to expire Midnight March 31, 2006.
The April 1, 2004 Working Agreement, which was
due to expire March 31, 2007, had a re-opener
clause for March 31 2006 to allow for negotiations
on rates of compensation for fiscal year 2006/07.
Negotiations between the BCMA and the government
resulted in the 2006 Agreement and an Amended
Second Master Agreement. The 2006 Agreement,
terms of which expire April 1, 2012, addresses
matters of financial interest to all physicians while
subsidiary agreements address matters of unique
interest to a particular group of physicians.
Under the 2006 Agreement, there were generalized
increases in compensation rates: in 2006/07 there
was 2.8 percent increase awarded, in 2007/08 there
was a 2 percent increase, in 2008/09 a 2 percent
increase was agreed, in 2009/10 a 3 percent increase
has been approved. There will be a financial re-opener
for 2010/11/12. Sessional agreements were adjusted
by 5.5 percent in the first year and incentives and
targeted funding were included in the Agreement to
bring the total increase by 2010 to about 19 percent.
The Working Agreement included some elements
of system redesign and renewal which included: a
review of the Medical On-Call/Availability Program,
support for improved access to specialist services;
support for patient access and improvement to full
service family practice, enabling shared care and
appropriate scopes of practice among general practitioners, specialist physicians and other health care
professionals; expansion of funding of alternative
payment plans; a review of the work of the Joint
Standing Committee on Rural Issues to improve
the accessibility of health care to rural British
Columbians; and the use of electronic technology
in physician practice to support patient care.
175
Chapter 3 — British Columbia
Physician benefits were also improved under the
Working Agreement and the 2006 Agreement and
included increased benefits to the Contributory
Professional Retirement Savings Plan Agreement and
changes in the physicians Pregnancy Leave program.
The 2006 Agreement requires the parties to develop
a Physician Master Agreement and Subsidiary
Agreements by February 28 2007. If, by that date,
the parties have not agreed upon the terms of a
Physician Master Agreement and master Subsidiary
Agreements then a conciliator will be asked to issue
a report identifying outstanding issues. The conciliator was asked to begin working with the parties
in the winter of 2006.
The parties agreed that the Amended Second Master
Agreement remains in effect after March 31, 2007 or
until replaced by the Physician Master Agreement
and Master Subsidiary Agreements. The Physician
Master Agreement is to expire on March 31 2012,
and is intended to structure the relationship between
government and the BCMA, and replace all previous
Agreements with this new structure. The levels of
compensation, terms and conditions of payments,
fee for service, sessional, contract and salary increases
agreed to in the 2006 Working Agreements and/or
Subsidiary Agreements will remain in place. The
Physician Master Agreement is also intended to
establish conflict resolution processes that will
create a framework, using experts in mediation
and arbitration, in which both rights and interest
disputes can be resolved in a manner that reduces
the impact on patients.
The government has approached negotiations with
physicians in a spirit of collaboration and with the
interest of quality care for patients as the foremost
concern. Negotiations for changes to the Second
Master Agreement and for compensation increases
for 2006–2007 began in 2005, using a principlebased approach. A tentative Agreement in Principle
was reached in March 2006 and was ratified in
May 2006, covering the period from 2006 to 2012.
The 2006 Agreement facilitates coordination with
health authorities and provides for their participation
176
on committees, enhancing coordination of patient
care services in cooperation with the BCMA and
the Ministry of Health. The agreements continue
to compensate physicians for direct patient care.
The agreement also included reform initiatives such
as enhancement of full-service family practice as well
as enhanced recruitment and retention of physicians
in the most rural communities and of specialists
where there is a current or anticipated problem.
With respect to dentists, the BC government negotiates with the Dental Association of BC. The previous
formal negotiation process led to an updated and
modernized contract which expired. The parties are
currently operating under a Memorandum of Understanding regarding funding. The Dental Association
of BC has requested renegotiation of a new contract
to commence in the spring of 2007.
Legislation
The Medicare Protection Act, RSBC 1996, c. 286,
provides the authority for the Medical Services
Commission to administer the Medical Services
Plan of British Columbia. There were no significant
amendments of the Act or regulations in 2006–2007.
Medical practitioners are licensed under the Medical
Practitioners Act and dentists under the Dentists Act.
Compensation Methods for Physicians and Dentists
Payment for medical services delivered in the
Province is made through the Medical Services
Plan to individual physicians, based on submitted
claims, and through the Alternative Payments
Program to health authorities for contracted physicians’ services. Over 90 percent of payments were
distributed as fee-for-service payments and nearly
10 percent were distributed as alternate payments.
Of the alternate payments, 63.5 percent are distributed through contracts, 26.3 percent as sessions
(3.5-hour units of service), 4.5 percent as salaried
arrangements and 5.7 percent for capitation. The
government funds health authorities for alternative
payments, but does not pay physicians directly.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
Payment for dental services delivered in the province
is made through the Medical Services Plan totally on
a fee-for-service basis.
5.5 Payments to Hospitals
Funding for hospital services is included in the
annual funding allocation and payments made to
regional health authorities. This funding allocation
is to be used to fund the full range of necessary
health services for the population of the region (or
for specific provincial services, for the population
of BC), including the provision of hospital services.
While the hospitals portion of the funding allocation
is normally not specified, the exception to this rule
is funding targeted for specific priority projects (e.g.,
reduction in wait times for hips and knees). For these
initiatives, funding is specifically earmarked, and must
be reported on separately.
Annual funding allocations to health authorities
are determined as part of the Ministry of Health’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 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’s 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.
Canada Health Act Annual Report, 2006–2007
No amendments were made during 2006–2007 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’s Population
Needs-Based Funding formula and other funding
allocation methodologies (to reflect specific program
delivery requirements within health authorities).
A total of $7.1 billion was allocated to health
authorities in 2006–2007 to provide the full
continuum of care (acute, residential, community
care, public and preventive health, adult mental
health, addictions programs, etc.).
The annual funding allocation to health authorities
does not include funding for programs directly
operated by the Ministry of Health, such as the
payments to physicians, payments for prescription
drugs covered under PharmaCare, or for provincial
ambulance services.
6.0 Recognition Given to
Federal Transfers
Funding provided by the federal government
through the Canada Health Transfer is recognized
and reported by the Government of British
Columbia through various government websites
and provincial government documents.
In 2006–2007, these documents included:
Public Accounts 2005–2006 (tabled July 17, 2006)
www.fin.gov.bc.ca/ocg/pa/05_06/pa05_06.htm
Budget and Fiscal Plan, 2006–2007 to
2008–2009 (tabled February 21, 2006)
www.bcbudget.gov.bc.ca/2006/bfp/default.htm
177
Chapter 3 — British Columbia
Estimates, Fiscal Year Ending March 31, 2007
(tabled February 21, 2006)
www.bcbudget.gov.bc.ca/2006/est/
Estimates_06a.pdf
7.0 Extended Health
Care Services
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
178
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 Community Care and Assisted Living Act, the
Adult Care Regulations, Continuing Care Act and
the Continuing Care Programs Regulation.
Assisted living residences provide housing, hospitality
and personal assistance services for adults who can
live independently, but require regular assistance
with daily activities, usually because of age, illness
or disabilities. Residences typically consist of onebedroom apartments.
Services include help with bathing, grooming,
dressing or mobility. Meals, housekeeping, laundry,
social and recreational opportunities and a 24-hour
response system are also provided. Clients pay a
monthly charge based on 70 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 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 are 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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
Services for Persons with Mental Illness
and Substance Use Disorders
There are three distinct types of housing and
programs for people with severe mental illness
and or substance use disorders: Community
Residential Care Facilities; Family Care Homes;
and Supported Housing.
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 for others their stay is longterm. All facilities are licensed under the Community
Care and Assisted Living Act. Clients pay a standard
daily fee based on income 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
based on income 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 crises management.
Canada Health Act Annual Report, 2006–2007
Supported Housing programs include: supported
apartments, block apartments, congregate housing;
group homes and low barrier housing. Clients pay
reduced rent base on income.
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,
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.
179
Chapter 3 — British Columbia
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.
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.
180
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
4,017,912
4,099,076
4,182,682
4,216,199
4,279,734
Insured Hospital Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
92
18
3
25
138
92
18
3
24
137
92
18
4
23
137
82
19
4
32
137
82
18
4
35
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
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
Number of private for-profit facilities
providing insured health services (#):
a. surgical facilities
b. diagnostic imaging facilities
c. total
1
not available
1
11
0
11
17
1
18
18
1
19
22
0
22
Payments to private for-profit facilities for
insured health services ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
358,600
not available
358,600
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
Public Facilities
2.
3.
Number (#): 1
a. acute care
b. chronic care
c. rehabilitative care
d. other
e. total
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.
For items 1–2: Historical and current data may differ from report to report because of changes in data sources, definitions and methodology from
year to year.
1.
In British Columbia, the categories under which these facilities are reported in this Health Act report table do not match those normally used in
the BC Ministry of Health, but facilities have been matched to this report’s specifications as closely as possible.
— Acute Care includes only acute care inpatient facilities from 2005/06 onward. In previous years this category also included acute care
ambulatory facilities and one psychiatric inpatient facility (both now counted under “Other”).
— Chronic Care includes extended care facilities. The one additional facility in 2005/06 is not a new facility. In the past, statistics for
this facility were reported as part of a larger group of facilities, but are now reported separately.
— Rehabilitative care includes rehabilitation facilities.
— Other includes acute care ambulatory care facilities, diagnostic and treatment centres and one inpatient pyschiatric inpatient facility.
The count of facilities in this table may not match counts produced from the Discharge Abstract Database, the MIS reporting system, or the
Societies Act because each reporting system has different approaches to counting multiple site facilities and categorizing them by function.
2.
In British Columbia, regional health authorities are responsible for the delivery of a wide range of health care services including hospital acute
care, residential care, home and community care, community mental health care, and public health services, but excluding physican, laboratory
and pharmacare services. Financial reporting does not separate expenditures for services provided under the Canada Health Act.
BC Ministry of Health Funding to Health Authorities for the provision of the full range of regionally delivered services are as follows:
$4.59 billion in 1999–2000, $5.20 billion in 2000–2001, $5.62 billion in 2001–2002, $6.06 billion in 2002–2003, $6.21 billion in 2003–04,
$6.25 billion in 2004–2005, $6.62 billion in 2005–2006, and $7.1 billion in 2006–2007.
Canada Health Act Annual Report, 2006–2007
181
Chapter 3 — British Columbia
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
7,618
7,294
7,467
6,517
7,172
40,195,515
45,318,174
51,869,175
49,899,859
65,678,542
83,152
81,911
80,386
77,537
81,878
11,223,254
11,105,322
13,574,737
14,089,042
17,937,647
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
1,795
1,970
2,294
2,345
1,858
2,294,341
2,365,051
3,811,717
4,248,649
3,452,739
949
611
761
1,247
960
543,969
294,712
741,617
770,215
453,698
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
4,471
3,421
0
7,892
4,573
3,510
0
8,083
4,629
3,642
0
8,271
4,681
3,773
0
8,454
4,756
3,870
0
8,626
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
3
3
0
6
3
2
0
5
4
2
0
6
4
2
0
6
3
2
0
5
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
1
0
0
1
1
0
0
1
1
0
0
1
1
0
0
1
1
0
0
1
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
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 ($)
61,640,648
1,904,028,933
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
3.
182
3
63,758,925
1,967,031,496
3
65,944,973
1,956,374,356
3
70,083,943
2,032,537,376
3
72,660,315
2,061,333,925
3
The MSP Fee-for-Service Payments listed in 18b exclude retroactive rate increases to be applied to the 2006/2007 medical expenditure; the
amount is yet to be determined.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — British Columbia
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
617,834
604,748
628,099
674,497
673,886
22,403,444
22,516,419
23,624,476
25,781,441
26,928,627
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
48,457
52,673
65,134
69,741
55,527
2,145,121
2,281,820
2,767,854
3,121,999
2,551,760
Insured Surgical-Dental Services Within Own Province or Territory
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
Canada Health Act Annual Report, 2006–2007
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
249
243
228
238
234
36,680
36,809
38,310
41,965
44,015
5,379,450
5,170,348
5,268,900
5,833,105
6,087,395
183
184
Canada Health Act Annual Report, 2006–2007
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 32,936 eligible persons registered with
the Yukon health care plan on March 31, 2007.
Canada Health Act Annual Report, 2006–2007
Other insured services provided to eligible Yukon
residents include the Travel for Medical Treatment
Program; the Chronic Disease and Disability Benefits
Program; the Pharmacare and Extended Benefits
Programs; and the Children’s Drug and Optical
Program. Non-insured health service programs
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,
modernize and improve system capabilities.
These initiatives include:
Insured Health Information System—a new
system has been in use for just over a year for
the processing of Health Care Registration,
Medical Claims, Hospital Claims and Drug
Claims. The design stage is underway for the
Medical Travel Claims component;
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;
planning is underway to recruit 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 operational and entering
phase two. This second phase sees physicians
in rural areas utilizing the Chronic Disease
Management Toolkit from BC to help
manage their diabetic cases.
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Chapter 3 — Yukon
The 2006–2007 health care expenditures increased
over the 2005–2006 expenditures as follows:
Insured Health Services increased by $ 8,500,000;1
Yukon Hospital Services increased by $2,102,272;
Continuing Care increased by $744,000;
Community Nursing and Emergency Medical
Services increased by $544,302; and
Community Health Programs increased by
$443,265.
Some of the major challenges facing the advancement of insured health care service delivery in the
Territory are:
effective linkages and coordination of existing
services and service providers;
recruitment and retention of qualified health
care professionals;
increasing costs related to service delivery;
increasing costs related to changing demographics; and
acquiring and maintaining new and advanced
high-technology diagnostic and treatment
equipment.
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 2006–2007.
The Hospital Insurance Services Act, sections 3(1)
and 5, establishes the public authority to operate
1.
186
the health hospital care plan. There were no amendments made to these sections of the legislation
in 2006–2007.
Subject to the Health Care Insurance Plan Act
(section 5) and Regulations, the mandate and
function of the Director, Insured Health and
Hearing Services, is to:
develop and administer the Plan;
determine eligibility for entitlement to insured
health services;
register persons in the Plan;
make payments under the Plan, including
the determination of eligibility and amounts;
determine the amounts payable for insured
health services outside the Yukon;
establish advisory committees and appoint individuals to advise or assist in operating the Plan;
conduct actions and negotiate settlements in
the exercise of the Government of Yukon’s right
of subrogation under this Act to the rights of
insured persons;
conduct surveys and research programs and
obtain statistics for such purposes;
establish what information is 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;
Increases are due to additional physicians, increases to benefits for Medical Travel program, rise in reciprocal inpatient and out patient rates and
an increase in visiting specialists
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
determine eligibility for and entitlement
to insured services;
1.3 Audit of Accounts
determine the amounts that may be paid for
the cost of insured services provided to insured
persons;
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.
enter into agreements on behalf of the
Government of Yukon with hospitals in
or outside the Yukon, or with the Government of Canada or any province or an
appropriate agency thereof, for the provision
of insured services to insured persons;
approve hospitals for purposes of this Act;
conduct surveys and research programs and
obtain statistics for such purposes;
appoint inspectors and auditors to examine
and obtain information from hospital records,
reports and accounts;
prescribe the forms and records necessary to
carry out the provisions of this Act; and
perform such other functions and discharge
such other duties as may be assigned by the
regulations.
1.2 Reporting Relationship
The Department of Health and Social Services
is accountable to the Legislative Assembly and
the Government of Yukon through the Minister.
Section 6 of the Health Care Insurance Plan Act
and section 7 of the Hospital Insurance Services
Act require that the Director, Insured Health and
Hearing Services, make an annual report to the
Executive Council Member respecting the administration of the two health insurance plans. A
Statement of Revenue and Expenditures is tabled
in the Legislature and is subject to discussion at
that level.
The most recent audit was for the year ended
March 31, 2007.
Regarding the Yukon Hospital Corporation,
section 11(2) of the Hospital Act requires every
hospital to submit a report of the operations of
the Corporation for that fiscal year; the report
is to include the financial statements of the
Corporation and the auditor’s report. The report
is to be provided to the Department of Health
and Social Services within six months of the end
of each fiscal year.
1.4 Designated Agency
The Yukon Health Care Insurance Plan has no other
designated agencies authorized to receive monies or
to issue payments pursuant to the Health Care Insurance Plan Act or the Hospital Insurance Services Act.
2.0 Comprehensiveness
2.1 Insured Hospital Services
The Hospital Insurance Services Act, sections 3, 4, 5
and 9, establish authority to provide insured hospital
services to insured residents. The Yukon Hospital
Insurance Services Ordinance was first passed in 1960
Canada Health Act Annual Report, 2006–2007
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Chapter 3 — Yukon
and came into effect April 9, 1960. There were no
amendments made to these sections of the legislation
in 2006–2007.
In 2006–2007, 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.
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,
188
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
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
In 2006–2007, a total of $550,000 was dedicated
to the purchase of new hospital equipment, which
included implementation of a bar coding/scanning
project, the purchase of and Olympus P3 or 4
nasopharengscope, Xomed microdebrider and
upgrade to the ENT microscope for the Specialist
Clinic.
Additional funding was provided to increase the
number of knee replacements performed in Yukon.
An additional $45,000 was dedicated to the
establishment of a Satellite Specialist Clinic
in Whitehorse.
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 2006–2007.
The Yukon Health Care Insurance Plan covers
physicians providing medically required services.
The conditions a physician must meet to participate
in the Yukon Health Care Insurance Plan are to:
register for licensure pursuant to the Medical
Professions Act; and
maintain licensure, pursuant to the Medical
Professions Act.
The estimated number of resident physicians participating in the Yukon Health Care Insurance Plan in
2006–2007 was 66.
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 2006–2007, no
physicians provided written notice of their election
to collect fees other than from the Yukon Health
Care Insurance Plan.
Canada Health Act Annual Report, 2006–2007
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 2006–2007, 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.
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Chapter 3 — Yukon
Dentists are able to opt out of the health care plan
in the same manner as physicians. In 2006–2007,
no dentists provided written notice of their election
to collect fees other than from the Yukon Health
Care Insurance Plan.
Insured dental services are limited to those surgicaldental procedures listed in Schedule B of the
Regulations and require the unique capabilities
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 longdistance telephone calls; preparing or providing
a drug; advice by telephone at the request of the
insured person; medicolegal 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.
190
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
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
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
2006–2007.
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, 2006, no insured
in-patient or out-patient hospital services, as
provided for in the Regulations, have been
deinsured. 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.
3.0 Universality
3.1 Eligibility
Eligibility requirements for insured health services
are set out in the Health Care Insurance Plan Act
and Regulations, sections 2 and 4 respectively, and
the Hospital Insurance Services Act and Regulations,
sections 2 and 4 respectively. Subject to the provisions of these Acts and Regulations, every Yukon
resident is eligible for and entitled to insured health
services on uniform terms and conditions. The term
“resident” is defined using the wording of the Canada
Health Act and means a person lawfully entitled to
be or to remain in Canada, who makes his or her
home and is ordinarily present in the Yukon, but
does not include a tourist, transient or visitor to
the Yukon. Where applicable, the eligibility of all
persons is administered in accordance with the InterProvincial 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;
members of the Royal Canadian Mounted
Police (RCMP);
Canada Health Act Annual Report, 2006–2007
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Chapter 3 — Yukon
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, 2007, there were 32,936 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 2006–2007.
192
3.3 Other Categories of Individual
The Yukon Health Care Insurance Plan provides
health care coverage for other categories of individuals, as follows:
Returning Canadians — waiting period is applied
Permanent Residents — waiting period is applied
Minister’s Permit — waiting period is applied,
if authorized
Foreign Workers — waiting period is applied,
if holding Employment Authorization
Clergy — waiting period is applied, if holding
Employment Authorization
Employment Authorizations must be in excess of
12 months.
The estimated number of new individuals receiving
coverage in 2006–2007 under the following conditions is:
Returning Canadians — 37
Permanent Residents — 34
Minister’s Permit — 0
Convention Refugees — 0
Armed Forces — 3
RCMP — 1
The estimated number of individuals receiving
coverage in 2006–2007 under the following conditions is:
Foreign Workers — 35
Clergy — 0
3.4 Premiums
The payment of premiums by Yukon residents was
eliminated on April 1, 1987.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
4.0 Portability
4.1 Minimum Waiting Period
Pursuant to section 4(1) of the Yukon Health Care
Insurance Plan Regulations and the Yukon Hospital
Insurance Services Regulations, “an insured person is
eligible for and entitled to insured services after midnight on the last day of the second month following
the month of arrival to the Territory”. All persons
entitled to coverage are required to complete the
minimum waiting period with the exception of
children adopted from outside Canada by insured
persons. (See section 3.1.)
4.2 Coverage During Temporary Absences
in Canada
The provisions relating to portability of health care
insurance during temporary absences outside Yukon,
but within Canada, are defined in sections 5, 6, 7
and 10 of the Yukon Health Care Insurance Plan
Regulations and sections 6, 7(1), 7(2), and 9 of the
Yukon Hospital Insurance Services Regulations.
The Regulations state that “where an insured person
is absent from the Territory and intends to return,
he is entitled to insured services during a period of
12 months continuous absence”. Persons leaving
the Territory for a period exceeding three months
are advised to contact the Yukon Health Care
Insurance Plan and complete a form of “Temporary
Absence”. Failure to do so may result in cancellation
of the coverage.
Students attending educational institutions outside
the Territory remain eligible for the duration of their
academic studies. The Director, Insured Health
and Hearing Services, may approve other absences
in excess of 12 consecutive months upon receiving
a written request from the insured person. Requests
for extensions must be renewed yearly and are subject
to approval by the Director.
Canada Health Act Annual Report, 2006–2007
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 2006–2007.
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 2006–2007:
In-patient services — $8,808,130
Out-patient services — $2,168,964
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Chapter 3 — Yukon
These figures are by date of service and may be
subject to adjustment.
is established through Order-in-Council and is
derived as follows:
In 2006–2007 payments to out-of-territory
physicians totalled $2,139,805.
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).
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 2006–2007. 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, 2006 was $1,382. This rate
194
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 Orderin-Council and derived by the Inter-provincial
Health Insurance Agreements Coordinating
Committee (IHIACC).
The following amounts were paid in 2006–2007
for elective and emergency services provided to
eligible Yukon residents outside Canada:
In-patient services — $20,257
Out-patient services — $7,101
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.
5.0 Accessibility
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
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, 2007, is:
The Whitehorse General Hospital and Community
Nursing manage the supply of nurses and health care
professionals in the Territory’s two hospitals with the
Department of Health and Social Services. Shortfalls
in staffing are covered by temporary, casual or auxiliary workers to ensure residents have continued
access to insured services.
Recruitment and Retention
Recruitment and retention initiatives include:
Community Nursing
A Yukon Advisory Committee on Nursing was
struck to advise the Department of Health and
Social Services on nursing issues. Recommendations
will help Yukon recruit and retain nurses in both
the long and short term. Yukon is providing:
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
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
monthly clinical skill development;
continuing education/development; and
Pharmacist
2.27
0
travel bonus / $2,000 after one year.
Physiotherapist
4.55
9.00
Occupational Therapist
1.40
0
Psychologist
0
0
Profession
Medical Lab/X-Ray
28.79
0
Dietician
4.50
0
Public Health
0
2.00
Home Care
0
1.00
Canada Health Act Annual Report, 2006–2007
competitive salaries;
wage scale recognizes experience;
cooperative work schedules;
on-site fitness centre/24-hour;
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.
195
Chapter 3 — Yukon
Emergency surgery patients at the Whitehorse
General Hospital are normally seen within 24 hours.
Elective surgery patients are normally seen within
one to two weeks. The number of Visiting Specialist
clinics is routinely adjusted to address wait times,
particularly for orthopaedics, ear/nose/throat and
ophthalmology (see section 5.3).
Surgical services provided include:
minor orthopaedics;
selected major orthopaedics;
gynecology/obstetrical;
paediatrics;
general abdominal;
mastectomy;
emergency trauma;
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.
196
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.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
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, 2007, (see Statistical Table item #14):
General/Family Practitioners — 57
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.
Canada Health Act Annual Report, 2006–2007
In addition, the Department of Health and Social
Services and the Visiting Specialist Program provide
local access at the Whitehorse General Hospital,
Mental Health Services or the Yukon Communicable
Disease Unit to non-resident visiting specialist services not regularly available in the Territory. Visiting
specialists are reimbursed for expenses in addition
to a sessional rate or fee-for-service billings.
The number of specialists providing services under
the Visiting Specialist Program and the Department
of Health and Social Services is:
Ophthalmology — 2
Oncology — 3
Internal Medicine — 2
Otolaryngology — 1
Neurology — 2
Rheumatology — 1
Dermatology — 1
Dental Surgery — 3
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, 2007, 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, 2007, the waitlist for nonemergency specialist services was estimated at:
197
Chapter 3 — Yukon
Neurology — 1 to 4 months
Gastroenterology — 1 to 6 months
Internal Medicine — 1 to 2 months
Dental surgery services are not provided through the
Visiting Specialist as administered by the Whitehorse
General Hospital. There are no waitlists for visiting
services not included in the above listing. Patients
are seen on the next scheduled visit.
The Department of Health and Social Services has
taken several measures to reduce waiting times for
insured physician services. A variety of recruitment
and retention initiatives were begun in 2001–2002
and 2002–2003 such as a Resident Support Program;
Locum Support Program; Physician Relocation
Program; Education Support; and a Rural Training
Fund. The Department of Health and Social Services
continues to work with the Yukon Medical Association to find additional cooperative initiatives to
be implemented within the terms of the renewed
Memorandum of Understanding in April 1, 2004.
Other measures taken in 2006–2007 to ensure
access and reduce wait times:
Yukon has declared a need that will permit
internationally trained medical graduates to
be granted a special license to practice in
Yukon. These physicians will work under
the supervision of a resident Yukon physician
and provide medical services to the residents
of Whitehorse.
The Yukon Government developed a Human
Resource Strategy in 2006 of which a key component is the implementation of the Family Physician
Incentive Program for New Graduates. This program
provides newly graduated family physicians who
meet the eligibility requirements with financial
assistance in exchange for years of service in the
Yukon. Also under the strategy, Yukon established
a bursary to support students in both medical and
health profession post-secondary institutions.
198
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 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 most recent four-year Memorandum of
Understanding came into effect April 1, 2004,
and shall remain in effect to March 31, 2008.
This MOU establishes the terms and conditions
for payment of physicians and established two new
programs: New Patient Program, and 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 2006–2007.
The fee-for-service system is used to reimburse the
majority of physicians and dentists providing insured
services to residents. In 2006–2007, one full-time
resident rural physician and four resident specialists
were compensated on a contractual basis. One
physician providing visiting clinics in an outlying
community was paid a sessional rate for services.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
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
2006–2007.
6.0 Recognition Given to
Federal Transfers
The Government of Yukon has acknowledged
the federal contributions provided through the
Canada Health and Social Transfer (CHST) in
its 2006–2007 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, 2006–2007
7.0 Extended Health
Care Services
7.1 Nursing Home Intermediate Care
and Adult Residential Care
Continuing Care Health Services are available to
eligible Yukon residents. In 2006–2007, 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 2006–2007.
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.
199
Chapter 3 — Yukon
There is no legislated requirement for home care
services in Yukon.
No other major changes were made in the administration of these services in 2006–2007.
7.3 Ambulatory Health Care Services
The Yukon Home Care Program provides the
majority of ambulatory health care services outside
institutional settings. Most other services are provided through Community Nursing or Public
Health. All residents have equal access to services.
These services are not provided for in legislation.
There were some changes made in the administration of these services in 2005–2006. The Travel for
Medical Treatment Program has increased both the
subsidy amount and the mileage reimbursement
amounts. Eligible individuals are now able to collect
$75/day starting on the second day they are on
Medical Travel Status. Mileage reimbursement for
those who travel by automobile has been increased
to $.30/km. 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)
200
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)
Mental Health Services provide assessment,
diagnostic, individual and group treatment,
consultation and referral services to individuals
experiencing a range of mental health problems.
(Mental Health Act and Mental Health Act
Regulations)
Public Health is designed to promote health
and well-being throughout the Territory through
a variety of preventive and education programs.
This is a non-legislated program.
Emergency Medical Services is responsible for
the emergency stabilization and transportation
of sick and injured persons from an accident
scene to the nearest health care facility capable
of providing the required level of care. This is
a non-legislated program.
Hearing Services provides services designed to
help people of all ages with a variety of hearing
disorders, by providing routine and diagnostic
hearing evaluations and community outreach.
This is a non-legislated program.
Dental Services provides a comprehensive diagnostic, preventive and restorative dental service
to children from preschool to grade eight in
Whitehorse and Dawson City. All other Yukon
communities receive services for preschool to
grade 12. This is a non-legislated program.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Yukon
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
30,534
30,917
31,505
32,226
32,936
Insured Hospital Services Within Own Province or Territory
Public Facilities
2.
3.
Number (#):
a. acute care
b. chronic care
c. rehabilitative care
d. other 2
e. total
Payments for insured health services ($):
a. acute care
b. chronic care
c. rehabilitative care
d. other 2
e. total
5.
2003–2004
2004–2005
2005–2006
2006–2007
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
22,515,448
not applicable
not applicable
6,133,453
28,648,901
24,877,479
not applicable
not applicable
6,318,565
31,196,044
26,255,596
not applicable
not applicable
6,509,897
32,765,493
29,150,174
not applicable
not applicable
6,862,368
33,729,869
3
4
4
33,739,214
not applicable
not applicable
7,718,344
41,457,558
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4.
2002–2003
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
666
783
674
714
738
5,861,530
7,587,906
5,857,725
8,698,387
8,808,130
7,241
6,938
7,412
8,450
8,735
1,037,692
936,376
1,306,531
1,735,520
2,168,964
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
9
8
14
15
11
9,339
13,536
30,566
43,454
20,257
26
46
64
55
42
2,451
5,994
9,965
8,372
7,101
2.
Includes 13 health centres.
3.
Amounts include payments for operating and maintenance and capital.
4.
Figure adjusted as Watson Lake Hospital inadvertently excluded in the 2005/06 submission.
Canada Health Act Annual Report, 2006–2007
201
Chapter 3 — Yukon
Insured Physician Services Within Own Province or Territory
5
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
53
6
0
59
55
8
0
63
54
8
0
62
55
9
0
64
57
9
0
66
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
232,624
10,625,211
235,642
11,769,018
238,797
12,892,522
248,646
13,752,251
254,170
13,788,028
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
197,519
7,711,835
200,462
8,321,114
219,031
9,201,579
225,815
9,847,991
245,069
11,076,701
34,726
1,980,657
27,274
1,840,478
13,035
1,495,701
17,127
1,886,289
32,272
2,323,060
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
6
Visiting Specialists, Locum Doctors and
Member Reimbursements: 7
a. number of services (#)
b. total payments ($)
Insured Physician Services Provided to Residents in Another Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
34,853
34,037
35,401
35,781
39,669
1,799,019
1,833,654
1,921,260
1,873,508
2,139,805
19. Number of services (#).
20. Total payments ($).
Insured Physician Services Provided Outside Canada
21. Number of services (#).
not available
not available
not available
not available
not available
22. Total payments ($).
not available
not available
not available
not available
not available
Insured Surgical-Dental Services Within Own Province or Territory
8
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
8
6
6
6
2
150
104
30
24
not available
9
37,342
25,093
29,712
25,072
not available
9
23. Number of participating dentists (#).
24. Number of services provided (#).
25. Total payments ($).
5.
Includes on-call payments to physicians.
6.
Includes only resident family physicians and specialists.
7.
Includes Visiting Specialists, Member Reimbursements, Locum Doctors, and Optometrist testing paid through fee-for-service. Excludes services
and costs provided by alternative payment agreements.
8.
Includes direct billings for insured surgical-dental services received outside the territory.
9.
Implementation of new information system occurred in 06/07. There have been some data conversion issues that are being resolved.
Dental information will be reported again next year.
202
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Northwest Territories
vending machines no longer sell tobacco products.
Retailers are not permitted to display tobacco
products, and are required to exhibit signs disclosing tobacco-related health risks.
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, 2007, there were more than 40,000
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 2006 population estimates, approximately 25 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 Tobacco Control Act.
This Act prohibits smoking in all public places
and controls the sale and display of tobacco in
the NWT. Pharmacies, recreation facilities, and
1.
The passing of the new Pharmacy Act in
November of 2006. This Act reflects a
number of differences from the previous
Pharmacy Act, ensuring that 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.
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.
1.0 Public Administration
1.1 Health Care Insurance Plans and
Public Authority
The NWT Health Care Plan includes the Medical
Care Plan and the Hospital Insurance Plan. The
public authority responsible for administering
the Medical Care Plan is the Director of Medical
Insurance as appointed under the Medical Care Act.
The Minister administers the Hospital Insurance
Plan through Boards of Management established
under section 10 of the Hospital Insurance and Health
and Social Services Administration Act (HIHSSA).
Statistics Canada.
Canada Health Act Annual Report, 2006–2007
203
Chapter 3 — Northwest Territories
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.
1.2 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 Heath 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
service facilities. The Boards’ chairpersons hold office
indefinitely, while other members hold office for a
term of three years. In the Tlicho, community governments appoint members to the Tlicho Board of
Management for a maximum of four years.
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 chairpersons 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.
204
2.0 Comprehensiveness
2.1 Insured Hospital Services
Insured hospital services are provided under the
authority of the HIHSSA and the Regulations.
During 2006–2007, 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Northwest Territories
and treat any injury, illness or disability, but not
including simple procedures such as examinations
of blood and urine, which ordinarily form part of a
physician’s routine office examination of a patient;
necessary nursing services; drugs, biologicals and
related preparations as provided in Schedule B, when
administered in a hospital; use of operating room
and anaesthetic facilities, including necessary equipment and supplies; routine 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. Physicians and nurse
practitioners must be licensed to practice in the
NWT. Midwifes and nurses must meet registration
requirements set out respectively in the Midwifery
Profession Act and the Nursing Profession Act. As
of March 31, 2007, there were 253 licenses issued,
most to locums.
Canada Health Act Annual Report, 2006–2007
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 written notice to that effect. There are no physicians who opted-out of the Medical Care plan as
of March 2007.
A wide range of medically necessary services is
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; eye examinations
provided by an Ophthalmologist; and with proper
referral from an approved medical practitioner,
visits to specialists.
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.
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Chapter 3 — Northwest Territories
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
3.0 Universality
Services provided by hospitals, physicians and
dentists, but not covered by the NWT Health Care
Insurance Plan, include: medical-legal services; thirdparty 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 2007, there were 45,551 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.
206
Canada Health Act Annual Report, 2006–2007
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.
4.0 Portability
4.1 Minimum Waiting Period
There are waiting periods imposed on insured persons moving to the NWT. The waiting periods are
consistent with the Interprovincial Agreement on
Eligibility and Portability. Generally the waiting periods are the first day of the third month of residency,
for those who move permanently to the NWT, or the
first day of the thirteenth month for those with temporary employment of less than 12 months, but who
can confirm that the employment period has been
extended beyond the 12 months.
4.2 Coverage During Temporary Absences
in Canada
The Interprovincial Agreement on Eligibility and
Portability and the NWT Health Care Plan Registration Guidelines define the portability of health
insurance during temporary absences within Canada.
Coverage is provided to students who are temporarily
out of the NWT for full-time attendance in a postsecondary institution, and for up to one year for
individuals who are temporarily absent from the
NWT for work, vacation, etc. Once an individual
has completed a Temporary Absence form and been
approved by the Department as being temporarily
absent from the NWT, the full cost of insured
services is paid for all services received in other
jurisdictions.
When a valid NWT health care card is produced,
most doctor visits and hospital care for medically
Canada Health Act Annual Report, 2006–2007
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 2006–2007 fiscal year, over
$14 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.
As per subsection 11 (1) (b) (ii) of the Canada
Health Act, insured residents may submit receipts for
costs incurred for services received outside Canada.
The NWT does provide personal reimbursement
when an NWT resident leaves Canada for a temporary period for personal reasons such as vacations
and requires medical attention during that time.
Individuals are required to cover their own costs and
seek reimbursement upon their return to the NWT.
Benefits payable are provided in the approved tariff.
If services are rendered outside Canada, the benefits
payable must not exceed the benefits for insured
services rendered in the Territories.
Individuals may be granted coverage for up to a year
with prior approval, if they are outside the country.
In the eligibility rules, NWT residents may continue
their coverage for up to one year if they are leaving
Canada, but they must provide extensive information
confirming that they are maintaining their permanent
residence in the NWT.
4.4 Prior Approval Requirement
The NWT requires prior approval if coverage is to
be considered for elective services in other provinces,
territories and outside the country. Prior approval is
207
Chapter 3 — Northwest Territories
also required if insured services are to be obtained
from private facilities.
5.0 Accessibility
5.1 Access to Insured Health Services
The Medical Travel Program ensures that economic
barriers are reduced for all NWT residents. As per
section 14 of the Medical Care Act, extra-billing is
not allowed unless the medical practitioner has made
an election to collect her or his fees for medical services to insured persons otherwise than under the
Medical Care Plan.
5.2 Access to Insured Hospital Services
Facilities in the NWT 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 2006–2007, Telehealth services were expanded
to include a total of 17 units across the NWT. The
Department has completed a three-year strategic
plan, and is currently developing project proposals
based on this plan. One such proposal is in regards
to the provision of Speech Language Pathology to
school age children in each community.
With regards to recruiting and retaining professional
staff, the NWT faces the same challenges as the rest of
Canada. In addition, the NWT faces unique demands
due to its remoteness and socio-economic realities.
The Department developed a comprehensive five-year
human resource strategy in 2004 to address these
issues. This strategy outlined alternatives available
to the NWT Health and Social Service System to
increase the supply of health professionals required
208
to meet the health care needs of NWT residents.
Initiatives directly related to increasing the supply
of health professionals include: the promotion of
health careers, succession planning, and maximizing
northern employment.
In the effort to maximize the effectiveness of recruitment, the GNWT established a Health Recruitment
Unit in 2006. This Unit is dedicated to the recruitment of public service allied health care professionals
and results in several advantages, including the ability to react to changes in healthcare personnel needs
throughout the NWT.
5.3 Access to Insured Physician and
Surgical-Dental Services
All NWT residents have access to all facilities operated
by the Government of the Northwest Territories.
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 government budget and level of services provided by the
hospital.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Northwest Territories
Payments to facilities providing insured hospital
services are governed under the HIHSSA and the
Financial Administration Act. No amendments were
implemented in 2006–2007 to provisions involving
payments to facilities. A comprehensive budget is
used to fund hospitals in the NWT.
6.0 Recognition Given to
Federal Transfers
Federal funding received through the Canada Health
Transfer (CHT) has been recognized and reported by
the Government of the Northwest Territories through
press releases and various other documents.
For fiscal year 2006–2007, these documents included:
2006–2007 Budget Address;
2006–2007 Main Estimates;
2005–2006 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.
7.0 Extended 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. These programs and services
operate where applicable according to HIHSSA and
the Hospital Standards Regulations.
Canada Health Act Annual Report, 2006–2007
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.
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 includes: 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 Nation and Inuit Health Branch.
209
Chapter 3 — Northwest Territories
Registered Persons
2002–2003
1.
Number as of March 31st (#).
40,399
2003–2004
2
43,202
2004–2005
2
44,504
2005–2006
2
44,082
2006–2007
2
45,551
2
Insured Hospital Services Within Own Province or Territory
2002–2003
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
48,384,358
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
51,553,729
2004–2005
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
56,475,975
2005–2006
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
56,228,443
2006–2007
3
3
4
3
3
4
not applicable
not applicable
28
32
not available
not applicable
not applicable
not available
62,789,300
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
2003–2004
3
3
4
3
3
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
1,237
1,338
1,246
1,183
1,094
5
8,580,504
8,737,798
9,015,697
11,347,098
11,566,331
5
9,172
9,591
10,252
10,634
12,010
5
1,834,134
2,110,818
2,573,103
2,628,794
2,673,172
5
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
11. Total payments, in-patient ($).
12. Total number of claims, out-patient (#).
13. Total payments, out-patient ($).
2
1
2
8
17
5
1,258
216
165
13,718
38,967
5
56
21
19
54
46
5
124,725
20,735
4,972
7,280
13,062
5
All data are subject to future revisions.
2.
2001–02 figure is as of September 18, 2002, 2002–03 figure is as of September 2, 2003, the 2003–2004 figure is as of August 25, 2004,
2004–05 figure as of September 1, 2005, 2005–06 figure as of September 6, 2006 and the 2006–07 figure as of September 6, 2007.
3.
Northwest Territories does not have facilities that provide these services as their primary type of care. Instead, the 4 hospital acute care facilities
provide long term care, extended care, day surgery, out-patient services, diagnostic services and rehabilitative care.
4.
Includes Health Centres and Public Health Units.
5.
2006/07 figures are projections based on year to date claim entry.
210
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Northwest Territories
Insured Physician Services Within Own Province or Territory
2002–2003
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
37
16
155
208
2003–2004
6
6
7
8
44
15
169
228
2004–2005
6
6
7
8
56
21
139
216
2005–2006
6
56
21
155
232
6
7
8
2006–2007
6
57
21
175
253
6
7
8
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
195,512
20,504,000
200,866
28,791,514
210,371
28,761,951
186,093
30,127,892
171,314
30,569,939
18. Services provided by physicians paid
through fee-for-service:
a. number of services (#)
b. total payments ($)
24,018
1,441,954
26,326
1,513,440
28,509
1,570,686
28,818
1,574,842
27,976
1,670,071
7
7
8
9
Insured Physician Services Provided to Residents in Another Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
43,571
41,658
43,211
51,079
44,111
2,790,861
2,973,537
3,124,955
3,981,191
3,408,204
19. Number of services (#).
20. Total payments ($).
Insured Physician Services Provided Outside Canada
21. Number of services (#).
22. Total payments ($).
135
83
91
85
79
40
407
20,103
38,722
39,083
Insured Surgical-Dental Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
23. Number of participating dentists (#).
not available
not available
not available
not available
not available
24. Number of services provided (#).
not available
not available
not available
not available
not available
25. Total payments ($).
not available
not available
not available
not available
not available
All data are subject to future revisions.
6.
2006/07 figures are projections based on year to date claim entry.
7.
2001/02 numbers from Canadian Institute for Health Information, Southam Medical Database; and 2002/03 and 2003/04 numbers are
estimates from NWT Department of Health and Social Services. 2004/05 to 2006/07 figures are based on funded positions.
8.
This is an estimate of the number of locum physicians.
9.
Estimate based on total active physicians for each fiscal year.
Canada Health Act Annual Report, 2006–2007
211
212
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
as Inuit Qaujimajatuqangit, in program and
policy development as well as in service design
and delivery, is an expectation placed on all
government departments.
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, which consists of 13 communities; the Kivalliq, which consists
of seven communities; and the Kitikmeot, which
consists of five communities. According to recent
statistics, the population in Nunavut was 31,113
as of July 1, 2007.
Approximately 53 percent of the population is under
the age of 25 years. Inuit make up about 85 percent
of Nunavut’s population. There is a small Frenchspeaking population of about 4 to 6 percent residing
on Baffin Island, predominantly in the capital city
of Iqaluit. Nunavut has a highly transient workforce,
which largely 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). Over the coming
years, the Department of Health and Social Services
plans to review existing legislation to ensure its relevancy and appropriateness with the Government of
Nunavut’s objectives as outlined in “Pinasuaqtavut
2004–2009”. “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.
The incorporation of traditional Inuit values, known
Canada Health Act Annual Report, 2006–2007
The delivery of health services in Nunavut is based
on a primary health care model. There are local
health centres in 24 communities across Nunavut,
including new regional facilities in Rankin Inlet
and Cambridge Bay (with in/out patient capacity)
and one regional hospital in Iqaluit. The primary
health care providers are family physicians, nurse
practitioners, community health nurses, and pharmacists. Of concern is the loss of two full time physicians
in Nunavut this past year, as both have chosen to
leave the Territory. The full-time family physicians
number 13 across Nunavut (although there is
funding for 18 Full Time Equivalent positions):
10 in the Baffin region; two in the Kivalliq region;
and one in the Kitikmeot region. 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 new website was created in 2006–07
as part of the recruitment and retention initiative,
it can be found at:
www.nunavut-physicians.gov.nu.ca
The management and delivery of health services in
Nunavut was integrated into the overall operations
of the Department on March 31, 2000, when the
former regional boards (Baffin, Kitikmeot and
Keewatin/Kivalliq) 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 2006–2007 was $277,524,000, which
includes approximately $40,264,000 allocated
for capital projects. This represents an increase
of $36,913,000 from 2005–2006 funding levels.
213
Chapter 3 — Nunavut
In 2005–2006, Telehealth was further expanded and
made available to all 25 communities in Nunavut.
In 2006–2007 it was further realigned, and increased
its clinical sessions by 5% from the previous year.
Nunavut’s Telehealth network provides communities
with a broad range of health-related services, which
include the following: clinical program delivery such
as specialist consultation services; health education;
continuing medical education; family visitation; and
administrative functions. The network also saw new
usage for a wider range of services such as; discharge
planning, Tele-psychiatry, Geriatrics, Occupational
Therapy, and Patient Post-operation Follow-up.
The network was successful in significant financial
savings associated with medical travel as in 2005–2006
some 753 trips were avoided as a result of Telehealth
consultations.
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. Still, it
is important to note that due to focused recruitment
initiatives, 34 new additional international nurses were
recruited to work in Nunavut during 2005–2006.
Presently there are 23 international nurses working
throughout the Territory. In 2006–2007 fifteen (15)
of the international nurses left the Territory and are
working towards full certification through Canadian
Registered Nursing Exam (CRNE). Recruitment and
retention of other health care professionals such as
social workers, physicians and physiotherapists are
also 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-ofterritory facilities. Due to the very low population
density in this vast territory and limited health
214
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. In fall 2005, two
new regional health facilities, one in Rankin
Inlet and one in Cambridge Bay were opened.
In addition, a new regional hospital in Iqaluit is
scheduled to open in the fall of 2007. These facilities
will enable Nunavut to build internal capacity and
enhance the range of services that can be provided
within the Territory.
With funds from the Primary Health Care Transition
Fund, the Government of Nunavut established a
new family practice clinic in Iqaluit. The clinic has
set a goal being staffed by two family physicians
and three nurse practitioners on a community-based
health services delivery model. In its first year of
operation it was successful in helping to reduce
pressure on the emergency and out-patient departments of the Baffin Regional Hospital during working
hours. At the present time two nurse practitioners
provide a collaborative practice clinic providing
primary health care services to the community of
Iqaluit with a monthly average of 2 consult visits
from doctors of the Baffin Regional Hospital; the
clinic averages 200 patients visits per month or
15 to 18 patients per day with 2 nurse practitioners.
Health promotion and prevention activities are
high on the Department’s list of service priorities.
This includes strategies to reduce tobacco use,
public education for healthy lifestyle choices, foetal
alcohol spectrum disorder (FASD) awareness, diabetes awareness and prevention, the importance of
traditional foods, and pre-natal nutrition. Strategies
implemented in Nunavut to reduce tobacco use
have produced demonstrated results, including
a 12 percent drop in smoking among youth in
Nunavut since 2004.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
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
of Health and Social Services.
The health care insurance plans of Nunavut, including
physician and hospital services, are administered by
the Department of Health and Social Services 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, Kitikmeot and Keewatin/Kivalliq were dissolved and their operations were integrated into the
Department of Health and Social Services effective
April 1, 2000. Regional sites were maintained to
support front-line workers and community-based
delivery of a wide range of health and social services.
There have been no legislative amendments in fiscal
year 2006–2007.
1.2 Reporting Relationship
A Director of Medical Care is appointed under the
Medical Care Act and is responsible for the administration of the Territory’s medical care insurance plan.
The Director reports to the Minister of Health and
Social Services and is required to submit an annual
report on the operations of the medical insurance
plan. Our annual submissions to the Canada Health
Act Annual Report serve as the basis for these reports
under the Medical Care Act.
Canada Health Act Annual Report, 2006–2007
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, and can be accessed at:
www.oag-bvg.gc.ca/domino/reports.nsf/html/
01nunavut_e.html
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. Plans are underway
to conduct an audit for the 2006–2007 year.
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 2006–2007.
In 2006–2007, insured hospital services were delivered
in 25 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. The Baffin
Regional 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
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Chapter 3 — Nunavut
able to recruit additional physicians, they will also
be able to offer a broader range of in-patient and
out-patient services offered at community health
centres. Community health centres provide public
health, out-patient services and urgent treatment
centre 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 in Rankin Inlet and Iqaluit.
No new services were added in 2006–2007 to the
list of insured hospital services.
The Department is responsible for authorizing,
licensing, inspecting and supervising all health facilities and social services facilities in the Territory.
The Nursing Act (2004) now allows for licensure of
nurse practitioners in Nunavut as a result of legislative amendments; previously only medical doctors
were permitted to deliver insured physician services
in Nunavut. The Department examined and was
successful in introducing legislative amendments
that now give nurse practitioners an expended role
in the delivery of primary health care in the communities. An amendment to the Nursing Act was
approved during the February 2007 session of the
Legislative Assembly of Nunavut.
Insured in-patient hospital services include: accommodation and meals at the standard ward level;
necessary nursing services; laboratory, radiological
and other diagnostic procedures, together with the
necessary interpretations; drugs, biological and related
preparations prescribed by a physician and administered in hospital; routine surgical supplies; use of
operating room, case-room and anaesthetic facilities;
use of radiotherapy and physiotherapy services where
available; psychiatric and psychological services provided under an approved program; services rendered
by persons who are paid by the hospital; and services
rendered by an approved detoxification centre.
Out-patient services include: laboratory tests and
x-rays, including interpretations, when requested
by a physician and performed in an out-patient
facility or in an approved hospital; hospital services
in connection with most minor medical and surgical procedures; physiotherapy, occupational therapy,
limited audiology and speech therapy services in an
out-patient facility or in an approved hospital; and
psychiatric and psychology services provided under
an approved hospital program.
The Department of Health and Social Services
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.
216
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 2006–2007.
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 20 fulltime physician positions in Nunavut (11 in the
Baffin region; four and half positions in the
Kivalliq region; and two and half positions in
the Kitikmeot region), as well as one surgeon
and one anaesthetist at the Baffin Regional
Hospital, providing services to Nunavummiut.
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, 2007,
Nunavut had 127 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
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
month after a letter to that effect is delivered to the
Director. In 2006–2007, no physicians provided
written notice of this election. All physicians
practicing in Nunavut are under contract with
the Department.
Insured physician services—refers to all services
rendered by medical practitioners that are medically
required. Where insured services are unavailable in
some places in Nunavut, the patient is referred to
another jurisdiction to obtain the insured service.
Nunavut has in place health service agreements with
medical and treatment centres in Ottawa, Winnipeg,
Yellowknife and Edmonton. These are the out-ofterritory sites that 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 2006–2007.
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 2006–2007, 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
Canada Health Act Annual Report, 2006–2007
regular basis, but on rare occasions, for medically
complicated situations, patients are flown out of
the Territory.
The addition of new surgical-dental services to the
list of insured services requires government approval.
No new services were added to the list in 2006–2007.
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 Baffin Regional 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
217
Chapter 3 — Nunavut
could result in additional costs, only to the extent
that these costs are covered by Nunavut’s Medical
Insurance Plan (see section 4.2 under Portability).
Any query or complaint is handled on an individual
basis with the jurisdiction involved.
The Department also administers the Non-Insured
Health Benefits (NIHB) Program on behalf of
Health Canada for Inuit and First Nations residents
in Nunavut. NIHB covers a co-payment for medical
travel, accommodations and meals at boarding homes
(in Ottawa, Winnipeg, Churchill, Edmonton 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 2006–2007.
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
218
(e.g., newborns whose mothers or fathers are eligible
for coverage). As well, permanent residents (landed
immigrants), returning Canadians, repatriated
Canadians, returning permanent residents and a
non-Canadian who has been issued an employment
visa for a period of 12 months or more are also
granted first-day coverage.
Members of the Canadian Armed Forces, the
Royal Canadian Mounted Police (RCMP) and
inmates of a federal penitentiary are not eligible
for registration. These groups are granted first-day
coverage under the Nunavut Health Care Plan
upon discharge.
Pursuant to section 7 of the Inter-Provincial
Agreement on Eligibility and Portability, persons
in Nunavut who are temporarily absent from
their home province/territory and who are
not establishing residency in Nunavut remain
covered by their home provincial or territorial
health insurance plans for up to one year.
3.2 Registration Requirements
Registration requirements include a completed
application form and supporting documentation.
A health care card is issued to each resident. To
streamline document processing, a staggered renewal
process was initiated in Nunavut in 2006. No premiums exist. Coverage under the Nunavut Medical
Insurance Plan is linked to verification of registration,
although every effort is made to ensure registration
occurs when a coverage issue arises for an eligible
resident. For non-residents, a valid health care card
from their home province/territory is required.
As of March 31, 2007, 30,104 residents were
registered with the Nunavut Health Care Plan,
down by some 1,068 residents from the previous
year. Nunavut’s population statistics are published
by Statistics Canada and include a number of
temporary residents who are not eligible for
coverage under the Territory’s health plan. There
are no formal provisions for Nunavut residents
to opt out of the health care insurance plan.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
3.3 Other Categories of Individual
Non-Canadian holders of employment visas of less
than 12 months, foreign students with visas of less
than 12 months, transient workers and individuals
holding a Minister’s Permit (with one exception)
are not eligible for coverage. When unique circumstances occur, assessment is done on an individual
basis. This is consistent with section 15 of the NWT’s
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 2006–2007 with respect to
coverage outside Nunavut.
Canada Health Act Annual Report, 2006–2007
Students studying outside Nunavut must notify
the Department and provide proof of enrolment to
ensure continuing coverage. Requests for extensions
must be renewed yearly and are subject to approval
by the Director. Temporary absences for work, vacation or other reasons for up to one year are approved
by the Director upon receipt of a written request
from the insured person. The Director may approve
absences in excess of 12 continuous months, upon
receiving a written request from the insured person.
The provisions regarding coverage during temporary absences in Canada fully comply with the terms
and conditions of the Inter-Provincial/Territorial
Agreement on Eligibility and Portability, as of
January 1, 2001.
Nunavut participates in Physician and Hospital
Reciprocal Billing. As well, special bi-lateral 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 Arctic).
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 $23,907,398
in the fiscal year 2006–2007.
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Chapter 3 — Nunavut
4.3 Coverage During Temporary Absences
Outside Canada
5.0 Accessibility
The Medical Care Act, section 4(3), prescribes the
benefits payable where insured medical services are
provided outside Canada. The Hospital Insurance
and Health and Social Services Administration Act,
section 28(1) (j) (o), provides the authority for the
Minister to set the terms and conditions of payment
for services provided to Nunavut residents outside
Canada. Individuals are granted coverage for up to
one year if they are temporarily out of the country
for any reason, although they must give prior notice
in writing. For services provided to residents who
have been referred out of the country for highly
specialized procedures unavailable in Nunavut and
Canada, Nunavut will pay the full cost. For 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 2006–2007.
5.1 Access to Insured Health Services
In 2006–2007, Nunavut paid a total of $1,105
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.
220
The Medical Care Act, section 14, prohibits extrabilling by physicians unless the medical practitioner
has made an election that is still in effect. Access
to insured services is provided on uniform terms
and conditions. To break down the barrier posed
by distance and cost of travel, the Government of
Nunavut provides medical travel assistance. Interpretation services are also provided to patients in
any health care setting.
5.2 Access to Insured Hospital Services
The Baffin Regional Hospital which is expected
to be renamed the Qikiqtani General Hospital in
the fall of 2007 with the addition of a new hospital
facility connected to the current hospital, is located
in Iqaluit and currently the only operating acute
care hospital facility in Nunavut. (Recently opened
regional facilities located in Rankin Inlet and
Cambridge Bay, were both designed with acute
care capacity.) The hospital currently has 26 beds,
(which is expected to increase to 31 beds in the
new Qikiqtani General Hospital in 2007–2008)
available for acute, rehabilitative, palliative and
chronic care services and three stretchers in the
emergency room. The hospital has a staff of 87,
including 34 nurses and 10 physician positions
and in 2006–2007 the process to advertise for and
screen staff for an additional 26 new positions was
underway in preparation for the opening of the
new Qikiqtani General Hospital. 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/out-patient clinic, limited intensive
care services, and general medical care, maternity
and palliative care. Surgical services provided
include minor orthopaedics, gynaecology, paediatrics,
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
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.
In 2006–2007, acute care in Nunavut stayed at a total
of 53 beds (35 beds in Baffin Regional Hospital and
9 beds in each of the two regional centres located in
Rankin Inlet and Cambridge Bay).
Nunavut has special arrangements with facilities in
Ottawa, Toronto, Churchill, Winnipeg, Edmonton
and Yellowknife to provide insured services to
referred patients.
Outside the Baffin Regional Hospital, out-patient and
24-hour emergency nursing services are provided by
all 24 health centres located in the communities.
Although nursing and other health professionals
were not at the desired levels of staffing, basic
services were provided in 2006–2007. Nunavut
is seeking to increase resources in all areas.
Telehealth services are available in all 25 communities throughout 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.
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
Canada Health Act Annual Report, 2006–2007
and internal medicine; rehabilitation services; regularly scheduled counselling sessions; family visitation;
and continuing medical education. In 2006–2007,
Nunavut had 127 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 of Health and Social
Services. 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 Baffin Regional Hospital, the
two new regional facilities in Rankin Inlet and
Cambridge Bay, and the 22 community health
centres, are part of the Department’s budget as
represented in the budgets for regional operations.
No payments are made directly to hospitals or
community health centres.
6.0 Recognition Given to
Federal Transfers
Recognition of Canada Health Transfer by
the Government of Nunavut for 2002–2003
through to 2004–2005 was given when the
“Medical Care Act Annual Report 2005–2006”
was tabled in the Nunavut Legislative Assembly
on November 27, 2006.
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Chapter 3 — Nunavut
7.0 Extended Health
Care Services
Nursing Home Intermediate Care and
Adult Residential Care
Adult Residential Care Facilities are located in a total
of seven 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 offered
to residents ranging from six to 36 visits per year,
depending on the facility.
No legislation currently exists in Nunavut to formally
enable the activities provided in the above-mentioned
extended health care facilities.
Intermediate care is available at Naja Isabelle Home
in Chesterfield Inlet. The facility provides 24-hour
care and is fully staffed with professional and paraprofessional personnel. Nursing services are available
between 7 a.m. and 7 p.m. After-hours services are
for personal care only. The community health centre
provides after-hours medical attention.
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.
222
Home Care Services
The Home Care Program assists Nunavut residents who are not fully able to care for themselves
at home. A community-based visiting service
encourages self-sufficiency and supports family
members and community involvement to enable
individuals to remain safely in their own homes.
During 2006–2007, home care in Nunavut included
a full array of services; including nursing and personal
care, respite care, palliative 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 are offered to clients on
an “as needed” basis.
Home and Community Care (HCC) program
standards are developed by a territorial HCC
Coordinator through Regional Home and
Community Care Managers—one located in
each of the three Regions of Nunavut—who
report operationally to the Executive Director
in each Region. Home Care Nurses in each
community in turn, report to the Managers.
Home Care support staff (which include Home
& Community Care Representatives and Home
& Community Care Workers) report to their
respective Home Care Nurse. In communities
in which Home Care Nurses are not present,
support staff report to the Supervisor of the local
Health Centre. (Health Centre Supervisors in
turn report to their respective Regional Executive
Director, who is in turn, directly accountable
to their respective Home and Community
Care Manager).
Due to human and fiscal constraints, limitations
have been noted in some communities. As such,
services offered in communities are not consistent
across the Territory.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
Ambulatory Health Care Services
In 2006–2007, ambulatory health care services were
not offered across Nunavut.
However, to address this, a proposal was tabled
in the November 2006 sitting of the Legislative
Assembly, it recommended the approval of a
Continuing Care Plan; the construction of four
new continuing care facilities over the next four
years; 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);
Canada Health Act Annual Report, 2006–2007
the increase of Home and Community Care Services
to support independent living; the expansion of
the Supportive Living Stream, intended to provide
greater flexibility for seniors (by bridging the gap
between living at home with support, and living
in a nursing home). Continuing Care Centres are
intended to provide facility-based long term care,
palliative care, sub-acute care, respite care, wellness
and community care programs. Two new continuing
care facilities are planned for construction in winter
of 2007–08 with materials and designs slated for
delivery in fall and winter of 2006–2007.
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Chapter 3 — Nunavut
Registered Persons
1.
Number as of March 31st (#).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
29,478
31,660
31,525
31,172
30,104
Insured Hospital Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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
not available
25
not available
1
not available
1
26
28
1
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.
1
1
1
1
26
28
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
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 ($):
a. surgical facilities
b. diagnostic imaging facilities
c. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4.
1
Insured Hospital Services Provided to Residents in Another Province or Territory
6.
Total number of claims, in-patient (#).
7.
Total payments, in-patient ($).
8.
Total number of claims, out-patient (#).
9.
Total payments, out-patient ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
2,524
2,526
2,544
2,721
2,644
18,640,982
17,202,646
15,851,159
17,909,264
20,572,287
10,677
12,112
14,492
16,939
14,540
1,740,038
1,552,418
2,521,841
3,596,878
3,335,111
Insured Hospital Services Provided Outside Canada
10. Total number of claims, in-patient (#).
0
2
1
1
0
11. Total payments, in-patient ($).
0
6,300
6,345
954
0
12. Total number of claims, out-patient (#).
3
2
1
16
5
982
400
433
2,637
1,105
13. Total payments, out-patient ($).
1.
224
This includes 22 community health centres and two regional health centres located in communities throughout the territory; and a public health
unit and a family practice clinic, located in Iqaluit. The family practice clinic has nurse practitioners (NPs) and a physician offering primary
health care, as it would if located in one of the communities and operating as a community health centre.
Canada Health Act Annual Report, 2006–2007
Chapter 3 — Nunavut
Insured Physician Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
106
80
0
186
75
64
0
139
86
82
0
168
74
61
0
135
60
67
0
127
15. Number of opted-out physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16. Number of not participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17. Services provided by physicians paid
through all payment methods:
a. number of services (#)
b. total payments ($)
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: 2
a. number of services (#)
b. total payments ($)
65,532
3,336,866
60,561
3,548,457
59,542
3,112,661
57,363
2,863,075
46,368
2,380,746
14. Number of participating physicians (#):
a. general practitioners
b. specialists
c. other
d. total
Insured Physician Services Provided to Residents in Another Province or Territory
19. Number of services (#).
20. Total payments ($).
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
43,064
51,050
45,334
57,332
59,121
2,674,445
2,955,996
2,816,282
3,471,307
3,623,163
Insured Physician Services Provided Outside Canada
21. Number of services (#).
1
19
0
36
5
22. Total payments ($).
8
1,519
0
2,459
1,105
Insured Surgical-Dental Services Within Own Province or Territory
2002–2003
2003–2004
2004–2005
2005–2006
2006–2007
23. Number of participating dentists (#).
not available
not available
not available
not available
not available
24. Number of services provided (#).
not available
not available
not available
not available
not available
25. Total payments ($).
not available
not available
not available
not available
not available
2.
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.
Canada Health Act Annual Report, 2006–2007
225
226
Canada Health Act Annual Report, 2006–2007
Annex A – Canada Health Act and 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
Canada Health Act Annual Report, 2006–2007
and territories to provide estimates 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 the actual deductions can be made. These
regulations are also presented in an office consolidation format. This unofficial consolidation is
current to June 2001.
227
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
AVERTISSEMENT
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.
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
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;
—that Canadians, through their system of
insured health services, have made outstanding progress in treating sickness and alleviating the consequences of disease and disability among all income groups;
—that Canadians can achieve further
improvements in their well-being through
combining individual lifestyles that emphasize fitness, prevention of disease and health
promotion with collective action against the
social, environmental and occupational causes of disease, and that they desire a system of
health services that will promote physical
and mental health and protection against disease;
—that future improvements in health will
require the cooperative partnership of governments, health professionals, voluntary
organizations and individual Canadians;
—that continued access to quality health care
without financial or other barriers will be
critical to maintaining and improving the
health and well-being of Canadians;
And whereas the Parliament of Canada wishes to encourage the development of health serv-
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
Considérant que le Parlement du Canada
reconnaît :
que le gouvernement du Canada n’entend pas
par la présente loi abroger les pouvoirs,
droits, privilèges ou autorités dévolus au
Canada ou aux provinces sous le régime de la
Loi constitutionnelle de 1867 et de ses modifications ou à tout autre titre, ni leur déroger
ou porter atteinte,
que les Canadiens ont fait des progrès remarquables, grâce à leur système de services de
santé assurés, dans le traitement des maladies
et le soulagement des affections et déficiences parmi toutes les catégories socioéconomiques,
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;
Préambule
231
Chap. C–6
Canada Health Act
ices throughout Canada by assisting the
provinces in meeting the costs thereof;
Now, therefore, Her Majesty, by and with the
advice and consent of the Senate and House of
Commons of Canada, enacts as follows:
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,
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.
Short title
1. Loi canadienne sur la santé.
Titre abrégé
1984, ch. 6, art. 1.
1984, c. 6, s. 1.
Definitions
“cash contribution”
« contribution
pécuniaire »
“dentist”
« dentiste »
“extended health
care services”
« services complémentaires de
santé »
“extra-billing”
« surfacturation »
“health care
insurance plan”
« régime d’assurance-santé »
“health care practitioner”
« professionnel de
la santé »
“hospital”
« hôpital »
232
INTERPRETATION
DÉFINITIONS
2. In this Act,
“Act of 1977” [Repealed, 1995, c. 17, s. 34]
“cash contribution” means the cash contribution in respect of the Canada Health and
Social Transfer that may be provided to a
province under subsections 15(1) and (4) of
the Federal-Provincial Fiscal Arrangements
Act;
“contribution” [Repealed, 1995, c. 17, s. 34]
“dentist” means a person lawfully entitled to
practise dentistry in the place in which the
practice is carried on by that person;
“extended health care services” means the following services, as more particularly defined
in the regulations, provided for residents of a
province, namely,
(a) nursing home intermediate care service,
(b) adult residential care service,
(c) home care service, and
(d) ambulatory health care service;
“extra-billing” means the billing for an insured
health service rendered to an insured person
by a medical practitioner or a dentist in an
amount in addition to any amount paid or to
be paid for that service by the health care
insurance plan of a province;
“health care insurance plan” means, in relation
to a province, a plan or plans established by
the law of the province to provide for insured
health services;
“health care practitioner” means a person lawfully entitled under the law of a province to
provide health services in the place in which
the services are provided by that person;
“hospital” includes any facility or portion thereof that provides hospital care, including
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’emprisonnement 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.
Définitions
« assuré »
“insured person”
« contribution
pécuniaire »
“cash contribution”
«dentiste »
“dentist”
« frais modérateurs »
“user charge”
Loi canadienne sur la santé
“hospital services”
« services hospitaliers »
“insured health
services”
« services de
santé assurés »
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;
“hospital services” means any of the following
services provided to in-patients or outpatients 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 interpretations,
(d) drugs, biologicals and related preparations when administered in the hospital,
(e) use of operating room, case room and
anaesthetic facilities, including necessary
equipment and supplies,
(f) medical and surgical equipment and
supplies,
(g) use of radiotherapy facilities,
(h) use of physiotherapy facilities, and
(i) services provided by persons who
receive remuneration therefor from the
hospital,
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
Chap. C–6
« 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 :
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 :
a) les soins intermédiaires en maison de
repos;
b) les soins en établissement pour
adultes;
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.
« habitant »
“resident”
« hôpital »
“hospital”
« médecin »
“medical practitioner”
« ministre »
“Minister”
« professionnel de
la santé »
“health care
practitioner”
« régime d’assurance-santé »
“health care
insurance plan”
« services complémentaires de
santé »
“extended health
care services”
« services de
chirurgie dentaire
»
“surgical-dental
services”
233
Chap. C–6
“insured person”
« assuré »
“medical practitioner”
« médecin »
“Minister”
« ministre »
“physician services”
« services médicaux »
“resident”
« habitant »
“surgical-dental
services”
« services de
chirurgie dentaire »
“user charge”
« frais modérateurs »
Canada Health Act
(a) a member of the Canadian Forces,
(b) a member of the Royal Canadian
Mounted Police who is appointed to a rank
therein,
(c) a person serving a term of imprisonment in a penitentiary as defined in the
Penitentiary Act, or
(d) a resident of the province who has not
completed such minimum period of residence or waiting period, not exceeding
three months, as may be required by the
province for eligibility for or entitlement
to insured health services;
“medical practitioner” means a person lawfully
entitled to practise medicine in the place in
which the practice is carried on by that person;
“Minister” means the Minister of Health;
“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.
CANADIAN HEALTH CARE POLICY
« services de santé assurés » Services hospitaliers, médicaux ou de chirurgie dentaire fournis aux assurés, à l’exception des services de
santé auxquels une personne a droit ou est
admissible en vertu d’une autre loi fédérale
ou d’une loi provinciale relative aux accidents du travail.
« services hospitaliers » Services fournis dans
un hôpital aux malades hospitalisés ou
externes, si ces services sont médicalement
nécessaires pour le maintien de la santé, la
prévention des maladies ou le diagnostic ou
le traitement des blessures, maladies ou invalidités, à savoir :
a) l’hébergement et la fourniture des
repas en salle commune ou, si médicalement nécessaire, en chambre privée ou
semi-privée;
b) les services infirmiers;
c) les actes de laboratoires, de radiologie
ou autres actes de diagnostic, ainsi que les
interprétations nécessaires;
d) les produits pharmaceutiques, substances biologiques et préparations connexes administrés à l’hôpital;
e) l’usage des salles d’opération, des
salles d’accouchement 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.
234
« services de
santé assurés »
“insured health
services”
« services hospitaliers »
“hospital services”
« services médicaux »
“physician services”
« surfacturation »
“extra-billing”
Loi canadienne sur la santé
Primary objective
of Canadian
health care policy
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.
1984, c. 6, s. 3.
PURPOSE
Purpose of this
Act
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.
R.S., 1985, c. C-6, s. 4; 1995, c. 17, s. 35.
CASH CONTRIBUTION
Cash contribution
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.
R.S., 1985, c. C-6, s. 5; 1995, c. 17, s. 36.
6. [Repealed, 1995, c. 17, s. 36]
Chap. C–6
POLITIQUE CANADIENNE DE LA SANTÉ
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.
Objectif premier
1984, ch. 6, art. 3.
RAISON D’ÊTRE
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.
Raison d’être de
la présente loi
L.R. (1985), ch. C-6, art. 4; 1995, ch. 17, art. 35.
CONTRIBUTION PÉCUNIAIRE
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).
Contribution
pécuniaire
L.R. (1985), ch. C-6, art. 5; 1995, ch. 17, art. 36.
PROGRAM CRITERIA
Program criteria
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:
(a) public administration;
(b) comprehensiveness;
(c) universality;
(d) portability; and
(e) accessibility.
1984, c. 6, s. 7.
Public administration
8. (1) In order to satisfy the criterion
respecting public administration,
(a) the health care insurance plan of a
province must be administered and operated
on a non-profit basis by a public authority
appointed or designated by the government
of the province;
6. [Abrogé, 1995, ch. 17, art. 36]
CONDITIONS D’OCTROI
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’assurance-santé de satisfaire,
pendant tout cet exercice, aux conditions d’octroi énumérées aux articles 8 à 12 quant à :
a) la gestion publique;
b) l’intégralité;
c) l’universalité;
d) la transférabilité;
e) l’accessibilité.
Règle générale
1984, ch. 6, art. 7.
8. (1) La condition de gestion publique suppose que :
a) le régime provincial d’assurance-santé
soit géré sans but lucratif par une autorité
publique nommée ou désignée par le gouvernement de la province;
b) l’autorité publique soit responsable
devant le gouvernement provincial de cette
gestion;
Gestion publique
235
Chap. C–6
Designation of
agency permitted
Canada Health Act
(b) the public authority must be responsible
to the provincial government for that administration and operation; and
(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.
(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.
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 :
a) soit de recevoir en son nom les montants
payables au titre du régime provincial d’assurance-santé;
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.
Désignation d’un
mandataire
1984, ch. 6, art. 8.
1984, c. 6, s. 8.
Comprehensiveness
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.
1984, c. 6, s. 9.
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
(a) must not impose any minimum period of
residence 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;
(b) must provide for and be administered and
operated so as to provide for the payment of
amounts for the cost of insured health servic-
Portability
236
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.
10. La condition d’universalité suppose
qu’au titre du régime provincial d’assurancesanté, cent pour cent des assurés de la province
ait droit aux services de santé assurés prévus
par celui-ci, selon des modalités uniformes.
Universalité
1984, ch. 6, art. 10.
11. (1) La condition de transférabilité suppose
que le régime provincial d’assurance-santé :
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;
Transférabilité
Loi canadienne sur la santé
Requirement for
consent for elective insured health
services permitted
Definition of
“elective insured
health services”
es provided to insured persons while temporarily absent from the province on the
basis that
(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) 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
(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.
(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 temporarily absent from the
province if the services in question were available on a substantially similar basis in the
province.
(3) For the purpose of subsection (2), “elective insured health services” means insured
health services other than services that are provided in an emergency or in any other circumstance in which medical care is required without delay.
1984, c. 6, s. 11.
12. (1) In order to satisfy the criterion
respecting accessibility, the health care insurance plan of a province
Chap. C–6
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 :
(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,
(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;
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.
Accessibility
12. (1) La condition d’accessibilité suppose
que le régime provincial d’assurance-santé :
Accessibilité
237
Chap. C–6
Reasonable compensation
Canada Health Act
(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;
(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
(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.
(2) In respect of any province in which extrabilling 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
(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.
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;
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;
c) 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.
(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 :
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.
Rémunération
raisonnable
1984, ch. 6, art. 12.
1984, c. 6, s. 12.
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
(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
Conditions
238
CONTRIBUTION PÉCUNIAIRE ASSUJETTIE À DES CONDITIONS
13. Le versement à une province de la pleine
contribution pécuniaire visée à l’article 5 est
assujetti à l’obligation pour le gouvernement de
la province :
a) de communiquer au ministre, selon les
modalités de temps et autres prévues par les
règlements, les renseignements du genre
Obligations de la
province
Loi canadienne sur la santé
(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.
Chap. C–6
prévu aux règlements, dont celui-ci peut normalement avoir besoin pour l’application de
la présente loi;
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.
DEFAULTS
Referral to
Governor in
Council
Consultation
process
Where no consultation can be
achieved
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
(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
(b) the province has failed to comply with
any condition set out in section 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
province, the Minister shall
(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;
(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.
(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.
Order reducing or
withholding
contribution
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
MANQUEMENTS
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) soit que le régime d’assurance-santé de
la province ne satisfait pas ou plus aux conditions visées aux articles 8 à 12;
b) soit que la province ne s’est pas conformée aux conditions visées à l’article 13,
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 :
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;
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.
Renvoi au gouverneur en conseil
Étapes de la consultation
Impossibilité de
consultation
1984, ch. 6, art. 14.
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
Décret de réduction ou de retenue
239
Chap. C–6
Amending orders
Notice of order
Commencement
of order
Canada Health Act
any condition set out in section 13, the
Governor in Council may, by order,
(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.
(2) The Governor in Council may, by order,
repeal or amend any order made under subsection (1) where the Governor in Council is of the
opinion that the repeal or amendment is warranted in the circumstances.
(3) A copy of each order made under this
section together with a statement of any findings on which the order was based shall be sent
forthwith by registered mail to the government
of the province concerned and the Minister
shall cause the order and statement to be laid
before each House of Parliament on any of the
first fifteen days on which that House is sitting
after the order is made.
(4) An order made under subsection (1) shall
not come into force earlier than thirty days after
a copy of the order has been sent to the government of the province concerned under subsection (3).
R.S., 1985, c. C-6, s. 15; 1995, c. 17, s. 38.
Reimposition of
reductions or
withholdings
When reduction
or withholding
imposed
(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.
(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.
(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).
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.
L.R. (1985), ch. C-6, art. 15; 1995, ch. 17, art. 38.
R.S., 1985, c. C-6, s. 16; 1995, c. 17, s. 39.
L.R. (1985), ch. C-6, art. 16; 1995, ch. 17, art. 39.
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.
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.
R.S., 1985, c. C-6, s. 17; 1995, c. 17, s. 39.
EXTRA-BILLING AND USER CHARGES
240
conditions visées à l’article 13, le gouverneur
en conseil peut, par décret :
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;
b) soit, s’il l’estime indiqué, ordonner la
retenue de la totalité de la contribution pécuniaire d’un exercice à la province.
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.
L.R. (1985), ch. C-6, art. 17; 1995, ch. 17, art. 39.
SURFACTURATION ET FRAIS MODÉRATEURS
Modification des
décrets
Avis
Entrée en vigueur
du décret
Nouvelle application des réductions ou retenues
Application aux
exercices
ultérieurs
Loi canadienne sur la santé
Extra-billing
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.
1984, c. 6, s. 18.
User charges
Limitation
Deduction for
extra-billing
Deduction for
user charges
Consultation with
province
Chap. C–6
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.
Surfacturation
1984, ch. 6, art. 18.
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.
(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 attending physician, requires chronic care
and is more or less permanently resident in a
hospital or other institution.
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.
(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.
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.
(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.
(3) The Minister shall not estimate an
amount under subsection (1) or (2) without first
undertaking to consult the minister responsible
for health care in the province concerned.
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.
(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) 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.
Frais modérateurs
Réserve
Déduction en cas
de surfacturation
Déduction en cas
de frais modérateurs
Consultation de la
province
241
Chap. C–6
Separate accounting in Public
Accounts
Refund to
province
Saving
When deduction
made
Regulations
Agreement of
provinces
242
Canada Health Act
(4) Any amount deducted under subsection
(1) or (2) from a cash contribution in any of the
three consecutive 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.
(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 eliminated in a province, the
total amount deducted in respect of extrabilling or user charges, as the case may be, shall
be paid to the province.
(6) Nothing in this section restricts the
power of the Governor in Council to make any
order under section 15.
(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.
(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.
(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.
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.
Comptabilisation
Remboursement à
la province
Réserve
Application aux
exercices
ultérieurs
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 generality of the foregoing, regulations
(a) defining the services referred to in paragraphs (a) to (d) of the definition “extended
health care services” in section 2;
(b) prescribing the services excluded from
hospital services;
(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
(d) prescribing the manner in which recognition to the Canada Health and Social Transfer is
required to be given under paragraph 13(b).
(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.
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 :
a) définir les services visés aux alinéas a) à
d) de la définition de «services complémentaires de santé» à l’article 2;
b) déterminer les services exclus des services hospitaliers;
c) 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).
Règlements
(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.
Consentement des
provinces
Loi canadienne sur la santé
Exception
Consultation with
provinces
(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.
(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.
Chap. C–6
(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.
(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.
Exception
Consultation des
provinces
L.R. (1985), ch. C-6, art. 22; 1995, ch. 17, art. 40.
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.
Rapport annuel
du ministre
1984, ch. 6, art. 23.
1984, c. 6, s. 23.
243
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
AVERTISSEMENT
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.
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 EXTRABILLING 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,
"Act" means the Canada Health Act; (Loi)
"Minister" means the Minister of National Health and
Welfare; (ministre)
"fiscal year" means the period beginning on April 1 in one
year and ending on March 31 in the following year. (exercice)
2. Les définitions qui suivent s'appliquent au présent
règlement.
« exercice » La période commençant le 1er avril d'une année
et se terminant le 31 mars de l'année suivante. (fiscal
year)
« Loi » La Loi canadienne sur la santé. (Act)
« ministre » Le ministre de la Santé nationale et du Bienêtre 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 extra-billing 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 through
extra-billing, including an explanation regarding the
method of determination of the estimate; and
(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.
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) 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) 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,
accompagnée 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.
247
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:
(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
(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.
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) pour les estimations visées aux alinéas 3a) et 4a),
avant le 1er avril de l'exercice visé par ces estimations;
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.
248
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, 2006–2007
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 insurance plan pays the physician fee for a medically
necessary service delivered at a private clinic, it must
also pay the facility fee or face a deduction from
federal transfer payments
249
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.
250
Canada Health Act Annual Report, 2006–2007
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 determination 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, 2006–2007
251
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.
252
Canada Health Act Annual Report, 2006–2007
Annex B — Policy Interpretation Letters
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, 2006–2007
253
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.
254
Canada Health Act Annual Report, 2006–2007
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, 2006–2007
255
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 interpretations 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
256
Canada Health Act Annual Report, 2006–2007
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, 2006–2007
257
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
258
Canada Health Act Annual Report, 2006–2007
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
Canada Health Act Annual Report, 2006–2007
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.
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.
259
260
Canada Health Act Annual Report, 2006–2007
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, 2006–2007
261
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.
262
Canada Health Act Annual Report, 2006–2007
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, 2006–2007
263
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:
264
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, 2006–2007
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.
Acute Care Facility
An acute care facility is a health care facility providing care or treatment of
patients with an acute disease or health condition.
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
This is a fee charged by a physician for services that are not insured by
the provincial or territorial health insurance plan, such as telephone
advice, renewal of prescriptions by telephone, and completion of forms
or documents.
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.
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.
Canada Health Act Annual Report, 2006–2007
265
Annex D — Glossary
Term
Description
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.
Family-based Registration
A method for registering or enrolling persons under a health care insurance
plan whereby insured persons are registered as family units.
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 Care Facility
A health care facility is a building or group of buildings under a common
corporate structure that houses health care personnel and health care
equipment to provide health care services (e.g., diagnostic, surgical, acute
care, chronic care, physiotherapy) on an in-patient or out-patient basis to
the public in general or to a designated group of persons or residents.
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
out-of-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).
266
Canada Health Act Annual Report, 2006–2007
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.
Private Diagnostic Facility
This is a privately owned health care facility providing laboratory tests,
radiological services and other diagnostic procedures.
Canada Health Act Annual Report, 2006–2007
267
Annex D — Glossary
Term
Description
Private (for-profit)
Health Care Facility
This is a privately owned health care facility that provides laboratory
tests, radiological services and other diagnostic procedures, and pays out
dividends or profits to its owners, shareholders, operators or members.
Private (not-for-profit)
Health Care Facility:
This is a privately owned health care facility providing laboratory tests, radiological services and other diagnostic procedures, recognized as operating
on a non-profit basis under the laws of the provincial, territorial or federal
governments.
Private Surgical Facility
This is a privately owned health care facility providing surgical health services.
Public Health Care Facility
A public health care facility is a publicly administered institution located
within Canada that provides insured health care services under a provincial
or territorial health care insurance plan on an in- or out-patient basis.
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.
Tray Fees
Tray fees are charges permitted under a provincial or territorial health care
insurance plan for medical supplies and equipment such as alcohol swabs,
instruments, sutures, etc., that are associated with the provision of an insured
physician service.
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Canada Health Act Annual Report, 2006–2007
Contact Information for Provincial and Territorial Departments of Health
Newfoundland and Labrador
Manitoba
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
Manitoba Health
300 Carlton Street
Winnipeg, MB R3B 3M9
1-800-392-1207
www.gov.mb.ca/health
Prince Edward Island
Department of Health
P.O. Box 2000
Charlottetown, PE C1A 7N8
(902) 368-6130
www.gov.pe.ca/
Nova Scotia
Nova Scotia Department of Health
P.O. Box 488
Halifax, NS B3J 2R8
(902) 424-5818
www.gov.ns.ca/health/
New Brunswick
Department of Health
P.O. Box 5100
Fredericton, NB E3B 5G8
(506) 457-4800
http://www.gnb.ca/
Quebec
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
Ministry of Health
1515 Blanchard Street
Victoria, BC V8W 3C8
1-800-465-4911
www.gov.bc.ca/health
Yukon
Ministry of Health and Social Services
1075 Sainte-Foy Road
Québec, QC G1S 2M1
(418) 266-7005
www.msss.gouv.qc.ca
Health and Social Services
204 Lambert Street, 4th Floor
Financial Plaza
Whitehorse, YT Y1A 2C6
1-867-667-3096
www.hss.gov.yk.ca/
Ontario
Northwest Territories
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
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
http://www.gov.nu.ca/health/
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