2005 – 2006 Canada Health Act Annual Report

2005 – 2006 Canada Health Act Annual Report
Canada Health Act
Annual Report
2005 – 2006
2005 – 2006
Health Canada is the federal department responsible for helping Canadians maintain and improve their health. We assess the safety
of drugs and many consumer products, help improve the safety of food, and provide information to Canadians to help them make
healthy decisions. We provide health services to First Nations people and to Inuit communities. We work with the provinces to ensure
our health care system serves the needs of Canadians.
Published by authority of the Minister of Health.
Canada Health Act — Annual Report 2005–2006
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 2005-2006
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
E-Mail: [email protected]
© Her Majesty the Queen in Right of Canada, represented by the Minister of Health Canada, 2006
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.: 1237
Cat.: H1-4/2006E
ISBN: 0-662-44245-8
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, 2006.
Tony Clement
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Canada Health Act Annual Report, 2005–2006
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, 2005–2006
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Canada Health Act Annual Report, 2005–2006
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 2005–2006 _____________________________________13
Newfoundland and Labrador _____________________________________________________________________________________________ 15
Prince Edward Island ______________________________________________________________________________________________________ 19
Nova Scotia ________________________________________________________________________________________________________________ 43
New Brunswick ____________________________________________________________________________________________________________ 59
Quebec _____________________________________________________________________________________________________________________ 71
Ontario _____________________________________________________________________________________________________________________ 77
Manitoba ___________________________________________________________________________________________________________________ 93
Saskatchewan _____________________________________________________________________________________________________________ 109
Alberta ____________________________________________________________________________________________________________________ 129
British Columbia _________________________________________________________________________________________________________ 143
Yukon _____________________________________________________________________________________________________________________ 165
Northwest Territories ____________________________________________________________________________________________________ 183
Nunavut___________________________________________________________________________________________________________________ 193
Annex A — Canada Health Act and Extra-Billing and User Charges Information Regulations_________________________205
Annex B — Policy Interpretation Letters ___________________________________________________________________________________227
Annex C — Dispute Avoidance and Resolution Process under the Canada Health Act _________________________________237
Annex D — Glossary of Terms ______________________________________________________________________________________________ 243
Provincial and Territorial Departments of Health Contact Information _______________________________________inside back cover
Canada Health Act Annual Report, 2005–2006
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Canada Health Act Annual Report, 2005–2006
administration, comprehensiveness, universality, portability and accessibility. These principles are symbols of
the underlying Canadian values of equity and solidarity.
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, 10 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 cost-share 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 reiterated that health
care services in Canada ranked among the best in the
world, but warned that extra-billing by doctors and user
fees levied by hospitals were creating a two-tiered system
that threatened the accessibility of care. This report, and
the national debate it generated, led to the enactment of
the Canada Health Act in 1984.
The Canada Health Act, Canada’s federal health insurance
legislation, defines the national principles that govern
the Canadian health insurance system, namely, public
Canada Health Act Annual Report, 2005–2006
The roles and responsibilities for Canada’s health care
system are shared between the federal and provincial/
territorial governments. The provincial and territorial
governments have primary jurisdiction in the administration and delivery of health care services. This includes
setting their own priorities, administering their health
care budgets and managing their own resources. The
federal government, under the Canada Health Act, sets
out the criteria and conditions that must be satisfied by
the provincial and territorial health insurance plans for
them to qualify for their full share of the cash contribution available under the federal Canada Health Transfer.
On an annual basis, the federal Minister of Health is
required to report to Parliament on the administration
and operations of the Canada Health Act, as set out in
section 23 of the Act. The vehicle for so doing is the
Canada Health Act Annual Report. While the principal
and intended audience for the report is parliamentarians,
it is a readily accessible public document that offers a
comprehensive report on insured services in each of the
provinces and territories. The annual report is structured
to address the mandated reporting requirements of the
Act — its scope does not extend to commenting on the
status of the Canadian health care system as a whole.
Health Canada’s approach to the administration of the Act
emphasizes transparency, consultation and dialogue with
provincial and territorial health care ministries. The application of financial penalties through deductions under
the Canada Health Transfer is considered only as a last
resort when all options to resolve an issue collaboratively
have been exhausted. Pursuant to the commitment made
by premiers under the 1999 Social Union Framework
Agreement, federal, provincial and territorial governments
agreed through an exchange of letters, in April 2002, to
a Canada Health Act Dispute Avoidance and Resolution
(DAR) process. The DAR process was formalized in the
First Ministers’ 2004 Accord. Although the DAR process
includes dispute resolution provisions, the federal Minister
of Health retains the final authority to interpret and enforce
the Canada Health Act.
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Introduction
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
accessibility issues, especially patient charges and queue
jumping for medically necessary health services at private
clinics. Health Canada has made these concerns known
to the provinces that allow these charges.
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Canada Health Act Annual Report, 2005–2006
Chapter 1 – Canada Health Act Overview
Key Definitions Under the Canada Health Act
Chapter 1
Canada Health
Act Overview
This section describes the Canada Health Act, its
requirements and key definitions under the Act.
Also described are the regulations and regulatory
provisions of the Act and the interpretation letters
by former federal Ministers of Health Jake Epp and
Diane Marleau to their provincial and territorial
counterparts that are used in the interpretation and
application of the Act.
What is the Canada Health Act?
The Canada Health Act is Canada’s federal legislation
for publicly funded health care insurance. The Act sets
out the primary objective of Canadian health care policy,
which is “to protect, promote and restore the physical
and mental well-being of residents of Canada and to
facilitate reasonable access to health services without
financial or other barriers.”
The Act establishes criteria and conditions related to
insured health services and extended health care services
that the provinces and territories must fulfill to receive
the full federal cash contribution under the Canada
Health Transfer (CHT).
The aim of the Act is to ensure that all eligible residents
of Canada have reasonable access to medically necessary
services on a prepaid basis, without direct charges at the
point of service for such services.
Canada Health Act Annual Report, 2005–2006
Insured persons are eligible residents of a province or
territory. A resident of a province is defined in the Act
as “a person lawfully entitled to be or to remain in Canada
who makes his home and is ordinarily present in the
province, but does not include a tourist, a transient or
a visitor to the province.”
Persons excluded under the Act include serving members
of the Canadian Forces or Royal Canadian Mounted Police
and inmates of federal penitentiaries.
Insured health services are medically necessary hospital, physician and surgical-dental services provided to
insured persons.
Insured hospital services are defined under the Act
and include medically necessary in- and out-patient
services such as accommodation and meals at the standard or public ward level and preferred accommodation
if medically required; nursing service; laboratory, radiological and other diagnostic procedures, together with
the necessary interpretations; drugs, biologicals and
related preparations when administered in the hospital;
use of operating room, case room and anaesthetic
facilities, including necessary equipment and supplies;
medical and surgical equipment and supplies; use of
radiotherapy facilities; use of physiotherapy facilities;
and services provided by persons who receive remuneration therefore from the hospital, but does not include
services that are excluded by the regulations.
Insured physician services are defined under the Act
as “medically required services rendered by medical
practitioners.” Medically required physician services are
generally determined by physicians in conjunction with
their provincial and territorial health insurance plans.
Insured surgical-dental services are services provided
by a dentist in a hospital, where a hospital setting is
required to properly perform the procedure.
Extended health care services as defined in the Act are
certain aspects of long-term residential care (nursing
home intermediate care and adult residential care
services), and the health aspects of home care and
ambulatory care services.
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Chapter 1 — Canada Health Act Overview
Requirements of the
Canada Health Act
The Canada Health Act contains nine requirements
that the provinces and territories must fulfill in order
to qualify for the full amount of their cash entitlement
under the CHT. They are:
five program criteria that apply only to insured
health services;
two conditions that apply to insured health
services and extended health care services; and
extra-billing and user charges provisions that
apply only to insured health services.
The Criteria
1. Public Administration (section 8)
The public administration criterion, set out in section 8 of
the Canada Health Act, applies to provincial and territorial
health care insurance plans. The intent of the public administration criterion is that the provincial and territorial
health care insurance plans be administered and operated
on a non-profit basis by a public authority, which is
accountable to the provincial or territorial government
for decision-making on benefit levels and services, and
whose records and accounts are publicly audited.
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.
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.
4. Portability (section 11)
Residents moving from one province or territory to
another must continue to be covered for insured health
services by the “home” jurisdiction during any waiting
period imposed by the new province or territory of residence. The waiting period for eligibility to a provincial
or territorial health care insurance plan must not exceed
three months. After the waiting period, the new province
or territory of residence assumes responsibility for health
care coverage.
Residents who are temporarily absent from their home
province or territory or from Canada, must continue to
be covered for insured health services during their absence.
This allows individuals to travel or be absent from their
home province or territory, within a prescribed duration,
while retaining their health insurance coverage.
The portability criterion does not entitle a person to seek
services in another province, territory or country, but is
intended to permit a person to receive necessary services
in relation to an urgent or emergent need when absent on
a temporary basis, such as on business or vacation.
If insured persons are temporarily absent in another province or territory, the portability criterion requires that
insured services be paid at the host province’s rate. If
insured persons are temporarily out of the country, insured services are to be paid at the home province’s rate.
Prior approval by the health care insurance plan in a
person’s home province or territory may also be required
before coverage is extended for elective (non-emergency)
services to a resident while temporarily absent from
his/her province or territory.
3. Universality (section 10)
5. Accessibility (section 12)
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.
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).
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Canada Health Act Annual Report, 2005–2006
Chapter 1 — Canada Health Act Overview
In addition, the health care insurance plans of the province
or territory must provide:
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.
Extra-billing is seen as a barrier or impediment for people
seeking medical care, and is therefore contrary to the
accessibility criterion.
reasonable compensation to physicians and dentists
for all the insured health services they provide; and
payment to hospitals to cover the cost of insured
health services.
Reasonable access in terms of physical availability of
medically necessary services has been interpreted under
the Canada Health Act using the “where and as available”
rule. Thus, residents of a province or territory are entitled
to have access on uniform terms and conditions to insured
health services at the setting “where” the services are
provided and “as” the services are available in that setting.
The Conditions
1. Information (section 13(a))
The provincial and territorial governments shall provide
information to the Minister of Health as may be reasonably
required, in relation to insured health services and extended
health care services, for the purposes of the Act.
2. Recognition (section 13(b))
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).
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:
Canada Health Act Annual Report, 2005–2006
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.
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Chapter 1 — Canada Health Act Overview
To date, the only regulations in force under the Act
are the Extra-billing and User Charges Information
Regulations. These regulations require the provinces
and territories to provide estimates of extra-billing
and user charges before the beginning of a fiscal year
so that appropriate penalties can be levied. They must
also provide financial statements showing the amounts
actually charged so that reconciliations with 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:
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services that fall outside the definition of insured
health services; and
certain services and groups of persons are excluded from
the definitions of insured services and insured persons.
These exclusions are discussed below.
Non-insured Health Services
In addition to the medically necessary hospital and
physician services covered by the Canada Health Act,
provinces and territories also provide a range of programs
and services outside the scope of the Act. These are
provided at provincial and territorial discretion, on their
own terms and conditions, and vary from one province
or territory to another. Additional services that may be
provided include pharmacare, ambulance services and
optometric services.
The additional services provided by provinces and
territories are often targeted to specific population
groups (e.g., children, seniors or social assistance
recipients), and may be partially or fully covered by
provincial and territorial health insurance plans.
A number of services provided by hospitals and physicians
are not considered medically necessary, and thus are not
insured under provincial and territorial health insurance
legislation. Uninsured hospital services for which patients
may be charged include preferred hospital accommodation
unless prescribed by a physician, private duty nursing
services and the provision of telephones and televisions.
Uninsured physician services for which patients may
be charged include telephone advice, the provision of
medical certificates required for work, school, insurance
purposes and fitness clubs, testimony in court and
cosmetic services.
Excluded Persons
The Canada Health Act definition of “insured person”
excludes members of the Canadian Forces, persons
appointed to a position of rank within the Royal
Canadian Mounted Police and persons serving a term
of imprisonment within a federal penitentiary. The
Government of Canada provides coverage to these
groups through separate federal programs.
Canada Health Act Annual Report, 2005–2006
Chapter 1 — Canada Health Act Overview
As well, other categories of residents such as landed
immigrants and Canadians returning to live from other
countries may be subject to a waiting period by a province
or territory. The Act stipulates that the waiting period
cannot exceed three months.
In addition, the definition of “insured health services”
excludes services to persons provided under any other
Act of Parliament (e.g., refugees) or under the workers’
compensation legislation of a province or territory.
The exclusion of these persons from insured health
service coverage predates the adoption of the Act and
is not intended to constitute differences in access to
publicly insured health care.
Policy Interpretation Letters
There are two key policy statements that clarify the
federal position on the Canada Health Act. These
statements have been made in the form of ministerial
letters from former federal ministers of health to their
provincial and territorial counterparts. Both letters are
reproduced in Annex B of this report.
Epp Letter
In June 1985, approximately one year following the
passage of the Canada Health Act in Parliament, thenfederal Minister of Health and Welfare Jake Epp wrote
to his provincial and territorial counterparts to set out
and confirm the federal position on the interpretation
and implementation of the Act.
Minister Epp’s letter followed several months of consultation with his provincial and territorial counterparts.
The letter sets forth statements of federal policy intent
that clarify the Act’s criteria, conditions and regulatory
provisions. These clarifications have been used by the
federal government in assessing and interpreting compliance with the Act. The Epp letter remains an important
reference for interpreting the Act.
Canada Health Act Annual Report, 2005–2006
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 pay the facility fee or face a deduction
from federal transfer payments.
Dispute Avoidance and
Resolution Process
In April 2002, then-federal Minister of Health A. Anne
McLellan outlined in a letter to her provincial and
territorial counterparts a Canada Health Act Dispute
Avoidance and Resolution process, which was agreed
to by provinces and territories, except Quebec. The
process meets federal and provincial/territorial interests
of avoiding disputes related to the interpretation of
the principles of the Act, and when this is not possible,
resolving disputes in a fair, transparent and timely manner.
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Chapter 1 — Canada Health Act Overview
The process includes the dispute avoidance activities
of government-to-government information exchange;
discussions and clarification of issues as they arise; active
participation of governments in ad hoc federal/provincial/
territorial committees on Act-related issues; and Canada
Health Act advance assessments, upon request.
Where dispute avoidance activities prove unsuccessful,
dispute resolution activities may be initiated, beginning
with government-to-government fact-finding and
negotiations. If these are unsuccessful, either minister
of health involved may refer the issues to a third-party
panel to undertake fact-finding and provide advice and
recommendations.
The federal Minister of Health has the final authority
to interpret and enforce the Canada Health Act. In
deciding whether to invoke the non-compliance provisions of the Act, the Minister will take the panel’s report
into consideration.
A copy of Minister McLellan’s letter is included in Annex C
of this report.
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Canada Health Act Annual Report, 2005–2006
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. Our
preference is always to work with provinces and territories
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, 2005–2006
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 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
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Chapter 2 — Administration and Compliance
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 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
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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.
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 accessibility
issues, especially 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 five provinces
(British Columbia, Alberta, Manitoba, Quebec and
Nova Scotia). where private clinics are charging patients
and allowing them to jump the queue for insured
health services.
During 2005–2006, Health Canada was successful in
reaching an agreement with Manitoba to address patient
charges for medical surgical supplies, known as “tray fees.”
Canada Health Act Annual Report, 2005–2006
Chapter 2 — Administration and Compliance
Also during 2005–2006, the federal Health Minister
notified his counterpart in New Brunswick of his intent
to refer the province’s refusal to provide coverage for
medically necessary abortion services performed in clinics
to a panel review under the Canada Health Act Dispute
Avoidance and Resolution process.
Canada Health Transfer
Deductions in 2005–2006
Deductions were taken from the March 2006 Canada
Health Transfer (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.
History of Deductions and Refunds
Under the Canada Health Act
The Canada Health Act, which came into force
April 1, 1984, reaffirmed the national commitment
to the original principles of the Canadian health care
system, as embodied in the previous legislation, the
Medical Care Act and the Hospital Insurance and
Diagnostic Services Act. By putting into place mandatory dollar-for-dollar penalties for extra-billing
and user charges, the federal government took steps
to eliminate the proliferation of direct charges for
hospital and physician services, judged to be restricting
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
Canada Health Act Annual Report, 2005–2006
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 three-year
transition period, under which refunds to provinces and
territories for deductions were possible, penalties under
the Act did not reoccur until fiscal year 1994–1995.
As a result of a dispute between the British Columbia
Medical Association and the British Columbia government over compensation, several doctors opted out of
the provincial health insurance plan and began billing
their patients directly. Some of these doctors billed their
patients at a rate greater than the amount the patients
could recover from the provincial health insurance plan.
This higher amount constituted extra-billing under the
Act. Including deduction adjustments for prior years,
dating back to fiscal year 1992–1993, deductions began
in May 1994 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 noncompliance with the Federal Policy on Private Clinics.
11
Chapter 2 — Administration and Compliance
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.
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.
12
In 2004, British Columbia did not report to Health
Canada the amounts of extra-billing and user charges
actually charged during fiscal year 2001–2002, in
accordance with the requirements of the Extra-billing
and User Charges Information Regulations. As a result
of reports that British Columbia was investigating cases
of user charges, a $126,775 deduction was taken from
British Columbia’s March 2004 CHST payment, based
on the amount Health Canada estimated to have been
charged during fiscal year 2001–2002.
Deductions were taken from the March 2005 CHT
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.
Since the enactment of the Canada Health Act, from
April 1984 to March 2006, deductions totalling
$8,853,076 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2005–2006
Health Act, while statistics help to identify current and
future trends in the Canadian health care system.
Chapter 3
Provincial and
Territorial Health
Care Insurance Plans
in 2005–2006
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 2005–2006.
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, New Brunswick
and Quebec have chosen 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:
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
Canada Health Act Annual Report, 2005–2006
To help provinces and territories prepare their submissions to
the annual report, Health Canada provided them with the
document Canada Health Act Annual Report 2005–2006:
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 2005–2006 Canada Health Act Annual
Report was launched late spring 2006 when letters were
sent to all provinces and territories confirming the timetable for this year’s annual report. An updated User’s
Guide was also sent to the provinces and territories at
that time. Additionally, bilateral meetings were held this
year with provincial and territorial officials from Ontario
and Prince Edward Island to review the process and
reporting requirements.
Insurance Plan Descriptions
For the following chapter, provincial and territorial officials
were asked to provide a narrative description of their
health insurance plan. The descriptions follow the
program criteria areas of the Canada Health Act in order
to illustrate how the plans satisfy these criteria. This
narrative description also includes information on how
each jurisdiction met the Canada Health Act requirement
for 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.
13
Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2005–2006
The format remains the same for the 2005–2006 report.
The supplemental statistical information can be found at
the end of each provincial or territorial narrative, except
for New Brunswick and 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, 2006. 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.
Public Facilities: Statistics on facilities providing insured
hospital services, excluding psychiatric hospitals and
nursing homes (which are not covered under the CHA),
are provided in fields two and three.
14
Private-for-Profit Facilities: Measures four through six
capture statistics on private-for-profit health care facilities
that provide insured hospital services. These measures
have been broken down into two sub-categories based
on the services provided under the definition of insured
hospital services in the CHA.
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 Services Provided to Residents in Another
Province or Territory — Hospitals: 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 Services Provided to Residents in Another
Province or Territory — Physicians: This sub-section
reports on physician services that are paid by a jurisdiction
to other provinces or territories for their visiting residents.
Insured Services Provided Outside Canada —
Hospitals: Hospital services provided out of country
represent a person’s hospital costs incurred while travelling outside of Canada that are paid for by their home
province or territory.
Insured Services Provided Outside Canada —
Physicians: Physician services provided out of country
represent a person’s 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
Newfoundland
and Labrador
Introduction
The reorganization of the province’s 14 health boards
into four new regional health authorities occurred in
2005–2006. The new structure will achieve greater
integration of services on a regional basis. The four new
regional authorities will focus on the full continuum of
care including public health, community services and
acute and long-term care services. By the end of fiscal
year 2005–2006, new Boards of Trustees and senior
executive teams were in place and restructuring of
administrative and support services were underway.
The provincial government appoints Boards of Trustees
who serve as volunteers. These boards are responsible for
delivering health and community services to their regions
and, in some cases, to the province as a whole, interact.
Regional authorities interact with the public and stakeholders to determine health needs. The boards receive
their funding from the provincial government, to which
they are accountable. The Department of Health and
Community Services provides the boards with policy
direction and monitors programs and services.
In March 2006 the department released the Provincial
Wellness Plan. The first phase of the plan will be implemented over the next three years and will focus on key
areas including healthy eating, physical activity, tobacco
control and injury prevention.
Other key initiatives during the year included:
The appointment of the province’s first Chief Nurse.
A new Medical Act which will increase accountability
and public protection. Under this legislation, the
Newfoundland Medical Board is renamed the College
of Physicians and Surgeons of Newfoundland and
Labrador.
Canada Health Act Annual Report, 2005–2006
Working Together for Mental Health, a new provincial
policy for mental health and addictions services,
was released.
The Province reached a new four-year Memorandum
of Agreement with physicians.
Design and some site work began on new long-term
care sites in the Eastern and Western regions.
Budget 2005 continued Government’s development of
an Electronic Health Record through an investment of
$4 million to expand and enhance the Picture Archiving
and Communications System (PACS). This allows
diagnostic images including X-rays and CT scans to
be digitally captured, viewed, stored and transmitted
electronically from one facility to another. By 2007
there will be 27 PACS sites in Newfoundland and
Labrador making it the first province in Canada to
have a province-wide system.
A Provincial Wait Time Coordinator was hired in
September 2005 to coordinate improved monitoring
and reporting of wait times for select health services.
Regional Wait Times coordinators were put in place
to assist with this initiative. In December 2005,
Government announced the implementation of
pan-Canadian wait times for five select procedures
and committed to quarterly reporting.
Budget 2005 allocated $2.6 million to implement
another three primary health care teams (Port aux
Basques, Deer Lake/White Bay, Springdale/Green
Bay) and expand some of the existing networks,
with funding provided to four more areas (Grand
Falls-Windsor/Botwood, New-Wes-Valley, St. John’s
downtown and Burin Peninsula) to develop proposals
for PHC changes in their areas.
In spring 2005, a Chronic Disease Prevention and
Management Collaborative program, with diabetes
as the first collaborative, was funded provincially
and initiated in eight PHC team areas.
In winter 2005, funding was provided to develop
a provincial Telehealth Plan.
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.
In Newfoundland and Labrador, almost 19,000 health care
providers and administrators provided health services to
510,000 residents.
15
Chapter 3 — Newfoundland and Labrador
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. Both plans are non-profit and publicly administered.
The Hospital Insurance Agreement Act, amended in 1994,
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) which came into
force on April 1, 2000, empowers the Minister to administer a plan of medical care insurance for residents of the
province. It allows for developing regulations to ensure
that the provisions of the statute meet the requirements
of the Canada Health Act as it relates to administering
the Medical Care Plan.
The Medical Care Plan facilitates the delivery of comprehensive medical care to all residents of the province
by implementing policies, procedures and systems that
permit appropriate compensation to providers for rendering insured professional services. The Medical Care
Plan operates in accordance with the provisions of the
Medical Care Insurance Act (1999) and Regulations, and
in compliance with the Canada Health Act.
There were no legislative amendments to the Medical
Care Insurance Act (1999) or the Hospital Insurance
Agreement Act in 2005–2006.
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 2005–2006 Annual
Report in the House of Assembly in fall 2006. The four
regional health authorities, on behalf of predecessor boards,
and some health agencies will also table their reports.
16
The Department’s Annual Report highlights the accomplishments of 2005–2006 and provides an overview
of the initiatives and programs that will continue to be
developed in 2006–2007. 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. The 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 were performed
by independent auditing firms that are selected by the
health authorities under the terms of the Public Tendering Act. Review engagements, compliance audits and
physician audits were carried out by personnel from the
Department under the authority of the Newfoundland
Medical Care Insurance Act (1999). Physician records and
professional medical corporation records were reviewed to
ensure that the records supported the services billed and
that the services are insured under the Medical Care Plan.
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 (as amended)
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 outpatients in 36 facilities (14 hospitals and 22 community
health centres) and 14 nursing stations. Insured services
include: accommodation 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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
room, case room and anaesthetic facilities; rehabilitative
services (e.g. physiotherapy, occupational therapy, speech
language pathology and audiology); out-patient 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 delisting a hospital service from
the list of insured services based on direction from the
Minister. There were no services added or de-listed in
2005–2006.
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 Newfoundland
Medical Board (now named the College of Physicians
and Surgeons of Newfoundland and Labrador) to
practice 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
Canada Health Act Annual Report, 2005–2006
diagnostic and therapeutic x-ray and laboratory
services in facilities approved by the appropriate
authority that are not provided under the Hospital
Insurance Agreement Act and Regulations made
under the Act.
Physicians can choose not to participate in the health
care insurance plan as outlined in subsection 12(1) of
the Medical Care Insurance Act (1999), namely:
(1) Where a physician providing insured services is not
a participating physician, and the physician provides
an insured service to a beneficiary, the physician is
not subject to this Act or the regulations relating to
the provision of insured services to beneficiaries or
the payment to be made for the services except that
he or she shall:
(a) before providing the insured service, if he or
she wishes to reserve the right to charge the
beneficiary for the service an amount in excess
of that payable by the Minister under this Act,
inform the beneficiary that he or she is not a
participating physician and that the physician
may so charge the beneficiary; and
(b) provide the beneficiary to whom the physician has
provided the insured service with the information
required by the minister to enable payment to be
made under this Act to the beneficiary in respect
of the insured service.
(2) Where a physician who is not a participating physician
provides insured services through a professional medical
corporation, the professional medical corporation is
not, in relation to those services, subject to this Act
or the regulations relating to the provision of insured
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, 2006, there were no physicians who had
opted out of the Medical Care Plan.
Ministerial direction is required to add to or to de-insure
a physician service from the list of insured services. This
process is managed by the Department in consultation
with various stakeholders, including the provincial medical
association and the public. There were no services added
or deleted during the 2005–2006 fiscal year to the list of
insured physician services.
17
Chapter 3 — Newfoundland and Labrador
2.3 Insured Surgical-Dental Services
The provincial Surgical-Dental Program is a component of
the Medical Care Plan. Surgical-dental treatments provided
to a beneficiary and carried out in a hospital by a dentist
are covered by Medical Care Plan 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 Licensing Board.
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. One dentist
is currently in the opted-out category.
Because the Surgical-Dental Program is a component of
the Medical Care Plan, management of the Program is
linked to the Plan 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 the Plan 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; non-medically required x-rays or other services
for employment or insurance purposes; drugs (except antirejection and AZT drugs) and appliances issued for use
after discharge from hospital; bedside telephones, radios
or television sets for personal, non-teaching use; fibreglass
splints; services covered by Workers’ Compensation legislation or by other federal or provincial legislation; and
services relating to therapeutic abortions performed in
non-accredited facilities or facilities not approved by the
Newfoundland Medical Board.
The use of the hospital setting for any services deemed
not insured by the Medical Care 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:
18
any advice given by a physician to a beneficiary
by telephone;
the dispensing by a physician of medicines, drugs or
medical appliances and the giving or writing of medical
prescriptions;
the preparation by a physician of records, reports or
certificates for, or on behalf of, or any communication
to, or relating to, a beneficiary;
any services rendered by a physician to the spouse and
children of the physician;
any service to which a beneficiary is entitled under
an Act of the Parliament of Canada, an Act of the
Province of Newfoundland and Labrador, an Act
of the legislature of any province of Canada, or any
law of a country or part of a country;
the time taken or expenses incurred in travelling to
consult a beneficiary;
ambulance service and other forms of patient
transportation;
acupuncture and all procedures and services related
to acupuncture, excluding an initial assessment specifically related to diagnosing the illness proposed to
be treated by acupuncture;
examinations not necessitated by illness or at the
request of a third party except as specified by the
appropriate authority;
plastic or other surgery for purely cosmetic purposes,
unless medically indicated;
testimony in a court;
visits to optometrists, general practitioners and ophthalmologists solely for determining whether new
or replacement glasses or contact lenses are required;
the fees of a dentist, oral surgeon or general
practitioner for routine dental extractions performed
in hospital;
fluoride dental treatment for children under four years
of age; excision of xanthelasma;
circumcision of newborns;
hypnotherapy;
medical examination for drivers;
alcohol/drug treatment outside Canada;
consultation required by hospital regulation;
therapeutic abortions performed in the province
at a facility not approved by the Newfoundland
Medical Board;
sex reassignment surgery, when not recommended
by the Clarke Institute of Psychiatry;
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
in vitro fertilization and ovarian stimulation and
sperm transfer (OSST); reversal of previous
sterilization procedure;
surgical, diagnostic or therapeutic procedures not
provided in facilities other than those listed in the
Schedule to the Hospitals Act or approved by the
appropriate authority under paragraph 3(d); and
other services not within the ambit of section 3 of
the Act.
The majority of diagnostic services, e.g. laboratory services
and x-ray are performed within public facilities in the
province. Hospital policy concerning access ensures that
third parties are not given priority access.
Medical goods and services that are implanted and associated with an insured service are provided free of charge to
the patient and are consistent with national standards of
practice. Patients retain the right to financially upgrade the
standard medical goods or services. Standards for medical
goods are developed by the hospitals providing those
services in consultation with service providers.
Surgical-dental and other services not covered by the
Surgical-Dental Program include the dentist’s fee and the
oral surgeon’s or general practitioner’s fees for routine
dental extractions in a hospital.
3.0 Universality
3.1 Eligibility
Residents of Newfoundland and Labrador are eligible for
coverage under the Medical Care Insurance Act (1999) and
the Hospital Insurance Agreement Act (as amended).
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. The Medical
Care Plan has established rules to ensure that the Regulations are applied consistently and fairly in processing
applications for coverage.
Canada Health Act Annual Report, 2005–2006
Persons not eligible for coverage under the plans include:
students and their dependants already covered by another
province or territory; dependants of residents if covered
by another province or territory; certified refugees and
refugee claimants and their dependants; foreign workers
with Employment Authorizations and their dependants
who do not meet the established criteria; foreign students
and their dependants; tourists, transients, visitors and
their dependants; Canadian Forces and Royal Canadian
Mounted Police (RCMP) personnel; inmates of federal
prisons; and armed forces personnel from other countries
who are stationed in the province.
3.2 Registration Requirements
Registration under the Medical Care Plan and possession
of a valid Medical Care Plan 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.
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 Medical Care
Plan number. A birth or baptismal certificate will be
required where the child’s surname differs from either
parent’s surname.
Applications for coverage of an adopted child require
a copy of the official adoption documents, the birth
certificate of the child, or a Notice of Adoption Placement from the Department. Applications for coverage
of a child adopted outside Canada require Permanent
Resident documents for the child.
3.3 Other Categories of Individual
Foreign workers, 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 500 beneficiaries covered under a
work permit, only one under a Minister’s permit and
approximately 15 dependents of NATO personnel.
Clergy are included under the work permit or other
category and numbers are not readily available.
19
Chapter 3 — Newfoundland and Labrador
4.0 Portability
4.1 Minimum Waiting Period
Insured persons moving to Newfoundland and Labrador
from other provinces or territories are entitled to coverage
on the first day of the third month following the month
of arrival.
Persons arriving from outside Canada to establish residence
are entitled to coverage on the day of arrival. The same
applies to discharged members of the Canadian Forces,
the RCMP and released inmates of federal penitentiaries.
For coverage to be effective, however, registration is
required under the Medical Care Plan. Immediate
coverage is provided to persons from outside Canada
authorized to work in the province for one year or more.
4.2 Coverage During Temporary Absences
in Canada
Newfoundland and Labrador is a party to the
Agreement on Eligibility and Portability regarding
matters pertaining to portability of insured services
in Canada.
Sections 12 and 13 of the Hospital Insurance
Regulations (1996) define portability of hospital
coverage during temporary absences both within
and outside Canada. Portability of medical coverage
during temporary absences both within and outside
Canada is defined in departmental policy.
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).
20
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 Medical
Care Plan for payment at host province rates.
In order to qualify for out-of-province coverage,
a beneficiary must comply with the legislation and
Medical Care Plan 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:
Before leaving the province for extended periods,
a resident must contact the Medical Care Plan
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 of four
consecutive months. Thereafter, certificates will only
be issued for up to eight months of coverage;
Students leaving the province may receive a certificate,
renewable each year, provided they submit proof of
full-time enrolment in a recognized 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 outof-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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
Coverage is immediately discontinued when residents
move permanently to other countries.
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 emergency, sudden illness and elective procedures
at established rates. Hospital services are considered
under the Plan when the insured services are provided
by a recognized facility (licensed or approved by the
appropriate authority within the state or country in which
the facility is located) outside Canada. The maximum
amount payable by the Government’s hospitalization plan
for out-of-country in-patient hospital care is $350 per
day, if the insured services are provided by a community
or regional hospital. Where insured services are provided
by a tertiary care hospital (a highly specialized facility),
the approved rate is $465 per day. The approved rate
for out-patient services is $62 per visit and hæmodialysis
is $220 per treatment. The approved rates are paid in
Canadian funds.
Physician services are covered for emergencies or sudden
illness and are also insured for elective services not available
in the province or within Canada. Physician services are
paid at the same rate as would be paid in Newfoundland
and Labrador for the same service. If the services are not
available in Newfoundland and Labrador, they are usually
paid at Ontario rates, or at rates that apply in the
province where they are available.
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 Medical Care Plan for
prior approval.
Canada Health Act Annual Report, 2005–2006
Prior approval is not required for physician services;
however, it is suggested that physicians obtain prior
approval from the Medical Care Plan 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 2005–2006, the Department continued with 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 in the province and is continuing
work in this regard. The Department participates in
the Provincial Nursing Network, which was formed to
develop human resource strategies for registered nurses
and licensed practical nurses. The Department also
created a Chief Nurse position.
The Atlantic Health Human Resources Planning Study
was completed in 2005–2006. The study’s deliverables
include comparative analysis of the previous provincial
studies and roll-up of data, inventories of health education
programmes, an environmental scan, reusable simulation
modelling software and recommendations. The study’s
executive summary is available at www.ahhra.ca.
21
Chapter 3 — Newfoundland and Labrador
Five health human resource projects were completed,
including: 1) developing province-wide standards related
to HHR data; 2) developing best practices for the recruitment and retention of physicians; 3) implementing a
system in one organization to establish the collection
of nursing workload data; 4) provision of community
mental health services in the province; and 5) assisting
regional health authorities to develop and sustain quality
professional practice environments for registered nurses
and licensed practical nurses to positively impact nurse
retention and client outcomes. These projects were funded
by Health Canada.
in increasing the number of surgeries performed and
cancer treatments delivered in 2005–2006.
The department continued to offer recruitment incentives for physicians, registered nurses, audiologists, speech
language pathologists, pharmacists and other health professionals in 2005–2006.
In late 2005–2006, Newfoundland and Labrador announced a $14.5 million investment in a province wide Picture
Archiving and Communications System (PACS) by 2007.
This amount includes a contribution of $10.5 million by
Canada Health Infoway Inc. and a provincial investment
of $4 million. PACS will benefit patients, health care
providers and managers through improved access to
diagnostic imaging services in rural areas, reduced wait
time for patients in physicians’ offices, improved access to
specialist consultations due to improved image portability,
and improved test-to-results time. A combined investment
of $14.5 million by government and Infoway will result
in the implementation of the PACS project in the Western
and Labrador-Grenfell regions of the province allowing
these regions to link into existing sites in Central and
Eastern regions.
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 invest $23.2 million in
2005–2006 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. These monies will
allow the delivery of 43,344 additional MRI, CT, cardiac
and other key diagnostic procedures, surgeries, as well
as cancer treatments to reduce wait times for provincial
residents. The new equipment includes a second MRI in
St. John’s, replacement of aging CT scanners with multislice scanners, new and replacement ultrasound equipment
at four sites and four new mammography machines. The
MRI, CT scanners, ultrasound and mammography equipment at the St. John’s tertiary sites became operational in
late 2005–2006. Ultrasound and mammography in other
health regions will be available in 2006–2007. Expanded
select services include increased cardiac surgeries, increased
surgical capacity for joint replacement and cancer, and
extended hours of operation to give cancer patients greater
access to chemotherapy and radiation. Progress was made
22
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 hired a provincial wait times
coordinator in 2005–2006 and is completing baseline
assessment of wait times in the province. Government
is working in partnership with health authorities and
health care professionals in improving access to insured
hospital services.
The provincial Primary Health Care framework, Moving
Forward Together: Mobilizing Primary Health Care is
providing direction for remodelling primary health care in
Newfoundland and Labrador through 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 primary health care 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 evidence-based approach to
services provision; and (4) enhanced accountability
and satisfaction of health professionals. Provincial
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
supports have included an Office of Primary Care, the
Primary Health Care Advisory Council, linkages with
local college and university programs and professional
associations, and developing provincial working groups
to support learning/problem-solving and provider
capacity-building.
Eight interdisciplinary, team-based, primary health care
team areas have initiated changes to service delivery based
on the provincial framework, including the development
of Community Advisory Committees and enhanced activities support health promotion and illness prevention. In
addition, three PHC team areas have completed proposals
and provided with funding for implementation, and four
other areas have been provided funds for proposal development. Registration processes for primary health care
services have commenced in one of the team areas. Formal
evaluation of these changes is ongoing by external evaluators, and a report will be available in fall 2006.
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 primary health care team areas,
with the development of action plans to assist in shifting
scope of practices.
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 primary health care team areas,
and a physician network contract (for signing by the
Department of Health and Community Services, the
region, and the physician network for medical services to
the PHC team area) is in the later stages of completion.
In spring 2005, a Chronic Disease Prevention and
Management Collaborative program, with diabetes
as the first collaborative, was funded provincially on
an operational basis, and initiated in eight 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
Canada Health Act Annual Report, 2005–2006
guidelines, and also for service planning at the individual
client, PHC team area, regional and provincial levels.
There are plans in the early stages to move forward with
collaboratives for mental health and arthritis.
Newfoundland and Labrador is currently involved in two
Atlantic Canada projects. Building a Better Tomorrow
Initiative has been supporting team and inter-professional
development and change management in primary health
care team areas through a variety of training modules
(team development, conflict resolution, adult learning,
understanding primary health care, community development and program planning and evaluation).
In partnership with New Brunswick, a Memorandum
of Understanding is being completed for a 24/7 nurse
health advice telephone, and plans are in place for
implementation, including identification of a site for
the call center.
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 boards to develop a provincial human
resource plan for physicians based on the principle of
access to services.
As of March 31, 2006, there were 471 general practitioners and 500 specialists in practice, compared with
460 general practitioners and 494 specialists as of
March 31, 2005. This represents a two percent increase
in general practitioners and a one percent increase
in specialists.
The Department initiated several measures to ensure access
for insured physician services. Some of these included:
funding for the Provincial Office of Recruitment;
retention bonuses for salaried physicians based on
geography and years of service;
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 2005–2006, 39 bursaries and travelling
fellowships were funded.
23
Chapter 3 — Newfoundland and Labrador
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.
The award provides for agreed-to increases to fees and
salaries during the life of the agreement, additional payments for on-call and recognition of on-call services by
salaried physicians. The current methods of remuneration
to compensate physicians for providing insured health
services are fee-for-service (63% of physicians); salaried
(35% of physicians); and alternate payment plans (2% of
physicians) such as block funding and new case payments.
5.5 Payments to Hospitals
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 introduces 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 2005–2006, these documents included:
the 2005–2006 Public Accounts;
the Estimates 2005–2006; and
the Budget Speech 2005.
The Department is responsible for funding regional
health authorities for ongoing operations and capital
purchases. Funding for insured services is provided to
the regional health authorities as an annual global budget.
Payments are made in accordance with the Hospital
Insurance Agreement Act (1990) and the Hospitals Act.
As part of their accountability to the Government, the
health authorities are required to meet the Department’s
annual reporting requirements, which include audited
financial statements and other financial and statistical
information. The global budgeting process devolves
the budget allocation authority, responsibility and
accountability to all appointed boards in the discharge
of their mandates.
Throughout the fiscal year, the regional health authorities
forwarded additional funding requests to the Department
for any changes in program areas or increased workload
volume. These requests were reviewed and, when approved
by the Department, funded at the end of each fiscal year.
Newfoundland and Labrador has established long-term
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:
24
The Public Accounts and Estimates, tabled by the
Government in the House of Assembly, are publicly
available to Newfoundland and Labrador residents
and have been shared with Health Canada for
information purposes.
7.0 Extended Health
Care Services
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
Long-term residential accommodations are provided
for residents requiring high levels of nursing care in
21 community health centres and 20 nursing homes.
There are approximately 2,800 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 2,750 beds located
in 94 homes across the province. These homes are
operated by the private for-profit sector. Residents
are subsidized to a maximum of $1,138.10 per
month, based on an individual client assessment
using standardized financial criteria.
Home Care Services
Home care services include professional and nonprofessional supportive care to enable people to remain
in their own homes for as long as possible without risk.
Professional services include nursing as well as some
rehabilitative programs. These services are publicly
funded and delivered by staff employed by the four
regional health authorities. Non-professional services
include personal care, household management, respite
and behavioural management. These services are
delivered by home support workers through agency
or self-managed care arrangements. Eligibility for
non-professional services is determined through a
client financial assessment using provincial criteria.
The monthly ceiling for home support services (fiscal
2005–2006) is $2,707 for seniors and $3,875 for
persons with disabilities.
Special Assistance Program
The Special Assistance Program is a provincial program
that provides basic supportive services to assist financially
eligible clients in the community with activities of daily
living. The benefits include access to health supplies,
oxygen, orthotics and equipment.
Canada Health Act Annual Report, 2005–2006
Drug Programs
The Senior Citizens’ Drug Subsidy Program is provided to
residents over 65 years of age who receive the Guaranteed
Income Supplement and who are registered for Old Age
Security benefits. Eligible individuals are given coverage
for the ingredient portion of benefit prescription items.
Any additional cost, such as dispensing fees, is the client’s
responsibility. Income support recipients are eligible for
the Income Support Drug Plan, which covers the full cost
of benefit prescription items, including a set mark-up
amount and dispensing fee.
Other Programs
The Department administers the Emergency Air and
Road Ambulance Programs.
The Road Ambulance Program provides quality prehospital emergency and routine treatment, care and
transportation. It also includes the transfer of patients
between facilities and return of patients to their place
of residence. Road ambulances are operated by 56 organizations — 30 private companies, 22 community or
volunteer groups, and four regional health authorities.
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 fixed-wing
aircraft is used in Labrador for regional medical services
transports, including routine appointments by coastal
residents in Happy Valley/Goose Bay, Labrador.
Residents who travel by commercial air to access medically
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.
25
Chapter 3 — Newfoundland and Labrador
The Dental Health Plan incorporates a children’s dental
component and an income support component. The
children’s program covers the following dental services for
all children up to and including the age of 12: examinations at six-month intervals; cleanings at 12-month
intervals; fluoride applications at 12-month intervals for
children aged 6 to 12; x-rays (some limitations); fillings
and extractions; and some other specific procedures that
require approval before treatment. Services are available to
recipients of income support 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. Beneficiaries covered under the Dental
Health Plan must pay a variable amount directly to the
dentist for each service provided (e.g., fillings, extractions,
etc.). In circumstances where the beneficiary is receiving
income support, a $5 co-payment is paid by the Dental
Health Plan.
Registered Persons
2001–2002
565,000
1. Number as of March 31st.
2002–2003
560,644
2003–2004
2004–2005
599,907
2005–2006
569,835
545,160
1
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
2
36
36
36
36
36
b.
chronic care
0
0
0
0
0
c.
rehabilitative care
0
0
0
0
0
d.
other
0
0
0
0
0
e.
total
36
36
36
36
36
3. Payments:
a. acute care
619,884,087
666,472,833
666,773,382
679,024,717
764,301,116
b.
chronic care
0
0
0
0
0
c.
rehabilitative care
d.
e.
other
total
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
619,884,087
666,472,833 3
666,773,382
3
670,024,717
3
764,301,116
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1
1
1
1
1
0
1
0
1
0
1
0
1
0
1
3
5. Number of insured hospital services
provided:
a.
surgical facilities
not available
not available
not available
not available
not available
b.
diagnostic imaging facilities
c.
total
0
not available
0
not available
0
not available
0
not available
0
not available
338,200
286,425
280,250
264,575
285,475
0
338,200
0
286,425
0
280,250
0
264,575
0
285,475
6. Payments:
a. surgical facilities
1.
2.
3.
26
b.
diagnostic imaging facilities
c.
total
Number of registered persons exceeds number of residents. Re-registration of residents commencing in 2006.
Restated number of hospital and health centres providing acute care services (rather than only those with acute care beds.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Newfoundland and Labrador
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
7. Number of participating physicians: 4
a.
b.
c.
d.
general practitioners
specialists
other
total
421 5
465 5
not applicable
886 5
437 5
477 5
not applicable
914 5
451 5
499 5
not applicable
950 5
460 5
494 5
not applicable
954 5
471 5
500 5
not applicable
971 5
8. 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
9. 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
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
2,263,000
2,218,000
not applicable
4,481,000
2,147,000
2,206,000
not applicable
4,353,000
2,109,987
1,843,902
not applicable
3,953,889
2,145,000
1,874,000
not applicable
4,019,000
2,222,000
2,012,000
not applicable
4,234,000
42,751,000
75,177,000
not applicable
117,928,000
50,961,000
78,157,000
not applicable
129,118,000
62,613,000
90,739,000
not applicable
153,352,000
72,225,000
103,685,000
not applicable
175,910,000
75,475,000
104,788,000
not applicable
180,263,000
2,728,000
398,000
1,345,000
not applicable
4,481,000
2,607,000
379,000
1,367,000
not applicable
4,353,000
3,170,000
270,000
480,000
34,000
3,954,000
3,195,000
270,000
502,000
52,000
4,019,000
3,358,000
282,000
540,000
49,000
4,234,000
not available
not available
not available
not applicable
117,928,000
not available
not available
not available
not available
129,118,000
96,261,000
26,456,000
12,430,000
18,205,000
153,352,000
105,090,000
27,946,000
14,611,000
28,263,000
175,910,000
114,468,000
30,649,000
15,894,000
19,252,000
180,263,000
10. Services provided by physicians paid through all
payment methods :
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for service,
by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a.
b.
c.
d.
e.
4.
5.
medical
surgical
diagnostic
other
total
Excludes inactive physicians.
Total salaried and fee-for-service.
Canada Health Act Annual Report, 2005–2006
27
Chapter 3 — Newfoundland and Labrador
Insured Services Provided to Residents in Another Province or Territory
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
17. Total payments, in-patient ($).
18. Total payments, out-patient ($).
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1,681
1,588
1,640
1,699
1,809
26,155
26,464
25,762
26,467
29,628
10,312,515
10,817,595
12,397,072
12,248,758
15,130,363
3,213,978
3,488,186
3,232,235
4,321,173
5,132,112
6,135.00
6,812.00
7,559.00
7,209,00
8,364.00
123.00
132.00
125.00
163.00
173.00
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
116,000
116,000
139,000
113,000
136,000
4,082,000
4,231,000
4,518,000
4,770,000
5,197,000
35.19
36.47
32.50
42.21
38.21
Insured Services Provided Outside Canada
Hospitals
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
26. Total payments, in-patient.
27. Total payments, out-patient.
28. Average payment, in-patient.
29. Average payment, out-patient.
Physicians
30. Number of services.
31. Total payments.
32. Average payment per service.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
62
61
62
50
54
258
278
283
301
261
123,692
269,963
363,153
76,981
112,039
22,567
18,432
167,588
60,159
24,265
1,995.00
4,426.00
5,857.00
1,540.00
2,075.00
87.00
66.00
592.00
200.00
93.00
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1,700
2,400
1,800
2,400
2,300
67,000
172,000
199,000
136,000
135,000
39.41
71.67
110.56
56.67
58.70
Insured Surgical-Dental Services Within Own Province or Territory
33. Number of participating dentists.
34. Number of services provided.6
35. Total payments.
36. Average payment per service.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
26
33
25
31
26
3,319
3,522
3,609
3,022
2,633
409,000
419,000
462,000
329,000
313,000
123.35
118.88
127.87
108.97
117.80
6. Number of surgical-dental services has been revised to coincide with changes in the way data is compiled for total payments.
28
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
Prince Edward Island
Introduction
The Ministry of Health is a large and complex system
of integrated services whose aim is to protect, maintain
and improve the health and well-being of Prince Edward
Islanders. 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 ministry is responsible for a variety of health
services to promote and help foster the optimal health
of Islanders, including public health services, primary
care, acute care, community hospital and continuing
care services. These services are delivered by a staff
of over 4,000 dedicated professionals through a large
number of facilities and programs across the province.
Among them are acute care facilities, community
hospitals, provincial manors, an in-patient mental
health facility, provincial addictions treatment facilities
and programs, family health centres, public health, home
care, community addictions programs and community
mental health.
In spring 2005, a major reorganization of the health
and social service system was undertaken. As a result
of the reorganization, the Department of Health and
Social Services was divided into the Department of
Health, and the Department of Social Services and
Seniors. All regional health authorities were disbanded,
and health services were brought together under a
centralized management model.
In addition to creating two new departments and
the attendant realignment of services, the restructuring also resulted in a number of administrative
and systemic changes. Some of the most significant
include the following:
Canada Health Act Annual Report, 2005–2006
The role of the Department of Health changed from
responsibility for quality of advice and assistance to line
services to a responsibility for direct service delivery.
Administrative and support services for line services
moved from a regional to a departmental model, in
line with the dissolution of the health authorities.
Under the previous organizational structure, each
of the five regional health authorities had governing
boards. Under the new organizational model, each of
the five community hospitals has a governing board.
Overview of the Health System
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.
A Minister of the Crown is ultimately accountable to
the rest of government and the citizens of Prince Edward
Island 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
division of roles is outlined below.
Acute Care: Provides regional and provincial secondary,
specialty services and in-patient mental health services to
residents of Prince Edward Island. 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, each of whom is a member of the Departmental
Management Committee.
Community Hospitals and Continuing Care: Provides
acute care services to rural communities and support
services to adults and seniors in need of continuing care
on Prince Edward Island. 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.
29
Chapter 3 — Prince Edward Island
A governing board has been put in place for each of the
five community hospitals. 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.
Primary Care: Provides primary health services to citizens
of Prince Edward Island. Programs and facilities include:
Community Mental Health and Addictions which encompasses the Provincial Addictions Treatment Facility,
seven Family Health Centres, Public Health Nursing
and Chronic Disease Prevention. The Director of
Primary Care has the administrative responsibility for
this division and is a member of the Departmental
Management Committee
Population Health: Provides public health and regulatory
services to the citizens of Prince Edward Island. The
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 Dietetic Services.
The Director of Population Health has administration
responsibility for this division and is a member of the
Departmental Management Committee.
Facilities
Prince Edward Island has two referral hospitals and five
community hospitals, with a combined total of 463 beds.
Along with nine government manors (and facilities) that
house 558 (plus 10 respite) long-term care nursing beds,
Islanders have access to an additional 389 (plus 11 temporary beds) in nine private nursing homes. The system
also operates several addictions and mental health facilities,
1,146 seniors’ housing units and 468 family housing units.
A $50 million health facility, the Prince County Hospital,
was opened in April 2004 in Summerside. Computed
Tomography (CT) scanning and a wide range of
diagnostic imaging, surgical and other specialty services
are available at the referral hospitals. Phase I of a multiphase redevelopment plan to upgrade the 23-year-old
Queen Elizabeth Hospital was recently announced and
construction will begin in 2007.
30
Human Resources
The public sector health workforce has approximately
4,000 employees. There is ongoing recruitment to address
vacancies in the physician complement in this province,
although enticing new physicians to the province and
retaining the appropriate number of required physicians
to meet the needs of Islanders is challenging. These challenges are being met by developing a long-term physician
resource plan, by providing salary options to new graduates
and existing physicians, and with more communication
with Prince Edward Island students and residents through
the Medical Education Program. A coordinator has been
hired for the Physician Recruitment and Medical Education
Programs who will be responsible for their administration
as well as establishing a centralized locum support program.
The following vacancies currently exist in the physician
complement: Family Medicine, Internal Medicine,
Emergency Medicine, Psychiatry, Radiology, Pathology,
Hospitalists, Ophthalmology and Plastic Surgery.
Recruitment to find suitable placements for these
positions is ongoing.
In addition to the aforementioned programs, there are
other current and planned initiatives such as the Nurse
Recruitment Strategy, Provider Registry, Supports for
Other Health Care Providers, and the Musco-skeletal
Injury Prevention Program (workplace safety).
In the 2005–2006 provincial budget, the government
announced that the Registered Nurse Recruitment and
Retention Strategy would be delayed for 2005–2006.
However, 32 third-year Bachelor of Nursing students
who received sponsorships during the 2004–2005 year
were eligible to receive sponsorship for their final year
of study. On March 30, 2006, the Government announced in the 2006–2007 provincial budget that this strategy
would be reinstated.
The Physician Master Agreement is effective until
March 31, 2007 and ensures Prince Edward Island
remains competitive with other jurisdictions and
that Islanders continue to access a quality health care
system. The government has also made investments
intended to make the health system more competitive
in order to maintain services and increase the success
of recruitment and retention efforts for physicians.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
Financial Resources
Access to Care
The 2005–2006 budget estimate for the Department of
Health amounts to $312 million. Prior to the reorganization of the health and social service system, the 2005–2006
combined budget for the Department of Health and Social
Services totalled $422 million. The remaining $110 million
represents the budget of the new Department of Social
Services and Seniors.
In Prince Edward Island, as across Canada, access to care is
a significant public concern, whether from the perspective
of ensuring appropriate wait times for services, access to
specialty services, or access to services which are delivered
in the official language of choice and or in a culturally
sensitive way for linguistic and ethnic minorities. A variety
of local initiatives have been undertaken to address these
and other access related issues.
Major health expenditures are allocated as following:
Provincial Acute Care, 36 percent; Medical Programs,
27 percent; Community Hospitals and Continuing Care,
24 percent; Primary Care, eight percent; and other
services such as Corporate Services, Financial Services
and Population Health, five percent.
Current and/or Planned Initiatives
In 2005–2006, funding for the Oncology Centre increased
by $275,000. Approval was given for the development
and implementation of a $14 million Clinical Information
System within the seven acute care hospitals and four
community health centres. Funding in the amount of
$2.2 million was made available to create a fourth orthopaedic surgeon position in an effort to alleviate wait times
for procedures such as hip and knee replacements.
Critical Issues
Health Care in Small Communities
Prince Edward Island is 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 enhance health care
service delivery in rural areas, family health centres
will be established. The planned Clinical Information
System / Integrated Electronic Health Record will
link all hospitals in the province to electronic patient
information.
Canada Health Act Annual Report, 2005–2006
A part of the Wait Times Strategy, the staffing
complement at the Prince Edward Island Cancer
Treatment Center was increased in the area of
Radiation Oncology; a fourth Orthopedic Surgeon
has been added; and an Oncology Associate has
been put in place at PCH.
Family Health Centres have initiated a variety
of specialized clinics (i.e. influenza vaccination).
Ambulatory Care, currently in place at the new
PCH, and enhancements planned as part of the
QEH redevelopment allow patients to receive
many hospital treatments on an out-patient basis.
This would previously have required admission.
Health Human Resource Recruitment Strategies
and other initiatives help ensure that an adequate
number of health professionals are in place to
deliver services to Islanders.
New information technology systems, such
as the Clinical Information System/Integrated
Electronic Health Record will improve timeliness
and the availability of patient information for
health care providers.
Functional or Community Needs
The health service delivery system is large and complex.
Issues or decisions in one area typically affect components
elsewhere in the system. For instance, elderly patients or
adults with special requirements may not be able to return
home upon discharge from hospital and may require
admission to long term care. When long term care beds
are not available, they may need to remain in the hospital
until a long term care bed becomes available. This is a
problem for these patients, since they require the kind
31
Chapter 3 — Prince Edward Island
of care provided by a manor B not a hospital. This is also
a problem for people who need access to hospital care,
since an occupied hospital bed is not available for other
patients. Inconsistent availability of community supports,
including drugs and supplies for home care/ambulatory
patients, further challenges the ability to provide the right
service at the right place by the right provider.
The provincial hospitals undertook a number of initiatives to help improve patient flow from acute to long term
care. A “First Available Bed Policy” was put in place for
QEH and PCH and a transition unit was put in place at
the QEH.
Initiatives such as the QEH Redevelopment and the
new PCH with their emphasis on ambulatory care;
the PCH Restorative Care Unit; and the Primary Care
Redesign all help the frail elderly and adults with special
functional or community needs to live in the community
as long as possible, if that is best choice for them. The
Provincial Palliative Care Program helps ensure continuity
of care for individuals at end of life and their care givers,
by the provider and at the location most appropriate to
their needs.
Chronic Diseases
The rate of chronic diseases continues to rise. As the
population ages, so too will the number of people affected
by chronic disease. Several initiatives are planned or
underway which could directly or indirectly address
current and future levels of chronic disease, including:
Primary care redesign, including establishment
of family health centers.
Innovations and improvements in areas of
pharmacare, home care and wait times are
being developed and implemented.
The Clinical Information System / Electronic
Health Record will improve health care provider
access to timely and accurate information.
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
QEH Redevelopment Project) and primary health care
will contribute to chronic disease prevention, treatment,
and management. A number of other targeted strategies
32
have been adopted or are planned, such as the Cancer
Control Strategy, the Healthy Living Strategy and the
Diabetes Education and the Stroke Strategy.
Emerging Technologies
The exponential rate of growth of societal knowledge
translates into new technologies, standards and procedures
which render previous technologies, standards and
procedures obsolescent. New MRI and linear accelerator
technology was recently installed at the Cancer Treatment
Center; a Provincial RIS/PACS system was recently
implemented; and new CT Scan equipment was recently
installed at PCH and QEH. There has been an increased
adoption of laparoscopic surgical techniques and the
use of less-invasive devices. Finally, Clinical Information
Systems/Electronic Patient Health Record systems are
under development.
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.
As a result of the reorganization of the Department
and the dissolution of the former health authorities,
the Department of Health is now responsible for service
delivery, operates hospitals, health centres, manors and
mental health facilities. The Public Service Commission
hires physicians, nurses and other health related workers.
Under Part I of the Hospital and Diagnostic Services
Insurance Act, it is the function of the Minister, and
the Minister has the power, to:
ensure the development and maintenance throughout
the province of a balanced and integrated system
of hospitals and schools of nursing and related
health facilities;
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
approve or disapprove the establishment of new
hospitals and the establishment of, or additions
to, related health facilities;
approve or disapprove all grants to hospitals for
construction and maintenance;
establish and operate, alone or in cooperation with
one or more organizations, institutes for training
hospital and related personnel;
conduct surveys and research programs and to obtain
statistics for its purposes;
approve or disapprove hospitals and other facilities
for the purposes of the Act in accordance with the
Regulations; and
subject to the approval of the Lieutenant Governor
in Council, to do all other acts and things that the
Minister considers necessary or advisable for carrying
out effectively the intent and purposes of the Act.
In addition to the duties and powers enumerated in
Part I of the Act, it is the function of the Minister,
and the Minister has power, to:
administer the plan of hospital care insurance established by this Act and the Regulations;
determine the amounts to be paid to hospitals and to
pay hospitals for insured services provided to insured
persons under the plan of hospital care insurance and
to make retroactive adjustments with hospitals for
under payment or over payment for insured services
according to the cost as determined in accordance
with the Act and the Regulations;
receive and disburse all monies pertaining to the plan
of hospital care insurance;
approve or disapprove charges made to all patients by
hospitals in Prince Edward Island to which payments
are made under the plan of hospital care insurance;
enter into agreements with hospitals outside Prince
Edward Island and with other governments and
hospital care insurance authorities established by
other governments for providing insured services to
insured persons;
prescribe forms necessary or desirable to carry out the
intent and purposes of the Act;
appoint inspectors and other officers with the duty
and power to examine and obtain information from
hospital accounting records, books, returns, reports
and audited financial statements and reports thereon;
The Health Ministry, through the Department, has the
responsibility for the overall efficiency and effectiveness
of the provincial health system.
Specifically, the Department is responsible for:
Canada Health Act Annual Report, 2005–2006
appoint medical practitioners with the duty and power
to examine and obtain information from medical
and other hospital records, including patients’ charts
with medical records and nurses’ notes, reports and
accounts of patients who are receiving or have received
insured services;
appoint inspectors with the duty and power to inspect
and examine books, accounts and records of employers
and collectors to obtain information related to the
hospital and insurance plan;
withhold payment for insured services for any insured
person who does not, in the opinion of the Minister,
medically require such services;
act as a central purchasing agent to purchase drugs,
biologicals or related preparations for all hospitals
in the province; to supervise, check and inspect the
use of drugs, biologicals or related preparations by
hospitals in the province; and to withhold or reduce
payments under the Act to a hospital that does not
comply with regulations relating to purchasing drugs,
biologicals or related preparations; and
supervise and ensure the efficient and economical use
of all diagnostic or therapeutic aids and procedures
used by or in hospitals and to withhold or reduce
payments under the Act to a hospital that does not
comply with the regulations relating to using such
aids and procedures.
setting overall directions and priorities;
developing policies and strategies, legislation,
provincial standards and measures;
monitoring provincial health status;
monitoring and ensuring that the provincial hospitals
and community hospital authority boards comply
with regulations and standards;
evaluating the performance of the health system;
allocating funds to the provincial hospitals and the
community hospital authority boards;
improving the quality and management of a comprehensive province-wide health information system;
ensuring access to high quality health services;
addressing emerging health issues and examining new
technology before implementation; and
directly administering certain services and programs.
33
Chapter 3 — Prince Edward Island
Health care services will continue to be subject to the
accreditation process. The next scheduled accreditation
is to take place in 2007.
1.2 Reporting Relationship
An annual report is submitted by the Department to
the Minister responsible who tables it in the Legislative
Assembly. The Report provides information on the
operating principles of the Department and its legislative
responsibilities, as well as an overview and description
of the operations of the departmental divisions and
statistical highlights for the year.
The community hospital authority boards are accountable
to the Minister pursuant to the Community Hospital
Authorities Act and must submit annual business plans and
provide information to the Minister as and when required.
1.3 Audit of Accounts
The provincial Auditor General conducts annual audits
of the Public Accounts of the Province of Prince Edward
Island. The Public Accounts of the Province include
the financial activities, revenues and expenditures of
the Department of Health.
The provincial Auditor General, through the Audit Act,
has the discretionary authority to conduct further audit
reviews on a comprehensive or program specific basis.
Community hospital authorities are reporting entities
under the Financial Administration Act.
2.0 Comprehensiveness
2.1 Insured Hospital Services
Insured hospital services are provided under the Hospital
and Diagnostic Services Insurance Act (1988). The accompanying Regulations (1996) define the insured in- and
out-patient hospital services available at no charge to a
person who is eligible. Insured hospital services include:
necessary nursing services; laboratory; radiological and
other diagnostic procedures; accommodations and meals
at a standard ward rate; formulary drugs, biologicals
and related preparations prescribed by an attending
physician and administered in hospital; operating room,
34
case room and anaesthetic facilities; routine surgical
supplies; and radiotherapy and physiotherapy services
performed in hospital.
As of March 2006, 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 number of practitioners who billed the
Insurance Plan as of March 31, 2006, was 211.
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.
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, 2006, 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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
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.
2.3 Insured Surgical-Dental Services
Dental services are not insured in the Health Care Insurance
Plan. Only oral maxillofacial surgeons are paid through the
Plan. There are currently two surgeons in that category.
Surgical-dental procedures included as basic health services
in the Tariff of Fees are covered only when the patient’s
medical condition requires that they be done in hospital
or in an office with prior approval as confirmed by the
attending physician.
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.
Provincial hospital services not covered by the Hospital
Services Plan include:
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,
e.g. employment, insurance, education;
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;
Canada Health Act Annual Report, 2005–2006
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;
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
other services that the Department may, upon the
recommendation of the negotiation process between
the Department and the Medical Society, declare
non-insured.
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.
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.
35
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.
36
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, 2006, was 144,159.
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.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
Prince Edward Island participates in the Hospital Reciprocal
Billing Agreement and the Medical Reciprocal Billing
Agreement. The total amount paid under these agreements
was $24,465,674.
The payment rate currently ranges from $717 at the
community hospitals to $724 at Prince County Hospital
and $959 at the Queen Elizabeth Hospital per day for
hospital stays. The standard interprovincial outpatient
rate is $158. The methodology used to derive these rates
is as if the patient had the services provided in Prince
Edward Island.
4.3 Coverage During Temporary Absences
Outside Canada
The Health Services Payment Act is the enabling legislation that defines portability of health insurance during
temporary absences outside Canada, as allowed under
section 5.(1)(e) of the Health Services Payment Act.
Insured residents may be temporarily out of the country
for a 12-month period one time only. Students attending
a recognized learning 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 between the full
amount charged and the amount paid by the Department.
The amount paid for insured emergency services outside
Canada in 2005–2006 was $86,475.
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
Canada Health Act Annual Report, 2005–2006
from the Medical Director of the Department to receive
out-of-country hospital or medical services not available
in Canada.
5.0 Accessibility
5.1 Access to Insured Health Services
Both of Prince Edward Island’s hospital and medical
services insurance plans provide services on uniform
terms and conditions on a basis that does not impede
or preclude reasonable access to those services by
insured persons.
5.2 Access to Insured Hospital Services
The new Prince County Hospital in Summerside was
completed and occupied in April 2004.
As of March 31, 2006 the Department has agreements
with five private ambulance operators in the province
who provided emergency and non-emergency ground
ambulance services on a 24-hour, seven day per week
basis. The Department provides operating subsidies to
operators who deliver service as per the requirements
and standards contained within these agreements.
The Out-of-Province Medical Transport Support Program
subsidizes the user fee for patients who require ground
ambulance services to access specialized medical care
outside the province.
There is activity underway with Health Infostructure
Atlantic to further develop an Electronic Health Record
within Atlantic Canada. The major focuses of these
activities include the overall Electronic Health Record,
Health Surveillance and Telehealth activities.
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.
37
Chapter 3 — Prince Edward Island
5.4 Physician Compensation
A collective bargaining process is used to negotiate
physician compensation. Bargaining teams are appointed
by both physicians and government to represent their
interests in the process.
The legislation governing payments to physicians
and dentists for insured services is the Health Services
Payment Act.
Most physicians work on a fee-for-service 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 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.
Advance payments 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.
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 2005–2006 Annual Budget and
related budget documents and its 2004–2005 Public
38
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 an insured service, except for the insured chronic care beds noted
in section 2.1.
Nursing Home Intermediate Care and
Adult Residential Care Services
Nursing home services are available on approval from
regional admission and placement committees for placement into public manors and licensed private nursing
homes. There are currently 18 long-term care facilities
in the province, nine public manors and 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
supervision and care management. The standardized
Seniors Assessment Screening Tool is used to determine
service needs of residents for all admissions to nursing
homes. Payment for long-term care is the responsibility
of the individual. 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, 2006, 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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
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.
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
Seniors 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.
Canada Health Act Annual Report, 2005–2006
Ambulatory Health Care Services
Prince Edward Island has public adult day programs that
provide services such as recreation, education and socialization for dependent elders. Individuals who require this
service are assessed by regional home care staff. The overall
purpose of adult day programs is to allow clients to remain
in their homes as long as possible, provide respite for care
givers, monitor client’s health and provide social interaction. There are adult day programs located across Prince
Edward Island.
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 hemodialysis clinics in the province. This is
a publicly-funded service. Prince Edward Island also offers
a hemodialysis service to out-of-province/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.
39
Chapter 3 — Prince Edward Island
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
140,001
141,031
142,022
143,261
144,159
2004–2005
2005–2006
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
2001–2002
2002–2003
2003–2004
7
7
7
7
7
chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c.
rehabilitative care
not applicable
not applicable
not applicable
not applicable
not applicable
d.
other
not applicable
not applicable
not applicable
not applicable
not applicable
e.
total
7
7
7
7
7
b.
3. Payments:
a. acute care
b.
chronic care
109,128,000
115,697,000
121,944,000
125,118,252
129,976,900
900
not applicable
not applicable
not applicable
not applicable
c.
rehabilitative care
not applicable
not applicable
not applicable
not applicable
not applicable
d.
other
not applicable
not applicable
not applicable
not applicable
not applicable
e.
total
109,128,900
115,697,000
121,944,000
125,118,252
129,976,900
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
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. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
1
5. Number of insured hospital services
provided:
a.
surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
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
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
6. Payments:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
1. Figures are budget estimates, not actuals.
40
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Prince Edward Island
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
101
75
not applicable
176
97
92
not applicable
189
96
94
not applicable
190
98
96
not applicable
194
113
98
not applicable
211
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
7. Number of participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
8. Number of opted-out physicians:
a. general practitioners
b. specialists
c. other
d. total
9. Number of not participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
10. Services provided by physicians paid through all
payment methods:
a. number of services
b. total payments
1,642,832
35,337,086
1,264,991
36,475,710
1,330,946
36,732,119
2,504,320
40,012,026
1,387,070 2
40,027,386 2
816,197
358,600
not applicable
1,174,797
716,597
362,619
not applicable
1,079,216
783,632
397,916
not applicable
1,181,548
787,557
410,378
not applicable
1,197,935
665,499
386,668
not applicable
1,052,167
16,588,900
15,559,600
not applicable
32,148,500
16,537,250
16,446,970
not applicable
32,984,220
16,234,598
17,054,737
not applicable
33,289,335
16,502,193
17,921,200
not applicable
34,423,393
16,742,162
18,484,053
not applicable
35,226,215
107,683
140,020
110,897
816,197
1,174,797
96,152
150,036
116,431
716,597
1,079,216
111,896
162,577
123,443
783,632
1,181,548
111,043
169,954
129,381
787,557
1,197,935
92,544
159,071
125,053
665,499
1,052,167
5,061,000
8,703,600
1,795,000
16,588,900
32,148,500
4,892,997
9,509,720
2,044,253
16,537,250
32,984,220
4,845,230
9,880,089
2,329,418
16,234,598
33,289,335
4,937,461
10,095,966
2,887,773
16,502,193
34,423,393
4,922,883
10,456,374
3,104,796
16,742,162
35,226,215
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for service,
by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a. medical
b. surgical
c. diagnostic
d. other
e. total
2.
Reflects payments made through claim submissions.
Canada Health Act Annual Report, 2005–2006
41
Chapter 3 — Prince Edward Island
Insured Services Provided to Residents in Another Province or Territory
Hospitals
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
2,220
2,059
2,006
2,163
2,187
17,572
16,790
15,638
14,368
15,547
17. Total payments, in-patient ($).
9,417,000
11,713,751
14,208,471
15,325,267
16,463,548
18. Total payments, out-patient ($).
2,930,100
2,879,064
2,578,895
2,667,968
3,225,803
4,242.00
5,689.00
7,083.00
7,085.00
7,528.00
167.00
171.00
165.00
186.00
207.00
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
2001–2002
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2002–2003
2003–2004
2004–2005
2005–2006
67,435
48,369
45,255
48,928
54,269
3,871,900
3,778,171
3,795,244
4,122,725
4,674,004
57.00
78.00
84.00
84.00
86.13
Insured Services Provided Outside Canada
Hospitals
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
24. Total number of claims, in-patient.
26
23
37
30
25
25. Total number of claims, out-patient.
85
152
130
93
91
123,127
79,577
155,922
95,719
69,391
13,702
25,954
24,366
16,304
17,084
4,736.00
3,459.00
4,214.00
3,191.00
2,775.00
161.00
171.00
187.00
175.00
188.00
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
677
521
706
627
534
33,995
30,076
37,100
21,849
15,844
50.00
58.00
53.00
35.00
30.00
26. Total payments, in-patient ($).
27. Total payments, out-patient ($).
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
Insured Surgical-Dental Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
2
2
2
2
3
176
312
393
410
303
35. Total payments ($).
60,989
88,443
90,851
96,490
115,918
36. Average payment per service ($).
347.00
283.00
231.00
235.00
382.00
33. Number of participating dentists.
34. Number of services provided.
42
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
Nova Scotia
Introduction
The Nova Scotia Department of Health’s mission is
to ensure, through leadership and collaboration, 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 be 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 in the
Department of Health: the Office of the Chief Medical
Officer of Health and the Public Health Branch.
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,
the Community Health Boards (CHBs). DHAs are
responsible for governing, planning, managing, delivering,
monitoring and funding health services within each
respective district and for providing planning support
to the CHBs. Services delivered by the DHAs include
acute and tertiary care, public health, mental health
and addictions.
The province’s 37 CHBs develop community health plans
with primary health care and health promotion as their
foundation. District Health Authorities 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 (Women and Children’s Tertiary Care Hospital)
continues to have separate board, administrative and service
delivery structures.
The Department of Health is responsible for setting
strategic direction and standards for health services
which are meant to ensure the availability of quality
Canada Health Act Annual Report, 2005–2006
health care; for, monitoring, evaluating and reporting
on performance and outcomes and for 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 2005–2006 accountability
report will be available in late 2006.
The spending of Nova Scotia's 2005–2006 health care
dollars was consistent with commitments in Your Health
Matters — a report released by the Department of Health
in March 2003 outlining its multi-year plan for better
health care. This plan focuses on five key areas:
helping people stay healthy;
training, recruiting, and keeping more doctors, nurses,
and health professionals;
shortening wait lists for tests, treatment, and care;
caring for our seniors; and
accessing health services close to home.
This report can be viewed at:
http://www.gov.ns.ca/health/your_health_matters.htm
As part of the commitments contained in Your Health
Matters, Nova Scotia publishes annual reports on progress
made, which account for how the year’s activities matched
plans. It reports specifically on issues such as quality,
access and efficiency, as well as progress in primary
or community-based health care, home care and drug
coverage. The report for 2005–2006, Working Together
Toward Better Health: Ministers’ Report to Nova Scotians
can be viewed at:
http://www.gov.ns.ca/health/reports.htm#MinisterReport
43
Chapter 3 — Nova Scotia
Nova Scotia faces a number of challenges in the delivery
of health care services. Nova Scotia’s population is aging.
Currently, 14.1% of the Nova Scotia Population is sixtyfive or over and this figure is expected to nearly double by
2026. Aging populations increase the pressure to expand
the basket of publicly-insured services to include home
care, long-term care and enhanced pharmaceutical
coverage. The burden of illness resulting from much
higher than average rates of chronic diseases such as
cancers and diabetes are major contributors to the rising
costs of health care delivery in Nova Scotia. Other major
cost drivers are a highly competitive labour market for
health human resources, the increasing costs of pharmaceuticals and aging facility infrastructure.
Despite these ever-increasing pressures and challenges,
Nova Scotia continues to be committed to the delivery of
medically necessary services consistent with the principles
of the Canada Health Act.
Additional information related to health care in Nova
Scotia may be obtained from the Department of Health
website at: www.gov.ns.ca/health
1.0 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
44
uniform terms and conditions in respect of the payment
of insured professional services to the extent of the
established tariff. Section 8 of the Act gives the Minister
of Health, with approval of the Governor in Council,
the power to, from time to time, 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.
There were no changes to the Health Services and Insurance
Act or regulations under this act in 2005–2006.
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,
their annual budget estimates and their monthly reports
of actual revenues and expenditures.
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
new service level agreement in place with Medavie Blue
Cross, effective August 1, 2005. An audit plan is under
development for this agreement, including Medicare
payments, which has been recommended by the Auditor
General’s office.
All long-term care facilities, home care and home support
agencies are required to provide the Department with
annual audited financial statements.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
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
1.4 Designated Agency
Medavie Blue Cross Care administers and has the
authority to receive monies to pay physician accounts
under a new service level agreement with the Department
of Health, effective August 1, 2005. Medavie Blue Cross
Care receives written authorization from the Department
for the physicians to whom it may make payments. The
rates of pay and specific amounts depend on the physician
contract negotiated between Doctors Nova Scotia and the
Department of Health.
All Medavie Blue Cross Care system development for
MSI and Pharmacare is controlled through a joint
committee. All MSI and Pharmacare transactions are
subject to a review by the Office of the Auditor General.
2.0 Comprehensiveness
2.1 Insured Hospital Services
Nine DHAs and the IWK Health Centre (Women and
Children’s Tertiary Care Hospital) deliver insured hospital
services to both in-patients and out-patients in Nova
Scotia in a total of 35 facilities.
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. 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;
Canada Health Act Annual Report, 2005–2006
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.
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 parenteral nutrition; and haemodialysis
and peritoneal dialysis.
In order to add a new hospital service to the list of insured
hospital services, DHAs 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 Departmentdeveloped process format is forwarded to the DHAs for
their guidance. A departmental working group reviews and
prioritizes all requests received. Based on available funding,
a number of top priorities may be approved by the Minister
of Health.
2.2 Insured Physician Services
The legislation covering the provision of insured physician
services in Nova Scotia is the Health Services and Insurance
Act, sections 3(2), 5, 8, 13, 13A, 17(2), 22, 27–31, 35 and
the Medical Services Insurance Regulations.
The Health Services and Insurance Act was amended in
2002–2003 to include section 13B stating that: “Effective
November 1, 2002, any agreement between a provider
and a hospital, or predecessors to a hospital, stipulating
compensation for the provision of insured professional
services, for the provider undertaking to be on-call for the
provision of such services or for the provider to relocate or
maintain a presence in proximity to a hospital, excepting
agreements to which the Minister and the Society are a
party, is null and void and no compensation is payable
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Chapter 3 — Nova Scotia
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 2005–2006, 2,220 physicians
and 33 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, 2006, no
physicians had opted out.
Insured services are those medically necessary to diagnose,
treat, rehabilitate or otherwise alter a disease pattern. There
are no limitations on medically necessary insured services.
No new large-scale services were added to the list of
insured physician services in 2005–2006. On a quarterly,
ongoing 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
46
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 that person carries
on such practice.
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, 2006, no dentists had opted out. In
2005–2006, 33 dentists were paid through the MSI
Plan for providing insured surgical-dental services.
Insured surgical-dental services must be provided in
a health care facility. Insured services are 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 surgicaldental services are orthognathic surgery, surgical removal
of impacted teeth and oral and maxillary facial surgery.
Routine extractions services are provided for cardiac
patients, transplant patients, immunocompromised
patients and radiation patients when these patients are
undergoing active treatment in a hospital setting and
the attendant medical procedure requires the removal
of teeth. Other approved services include coverage for
all precancerous or cancerous dental surgical biopsies.
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
to add 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital services include: preferred accommodation at the patient’s request; telephones; televisions;
drugs and biologicals ordered after discharge from
hospital; cosmetic surgery; reversal of sterilization
procedures; surgery for sex reassignment; in vitro
fertilization; procedures performed as part of clinical
research trials; 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,
travelling 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; services in connection
with an electrocardiogram, electromyogram or electroencephalogram, unless the physician is a specialist in the
appropriate specialty; cosmetic surgery; acupuncture;
reversal of sterilization; and in vitro fertilization.
Major third-party agencies purchasing medically necessary
health services in Nova Scotia include Workers Compensation, the Canadian Armed Forces and the Royal Canadian
Mounted Police (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
Doctors Nova Scotia and Department of Health
representatives, who jointly evaluate a procedure or
Canada Health Act Annual Report, 2005–2006
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.
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.
Members of the RCMP, members of the Canadian Forces,
federal inmates and members of the North Atlantic Treaty
Organization (NATO) are ineligible for MSI coverage.
When their status changes, they immediately become
eligible for provincial Medicare.
There were no changes to eligibility requirements in
2005–2006.
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Chapter 3 — Nova Scotia
3.2 Registration Requirements
To obtain a health card in Nova Scotia, residents must
register with MSI. Once eligibility has been determined,
an application form is generated. The applicant (and
spouse if applicable) must sign the form before it can be
processed. The applicant must indicate on the application
the name and mailing address of a witness. The witness
must be a Nova Scotia resident who can confirm the
information on the application. The applicant must
include proof of Canadian citizenship or provide a copy
of an acceptable immigration document.
When the application has been approved, health cards
will be issued to each family member listed. MSI
registration information is maintained as a family unit.
Each health card number is unique and is issued for the
lifetime of the applicant. Health cards expire every four
years. The health card number also acts as the primary
health record identifier for all health service encounters
in Nova Scotia for the life of the recipient. Proof of
eligibility for insured services is required before residents
are eligible to receive insured services. Renewal notices are
sent to most cardholders three months before the expiry
date of the current health card. Upon return of a signed
renewal notice, MSI will issue a new health card.
There is no legislation in Nova Scotia forcing residents
of the province to apply for MSI. There may be residents
of Nova Scotia who, therefore, are not members of the
health insurance plan.
In 2005–2006, there were 933,259 residents registered
with the health insurance plan.
3.3 Other Categories of Individual
The following persons may also be eligible for insured
health care services in Nova Scotia, once they meet the
specific eligibility criteria for their situations:
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
permanent residency document. These individuals,
formerly called “landed immigrants”, are now referred
to as “Permanent Residents”.
48
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 residency, provided they
have a letter 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 have a letter from the Immigration Department
stating that they have applied for Permanent Residence.
In 2005–2006, there were 22,098 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,
provided that they remain in Nova Scotia for at least one
full year. A declaration must be signed to confirm that
the worker will not be outside Nova Scotia for more than
31 consecutive days, except in the course of employment.
MSI coverage is extended for a maximum of 12 months
at a time. Each year a copy of their renewed immigration
document must be presented and a declaration signed.
Dependants of such persons, who are legally entitled to
remain in Canada, are granted coverage on the same basis.
Once coverage has terminated, the person is to be treated
as never having qualified for health services coverage
as herein provided, and must comply with the above
requirements before coverage will be extended to him/her
or their dependents.
In 2005–2006, there were 1,230 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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
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 2005–2006, there were 943 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 are eligible for MSI on the first day
of the third month following the month of their arrival.
4.2 Coverage During Temporary Absences
in Canada
The Agreement of Eligibility and Portability is followed
in all matters pertaining to portability of insured services.
Generally, the Nova Scotia MSI Plan provides coverage
for residents of Nova Scotia who move to other provinces
or territories for a period of three months 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
Canada Health Act Annual Report, 2005–2006
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 2005–2006, for in- and
out-patient hospital services received in other provinces
and territories were: $16,285,032 for out-of-province,
in-patient services and $7,345,702 for out-of-province,
out-patient services. Nova Scotia pays the host province
rates for insured services in all reciprocal-billing situations.
There were no changes made in Nova Scotia in 2005–2006
regarding in-Canada portability.
4.3 Coverage During Temporary Absences
Outside Canada
Nova Scotia adheres to the Agreement on Eligibility and
Portability for dealing with insured services for residents
temporarily outside Canada. Provided a Nova Scotia
resident meets eligibility requirements, out-of-country
services will be paid, at a minimum, on the basis of the
amount that would have been paid by Nova Scotia for
similar services rendered in this province. Ordinarily, to
be eligible for coverage, residents must not be outside
the country for more than six months in a calendar year.
In order to be covered, procedures of a non-emergency
nature must have prior approval before they will be
covered by MSI.
Students and their dependants who are temporarily
absent from Nova Scotia and in full-time attendance at
an educational institution outside Canada may remain
eligible for MSI on a yearly basis. To qualify for MSI,
the student must provide to MSI, a letter obtained from
the educational institution that verifies the student’s
attendance there in each year for which MSI coverage
is requested.
Persons who engage in employment (including volunteer/
missionary work/research) outside Canada, which does
not exceed 24 months, are still covered by MSI; providing
the person has already met the residency requirements.
Emergency out-of-country services are paid at a minimum
on the basis of the amount that would have been paid by
Nova Scotia for similar services rendered in this province.
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Chapter 3 — Nova Scotia
The total amount spent in 2005–2006 for insured inpatient services provided outside Canada was $1,495,313.
5.2 Access to Insured Hospital Services
There were no changes made in Nova Scotia in 2005–2006
regarding out-of-Canada portability.
The Government of Nova Scotia continues to emphasize
the provision of sustainable, quality health care services to
its citizens. In December 2005, Nova Scotia Department
of Health released the Health Human Resources Action
Plan as a first step in the development of a comprehensive
health human resources strategy for the province which
will ensure that the supply of health care professionals
in Nova Scotia is sufficient, has the right mix of health
professionals, and has the right geographical distribution.
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.
In 2005–2006 Nova Scotia Department of Health invested
$650,000 to increase the number of community-based,
multi-disciplinary teams available to serve the primary
health-care needs of Nova Scotians.
To address the access needs of its culturally diverse population, the Nova Scotia Department of Health produced
Guidelines for Diversity and Social Inclusion in Primary
Health Care with plans to begin implementation of these
guidelines in 2006–2007.
In 2005–2006, there were a total of 2,220 physicians
operating in Nova Scotia, 53 more than in the previous
year. This includes 948 general practitioners and 1,270
specialists. As in previous years, all were participating in
the health insurance plan.
Nova Scotia has a nursing strategy, which was introduced
in 2001. It is a multi-year plan that provides a comprehensive and coordinated approach to enhancing the
quality of work life for nurses, retaining experienced
nurses in the system, and creating an environment in
which recruitment efforts will be successful. Nova Scotia
invests approximately $10 million annually on the strategy
and on training more nurses.
Nova Scotia has a Telehealth Network (NSTHN),
which connects DHAs and the IWK Health Centre
with a sophisticated videoconferencing communications
network. The network allows patients in rural areas
to consult with specialists in large health centres. The
NSTHN enhances access to health services closer to
home for patients and their families. The NSTHN also
provides health professionals across Nova Scotia with
access to educational opportunities without leaving
their communities.
In October of 2005, Nova Scotia officially launched its
wait times website (see: www.gov.ns.ca/health/waittimes/
default.htm)
This site provides Nova Scotians with information to help
them, and their health-care providers, make decisions
about their testing and treatment options. It provides
provincial health-care wait times for tests, treatments and
services by the various choice locations in Nova Scotia.
In 2005–2006, Nova Scotia announced a number of
investments that will improve access to health care
services for Nova Scotians. Some of these included:
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Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
A $2 million renovation project at the Lillian Fraser
Memorial Hospital to improve access to community
health care services
More than $1 million in the Picture Archive and
Communication System expansion project.
$3 million investment in a PET scans.
Establishment of a new primary health care clinic
at Yarmouth Regional Hospital.
$78 million commitment to replace Colchester
Regional Hospital.
$9.3 million investment in St. Martha’s Hospital.
Plans to establish a provincial renal care program.
The completion of the Nova Scotia Hospital
Information System with implementation in
34 hospitals with over 1 million patients on file.
5.3 Access to Insured Physician and
Surgical-Dental Services
In 2005–2006, 2,220 physicians and 33 dentists actively
provided insured services under the Canada Health Act
or provincial legislation.
According to the 2005 Canadian Community Health
Survey, 95.1 percent of Nova Scotians have a regular
family physician. The Canadian average is 86.4 percent.
Innovative funding solutions for physicians, such as
block funding and personal services contracts, have
enhanced recruitment. A five-year incentive program is
offered in 21 rural communities to recruit doctors. The
program provides an annual bonus for each completed
year of service, moving expenses, continuing medical
education funding and guaranteed minimum billing
(income) for the year.
Other provincial programs include: start-up contracts for
family doctors, alternative payment plans, a debt assistance
program, and a physician recruitment office that maintains
a recruitment website and co-ordinates site visits, advertising, and c.v. distribution within the province.
The Province has increased the capacity for medical
education and has provided funding to create a reentry program for general practitioners wishing to
enter specialty training after completing two years
of general practice service in the province.
Canada Health Act Annual Report, 2005–2006
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 payment, on-call funding, specific fee
adjustments, dispute resolution processes, and other
process or consultation issues.
Fee-for-service is still the most prevalent method of
payment for physician services. However, there has
been significant growth in the number of alternative
payment arrangements in place in Nova Scotia.
Over the past number of years, we have seen a significant
shift toward alternative payment. In the 1997–1998 fiscal
year, about nine percent of our doctors were paid solely
through alternative funding. In 2005–2006 over 30 percent of physicians are remunerated through alternative
funding. They can be broken down into three groups:
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.
District Specialists (Obstetrics/Gynecology,
Anaesthesiology, Pediatrics).
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.
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Chapter 3 — Nova Scotia
In 2005–2006 total payments to physicians for insured
services in Nova Scotia were $540,495,196. The Department paid an additional $6,619,938 for insured physician
services provided to Nova Scotia residents outside the
province, but within Canada.
6.0 Recognition Given to
Federal Transfers
Payment rates for dental services in the province are
negotiated between the Department of Health and the
Nova Scotia Dental Association and follow a process
similar to physician negotiations. Dentists are paid on
a fee-for-service basis. The current agreement, which
was reached in April 2004, expires on March 31, 2008.
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.
5.5 Payments to Hospitals
The Department of Health establishes budget targets
for health care services. It does this by receiving business
plans from the nine DHAs, the IWK Health Centre
and other non-DHA organizations. Approved provincial
estimates form the basis on which payments are made
to these organizations for service delivery.
The Health Authorities Act 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. Under section 20 of the Health
Authorities Act, the DHAs are responsible 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 2005–2006, there were 2,891 hospital beds in Nova
Scotia (3.0 beds per 1,000 population). Department of
Health direct expenditures for insured hospital services
operating costs were increased to $1.13 billion.
The Government of Nova Scotia also recognized the
federal contribution under the CHT in various published
documents including the following documents released
in 2005–2006:
Public Accounts 2004–2005; and
Budget Estimates 2005–2006.
7.0 Extended Health
Care Services
The Nova Scotia Department of Health’s Continuing
Care branch offers home care and long-term care services.
These services promote independence, fairness, equity,
and choice for people with care needs. The Department
of Health provides a Single Entry Access to its continuing
care services. Nova Scotians can connect with Continuing
Care through a single toll-free number.
In 2006, the Department of Health released a broad based,
multi-year Continuing Care strategy that will see the
addition of long-term care beds and the expansion and
enhancement of community and home based services
over the ensuing five to ten years.
7.1 Nursing Home Intermediate Care and
Adult Residential Care Services
The Department of Health provides residentially based
long-term care services in the following facility types:
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Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
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 longterm 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
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 Indian
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
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
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 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.
Canada Health Act Annual Report, 2005–2006
53
Chapter 3 — Nova Scotia
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.
program. This integrated province-wide systemhas
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 preventionoriented 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.
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; in-hospital 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.
54
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 communitybased (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
Nova Scotia Addiction Services — A range of
treatment and rehabilitation options are provided,
including withdrawal management (detoxification and
treatment orientation) programs and communitybased structured treatment, out-patient 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.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — 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.
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
953,385
955,475
956,820
961,089
933,259
2004–2005
2005–2006
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
2001–2002
2002–2003
2003–2004
35
35
35
35
35
b.
chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c.
rehabilitative care
not applicable
not applicable
not applicable
not applicable
not applicable
d.
other
not applicable
not applicable
not applicable
not applicable
not applicable
e.
total
35
35
35
35
35
3. Payments ($): 1
a. acute care
926,797,569
1,021,934,504
1,095,584,706
1,133,215,533
1,230,549,093
b.
chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c.
rehabilitative care
d.
e.
other
total
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
926,797,569
1,021,934,504
1,095,584,706
1,133,215,533
1,230,549,093
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1
1
1
0
0
0
1
0
1
0
1
1
1
1
1
81
83
38
0
0
0
0
0
0
0
38
not available
not available
not available
not available
10,926
11,714
5,531
0
0
0
0
0
0
0
5,531
not available
not available
not available
not available
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
5. Number of insured hospital services
provided:
a.
surgical facilities
b.
diagnostic imaging facilities
c.
total
6. Payments ($):
a. surgical facilities
1.
b.
diagnostic imaging facilities
c.
total
Dollars are paid to acute care facilities/District Health Authorities.
Canada Health Act Annual Report, 2005–2006
55
Chapter 3 — Nova Scotia
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
865
1,128
10
2,003
875
1,142
9
2,026
904
1,198
14
2,116
905
1,235
27
2,167
948
1,270
2
2,220
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7,905,797
359,193,862
9,023,272
398,328,665
9,199,462
434,000,386
9,290,207
464,685,571
9,599,128
540,495,196
4,521,991
1,650,685
2,999
6,175,675
4,563,449
1,677,973
2,512
6,243,934
4,629,753
1,924,079
7,098
6,560,930
4,706,554
1,629,835
16,993
6,353,382
4,916,485
1,636,464
825
6,553,774
102,555,964
118,414,434
162,779
221,133,176
113,507,874
127,688,914
165,984
241,362,772
120,455,816
133,964,947
250,201
254,670,965
124,586,294
121,524,641
613,173
246,724,107
133,168,106
121,365,556
87,992
254,621,655
5,124,398
1,009,997
34,036
7,244
6,175,675
5,163,027
1,034,307
39,099
7,501
6,243,934
5,262,750
1,054,059
41,161
2,960
6,360,930
5,312,025
993,621
45,191
2,545
6,353,382
5,527,154
975,434
50,042
1,144
6,553,774
149,555,510
69,173,647
2,007,251
396,769
221,133,177
163,116,603
75,601,138
2,184,138
460,894
241,362,772
172,722,629
79,322,814
2,413,712
211,844
254,670,999
172,581,326
71,375,047
2,638,998
128,736
246,724,107
181,786,160
69,832,367
2,895,304
107,824
254,621,655
7. Number of participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
8. Number of opted-out physicians:
a. general practitioners
b. specialists
c. other
d. total
9. Number of not participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
10. Services provided by physicians paid through all
payment methods:
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($): 2
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for
service, by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($): 2
a.
b.
c.
d.
e.
2.
56
medical
surgical
diagnostic
other
total
Discrepancies may exist between data presented here and the Nova Scotia Annual Statistical Tables due to methodological differences.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nova Scotia
Insured Services Provided to Residents in Another Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
15. Total number of claims, in-patient.
2,050
2,300
2,368
2,335
2,252
16. Total number of claims, out-patient.
Hospitals
30,749
34,425
32,968
34,166
37,811
17. Total payments, in-patient ($).
8,536,691
12,685,659
15,859,930
15,795,451
16,285,032
18. Total payments, out-patient ($).
4,009,667
4,447,816
4,303,236
6,107,316
7,345,702
4,115.45
5,515.50
6,697.61
6,764.65
7,231.36
130.39
129.20
130.58
178.75
194.27
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
179,833
187,390
180,897
188,118
198,262
5,078,794
5,562,125
5,747,516
5,866,887
6,619,938
28.24
29.68
31.77
31.19
33.39
2003–2004
2004–2005
2005–2006
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
Insured Services Provided Outside Canada
2001–2002
Hospitals
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
26. Total payments, in-patient ($).
27. Total payments, out-patient ($).
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
2002–2003
not available
not available
not available
not available
not available
not applicable
not applicable
not applicable
not applicable
not available
1,000,023
938,092
623,896
678,205
1,495,313
not applicable
not applicable
not applicable
not applicable
not available
not available
not available
not available
not available
not available
not applicable
not applicable
not applicable
not applicable
not available
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
2,421
2,748
2,667
3,111
2,981
109,484
121,780
120,977
151,175
151,414
45.22
44.32
45.36
48.59
50.79
Insured Surgical-Dental Services Within Own Province or Territory
33. Number of particpating dentists.
34. Number of services provided.
35. Total payments ($).
36. Average payment per service ($).
Canada Health Act Annual Report, 2005–2006
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
35
36
28
25
33
4,497
5,188
3,780
4,343
5,169
884,506
939,004
904,283
995,966
1,060,006
196.69
181.00
239.23
229.33
205.07
57
58
Canada Health Act Annual Report, 2005–2006
Chapter 3 — New Brunswick
1.0 Public Administration
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 2005–2006 fiscal year
as the Government of New Brunswick implemented its
Provincial Health Plan.
The Provincial Health Plan, released in June 2004, sets key
goals, principles, strategies and priorities to guide health
care investments and improvements. It set out a vision of
a single, integrated, patient-focused, community-based
health services system, accessible to all New Brunswickers
in both official languages and managed in a fiscally sustainable manner. It sets out strategies to improve health
care services through investments in health promotion,
primary health care, recruitment and retention of health
human resources, and enhanced accountability and
evidence-based decision making.
The goals set out in the Provincial Health Plan are in
line with the priorities agreed to by First Ministers in
the 10-Year Plan to Strengthen Health Care. The New
Brunswick plan includes initiatives to improve patient
access to health care services, provide access to needed
drug therapies, increase the supply of valued health
professionals, and promote wellness and healthy living.
A number of initiatives to implement aspects of the
Provincial Health Plan were undertaken during the
2005–2006 fiscal year.
On February 14, 2006 the Department was renamed the
Department of Health, as responsibility for wellness moved
to another ministry.
Canada Health Act Annual Report, 2005–2006
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.
The Minister of Health is responsible for establishing a
medical services plan that identifies beneficiaries, which
services are and are not covered, and the amounts to be
paid for entitled services. Under the Plan, the Minister
assesses and audits physician billings through inspectors
appointed by him or her and through a professional
review committee as defined in sections 24(1) to 33 of
the Medical Services Payment Act and Regulations. The
Minister also has the authority to recover the cost of
entitled services from a person who is negligent.
1.2 Reporting Relationship
The Medicare Branch of the Department of Health
has a mandate to administer the Medical Services Plan.
The Minister reports to the Legislative Assembly through
the Department’s annual report and through regular
legislative processes.
59
Chapter 3 — New Brunswick
The Regional Health Authorities Act, which came into
force on April 1, 2002, sets out the relationship between
the eight 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.
Comptroller continued to gather risk assessment data
on programs offered by the Department and reviewed
common services in the Department and other selected
departments.
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 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.
1.3 Audit of Accounts
Three groups have a mandate to audit the Medical
Services Plan.
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 2005–2006, 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
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 Audit, Information
Systems Audit, Statutory Audits and Value-For-Money
Audits. The audit work performed by the Office varies,
depending on the nature of the entity audited and the
audit objectives. During 2005–2006, the Office of the
60
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 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 outpatients. Each RHA has other 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.
In-patient services in a hospital facility operated by an
approved regional health authority 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;
Canada Health Act Annual Report, 2005–2006
Chapter 3 — New Brunswick
drugs, biologicals and related preparations, as provided
for under Schedule 2; 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 RHA.
Out-patient services in a hospital facility operated by an
approved RHA as follows:
laboratory and diagnostic procedures, together with
the necessary interpretations, when referred by a
medical practitioner or nurse practitioner, when
approved facilities are available;
laboratory and diagnostic procedures, together with
the necessary interpretations, where approved facilities
are available, when performed for the purpose of
a mammography screening service that has been
approved by the Minister of Health;
the hospital component of available out-patient 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;
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.
2.2 Insured Physician Services
The enabling legislation providing for insured physician
services is the Medical Services Payment Act.
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
Canada Health Act Annual Report, 2005–2006
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.
No changes, pertaining to physician services, to this Act
and regulations were introduced during 2005–2006.
The New Brunswick Medical Services Plan covers physicians who provide medically required services. The
conditions that a physician must meet to participate
in the New Brunswick Medical Services Plan are:
maintain current licensure with the New Brunswick
College of Physicians and Surgeons;
maintain membership in the New Brunswick
Medical Society;
hold privileges in a RHA; and
have signed the Participating Physicians Agreement.
The number of practitioners participating in New
Brunswick’s Medical Services Plan as of March 31, 2006,
was 1,461.
A total of 751 general or family practitioners, 844 specialists, seven dentists and five oral maxillofacial surgeons provided insured services in New Brunswick in 2005–2006. No
orthodontists provided insured services in the same period.
Physicians in New Brunswick have the option to opt out
totally 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.
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; and
the beneficiary seeks reimbursement by certifying on
the claim form that the services have been received
and by forwarding the claim form to Medicare.
61
Chapter 3 — New Brunswick
If the charges will be in excess of the Medicare tariff,
the practitioner must inform the beneficiary before
rendering the service that:
they are opting out and charging fees above the
Medicare tariff;
in accepting service under these conditions, the
beneficiary waives all rights to Medicare reimbursement; and
the patient is entitled to seek services from
another practitioner who participates in the
Medical Services Plan.
The physician must obtain a signed waiver from the
patient on the specified form and forward that form
to Medicare.
As of March 31, 2006, no physicians rendering health
care services had elected to completely opt out of the
New Brunswick Medical Services Plan.
The range of entitled services under Medicare includes
the medical portion of all services rendered by medical
practitioners that are medically required. It also includes
certain surgical-dental procedures 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. No new
services were de-insured during 2005–2006.
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.
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
62
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, 2006, there were 78 dentists registered
with the plan.
Dentists have the same opting-out provision as previously
explained for physicians 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 in New Brunswick 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 out-patient setting.
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.
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 intra-ocular lenses,
fibreglass casts, etc.), provided in conjunction with an
insured health service, do not compromise reasonable
access to insured services.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — New Brunswick
Uninsured Physician and Surgical-Dental Services
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
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 106 and 108 of New Brunswick Regulation
88-200 under the Health Act;
advice or prescription renewal by telephone which is
not specifically provided for in the Schedule of Fees;
examinations of medical records or certificates at the
request of a third party, or other services required by
hospital regulations or medical by-laws;
dental services 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 to members
of their immediate family;
psychoanalysis;
electrocardiogram (ECG) where not performed
by a specialist in internal medicine or paediatrics;
Canada Health Act Annual Report, 2005–2006
laboratory procedures not included 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;
circumcision of the newborn;
reversal of vasectomies;
second and subsequent injections for impotence;
reversal of tubal ligations;
intrauterine insemination;
gastric stapling or gastric by-pass; and
venipuncture in order to take blood when performed
as a stand-alone procedure in a facility that is not an
approved hospital facility.
Dental services not specifically listed in Schedule 4 of
the Dental Schedule are not covered by the Plan. Those
listed in Schedule 2 are considered the only non-insured
medical services.
The decision to de-insure physician or surgical-dental
services is based on the conformity of the service to the
definition of “medically necessary,” a review of medical
service plans across the country and the previous use
of the particular service. Once a decision to de-insure
is reached, the Medical Services Payment Act dictates
that the government may not make any change 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, 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.
No medical or surgical-dental services were removed
from the insured service list in 2005–2006.
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Chapter 3 — New Brunswick
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 a valid Canadian immigration document. A resident is
defined as a person lawfully entitled to be, or to remain,
in Canada, who makes his or her home and is ordinarily
present in New Brunswick, but does not include a tourist,
transient or visitor to the province.
All persons entering or returning to New Brunswick
(excluding children adopted from outside Canada)
have a waiting period before becoming eligible for
Medicare coverage. Coverage commences on the first
day of the third month following the month of arrival.
Residents who are ineligible for Medicare coverage include:
regular members of the Canadian Armed Forces;
members of the Royal Canadian Mounted Police
(RCMP);
inmates of federal prisons;
persons moving to New Brunswick as temporary
residents;
a family member who moves from another province
to New Brunswick before other family members move;
persons who have entered New Brunswick from
another province to further their education and
who are eligible to receive coverage under the
medical services plan of that province; and
non-Canadians who are issued certain types of
Canadian authorization permits (e.g. a Student
Authorization).
Provisions to become eligible for Medicare coverage include:
non-Canadians who are issued an immigration permit
that would not normally entitle them to coverage
are eligible if legally married to, or in a common-law
relationship with, an eligible New Brunswick resident.
Provisions when status changes include:
64
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 dependents
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
dependents are registered and a Medicare card with an
expiry date is issued to the beneficiary and each dependent.
A Notice of Expiry form providing all family information
currently existing on the Medicare files is issued to the
beneficiary two or three months before the expiry date
of the Medicare card or cards. A beneficiary who wishes
to remain eligible to receive entitled services is required
to confirm the information on the Notice of Expiry, to
make any changes as appropriate and return the form
to Medicare. Upon receiving the completed form, the file
is updated and new card(s) are issued bearing a revised
expiry date.
Currently in New Brunswick, only those individuals
deemed eligible are registered.
All family members (the beneficiary, spouse and dependents under the age of 19) are required to register as
a family unit. Residents who are co-habiting, 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — New Brunswick
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.
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).
directly from Quebec physicians. Any paid claims
submitted by the patient are reimbursed to the patient
according to New Brunswick regulations.
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).
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 enrollment;
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.
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:
Temporary Workers: 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 be for work purposes
or vacation, would require the Director’s approval. This
approval can only be up to 12 months in duration and
can 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.
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 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 such claims are received
Canada Health Act Annual Report, 2005–2006
Exception for Temporary Workers: Mobile workers
are residents whose employment requires them to travel
frequently outside the province. Certain guidelines must
be met to receive Mobile Worker designation:
applications must be submitted in writing;
documentation is required as proof of Mobile Worker
status (e.g. a letter from an employer or photocopy of
an Immigration Permit);
the worker’s permanent residence must remain in
New Brunswick;
the worker must return to New Brunswick during
their off-time; and
65
Chapter 3 — New Brunswick
the Mobile Worker designation is assigned for a
maximum of two years, after which the resident
must re-apply and re-submit documentation to
confirm his or her status.
Contract Workers: Any New Brunswick resident accepting an out-of-country employment contract must supply
the following information and documentation:
letter of request from the New Brunswick resident
with his or her signature, detailing his or her absence,
including Medicare number, New Brunswick address,
date of departure, destination and forwarding address,
reason for absence and date of return; and
copy of the contractual agreement between employee
and employer that defines a start date and end date of
employment.
Contract worker status is assigned for a maximum of two
years. Any further requests for contract worker status must
be forwarded to the Director of Medicare for approval on
an individual basis.
New Brunswick Medicare covers out-of-country medical
and hospital services for emergency out-patients and
resulting in-patient services only. Medicare pays New
Brunswick rates for physician services associated with
the emergency interventions. The associated facility rates,
paid in Canadian funds, are as follows: in-patient services
$100 per day; and out-patient services $50 per visit.
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 out-of-country
services; however, those who receive such services will
assume responsibility for the total cost.
4.4 Prior Approval Requirement
New Brunswick residents may be eligible for reimbursement
if they receive elective medical services outside the country,
provided they fulfill the following requirements:
66
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 services must be rendered by a medical doctor; and
the service must be an accepted method of treatment
recognized by the medical community and be regarded
as scientifically proven in Canada. Experimental
procedures are not covered.
If the above requirements are met, it is mandatory to
request prior approval from Medicare in order to receive
coverage. A physician, patient or family member may
request prior approval to receive these services outside
the country, accompanied by supporting documentation
from a Canadian specialist or specialists.
The following are considered exemptions under the outof-country coverage policy:
haemodialysis: patients will be required to obtain
prior approval and Medicare will reimburse the
resident at a rate equivalent to the interprovincial
rate of $220 per session; and
allergy testing for environmental sensitivity: all tests
sent outside the country will be paid at a maximum
rate of $50 per day, an amount equivalent to an outpatient 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.
5.2 Access to Insured Hospital Services
The New Brunswick Hospital Master Plan identifies
the number of approved beds for each Regional Health
Authority.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — New Brunswick
All facilities that provide insured services in accordance
with the Canada Health Act have appropriate medical,
surgical, rehabilitative and diagnostic equipment or systems
corresponding to their designated levels of care. As of
March 31, 2006, there were nine Computed Tomography
(CT) scanners operating in New Brunswick — one in
each of the eight RHAs, with a second unit operating
in RHA 2. The Province also has two mobile Magnetic
Resonance Imaging (MRI) units operating and three
fixed-site MRI systems.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2006, there were 668 GPs, 715 Specialists,
78 Dentists (69 dentists, five oral maxillofacial surgeons,
four orthodontists) registered with the plan.
In fiscal year 2005–2006, 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 of
$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.
5.4 Physician Compensation
Fiscal year 2004–2005 marked the third year of an
agreement with fee-for-service physicians that provides
for a 15 percent increase in fees over a three-year period
(2002–2003 to 2004–2005). Discussions were held
during the year with the New Brunswick Medical Society
to implement the initiatives contained in that agreement.
Canada Health Act Annual Report, 2005–2006
On March 29, 2006, a tentative agreement was reached
with the New Brunswick Medical Society for a new
collective agreement.
There is no formal negotiation process for dental practitioners in New Brunswick.
Payments to physicians and dentists are governed under
the Medical Services Payment Act, Regulations 84-20,
93-143 and 96-13.
The methods used to compensate physicians for providing
insured health services in New Brunswick are fee-forservice, 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 2005–2006 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);
community-based services (Extra-Mural Program;
health service centres); and
general patient care.
Added to this are non-patient care support services (e.g.
general administration, laundry, food services, energy).
The CSL approach establishes base budgets for the eight
RHAs for the above-noted programs and services, with
measures for population and service volumes. The base
budgets are then adjusted annually for inflation and
other factors such as centrally negotiated salary rates.
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Chapter 3 — New Brunswick
The population-based funding distribution formula,
which was enhanced during fiscal year 2000–2001, was
still in use in fiscal year 2005–2006. This methodology
attempts to predict the appropriate distribution of
available funding for the RHAs based on demographic
characteristics and current market share of patient
volumes, with cases measured by “Resource Intensity
Weights.” Currently, this methodology is more suitable
to in-patient volumes because of a lack of case grouping
and weighting methodologies for out-patient volumes,
especially tertiary out-patient services (e.g. oncology and
haemodialysis).
The current budget process may extend over more than
one fiscal year and includes several steps. By January 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, are 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.
the Public Accounts presented by the Minister of
Finance on December 20, 2005; and
the Main Estimates presented by the Minister of
Finance on March 30, 2006.
New Brunswick does not produce promotional documentation on its insured medical and hospital benefits.
7.0 Extended Health
Care Services
The New Brunswick Long-Term Care program, a noninsured service, was transferred to the Department of
Family and Community Services on April 1, 2000.
Nursing home care, also a non-insured service, is offered
through the Nursing Home Services program of the
Department of Family and Community Services. Other
adult residential care services and facilities are available
through a variety of agencies and funding sources within
the province.
Residential and Extended Care Services
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.
6.0 Recognition Given to
Federal Transfers
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. Clients are admitted after
going through the same evaluation process used for
nursing home admissions.
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:
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.
68
the Budget Papers presented by the Minister of
Finance on March 30, 2006;
Canada Health Act Annual Report, 2005–2006
Chapter 3 — New Brunswick
Ambulatory Health Care
In New Brunswick, ambulatory health care includes
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.
Extra-Mural Program
The New Brunswick Extra-Mural Program, also known
as the hospital-at-home program, is an active treatment
program of acute, palliative and long-term health care
and rehabilitation services provided in community
settings (an individual’s home, a nursing home or a
public school). Since 1996, this program has been
delivered by New Brunswick’s eight RHAs. Service
providers include nurses, social workers, dieticians,
respiratory therapists, physiotherapists, occupational
therapists and speech language pathologists. These
services, although not covered by the Canada Health
Act, are considered an insured service under the provincial Hospital Services Plan.
Canada Health Act Annual Report, 2005–2006
69
Chapter 3 — New Brunswick
70
Canada Health Act Annual Report, 2005–2006
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’assurance
hospitalisation du Québec, is administered by the
Ministère de la Santé et des Services sociaux (MSSS).
[Quebec Department of Health and Social Services]
Quebec’s health insurance plan, the Régime d’assurance
maladie du Québec, is administered by the Régie de
l’assurance maladie du Québec (RAMQ) [Quebec Health
Insurance Board], a public body established by the
provincial government and reporting to the Minister
of Health and Social Services.
1.2 Reporting
The Public Administration Act (R.S.Q., chapter A-6.01)
sets out the government criteria for preparing reports
on the planning and performance of public authorities,
including the MSSS and the RAMQ.
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 Quebec.
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 RAMQ
also covers the following, with some limitations, for
certain residents of Quebec, as defined by the Health
Insurance Act, and for employment assistance recipients:
optometric services; dental care for children and
employment assistance recipients, and acrylic dental
prostheses for employment assistance recipients;
prostheses, orthopedic appliances, locomotion and
postural aids, and other equipment that helps with a
physical disability; external breast prostheses; ocular
prostheses; hearing aids, assistive listening devices and
visual aids for people with a visual or auditory disability;
and permanent ostomy appliances.
Since January 1, 1997, in terms of drug insurance,
the RAMQ covers, over and above its regular clientele
(employment assistance recipients and persons 65 years
Canada Health Act Annual Report, 2005–2006
71
Chapter 3 — Quebec
of age or older), individuals who do not have access to
a private drug insurance plan. The drug insurance plan
covers 3.15 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:
72
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 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
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Quebec
3.0 Universality
4.0 Portability
3.1 Eligibility
4.1 Minimum Waiting Period
Registration with the hospital insurance plan is not
required. Registration with the RAMQ or proof of
residence is sufficient to establish eligibility. All persons
who reside or stay in Quebec must be registered with
the RAMQ to be eligible for coverage under the health
insurance plan.
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 RAMQ.
3.2 Registration Requirements
Registration with the hospital insurance plan is not
required. Registration with the RAMQ 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.
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 Quebec
resident become eligible the day they arrive, and inmates
of federal penitentiaries become eligible the day they are
released. Immediate coverage is provided for certain
seasonal workers, repatriated Canadians, persons from
outside Canada who are living in Quebec under an
official bursary or internship program of the Ministère
de l’Éducation, du Loisir et du Sport [Quebec Department
of Education, Leasure and Sport], 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.
Canada Health Act Annual Report, 2005–2006
4.2 Coverage During Temporary Absences
Outside Quebec (in Canada)
If living outside Quebec in another province or territory
for 183 days or more, students and full-time unpaid
trainees may retain their status as residents of Quebec,
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 retain their status
as residents of the province, provided their families remain
in Quebec or they retain a dwelling there.
Status as a resident 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 RAMQ of the absence.
The costs of medical services received in another province
or territory of Canada are reimbursed at the amount
actually paid or the rate that would have been paid by
the RAMQ 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
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Chapter 3 — Quebec
November 1, 1989. A similar agreement was signed
in December 1991 between the Centre de santé
Témiscamingue [Témiscamingue Health Centre]
and North Bay, Ontario.
Costs of hospital services received 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/
territorial rates. However, since November 1, 1995,
Quebec reimburses a maximum of $450 per day of
hospitalization when an Outaouais resident 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.
4.3 Coverage During Temporary Absences
Outside Quebec (outside Canada)
Students, unpaid trainees, Quebec government officials
posted abroad and employees of non-profit organizations
working in international aid or cooperation programs
recognized by the MSSS must contact the RAMQ to
ascertain their eligibility. If the RAMQ recognizes them
as having special status, they receive full reimbursement
of hospital costs in case of emergency or sudden illness,
and 75 percent reimbursement in other cases.
Persons directly employed or working on contract
outside Canada, for a company or corporate body
having its headquarters or a place of business in Quebec,
or employed by the federal government and posted
outside Quebec, also retain their status as residents
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 RAMQ, 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.
74
However, hemodialysis treatments are covered to a
maximum of $220(CDN) per treatment. In such cases,
the RAMQ 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 RAMQ to a health professional recognized in Quebec, up to the amount of the
expenses actually incurred. The cost of all services insured
in the province are reimbursed at the Quebec rate, usually
in Canadian funds, when they are incurred abroad.
Coverage is discontinued as of the day of departure for insured residents who move permanently to another country.
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.
Improved telephone access to care: The Info-Santé
telephone line will be centralized in each of the 15 regions
where it exists, and a new Info-Social line will be developed
in all regions. An Info-médicament line and a public health
branch advisory module will be incorporated into InfoSanté. The plan is to have one communication centre in
each region and to link all of these centres into a network,
as well as to make them accessible to the general public
through a single three-digit number.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Quebec
New projects for seniors: In order to respect the wishes
of seniors needing medical care who wish to remain in
their own homes as long as possible, the MSSS has funded
new projects that offer innovative ways to deliver services
directly to these persons. In order to respect the wishes of
seniors needing medical care who wish to remain in their
own homes as long as possible, the MSSS has funded new
projects that offer innovative ways to deliver services directly
to these persons. Thirty-one projects were funded at a cost
of $12M to subsidize the network. This will assist some
510 persons over the three phases of the programme entitled A New Partnership for Seniors (Pour un nouveau
partenariat au services des aînés).
The results of an evaluation of the programme will
provide an assessment and understanding of what is
required to implement similar programmes throughout
the province of Quebec. This innovative way of better
serving seniors whose autonomy is severely impaired will
be instrumental in offering an alternative to remaining in
residential or long-term care facilities.
The vision of the MSSS is that, one day, spots in residential
and long-term care centres will be limited to patients who
for medical reasons must remain in these facilities.
5.2 Access to Insured Hospital Services
As of March 31, 2006, Quebec had 118 institutions
operating as hospital centres for a clientele suffering
from acute illnesses. There were 24,457 beds for persons
requiring care for acute physical or psychiatric ailments
allotted to these institutions. From April 1, 2004 to
March 31, 2005, Quebec hospital institutions had nearly
699,735 admissions for short stays (including births) and
close to 295,707 registrations for day surgeries. These
hospitalizations and registrations accounted for more
than 5,080,246 patient days.
Restructuring of the health network: In November 2003,
Quebec announced the implementation of local service
networks covering all of Quebec. At the heart of each
local network is a new local authority, the 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, residential and long-term care, and, in most
cases, neighbourhood hospital services. The health and
social services centres also provide the people in their
Canada Health Act Annual Report, 2005–2006
territory with access to other medical services, general
and specialized hospital services, and social services. To
do so, they 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.
Management of waiting lists: In October 2003, the
MSSS began publishing waiting lists for each hospital on
its website. It now provides physicians and institutions
with a computerized service access management system
(SGAS). This tool is based on the concept of “access
within a clinically acceptable period,” as defined by
committees of medical experts in certain fields. Once
applied uniformly throughout the province of Quebec,
these guidelines will ensure that all patients, regardless
of their place of origin, will be treated under the same
criteria. Once implemented, this system will supply the
data for the new waiting lists site and will enable the
concerned patients and professionals to obtain appropriate,
reliable and up-to-date information on the activities of
hospital centres and waiting periods for various services.
5.3 Access to Insured Medical and
Surgical-Dental Services
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, for some certain registered clients.
Quebec now has 114 FMGs. A new FMG has been
accredited in the Mauricie region. The number of such
groups has gone from 21 to 114 within three years.
The Conseil médical du Québec established a committee
to develop the concept of the physician/population ratio
because interprovincial comparisons suggest that Quebec
has an adequate number of physicians.
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Chapter 3 — Quebec
5.4 Physician Compensation
5.5 Payments to Hospitals
While the majority of physicians practise within the
provincial plan, Quebec allows two other options:
professionals who have withdrawan from the plan and
practise outside the plan, but agree to remuneration
according to the provincial fee schedule; and nonparticipating professionals practise outside the plan
and neither they nor their patients are reimbursed by
the RAMQ.
The Minister of Health and Social Services funds hospitals
through payments directly related to the cost of insured
services provided.
Physicians are remunerated in accordance with the
negotiated fee schedule. Physicians who have withdrawn
from the health insurance plan are paid directly by the
patient according to the fee schedule after the patient has
collected from the RAMQ. Non-participating 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.
The payments made in 2005–2006 to institutions
operating as hospital centres for insured health services
provided to persons living in Quebec were more than
$7.3 billion. Payments to hospital centres outside Quebec
were approximately $97.2 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.
In 2004–2005, the RAMQ paid an amount estimated at
$3,276,500 million to doctors in the province, while the
amount for medical services outside the province reached
an estimated $9.95 million.
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Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
1.2 Reporting Relationship
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 $32.5 billion (including capital) in spending for
2005–2006.
MOHLTC is responsible for providing services to the
Ontario public through such programs as: health insurance; drug benefits; assistive devices; mental health
services; home care; community support services; and
public health.
MOHLTC also regulates and funds hospitals and longterm care homes (nursing homes and homes for the aged);
operates psychiatric hospitals and medical laboratories;
and funds and regulates or directly operates emergency
health services.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The Ontario Health Insurance Plan (OHIP) is administered on a non-profit basis by MOHLTC. OHIP 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.
The Health Insurance Act provides that the Minister of
Health and Long-Term Care is responsible in respect
of the administration and operation of the Plan, and is
the public authority for Ontario for the purposes of the
Canada Health Act.
1.3 Audit of Accounts
MOHLTC is audited annually by the Office of the
Auditor General. The Auditor General’s 2005 Annual
Report was released on December 6, 2005.
MOHLTC’s accounts and transactions are published
annually in the Public Accounts of Ontario. The
2005–2006 Public Accounts of Ontario were released
on August 24, 2006.
1.4 Designated Agency
Local Health Integration Networks (LHINs) were established under the Local Health System Integration Act, 2006
to improve the health of Ontarians 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 will 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, 2006 requires
the board of directors of each Local Health Integration
Network 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.
The Act requires LHINs to prepare an Annual Report for
the Minister who is required to table the reports before
the Legislative Assembly. The LHIN Annual Reports for
2005–2006 were tabled in the Legislature of Ontario on
October 24, 2006.
For fiscal 2007–2008, the Ontario Ministry of Health
and Long-Term Care will enter into an accountability
agreement with each LHIN that will include performance
Canada Health Act Annual Report, 2005–2006
77
Chapter 3 — Ontario
goals and objectives for the networks, and 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.
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
necessary: 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 necessary:
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, anticancer 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; clozapine to patients with
treatment-resistant schizophrenia.
In 2005–2006, there were 152 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 134 acute care hospital corporations,
14 chronic care hospitals, and four general and special
78
rehabilitation units. Hospitals are categorized by major
activity, although they provide a mix of services. For
example, many acute care hospitals offer chronic care
services. A number of designated chronic care facilities
also offer rehabilitation.
When insured physician services are provided in licensed
facilities outside hospitals and where the total cost paid
for these insured services is not included in the physician
fees paid under the Health Insurance Act, MOHLTC
provides funding through the payment of facility fees
under the Independent Health Facilities Act. Facility fees
cover the cost of the premises, equipment, supplies,
and personnel used to render an insured service. Under
the Independent Health Facilities Act, patient charges for
facility fees are prohibited.
Facility fees are charged to the government only by
facilities that are licensed under the Independent Health
Facilities Act. Examples of facilities that are licensed
under the Independent Health Facilities Act, include
surgical/treatment facilities (e.g., those providing
abortions, cataract surgery, dialysis and non-cosmetic
plastic surgery) and diagnostic facilities (e.g., those
providing x-ray, ultrasound, nuclear medicine, sleep
studies and pulmonary function studies). New facilities
are ordinarily established through a request for proposals
process based on an assessment of need for the service.
2.2 Insured Physician Services
Insured physician services are prescribed under the
Health Insurance Act and regulations under that Act.
Under subsection 37.1(1) of Regulation 552 of the Health
Insurance Act, a service provided by a physician in Ontario
is an insured service if it is medically necessary; contained
in the Schedule of Benefits for Physician Services; and
rendered in such circumstances or under such conditions
as outlined in the Schedule of Benefits. Physicians provide
medical, surgical and diagnostic services, including primary
health care services. Services are provided in a variety of
settings, including private physician offices, community
health centres, hospitals, mental health facilities, licensed
independent health facilities, and long-term care homes.
In general terms, insured physician services include:
diagnosis and treatment of medical disabilities and
conditions; medical examinations and tests; surgical
procedures; maternity care; anaesthesia; radiology and
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
laboratory services in approved facilities; and immunizations, injections and tests.
The Schedule of Benefits is regularly reviewed and revised
to reflect current medical practice and new technologies.
New services may be added, existing services revised or
obsolete services removed through regulatory amendment.
This process involves consultation with the Ontario
Medical Association.
During 2005–2006, physicians could submit claims for
all insured services rendered to insured persons directly
to the Ontario Health Insurance Plan Office (OHIP), in
accordance with section 15 of the Health Insurance Act,
or a limited number could bill the insured person, as
specified in section 15 of the Act (see also Part II of the
Commitment to the Future of Medicare Act). Physicians
who do not bill OHIP directly are commonly referred to
as having “opted-out”. When a physician has opted out,
the physician bills the patient (not exceeding the amount
payable for the service under the Schedule of Benefits),
and the patient is then entitled to reimbursement by
OHIP. However, the number of physicians who may
opt out was 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 22,000 physicians who submitted claims to OHIP in 2005–2006.
2.3 Insured Surgical-Dental Services
Insured surgical-dental services are prescribed in the
Dental Schedule of Benefits and section 16 under
Regulation 552 of the Health Insurance Act. Ontario’s
health insurance plan covers certain dental services
when hospitalization is medically necessary. The Health
Insurance Act authorizes OHIP to cover a limited number
of procedures contained in the Schedule of Benefits for
services performed by a dentist on the staff of a hospital.
All of the insured procedures in the dental schedule
must be performed for medical reasons in a hospital by
an appointed dental staff member of the hospital.
Approximately 330 dentists and dental/oral surgeons
provided insured surgical-dental services in Ontario in
2005–2006.
Canada Health Act Annual Report, 2005–2006
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Services prescribed by and rendered in accordance with
the Health Insurance Act and regulations under that Act
are insured.
Uninsured hospital services include: additional charges
for preferred accommodation unless prescribed by
a physician, oral-maxillofacial surgeon or midwife;
telephones and televisions; charges for private-duty
nursing; provision of medications for patients to take
home from hospital, with certain exceptions; and
in-province, out-patient hospital visits solely for
administering drugs, subject to certain exceptions.
Section 24 of Regulation 552 details those physician
services that are specifically prescribed as uninsured.
Uninsured physician services include: services that are
not medically necessary; toll charges for long-distance
telephone calls; the preparation or provision of a drug,
antigen, antiserum or other substance unless the drug,
antigen or antiserum is used to facilitate a procedure;
advice given by telephone at the request of the insured
person or the person’s representative; an interview or
case conference (in limited circumstances); the preparation and transfer of records at the insured person’s
request; a service that is received wholly or partly for
producing or completing a document or transmitting
information to a “third party” in prescribed circumstances; the production or completion of a document
or transmitting information to any person other than
the insured person in prescribed circumstances; provision
of a prescription when no concomitant insured service is
rendered; acupuncture procedures; psychological testing;
and research and experimental survey programs.
3.0 Universality
3.1 Eligibility
To be considered a resident of Ontario for the purpose of
obtaining Ontario health insurance coverage, a person must:
hold Canadian citizenship or an immigration status
as prescribed in Regulation 552 of the Health Insurance Act;
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Chapter 3 — Ontario
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, new and returning residents applying
for health coverage must also be physically present
in Ontario for 153 of the first 183 days following
the date residency is established in Ontario (i.e., a
person cannot be away from the province for more
than 30 days in the first six months of residency).
With certain exceptions in which there is an exemption
from the waiting period, residents of Ontario, as defined
in Regulation 552 of the Health Insurance Act, are eligible
for Ontario health insurance coverage subject to a threemonth waiting period. MOHLTC will assess 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 three-month
waiting period include newborn babies born in Ontario,
children under the age of 16 adopted by an insured person,
and insured residents from another province or territory
who move to Ontario and immediately become residents
of approved charitable homes for the aged, 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 OHIP coverage,
if they arrive in Ontario after July 20th, 2006 from a
foreign country where an evacuation effort is being undertaken or facilitated by the federal government.
Individuals who are not eligible for Ontario health insurance 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 they have health insurance coverage 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.
80
When it is determined that a person is not eligible or
is no longer eligible for OHIP coverage, a request may
be made to MOHLTC to review MOHLTC's decision.
Anyone may request that MOHLTC review the determination of their OHIP eligibility simply by making
the request in writing to the General Manager of OHIP.
3.2 Registration Requirements
Every resident of Ontario, 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 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 the waiting
period).
Approximately 12.47 million Ontario residents were
registered with OHIP and held valid and active health
cards as of as of April 1, 2006.
3.3 Other Categories of Individual
MOHLTC provides health insurance coverage to
residents of Ontario other than just Canadian citizens
and Permanent Residents/Landed Immigrants. These
residents are required to provide acceptable documentation to support their eligible immigration status, their
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
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 by 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 — Holders of a Temporary Resident Permit/
Minister’s Permit with a case type of 80 (adoption only),
86, 87, 88 or 89 are eligible for Ontario health insurance
coverage for the duration of their permit if they meet
the residency requirements as defined in Regulation 552.
Members of this group are exempt from the three-month
waiting period. Holders of 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.
for Ontario health 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 3-month waiting period, and may be a resident for
less than the required five month period, not have a
permanent home in Ontario, and still qualify for OHIP.
3.4 Premiums
There are no premiums payable as a condition of obtaining
Ontario health insurance coverage. The Ontario Health
Premium is collected through the 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.
Clergy, Foreign Workers and their Accompanying
Family Members — An eligible foreign clergy is a person
who is sponsored by a religious organization or denomination and has finalized an agreement to minister
full-time to a religious congregation in Ontario for a
period of at least six consecutive months.
4.0 Portability
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.
In accordance with subsection 3(3) of Regulation 552
under the Health Insurance Act, individuals who move
to Ontario are typically entitled to OHIP coverage,
three months after establishing residency in the province,
unless listed as an exception in section 3(4).
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
Canada Health Act Annual Report, 2005–2006
4.1 Minimum Waiting Period
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.
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Chapter 3 — Ontario
4.2 Coverage During Temporary Absences
in Canada
Insured out-of-province services are prescribed under
sections 28, 29 to 32 of Regulation 552 of the Health
Insurance Act.
Ontario adheres to the terms of the Interprovincial Agreement on Eligibility and Portability; therefore, insured
residents who are temporarily outside of Ontario can use
their Ontario health cards to obtain insured health
services.
An insured person who leaves Ontario temporarily to
travel within Canada, without establishing residency
in another province or territory, may continue to be
covered by OHIP for a period of up to 12 months.
An insured person who seeks or accepts employment
in another province or territory may continue to be
covered by OHIP for a period of up to 12 months. If
the individual plans to remain outside Ontario beyond
the 12-month maximum, he or she should apply for
coverage in the province or territory where that person
has been working or seeking work.
Insured students who are temporarily absent from Ontario,
but remain within Canada, may be eligible for continuous
health insurance coverage for the duration of their fulltime 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 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 been present for at least
153 days in the last 12-month period immediately prior
to departure from Ontario.
Ontario participates in reciprocal agreements with all other
provinces and territories for insured hospital in- and outpatient 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.
82
Ontario also participates in reciprocal billing arrangements
with all other provinces and territories, except Québec
(which has not signed a reciprocal agreement with any
other province or territory), for insured physician services.
Ontario residents who may be required to pay for doctors’
services received in Québec can submit their receipts to
MOHLTC for payment as an insured service.
4.3 Coverage During Temporary Absences
Outside Canada
Health insurance coverage for insured Ontario residents
during extended absences outside Canada is governed
by sections 28.1 through 29 (inclusive) and section 31
of Regulation 552 of the Health Insurance Act.
In accordance with sections 1.1(3), 1.1(4), 1.1(5) and
1.1(6) of Regulation 552 of the Health Insurance Act,
MOHLTC may provide insured Ontario residents with
continuous Ontario health insurance coverage during
absences outside Canada of longer than 212 days (seven
months) in a 12-month period.
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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
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.
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:
Out-of-country services are covered under sections
28.1 to 28.6 inclusive, and sections 29 and 31 of
Regulation 552 of the Health Insurance Act.
Effective September 1, 1995, out-of-country emergency
hospital costs are reimbursed at Ontario fixed per diem
rates of:
a maximum $400 (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 2004–2005, 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 2005–2006, payments for out-of-country emergency
in-patient and out-patient insured hospital and medical
services amounted to $23.3 million (Note: the categories
of out-of-country services were realigned in 2005–2006
to provide a greater level of reporting accuracy).
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 out-of-country health services.
Canada Health Act Annual Report, 2005–2006
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 2005–2006, total payments for prior-approved
treatment outside Canada were $56.3 million.
There is no formal prior-approval process for services
provided to Ontario residents outside the province,
but within Canada. The Interprovincial Agreement
on Eligibility and Portability includes a schedule for
high-cost services.
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. This
Act prohibits any person or any entity from charging
more, or accepting payment or other benefit for more
than the amount payable by OHIP. In addition, the
Commitment to the Future of Medicare Act 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.
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
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Chapter 3 — Ontario
and health number/version code status (card status).
If patients require access to health services and do not
have a health card in their possession, the provider may
obtain the necessary information by submitting to
MOHLTC a Health Number Release Form signed by
the patient. An accelerated process for obtaining health
numbers for patients who are unable to provide a health
number and require emergency treatment is available to
emergency room facilities through the Health Number
Look Up service.
5.2 Access to Insured Hospital Services
Public hospitals in Ontario are not permitted to refuse to
provide services in life-threatening situations because the
person is not insured.
In 2005–2006, there were 152 public hospital corporations staffed and in operation in Ontario, which included
chronic, general and special rehabilitation units. There
were 6,764,626 acute patient days, 1,987,995 chronic
patient days and 758,452 rehabilitation patient days
delivered by public hospitals.
Priority services are designated highly specialized hospitalbased services that deal with life-threatening conditions.
These services are often high-cost and rapidly growing,
which makes access a concern. Generally, these services
are managed provincially, on a time-limited basis.
Priority services include: selected cardiovascular services;
selected cancer services; chronic kidney disease; and organ
and tissue donation and organ transplantation.
5.3 Access to Insured Physician and
Surgical-Dental Services
Initiatives
84
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 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 physician services
by funding locums and outreach clinics. Currently,
there are 137 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 (NHTGP):
NHTGP helps defray transportation costs for residents of northern Ontario who must travel long
distances to access insured non-emergency 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 2005–2006, Ontario
continued to align its new and existing primary care
delivery models to help improve and expand access to
primary care for all Ontarians by including elements
such as 24-hour, seven days a week access through
telephone health advisory services, increased afterhours coverage and preventive care initiatives that
enhance chronic disease management and disease
prevention. As of March 31, 2006, there were
approximately 6.0 million patients rostered to
physicians in the primary care models that have
these features. New agreements were negotiated and
signed for Health Service Organizations, Primary Care
Networks, Rural and Northern Physician Groups and
a number of other family physician groups working
in high-needs practices. As part of transforming its
health care system, Ontario committed to establish
150 Family Health Teams by 2007–2008 to further
facilitate physicians working as part of a team with
other health providers with a focus on keeping
patients healthy.
The 2004 Memorandum of Agreement between
MOHLTC and the Ontario Medical Association
provides for the alignment of the Primary Care Network and Health Service Organization models into
one model. This new model, the Family Health Organization, is expected to be implemented in Fall 2006.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
5.4 Physician Compensation
Physicians are paid for the services they provide
through a number of mechanisms. Some physician
payments are provided through fee-for-service
arrangements. Remuneration is based on the Schedule
of Benefits under the Health Insurance Act. Other
physician payment models may include Alternate
Payment Plans and new funding arrangements for
physicians in Academic Health Science Centres.
Family physicians paid solely on a fee-for-service basis
represent 49 per cent of Ontario’s registered family
physicians. The remaining family physicians in Ontario
receive funding through one of the primary care initiatives
such as 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 salary,
blended complement, or blended capitation. There are
also models for physicians in Academic Health Science
Centres where funding may include any combination
of capitation, salary, special payments, and bonuses.
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 acrossthe-board fee increase of 2 percent for specialists and
2.5 percent 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 longterm 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
Canada Health Act Annual Report, 2005–2006
in emergency departments; supports health promotion
and disease prevention by introducing special fees for
managing specific chronic diseases; invests in initiatives
to recruit physicians to Ontario; and, makes quality of
life improvements for physicians such as expanding
pregnancy and parental leave benefits.
Under the Agreement, the parties have committed to
begin meeting in April 2007, to undertake a performance
review of the degree to which the objectives under the
Agreement have been met.
With respect to insured surgical-dental services,
MOHLTC negotiates changes to the Schedule
of Benefits for Dental Services with the Ontario
Dental Association. In 2002–2003, MOHLTC and
the Ontario Dental Association agreed on a new
multi-year funding agreement for dental services,
which became effective on April 1, 2003, and will
end on March 31, 2007.
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 for service
volumes and performance targets that form the
contractual basis for the Hospital Accountability
Agreement.
In the Hospital Accountability Agreement, hospital
performance is measured through five key performance
indicators: total margin; current ratio; percentage of
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Chapter 3 — Ontario
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 is conducted between ministry
staff and hospitals.
Homes for the Aged and Rest Homes Act, the Nursing
Homes Act, and the Charitable Institutions Act.
This year, members from the Local Health Integration
Networks (LHINs) will be partners in the Hospital
Annual Planning Submissions and Hospital Accountability
Agreement process, attending training sessions and
meetings with the ministry. In April 2007, LHINs are
expected to take over funding authority for hospitals
in Ontario.
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 Given to
Federal Transfers
The Government of Ontario publicly acknowledged
the federal contributions provided through the Canada
health and social transfers in its 2005–2006 publications.
7.0 Extended Health
Care Services
Nursing Home Intermediate Care
and Adult Residential Care
Long-Term Care homes provide care and services for
people who are no longer able to live independently
and who require 24-hour supervision, personal care
and support. The home-like environment is intended
to foster the best possible quality of life. MOHLTC
funds and regulates all Long-Term Care homes licensed
or approved under three different Acts, including the
86
There are three types of Long-Term Care homes and
each type is governed by a separate Act:
Municipal Homes for the Aged by the Homes for the
Aged and Rest Homes Act;
Nursing Homes by the Nursing Homes Act; and
Charitable Homes for the Aged by the Charitable
Institutions Act.
Bill 140, the proposed new Long-Term Care Homes Act,
2006, received its first reading in the Legislature on
October 3, 2006. The proposed Act provides a legislative
framework to enable improved management of a growing
and rapidly changing sector and to better plan for the
needs of the population requiring the long-term care
residential services provided in a Long-Term Care home.
As of April 2006, there are approximately 602 Long-Term
Care homes with 75,008 beds including 252 not-forprofit homes (which consist of municipal, charitable and
not-for-profit nursing homes), and 350 for-profit homes.
Long-Term Care homes provide both health care services
and accommodation to residents, tailored to a range of
care needs from light to heavy care. In general, LongTerm Care homes offer higher levels of personal care
and support than those typically offered by either
retirement homes or supportive housing. Retirement
homes are neither regulated nor funded by the ministry.
MOHLTC also operates the 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 the compliance of Long-Term
Care homes with legislation, regulation, standards and
criteria, service agreements and, where necessary, uses
enforcement measures to achieve compliance.
In January 2005, a new regulation ensured that each
resident was offered a minimum of two baths per week,
and that resident meal plans were reviewed and approved
by dietitians. In October 2004, the ministry provided
the additional funding of $191M to enable all LongTerm Care homes to hire 2000 new staff including
600 Registered Nurses. As of August 1, 2005, the
ministry required all homes to provide around the
clock coverage by Registered Nurses.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
Effective January 1, 2006, all Long-Term Care homes
were required to implement two new standards: Skin
Care and Wound Management; and Continence Care.
Ministry inspectors began monitoring compliance with
the new standards effective April 1, 2006.
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.
CCACs provide simplified access for eligible Ontario
residents, of all ages, to home and community care;
deliver, make arrangements for and 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 provides or purchases 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, laboratory and diagnostic
services, and transportation to medical appointments
and hospitals.
The CCAC assesses an individual’s requirements and
determines 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.
CCACs develop plans of service and also provide
information and referral services for the public to
home and community care related services. CCACs
are responsible for admission to long-term care homes,
and manage the Requests for Proposal process for
purchased client services.
Legislation most relevant to CCACs include the LongTerm Care Act, 1994; Health Insurance Act; Community
Care Access Corporations Act, 2001; Nursing Homes Act;
Charitable Institutions Act; and Homes for the Aged and
Canada Health Act Annual Report, 2005–2006
Rest Homes Act. Each CCAC must also be familiar with
all other relevant laws, including but not limited to the
Health Care Consent Act, 1996; Substitute Decisions Act,
1992; Personal Health Information Protection Act, 2004;
and the Ministry of Health Appeal and Review Boards
Act, 1998.
Community service agencies provide support services
that include: respite, volunteer visiting hospices, services
for persons with physical disabilities, Alzheimer services,
homemaking, attendant care, adult day programs, caregiver support, meal services, home maintenance and
repair, friendly visiting, security checks and reassurance,
social and recreational services, and volunteer transportation. These services are also provided in programs which
include acquired brain injury services and assisted living
services in supportive housing. Community services are
part of a continuum of in-home and other health services,
and the assistance provided by family and friends.
Community services are legislated under the Long-Term
Care Act, 1994 and are delivered by community-based,
not-for-profit agencies that rely heavily on volunteers,
and are funded by the Ministry of Health and LongTerm Care.
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 clientcentred and interdisciplinary end-of-life care service
capacity; and to improve access to, and coordination/
consistency of comprehensive end-of-life care services.
End-of-Life care services are provided in home or the
community by CCACs, Community Support Service
agencies and residential hospices.
Ambulatory Health Care Services
Community Health Centres are transfer payment agencies
governed by a community board of directors. The name
“Community Health Centre” reflects the fact that the
agency is established by the community and provides
programs and services in response to needs identified
in that community. Community Health Centres deliver
services through inter-disciplinary teams including
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Chapter 3 — Ontario
physicians, nurses, counsellors, dietitians 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
who have experienced barriers to access based on culture,
language, literacy, age, socio-economic status, mental
health status and homelessness. Community Health
Centres also develop partnerships to improve access
to care, promote effective service integration and build
community capacity to address health risks.
88
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 2004–2005 and 2007–2008, 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
11,800,000
12,100,000
2003–2004
2004–2005
12,200,000
2005–2006
12,400,000
12,500,000 1
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
b. chronic care
c.
rehabilitative care
d. other
e. total
3. Payments:
a. acute care
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
139
139
139
135
134
11
11
11
13
14
4
4
4
4
4
3
3
3
3
157 2
157 2
157 2
4
155 2
156 2
not available 3
not available
3
not available
3
not available
3
not available 3
b. chronic care
not available 3
not available
3
not available
3
not available
3
not available 3
c.
not available 3
not available 3
not available
not available
3
not available
not available
3
not available
not available
3
not available 3
not available 3
rehabilitative care
d. other
e. total
Private For-Profit Facilities
4. Number:
a. surgical facilities
3
3
3
9,200,000,000
10,300,000,000
10,300,000,000
12,300,000,000
12,700,000,000
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
not available 4
not available
4
not available
4
not available
4
not available
4
b. diagnostic imaging facilities
not available 4
not available
4
not available
4
not available
4
not available
4
c.
not available 4
not available
4
not available
4
not available
4
not available
4
not available 4
not available
4
not available
4
not available
4
not available
4
not available
not available 4
not available
not available
4
not available
not available
4
not available
not available
4
not available
not available
4
not available 4
not available
4
not available
4
not available
4
not available
4
not available 4
not available 4
not available
not available
4
not available
not available
4
not available
not available
4
not available
not available
4
total
5. Number of insured hospital services
provided:
a. surgical facilities
b. diagnostic imaging facilities
c.
total
6. Payments:
a. surgical facilities
b. diagnostic imaging facilities
c.
1.
2.
3.
4.
total
4
4
4
4
4
4
4
4
4
These estimates represent the number of individuals registered for Ontario health coverage with valid and active health numbers as of
March 31, 2006.
Excludes the three Provincial Psychiatric Hospitals.
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.
“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.”
Canada Health Act Annual Report, 2005–2006
89
Chapter 3 — Ontario
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
a. general practitioners
10,395
10,508
10,611
10,660
10,774
b. specialists
c. other
10,520
10,724
10,703
11,016
7. Number of participating physicians:
not available 5
d. total
not available 5
20,915
not available 5
21,232
not available 5
21,314
11,460
not available 5
21,676
22,234
8. Number of opted-out physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
22
165
not available 5
187
17
134
not available 5
151
15
114
not available 5
129
14
62
not available 5
76
12
39
not available
51
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
5
9. Number of not participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available 6
available
available
available
available
6
6
6
6
10. Services provided by physicians paid through all
payment methods:
a. number of services
b. total payments
185,473,186 7
188,309,344 7
192,572,601 7
not available 7
5,420,010,700 7
5,945,003,300 7
200,825,265 7
6,424,329,400 7
7,072,813,000 7
215,980,656 7
77,800,000
99,600,000
not available 8
177,400,000
76,800,000
102,300,000
not available 8
179,100,000
78,700,000
103,300,000
not available 8
182,000,000
82,111,000
109,340,200
not available 8
191,451,200
84,989,000
118,667,000
not available 8
203,656,000
1,741,400,000
2,936,700,000
not available 8
4,678,100,000
1,733,200,000
3,065,100,000
not available 8
4,798,300,000
1,820,200,000
3,152,800,000
not available 8
4,973,000,000
1,891,180,350
3,420,905,268
not available 8
5,312,085,618
1,894,490,000
3,747,559,000
not available 8
5,642,049,000
81,800,000
22,700,000
72,900,000
not available 8
177,400,000
81,800,000
23,900,000
73,400,000
not available 8
179,100,000
80,900,000
27,100,000
74,000,000
not available 8
182,000,000
85,101,110
28,507,294
77,842,796
not available 8
191,451,200
88,800,000
33,600,000
81,300,000
not available 8
203,700,000
2,731,400,000
706,800,000
1,239,800,000
not available 8
4,678,100,000
2,742,800,000
735,000,000
1,320,500,000
not available 8
4,798,300,000
2,818,000,000
787,700,000
1,367,300,000
not available 8
4,973,000,000
3,010,146,244
841,409,580
1,460,529,794
not available 8
5,312,085,618
3,214,300,000
894,100,000
1,533,700,000
not available 8
5,642,100,000
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for
service, by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a.
b.
c.
d.
e.
5.
6.
7.
8.
90
medical
surgical
diagnostic
other
total
All physicians are categorized as general practitioner or specialist.
Ontario has no non-participating physicians, only opted-out physicians who are reported under item #8.
Number of services includes services provided by Ontario physicians through Fee-for-Service, Primary Care, Alternate Payment Programs,
and Academic Health Science Centres. Total Payments includes payments made to Ontario physicians through Fee-for-Service, Primary Care,
Alternate Payment Programs, and Academic Health Science Centres and the Hospital On Call Program. Services and payments related to Other
Practitioner Programs, Out-of-Country/Out-of-Province Programs, and Community Labs are excluded.
All physicians are categorized within general practitioner, specialist and within medical, surgical or diagnostic.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Ontario
Insured Services Provided to Residents in Another Province or Territory
2001–2002
Hospitals
15. Total number of claims, in-patient.
2002–2003
2003–2004
2004–2005
2005–2006
8,633
9,306
9,023
8,184
8,374
144,831
140,692
167,143
154,460
174,848
17. Total payments, in-patient ($).
36,800,000
48,500,000
63,000,000
52,000,000
54,000,000
18. Total payments, out-patient ($).
18,000,000
16,500,000
20,000,000
23,000,000
29,100,000
4,262.70
5,211.70
6,982.00
6,353.00
6,448.53
124.30
117.30
119.66
129.48
166.43
16. Total number of claims, out-patient.
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
2001–2002
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2002–2003
2003–2004
2004–2005
2005–2006
469,146
497,880
557,720
534,179
573,830
15,500,000
17,700,000
18,600,000
20,300,000
21,164,600
33.00
35.00
33.34
38.00
36.89
Insured Services Provided Outside Canada
2001–2002
Hospitals
24. Total number of claims, in-patient.
18,542
25. Total number of claims, out-patient.
not available
26. Total payments, in-patient ($).
19,300,000
27. Total payments, out-patient ($).
not available
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
31. Total payments ($).
32. Average payment per service ($).
23,295
9
not available
not available
not available
not available
2004–2005
not available
not available
not available
2002–2003
not available
2003–2004
23,845
9
42,466,826
not available
10
1,490.80
11
2005–2006
21,710
9
32,000,000
10
1,167.40
11
2003–2004
21,458
9
27,200,000
10
1,043.20
2001–2002
30. Number of services.
2002–2003
not available
2004–2005
9
66,916,271
10
1,956.10
11
not available
not available
10
2,806.30
11
not available
11
2005–2006
157,191
200,428
180,395
179,410
200,723
8,200,000
10,200,000
9,900,000
11,635,998
13,211,381
51.90
51.00
55.10
64.86
65.82
Insured Surgical-Dental Services Within Own Province or Territory
2001–2002
33. Number of participating dentists.
34. Number of services provided.
35. Total payments ($).
36. Average payment per service ($).
2002–2003
2003–2004
2004–2005
2005–2006
327
319
323
335
330
74,000
75,600
72,900
86,000
87,111
8,600,000
9,300,000
9,200,000
11,786,600
12,546,397
116.00
123.02
126.20
137.05
144.03
9. Included in #24.
10. Included in #26.
11. Included in #28.
Canada Health Act Annual Report, 2005–2006
91
92
Canada Health Act Annual Report, 2005–2006
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 Manitoba Health 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 2005–2006.
The Ministry of Healthy Living undertook a province-wide
consultation with Manitobans about ways to maximize
the health of children and youth today and into their
adult lives. A Chronic Disease Prevention initiative to
address risk factors associated with preventable chronic
diseases was implemented. A provincial physical activity
strategy entitled Manitoba in Motion and public education
campaigns such as Protect Your Noggin, which focuses on
the use of bicycle helmets were also launched.
Manitoba introduced a $155 million Five Point Plan
to improve access to quality care and reduce wait times
in key areas. The plan involves more diagnostic testing,
more surgeries, more health professionals, system innovation and better wait list management, prevention and
health promotion.
Canada Health Act Annual Report, 2005–2006
The Manitoba Institute for Patient Safety which was
established in 2004, undertook a variety of activities to
promote, coordinate and stimulate research and initiatives
that enhance patient safety and quality care. These included
key stakeholder consultations, culture of safety surveys,
Provincial Patient Safety Workshop and other forums.
Manitoba’s Pharmacare Program has been enhanced
by adding 220 new drugs and 43 new interchangeable
categories.
A new Long Term Care Seniors’ Strategy entitled Aging
in Place will increase community living support for
seniors and provide alternatives to institutional care.
Significant capital investments were also made in acute care
facilities, such as the initiation of the Cardiac Care Centre
at St. Boniface hospital and continued redevelopment of
the Critical Services area in the Health Sciences Centre
in Winnipeg; expansions or upgrades to the Swan Valley
Health Centre; the St. Anne and Flin Flon hospitals; and
a new a Health Centre in Wabowden.
The Role and Mission of
Manitoba 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
93
Chapter 3 — Manitoba
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 costeffectiveness; fostering behaviours and environments
that promote health; and promoting responsiveness
and flexibility of delivery systems and alternative, less
expensive services.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The Manitoba Health Services Insurance Plan (MHSIP)
is administered by the Department of Health under The
Health Services Insurance Act, R.S.M. 1987, c. H35. The
Act1 was significantly amended in 1992, dissolving the
Manitoba Health Services Commission and transferring
all assets and responsibilities to Manitoba Health. 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:
1
94
to provide insurance for residents of the province
in respect of the costs of hospital services, medical
services and other health services, and personal care;
to plan, organize and develop throughout the province
a balanced and integrated system of hospitals, personal
care homes and related health facilities and services
commensurate with the needs of the residents of the
province;
to ensure that adequate standards are maintained
in hospitals, personal care homes and related health
facilities, including standards respecting supervision,
licensing, equipment and inspection, or to make such
arrangements that the Minister considers necessary
to ensure that adequate standards are maintained;
to provide a consulting service, exclusive of individual
patient care, to hospitals and personal care homes
in the province or to make such arrangements as the
Minister considers necessary to ensure that such a
consulting service is provided;
to require that the records of hospitals, personal
care homes and related health facilities are audited
annually and that the returns in respect of hospitals,
which are required by the Government of Canada,
are submitted; and
in cases where residents do not have available medical
services and other health services, to take such measures
that are necessary to plan, organize and develop medical
services and other health services commensurate with
the needs of the residents.
The Minister may also enter into contracts and agreements with any person or group that he or she considers
necessary for the purposes of the Act. The Minister may
also make grants to any person or group for the purposes
of the Act on such terms and conditions that are considered advisable. Also, the Minister may, in writing,
delegate to any person any power, authority, duty or
function conferred or imposed upon the Minister under
the Act or under the regulations.
There were no legislative amendments to the Act or the
regulations in the 2005–2006 fiscal year that affected the
public administration of the Plan.
Where reference is made to “the Act” in the text, this refers to The Health Services Insurance Act as consolidated to March 31, 2006.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
1.2 Reporting Relationship
radiotherapy, physiotherapy, occupational and speech
therapy facilities, where available.
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.
All hospital services are added to the list of available
hospital services through the health planning process.
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 2005–2006 fiscal year and is contained in
the Manitoba Health Annual Report, 2005–2006. It
will also be available on the Province’s website in late
October 2006.
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, 2006, there were 98 facilities, providing
insured hospital services to both in- and out-patients.
Hospitals are designated by the Hospitals Designation
Regulation (M.R. 47/93) under the Act.
Services specified by the Regulation as insured in- and
out-patient hospital services include: accommodation
and meals at the standard ward level; 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
Canada Health Act Annual Report, 2005–2006
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 is sensitive to new developments in the health sciences.
2.2 Insured Physician Services
The enabling legislation that provides for insured
physician services is the Medical Services Insurance
Regulation (M.R. 49/93) made under the Act.
Physicians providing insured services in Manitoba must
be lawfully entitled to practise medicine in Manitoba,
registered and licensed under the Medical Act. As of
March 31, 2006, there were 2,169 physicians on the
Manitoba Health Registry. This figure is taken from
the Monthly Practitioner Registration Statistics and
includes all physicians registered with Manitoba Health
whether income was generated or not.
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 is listed in the Payment for Insured Medical
Services Regulation (M.R. 95/96). Coverage is provided
for all medically required personal health care services
that are not excluded under the Excluded Services
95
Chapter 3 — Manitoba
Regulation (M.R. 46/93) of the Act, rendered to an
insured person by a physician.
During fiscal year 2005–2006, a number of new insured
services were added to a revised fee schedule. In order for
a physician’s service to be added to the list of those covered
by Manitoba Health, 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. Manitoba
Health may also initiate this process.
2.3 Insured Surgical-Dental Services
by Manitoba Health; 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.
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, 2006, 600 dentists were registered
with Manitoba Health, however only 115 dentists were
paid for providing dental services.
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 to monitor usage
and service concerns.
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, 2006.
No services were removed from the list of those insured
by Manitoba Health in 2005–2006.
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.
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
96
To de-insure services covered by Manitoba Health, the
Ministry prepares a submission for approval by Cabinet.
The need for public consultation is determined on an
individual basis depending on the subject.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
The Residency and Registration Regulation (M.R. 54/93)
extends the definition of residency. The extensions are
found in sections 7(1) and 8(1). Section 7(1) allows
missionaries, individuals with out-of-country employment and individuals undertaking sabbatical leave to
be outside Manitoba for up to two years while still
remaining residents of Manitoba. Students are deemed
to be Manitoba residents while in full-time attendance
at an accredited educational institution. Section 8(1)
extends residency to individuals who are legally entitled
to work in Manitoba and have a work permit of
12 months or more.
The Residency and Registration Regulation, section 6,
defines Manitoba’s waiting period as follows:
“A resident who was a resident of another Canadian
province or territory immediately before his or her arrival
in Manitoba is not entitled to benefits until the first day
of the third month following the month of arrival.”
There are currently no other waiting periods in Manitoba.
The MHSIP excludes residents covered under the
following federal statutes: Aeronautics Act; Civilian
War-related Benefits Act; Government Employees
Compensation Act; Merchant Seaman Compensation
Act; National Defence Act; Pension Act; Royal Canadian
Mounted Police Act; Veteran’s Rehabilitation Act; or under
legislation of any other jurisdiction (Excluded Services
Regulations subsection 2(2)). The excluded are residents
who are members of the Canadian Forces, the Royal
Canadian Mounted Police (RCMP) and federal inmates.
These residents become eligible for Manitoba Health
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 (Residency and
Registration Regulation (M.R. 54/93, subsection 2(3)).
Manitoba has two health-related numbers. The registration
number is a six-digit number assigned to an individual
18 years of age or older who is not classified as a
dependant. This number is used by Manitoba Health
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, 2006, there were 1,173,815 residents
registered with the health care insurance plan.
There is no provision for a resident to opt out of the
Manitoba health 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 coverage.
As of March 31, 2006, there were 4,475 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 2005–2006 fiscal year affected
universality.
4.0 Portability
3.2 Registration Requirements
4.1 Minimum Waiting Period
The process of issuing health insurance cards requires
that individuals inform Manitoba Health 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 will provide a registration card for the individual
and all qualifying dependants.
The Residency and Registration Regulation (M.R. 54/93,
section 6) identifies the waiting period for insured persons
from another province or territory. A resident who lived in
another Canadian province or territory immediately before
arriving in Manitoba is entitled to benefits on the first day
of the third month following the month of arrival.
Canada Health Act Annual Report, 2005–2006
97
Chapter 3 — Manitoba
4.2 Coverage During Temporary Absences
in Canada
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.
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 for up to 24 consecutive months.
Students are considered residents and will continue to
receive health coverage for the duration of their full-time
enrolment 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 for
up to 24 consecutive months. These individuals also
must return and reside in Manitoba after completing
their leave.
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.
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 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.
In-patient services are paid based on a per-diem rate
according to hospital size:
The Residency and Registration Regulation (M.R. 54/93
section 7(1)) defines the rules for portability of health
insurance during temporary absences in Canada. Students
are considered residents and will continue to receive health
coverage for the duration of their full-time enrolment at
any accredited educational institution. The additional
requirement is that they intend to return and reside in
Manitoba after completing their studies.
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 2005–2006, Manitoba Health made payments of
approximately $23.7 million for hospital services and
$8.7 million for medical services provided in Canada.
4.3 Coverage During Temporary Absences
Outside Canada
The Residency and Registration Regulation (M.R. 54/93,
sub-section 7(1)) defines the rules for portability of health
insurance during temporary absences from Canada.
Residents on full-time employment contracts outside
Canada will receive Manitoba Health coverage for up
98
1–100 beds: $280
101–500 beds: $365
over 500 beds: $570
Out-patient services are paid at a flat rate of $100 per
visit or $215 for haemodialysis.
The calculation of these rates is complex due to the
diversity of hospitals in both rural and urban areas.
Manitobans requiring medically necessary hospital services
unavailable in Manitoba or elsewhere in Canada may
be eligible for costs incurred in the United States by
providing Manitoba Health 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 per cent 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 made payments of approximately
$3,410,500 for hospital care provided in hospitals out-
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
side Canada in the 2005–2006 fiscal year. In addition,
Manitoba Health made payments of approximately
$1,074,000 for medical care outside Canada.
Manitobans now have access to vital health information
and assistance in 120 languages 24-hours a day, seven
days a week.
In instances where Manitoba Health has given prior
approval for services provided outside Canada and
payment is less than 100 per cent of the amount billed
for insured services, Manitoba Health will consider
additional funding based on financial need.
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.
4.4 Prior Approval Requirement
Prior approval by Manitoba Health 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 to receive approval for coverage.
No legislative amendments to the Act or the regulations
in the 2005–2006 fiscal year had an effect on portability.
5.0 Accessibility
5.1 Access to Insured Health Services
Manitoba Health 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-ofthe-art call centre with a call capacity of 300,000 per year.
Canada Health Act Annual Report, 2005–2006
Through the Primary Health Care Transition Fund, multijurisdictional 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, outpatients 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. The most recent
NRRF initiative is the Conditional Grant Program that
was implemented in July 2004 to encourage new graduates to work in rural and northern Manitoba regions
(outside Winnipeg and Brandon).
In addition, Manitoba has a wide range of other health
care professionals. Shortages in some of the technology
fields persist, primarily in rural and northern areas of the
Province. Shortages in some of the technology fields such
as medical radiology technology, medical laboratory technology and sonography continue to be issues of concern,
however recent expansions of training opportunities are
expected to have positive impacts in the near future.
Manitoba currently has access to seven Magnetic
Resonance Imaging (MRI) machines, six of which are
used for clinical testing. The first unit was installed
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Chapter 3 — Manitoba
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.
information to help with patient decision-making, linkages with prostate cancer support groups and research
conducted in the area of prostate disease.
Manitoba has 17 Computerized Tomography (CT)
scanners: 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 all located in Winnipeg. 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 are all located
throughout the province. As well, planning is underway
to establish a CT scanner at Portage District General
Hospital. Brandon is in the process of purchasing a
64 slice scanner and Dauphin is in the process of
purchasing a 16 slice CT scanner.
Additional cataract procedures to reduce wait lists
have been added at Pan Am Clinic in Winnipeg and
at Brandon Regional Health Centre.
There are 67 ultrasound scanners located in Winnipeg
health facilities and 22 scanners in rural and northern
health facilities. Concordia and Seven Oaks Hospitals are
reviewing proposals for a new ultrasound for each facility.
Bethesda Hospital is also purchasing an ultrasound
scanner. Bone density testing is funded by Manitoba
Health on two machines, one located in Winnipeg and
one in Brandon.
In November 2004 new community cancer programs
were established in Deloraine and Pinawa. These new
cancer programs operate in conjunction with CancerCare
Manitoba and focus on prevention, early detection and
screening, diagnosis and treatment and rehabilitation.
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,
100
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. Rehabilitation clinics have also been
established in Winnipeg, Brandon and Boundary Trails
to provide care to patients while they wait for their joint
replacement surgery.
In March 2005 the expansion of pediatric dental
surgery services to Misericordia Health Centre (MHC)
was initiated to reduce the waiting times. Further,
200 surgeries were added to Thompson General
Hospital at the beginning of August 2005.
Services at the Pain Clinic at Health Sciences Centre
had been impacted by a shortage of anesthesiologists
and the lack of physical space in the clinic. Renovations
to expand clinic size and increase capacity were completed in 2005. The Health Sciences Centre Pain Clinic
has recruited two Geriatric Rehabilitation doctors
(psychiatrists) and a psychologist who are part of the
multi-disciplinary team treating patients.
The WRHA Emergency Care Task Force was initiated
in January 2004. The Task Force was closed effective
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.
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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
dental surgeries, mental health programs, pain management and treatment for sleep disorders.
A plan was developed in consultation with practitioners
and stakeholders, which will increase the number of
surgeries and procedures, invest in human resources,
technology and capital, and provide regional health
authorities with new wait-list management tools and
resources.
The 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.
5.3 Access to Insured Physician and
Surgical-Dental Services
In 2005–2006, Manitoba Health 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 is an initiative that
facilitates the entry of eligible foreign medical graduates
into the physician workforce. Through the 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. Another
initiative assists in facilitating the assessment of physicians
whose practice will be limited to a specialty field of
training. Through this program clinical assessments
are organized and facilitated in order for foreign trained
physicians to meet the College of Physicians and Surgeons
of Manitoba (CPSM) criteria for licensure.
Manitoba continues to experience increases in the number
of new physicians registering with the licensing body. To
encourage retention of Manitoba graduates, the Province
continued to provide a financial assistance grant, introduced in 2001, for students and residents. In return for
Canada Health Act Annual Report, 2005–2006
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 launched the new Manitoba
Telehealth site at St. Boniface General Hospital, officially
linking its medical specialists to patients and colleagues
province-wide.
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 2005–2006 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. Alternatefunded 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
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Chapter 3 — Manitoba
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 typically negotiate compensation agreements for physicians.
The June 27, 2005, settlement maintained the terms of
the June 2, 2002, Arbitration Agreement, (subsequently
entrenched in the 2003–2005 MMA- Manitoba Heath
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);
the continuation of the Continuing Medical
Education Fund ($1 million per annum from
2006 through 2011);
the continuation of a Maternity/Parental Benefits
Fund ($1 million per annum from 2005 through
to 2011);
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, Fee-For-Service
Agreement between the parties.
The highlights of the June 27, 2005, Negotiated Settlement include:
102
a three-year term from April 1, 2005 to March 31, 2008;
an overall increase of 7.5 per cent (non-compounded)
to the Fee-For-Service Schedule of Benefits, as well as
alternate-funded agreements and arrangements)
2.5 per cent effective April 1, 2005; 2.5 per cent
effective April 1, 2006; and 2.5 per cent 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-forservice 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;
increased incentives for family doctors to provide fullservice care and to maintain hospital privileges; and,
increases to the rates for physicians under alternate
funding agreements in the amount of 2.5 per cent
effective April 1, 2005; 2.5 per cent effective
April 1, 2006; and 2.5 per cent effective April 1, 2007
(non-compounded); were also applied over and above
the fee-for-service increase.
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 a Regional Health Authority
to determine funding based on objective evidence, best
practices and criteria that are commonly applied to
comparable facilities. In all other regions, the hospitals
are operated by the Regional Health Authorities Act.
Section 23 of the Act requires that Authorities allocate
their resources in accordance with the approved regional
health plan.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
The allocation of resources by Regional Health Authorities
for providing hospital services is approved by Manitoba
Health 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 2005–2006 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.
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
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
Canada Health Act Annual Report, 2005–2006
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 non-proprietary homes are licensed
by Manitoba Health. Residents of personal care homes
pay a residential charge towards accommodation costs,
with the cost of care funded by Manitoba Health through
the Regional Health Authorities. Total Manitoba Health
operating funding for personal care services delivered in
licensed personal care homes and in two long-term care
centres during fiscal year 2005–2006 was $445,588,400.
This funding supported the delivery of insured personal
care services in a total of 9,830 personal care beds plus
a total of 190 chronic care beds in two long-term care
facilities, 30 palliative care beds and 136 rehab beds.
In addition, Manitoba Health provided $13,054,100
in capital funding for approved capital projects,
information technology projects, safety and security
upgrades, and equipment.
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
All Regional Health Authorities provide community
mental health services. Community Mental Health
Workers provide assessment, service planning, short-term
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Chapter 3 — Manitoba
counselling interventions, rehabilitation and recovery
planning, crisis intervention, community consultation
and in some cases education. In addition to Community
Mental Health Workers, some regions have a variety
of intensive and supportive programs such as Intensive
Case Management, Supported Employment, Supported
Housing and, in Winnipeg, the Program for Assertive
Community Treatment and the Early Psychosis Prevention
and Intervention Service.
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 and Addictions Recovery Inc.
These agencies work to reduce the harm associated with
alcohol and other drugs. AFM also offers a gambling
program. Programs include education, prevention,
rehabilitation and research. In addition to the provincially
funded agencies, the Winnipeg Regional Health Authority
funds to detox programs and the Norman Regional
Health Authority funds a residential treatment agency.
Primary Health Care
One of Manitoba Health’s strategic priorities is the need
to address primary care renewal. One strategy includes
the development of Physician Integrated Networks
(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.
104
A PIN resource team has been established to work with
four demonstration sites during the development phase
of the implementation plan. The project is scheduled to
be operational early in 2007.
The federal government’s Primary Health Care Transition
Fund per capita grant funded twenty-two initiatives in
Manitoba. Some initiatives received sustainable funding
from their regional health authorities while others
concluded as of March 31, 2006. The final reports and
evaluations, submitted by the initiatives provided many
insights for future strategic planning and enhancement
of primary health care in the province.
Primary Health Care participated in a national initiative
to develop multidisciplinary collaborative care in order
to address human resource and quality issues in maternal
newborn services. Primary Health Care, in partnership
with MB Telehealth, held a workshop for regional health
authorities to pilot the project’s tool-kit, and assess its
usefulness in the provincial environment. Implementation
of the model begins with an environmental scan and
gap-analysis, is flexible to address northern, rural and
remote situations and is designed to begin with current
resources. Regional Health Authority representatives found
the model practical and useful, and plan to work with
Primary Health Care in development of collaborative
maternal/newborn services.
Midwifery, regulated in 2000, has now been introduced
in seven of 11 Regional Health Authorities. In 2003–2004
only six RHAs employed midwives. Services are distributed across the province, with half provided outside the
Winnipeg Region. Midwives provide primary care for
women and newborns; now attending five per cent of
Manitoba births, as well as providing well-woman care.
Provincial direction has focused the service on priority
populations, which represent over 65% of midwifery
clients; including those at high social risk such as substance abusers. The program, providing comprehensive,
community-based care, has significantly lower rates of
pre-term birth, high and low birth weights. Development
of human resources is being addressed through the
introduction of the Aboriginal Midwifery Education
Program at University College of the North.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
The primary health care staff participated in a PanCanadian Primary Health Care Indicator Development
Project also funded through the Primary Health Care
Transition Fund. The purpose of the project was to
develop a set of agreed-upon PHC indicators with
which to compare and measure PHC at multiple levels
within each jurisdiction across Canada.
Ambulatory Health Care Services
The Health Services Insurance Act includes a provision
authorizing the designation of non-profit, publicly
administered ambulatory health (primary care) centres
as institutions within the meaning of the Act.
Registered Persons
1. Number as of March
31st. 2
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1,152,982
1,156,217
1,159,784
1,169,667
1,173,815
2004–2005
2005–2006
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
b.
chronic care
c.
rehabilitative care
d.
other
e.
total
3. Payments ($):
a. acute care
2002–2003
2003–2004
96
92
92
98 3
98
3
3
5
5
34
3
4
not available
not available
not available
not available
not available
not applicable
not available
not available
not available
not available
99
97
97
98
98
1,488,094,835
1,046,407,229
1,148,652,940
1,220,253,362
1,400,448,441
b.
chronic care
70,872,152
107,840,132
117,642,127
96,364,992
71,117,677
c.
rehabilitative care
d.
e.
other
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
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
not applicable
1
1
1
1
not applicable
not applicable
0
1
0
1
0
1
0
1
not applicable
not available
not available
not available
not available
not applicable
not applicable
0
not available
0
not available
0
not available
0
not available
not applicable
not applicable
not applicable
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
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
5. Number of insured hospital services provided:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
6. Payments ($):
a. surgical facilities
b.
c.
2.
3.
4.
2001–2002
diagnostic imaging facilities
total
The population data is based on records of residents registered with Manitoba Health as of June 1.
Ninety-eight submitting acute facilities includes 22 nursing stations and 2 federal hospitals.
Three acute facilities have been given a chronic institution submitting number: Riverview Health Centre, Deer Lodge Centre and Brandon
General Hospital.
Canada Health Act Annual Report, 2005–2006
105
Chapter 3 — Manitoba
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
not available
not available
not applicable
not available
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
8. Number of opted-out physicians:
a. general practitioners
b. specialists
c. other
d. total
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
9. Number of not participating physicians:
a. general practitioners
b. specialists
c. other
d. total
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
not
not
not
not
applicable
applicable
applicable
applicable
7. Number of participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
10. Services provided by physicians paid through all
payment methods :
a.
b.
number of services
total payments
not available
496,268,700
not available
521,611,200
not available
559,271,513
not available
601,240,469
not available
653,290,519
6,244,197
9,198,787
not applicable
15,442,984
6,161,451
9,779,269
not applicable
15,940,720
6,224,463
10,044,381
not applicable
16,268,844
6,185,333
10,393,068
not applicable
16,578,401
6,365,965
11,100,403
not applicable
17,466,368
140,703,474
214,392,377
not applicable
355,095,851
143,846,209
221,948,290
not applicable
365,794,499
152,393,920
232,153,861
not applicable
384,547,781
167,728,376
248,021,396
not applicable
415,749,772
175,463,105
267,022,019
not applicable
442,485,124
not available
not available
not available
not available
15,442,984
not available
not available
not available
not available
15,940,720
not available
not available
not available
not available
16,268,844
not available
not available
not available
not available
16,578,401
not available
not available
not available
not available
17,466,368
not available
not available
not available
not available
355,095,851
not available
not available
not available
not available
365,794,499
not available
not available
not available
not available
384,547,781
not available
not available
not available
not available
415,749,772
not available
not available
not available
not available
442,485,124
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for service,
by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a.
b.
c.
d.
e.
106
medical
surgical
diagnostic
other
total
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Manitoba
Insured Services Provided to Residents in Another Province or Territory
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
17. Total payments, in-patient ($).
18. Total payments, out-patient ($).
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
2,892
2,714
2,928
3,036
2,995
26,479
26,059
31,100
24,057
29,685
11,427,627
12,918,117
16,290,426
15,393,378
19,153,208
3,776,489
3,783,059
4,369,889
3,896,789
5,670,133
3,951.50
4,759.81
5,563.67
5,070.28
6,395.06
142.60
145.17
140.51
161.98
191.01
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
211,464
212,795
210,294
209,152
228,090
7,381,785
7,691,159
7,579,028
8,109,229
8,966,703
34.900
36.14
36.00
39.00
39.31
Insured Services Provided Outside Canada
Hospitals
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
557
569
418
540
569
6,676
6,025
6,069
6,170
6,690
26. Total payments, in-patient ($).
2,008,580
1,847,910
1,348,148
1,085,650
1,455,908
27. Total payments, out-patient ($).
3,267,764
914,251
1,216,073
1,112,466
1,325,062
3,607.40
3,249.89
3,225.00
2,010.00
2,558.71
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
489.00
151.73
200.00
180.00
198.07
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
6,345
5,826
5,324
5,714
6,138
529,029
607,066
519,782
426,937
608,524
83.40
104.20
98.00
75.00
99.14
2004–2005
2005–2006
Insured Surgical-Dental Services Within Own Province or Territory
2001–2002
33. Number of particpating dentists.
34. Number of services provided.
35. Total payments ($).
36. Average payment per service ($).
Canada Health Act Annual Report, 2005–2006
2002–2003
2003–2004
not available
116
102
114
115
3,401
3,455
3,498
3,774
3,863
677,295
714,590
750,122
875,657
936,091
199.15
206.83
214.44
232.02
242
107
108
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
Saskatchewan
Introduction
In 2005–2006 Saskatchewan Health continued to base
its work on The Action Plan for Saskatchewan Health Care,
a blueprint and broad strategic plan for strengthening
the health care system. Our vision for Saskatchewan
remains unchanged:
“Building a province of healthy people and
healthy communities.”
In 2005–2006 Saskatchewan Health made significant
progress toward fulfilling its goals of:
improved access to quality health services;
effective health promotion and disease prevention;
retaining, recruiting and training health providers; and
a sustainable, efficient, accountable, quality
health system
The following examples highlight several significant
accomplishments by Saskatchewan Health during the
2005–2006 fiscal year.
Saskatchewan achieved a significant increase in
surgical capacity in 2005–2006 and a considerable
drop in the number of patients waiting for surgery.
Regina Qu’Appelle and Saskatoon Health Regions
together completed about 2,000 more surgeries in
2005–2006. The number of patients waiting for
surgery in those regions dropped by nearly 1,600
over the previous year.
The total number of patients waiting for an MRI
exam decreased provincially by 35.6 per cent since
March 2004. With the implementation of Regina’s
second MRI, it is anticipated that wait times will
be further reduced.
Funding was provided to more than 500 new
and continuing return service bursaries for health
care providers.
Canada Health Act Annual Report, 2005–2006
New International Medical Graduate residency seats were
added at the University of Saskatchewan to allow more
foreign-trained physicians to work in Saskatchewan.
It released the comprehensive report Working Together:
Saskatchewan's Health Workforce Action Plan —
an action plan designed to improve health care
in Saskatchewan by keeping and attracting health
care professionals.
It expanded immunization program to include free flu
shots for children between the ages of 6–23 months.
It announced the building of a new Provincial Laboratory to ensure we can even better identify, respond
to and prevent illness and disease in our province.
It expanded the Telehealth network to now include
26 sites across the province, and serve about 5,500
Saskatchewan residents and health care providers
every year.
In August 2005, Premier Lorne Calvert announced the
launch of the Premier’s Project Hope, a comprehensive
and integrated plan to prevent and treat alcohol and drug
addiction in Saskatchewan. Funding for 2005–2006
included $10 million of new annual funding in addition
to the $4.7 million increase in the 2005–2006 budget
for addictions programming. This amounted to a
60 per cent increase in substance abuse prevention
and treatment funding.
Saskatchewan has also made exciting progress in developing
new electronic health record (EHR) technologies; we were
successful in securing funding from Canada Health Infoway
to launch a number of important new projects such as
the Pharmaceutical Information Program (PIP). We will
continue to work closely with our health delivery partners
to introduce innovative technologies for improving the
health of our citizens. The EHR program will ensure
authorized front-line care providers have access to the
information they need — improving the quality, access
and effectiveness of health care services across the province
into the future.
Saskatchewan Health and the health care system provide
a wide range of services through a complex delivery
system that includes Regional Health Authorities, the
Saskatchewan Cancer Agency, affiliated health care
organizations and a range of professionals many of
whom are in private practice. The range and number
of services provided are partially illustrated by the
following examples of activity:
109
Chapter 3 — Saskatchewan
128,700 annual in-patient admissions or 2,100 (acute,
psychiatric and rehabilitation) patients in hospital beds
on any given day;
93,700 surgeries and select ambulatory procedures
(e.g., endoscopies and biopsies) per year or 257 per day;
4.6 million visits per year or 12,600 family physician
visits per day;
2,500 visits to specialists per day;
400,000 immunizations per year; and
more than 40,000 mammograms per year.
The health system employs over 37,000 individuals,
includes 26 self-regulated health professions, and
operates 269 health facilities.
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
110
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 5 and 11 of The Cancer Foundation Act provide
for establishing a Saskatchewan Cancer Agency and for
the Agency to coordinate a program for diagnosing,
preventing and treating cancer.
The mandates of the Department of Health, regional
health authorities and the Saskatchewan Cancer Agency
for 2005–2006 are outlined in The Department of Health
Act, The Regional Health Services Act and The Cancer
Foundation 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, surgicaldental and hospital services.
Section 36 of The Saskatchewan Medical Care Insurance
Act prescribes that the Minister of Health submit to the
Legislative Assembly an annual report concerning the
medical care insurance plan.
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 the regional health authority shall submit to the
Minister any reports that the Minister may request
from time to time. All regional health authorities are
required to submit a financial and health service plan
to Saskatchewan Health.
The Cancer Foundation Act prescribes that the Cancer
Foundation shall, in each fiscal year, submit a report about
its business and a financial statement to the Minister of
Health for the fiscal year immediately preceding.
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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
Saskatchewan Cancer Agency and to physicians and dental
surgeons for insured physician and surgical-dental services.
Section 57 of The Regional Health Services Act requires
that an independent auditor, who possesses the prescribed
qualification and is appointed for that purpose by the
regional health authority, shall audit the accounts of a
regional health authority at least once in every fiscal year.
A detailed, audited set of financial statements must be
submitted annually, by each regional health authority,
to the Minister of Health.
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, 2006.
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.
2.0 Comprehensiveness
2.1 Insured Hospital Services
The Regional Health Services Act was proclaimed on
August 1, 2002, to replace The Health Districts Act as
the authority to amalgamate the existing 32 health
districts into 12 regional health authorities. Section 8
of The Regional Health Services Act (the Act) gives the
Minister the authority to provide funding to a regional
health authority or a health care organization for the
purpose of the Act.
Section 10 of The Regional Health Services Act permits
the Minister to designate facilities including hospitals,
special-care homes and health centres. Section 11 allows
Canada Health Act Annual Report, 2005–2006
the Minister to prescribe standards for delivering
services in those facilities by regional health authorities
and health care organizations that have entered into
service agreements with a regional health authority.
The Act sets out the accountability requirements for
regional health authorities and health care organizations.
These requirements include submitting annual operational
and financial and health service plans for Ministerial
approval (sections 50–51); establishing community
advisory networks (section 28); and reporting critical
incidents (section 58). The Minister also has the authority
to establish a provincial surgical registry to help manage
surgical wait times (section 12). The Minister retains
authority to inquire into matters (section 59); appoint a
public administrator if necessary (section 60); and approve
general and staff practitioner by-laws (sections 42–44).
Funding for hospitals is included in the funding provided
to regional health authorities.
As of March 31, 2006, the following facilities were
providing insured hospital services to both in- and
out-patients:
66 acute care hospitals provided in- and out-patient
services; and
one rehabilitation hospital provided treatment,
recovery and rehabilitation care for patients disabled
by injury or illness. Rehabilitation services are also
provided in a geriatric rehabilitation unit in one other
hospital and in two special-care facilities.
A comprehensive range of insured services is provided by
hospitals. These may include: public ward accommodation;
necessary nursing services; the use of operating room and
case room facilities; required medical and surgical materials
and appliances; x-ray, laboratory, radiological and other
diagnostic procedures; radiotherapy facilities; anaesthetic
agents and the use of anaesthesia equipment; physiotherapeutic procedures; all drugs, biological and related
preparations required for hospitalized patients; and
services rendered by individuals who receive remuneration
from the hospital.
The Action Plan for Saskatchewan Health Care established
new hospital categories and outlined a standard array of
services that should be available in each hospital. Hospitals
are grouped into the following five categories: Community
Hospitals; Northern Hospitals; District Hospitals; Regional
Hospitals; and Provincial Hospitals.
111
Chapter 3 — Saskatchewan
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. The process is initiated by a regional
health authority and, depending on the specific service
request, it could include consultations involving several
branches within Saskatchewan Health as well as external
stakeholder groups such as health regions, service
providers and the public.
2.2 Insured Physician Services
Sections 8 and 9 of The Saskatchewan Medical Care
Insurance Act enable the Minister of Health to establish
and administer a plan of medical care insurance for
provincial residents. Amendments were made in April
and October 2005 to the Physician Payment Schedule
of The Saskatchewan Medical Care Insurance Payment
Regulations (1994) in accordance with an agreement
reached with the Saskatchewan Medical Association.
Those amendments provided for the addition of new
insured physician services, changes in payment levels
for selected services, and definition or assessment rule
revisions to existing selected services with significant
112
monetary impact. All new fee items for physicians can
be found in the Physician’s Newsletter at:
www.health.gov.sk.ca./ic_pub_2005oct1_pps.html
www.health.gov.sk.ca/ic_pub_2005apr1_pps.html
The Saskatchewan Health Medical Services Branch
2005–2006 Annual Statistical Report is available on the
website: www.health.gov.sk.ca/mc_publications.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, 2006, there were 1,719 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 “opted-out” physician
must also advise beneficiaries that the physician services
to be provided are not insured and that the beneficiary is
not entitled to be reimbursed for those services. Written
acknowledgement from the beneficiary indicating that
he or she understands the advice given by the physician
is also required.
As of March 31, 2006, 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
Medical Care Insurance Payment Regulations (1994)
of The Saskatchewan Medical Care Insurance Act.
There were approximately 3,100 different insured
physician services as of March 31, 2006.
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,
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
a regulatory amendment is made to the Physician
Payment Schedule.
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 make recommendations
about physician services to be added to the Plan.
Although formal public consultations are not held, any
member of the public may recommend that surgicaldental services be added to the Medical Services Plan.
2.3 Insured Surgical-Dental Services
2.4 Uninsured Hospital, Physician and
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, 2006, 78 dental specialists were
providing such services.
Amendments were made in April 2003, to The
Saskatchewan Medical Insurance Branch Payment
Schedule for Insured Services Provided by a Dentist.
Those amendments provided for changes in payment
levels for selected 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, 2006.
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 the 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
Canada Health Act Annual Report, 2005–2006
Uninsured hospital, physician and surgical-dental services
in Saskatchewan include: in-patient and out-patient
hospital services provided for reasons other than medical
necessity; the extra cost of private and semi-private
hospital accommodation not ordered by a physician;
physiotherapy and occupational therapy services not
provided by or under contract with a regional health
authority; services provided by health facilities other than
hospitals unless through an agreement with Saskatchewan
Health; non-emergency cataract surgery, MRIs and bone
densitometry provided outside Saskatchewan without
prior written approval; non-emergency insured hospital,
physician or surgical-dental services obtained outside
Canada without prior written approval; non-medically
required elective physician services; surgical-dental services
that are not medically necessary; and services received
under other public problems including The Workers’
Compensation Act, the federal Department of Veteran
Affairs and The Mental Health Act.
As a matter of policy and principle, insured hospital,
physician and surgical-dental services are provided to
residents on the basis of assessed clinical need. Compliance
is periodically monitored through consultation with
regional health authorities, physicians and dentists. There
are no charges allowed in Saskatchewan for medically
necessary hospital, physician or surgical-dental services.
Charges for enhanced medical services or products are
permitted only if the medical service or product is not
deemed medically necessary. Compliance is monitored
through consultations with regional health authorities,
physicians and dentists.
Insured hospital services could be de-insured by the
government if they were determined to be no longer
medically necessary. The process is based on discussions
among regional health authorities, practitioners and
officials from the Department of Health.
113
Chapter 3 — Saskatchewan
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.
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:
Such people become eligible for coverage as follows:
No health services were de-insured in 2005–2006.
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
114
members of the Canadian Forces and the Royal
Canadian Mounted Police (RCMP), federal inmates
and refugee claimants; visitors to the province; and
persons eligible for coverage from their home
province or territory for the period of their stay
in Saskatchewan (e.g. students and workers covered
under temporary absence provisions from their
home province or territory).
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.
The number of persons registered for health services
in Saskatchewan on June 30, 2005, was 1,021,080.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
3.3 Other Categories of Individuals
Other categories of individuals 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, 2005, there were 5,439 such temporary
residents registered with Saskatchewan Health.
4.0 Portability
4.1 Minimum Waiting Period
In general, insured persons from another province or
territory who move to Saskatchewan are eligible on the
first day of the third month following establishment of
residency. However, where one spouse arrives in advance
of the other, the eligibility for the later arriving spouse
is established on the earlier of a) the first day of the
third month following arrival of the second spouse; or
b) the first day of the thirteenth month following the
establishment of residency by the first spouse.
4.2 Coverage During Temporary Absences
in Canada
Section 3 of The Medical Care Insurance Beneficiary
and Administration Regulations of The Saskatchewan
Medical Care Insurance Act prescribes the portability
of health insurance provided to Saskatchewan residents
while temporarily absent within Canada. There were no
changes to the in-Canada temporary absence provisions
in 2005–2006.
Continued coverage during a period of temporary absence
is conditional upon the registrant’s intent to return to
Saskatchewan residency immediately on expiration of the
approved absence period as follows:
Section 6.6 of The Department of Health Act provides
the authority for paying in-patient hospital services to
Saskatchewan beneficiaries temporarily residing outside
the province. Section 10 of The Saskatchewan Medical
Care Insurance Payment Regulations (1994) provides
payment for physician services to Saskatchewan beneficiaries temporarily residing outside the province.
Saskatchewan has bilateral reciprocal billing agreements
with all provinces for hospital services and all but Quebec
for physician services. Rates paid are at the host province
rates. The reciprocal arrangement for physician services
applies to every province except Quebec.
Payments/reimbursement to Quebec physicians, for services
to Saskatchewan residents, are made at Saskatchewan rates
(Saskatchewan Physician Payment Schedule). However,
the physician fees may be paid at Quebec rates with prior
approval. In recent years, the out-of-province reciprocal
hospital per diem billing rates have increased significantly.
In 2005–2006, expenditures for insured physician services
in other provinces were $20.54 million. Insured hospital
services in other provinces were $44.72 million.
4.3 Coverage During Temporary Absences
Outside Canada
Section 3 of The Medical Care Insurance Beneficiary and
Administration Regulations describe the portability of
health insurance provided to Saskatchewan residents who
are temporarily absent from Canada.
Continued coverage for students, temporary workers and
vacationers and travellers during a period of temporary
absence from Canada is conditional on the registrant’s
intent to return to Saskatchewan residence immediately
on the expiration of the approved period as follows:
Canada Health Act Annual Report, 2005–2006
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.
education: for the duration of studies at a recognized
educational facility (written confirmation by a Registrar of full-time student status is required annually);
contract employment of up to 24 months (written
confirmation from the employer is required); and
vacation and travel of up to 12 months.
115
Chapter 3 — Saskatchewan
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).
Section 6.6 of The Department of Health Act provides the
authority under which a resident is eligible for health
coverage when temporarily outside Canada. In summary,
a resident is eligible for medically necessary hospital
services at the rate of $100 per in-patient and $50 per
out-patient visit per day.
In 2005–2006, $2.03 million was paid for in-patient
hospital services and $1.49 million was spent on outpatient hospital services outside Canada. In 2005–2006,
expenditures for insured physician services outside
Canada were $695,900.
4.4 Prior Approval Requirement
The Saskatchewan Cancer Agency is consulted
for out-of-country cancer treatment requests. If
approved, Saskatchewan Health will pay the full
cost of treatment, excluding any items that would
not be covered in Saskatchewan.
5.0 Accessibility
5.1 Access to Insured Health Services
To ensure that access to insured hospital, physician and
surgical-dental services is 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.
Out-of-Province
5.2 Access to Insured Hospital Services
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.
As of March 31, 2006, Saskatchewan had 3,073 staffed
hospital beds in 66 acute care hospitals, including 2,537
acute care beds, 218 psychiatric beds and 325 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.
Prior approval from the Department must be obtained
by the patient’s specialist for alcohol and drug, mental
health and problem gambling services; and cataract
surgery services, bone densitometry and non-urgent
MRI when provided out-of-province.
Out-of-Country
Prior approval is required for the following services
provided outside Canada:
116
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.
Saskatchewan’s Health Workforce Action Plan
In September 2004, Canada’s First Ministers agreed to
accelerate their work on health human resource (HHR)
action plans and/or initiatives to ensure an adequate
supply and appropriate mix of health care professionals.
They agreed to make their action plans public by
December 31, 2005, including targets for the training,
recruitment and retention of professionals.
On December 14, 2005 Working Together: Saskatchewan’s
Health Workforce Action Plan was released. The Plan
expanded on 2001 Action Plan for Saskatchewan Health
Care. Extensive consultations took place with stakeholders
while developing the plan, including a conference focused
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
on Finding Common Ground, hosted by the Canadian
Policy Research Network (CPRN). The purpose of this
event was to bring together the major partners to discuss
the key elements of a provincial HHR plan. The CPRN
facilitated a structured dialogue of the key issues to
help achieve consensus on key elements of a framework,
solutions and courses of action.
The Plan contains the following 5 goals:
that the health care system have a sufficient number
and effective mix of health care professionals who
are used fully to provide safe, high-quality care;
that the health system have safe, supportive and
quality workplaces that help to retain and recruit
health care professionals;
that Aboriginal people fully participate in the health
sector in all health occupations;
that the education and training supply of Saskatchewan
health care professionals be aligned with projected
workforce requirements and health service needs; and
that the health workforce be 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. A
copy of the CPRN conference documents can be found at
www.cprn.org. These documents include a pre-conference
report entitled: Finding Common Ground: Consultations
and Directions, as well as the final conference report
entitled: Setting Priorities and Getting Direction.
The Workforce Action Plan strives to improve
Saskatchewan’s self-sufficiency in training its own
health professionals, within available resources. At the
same time, it proposes employment opportunities for
newly trained professionals, building a representative
workforce, drawing upon the experience of veteran
employees to mentor new graduates, better aligning
education with health service needs, and establishing
a steering committee to help implement the plan and
guide continued planning efforts.
Saskatchewan’s plan has been enjoying kudos from
a number of groups at the national level. The Health
Council of Canada noted the Saskatchewan plan for
its innovative health care planning, and Saskatchewan
ranked highest among all provinces and territories
that reported health human resources action plans.
The plan identifies a number of initiatives/actions that
will assist in recruiting and retaining nurses including:
Canada Health Act Annual Report, 2005–2006
establishment of a provincial recruitment agency;
enhanced clinical placement capacity;
resources to support Occupational Health and Safety
initiatives, training and research;
working with our training and learning institutions,
as well as our Aboriginal community to bridge our
youth into health programs; and
work related to recruitment of internationally
educated health professionals.
Province-wide Employee Opinion Survey
Regional health authorities conducted a province-wide
employee opinion survey in 2005–2006. The survey
results were officially released on December 12, 2005.
Health employers are using the survey results to develop
more specific actions to improve workplaces, and help
fulfil regional health authority accreditation requirements.
Based on the survey company’s (NRC Picker) national
database, Saskatchewan healthcare employees are more
positive on average than their national counterparts
within the NRC Picker database. Survey results showed
that physical environment, and safety and respect were
the highest positively rated topic areas. It also showed
that the learning environment was the lowest positively
rated topic area.
Bursary Program
Saskatchewan Health administers a Bursary Program,
which is a recruitment and retention tool designed to
improve the number of health professionals working
in publicly funded organizations in the province.
Bursaries are awarded on a competitive basis based upon
criteria that match the program goals. Those who are
awarded a bursary agree to a return-service contract that
commits them to work in a publicly funded facility in
Saskatchewan upon graduation for a set period of time.
Bursary amounts vary by discipline as well as the amount
of return service. For each year of bursary assistance,
students commit to one year if they accept a position
in rural or northern Saskatchewan and two years if they
work in the urban centres of Regina or Saskatoon. Failure
to complete their return service means that they must
repay the bursary assistance with interest.
The number of new bursaries awarded to health science
(non-physician) students has been increased substantially
from 2001–2002 when 27 bursaries were awarded, to
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Chapter 3 — Saskatchewan
2005–2006 in which 305 new bursaries were awarded.
Bursaries are awarded to a wide range of nursing and
allied health disciplines, with 20 types of allied health
bursaries and six categories of nursing bursaries.
Supply of Health Providers
Negotiations
Regarding the availability of selected diagnostic, medical,
surgical and treatment equipment and services in facilities
providing insured hospital services, Saskatchewan Health
notes the following:
In looking at the trend of selected health professionals,
the majority of Saskatchewan’s health professionals have
increased between 1995 and 2004 (Table 1).
During the 2005–2006 fiscal year, a 3-year collective
agreement was reached with the Saskatchewan Union
of Nurses and a 4-year collective agreement was reached
with the provider unions.
MRI machines are located in Saskatoon (2) and
Regina (2). Regina Qu’Appelle Regional Health
Authority’s second MRI became operational in
December, 2005.
Table 1. Selected Allied Health Professionals, Saskatchewan and Canada
Total
Occupations
Saskatchewan
1995
2000
Canada
2004
2004
Saskatchewan
Per 100,000
Population, 2004
Audiologists
n/a
n/a
35
1,175
4
Dental Hygienists
131
162
182
6,892
18
Dieticians
182
222
251
7,783
25
92
93
103
7,274
10
Social Workers
449
930
1,019
28,689
102
Speech-Language Pathologists
n/a
n/a
218
6,062
22
Medical Laboratory Technologists
998
972
949
19,401
95
Respiratory Therapists
Medical Physicists
7
10
10
314
1
Medical Radiation Technologists
418
438
429
15,693
43
Occupational Therapists
136
203
214
10,984
22
Optometrists
Pharmacists
Physiotherapists
Psychologists
106
109
113
3,941
11
1,043
1,108
1,170
28,537
118
407
521
526
15,607
83
71
74
404
14,695
41
n/a — Data not available.
Source: Health Personnel Provincial Profiles 2004, Canadian Institute for Health Information (CIHI): Last updated June 2006.
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.
118
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
CT scanners are available in Saskatoon (4),
Regina (3), Prince Albert (1), Swift Current (1),
Moose Jaw (1), Yorkton (1), North Battleford (1)
and Lloydminster (1).
Renal dialysis is provided at Saskatoon, Regina,
Lloydminster, Prince Albert, Tisdale, Yorkton,
Swift Current, North Battleford, and Moose Jaw.
Cancer treatment services are provided by the
Saskatchewan Cancer Agency’s two cancer clinics,
the Saskatoon Cancer Centre and the Allan Blair
Cancer Centre in Regina. In calendar year 2005,
approximately 5,000 new patients began treatment
for cancer. Both centres provided approximately
39,000 radiation therapy treatments and 17,500
chemotherapy treatments to cancer patients in
Saskatoon and Regina.
Sixteen (16) sites are involved in the Community
Oncology Program of Saskatchewan (COPS) that
allows patients to receive chemotherapy and other
supports closer to home, while maintaining a
close link to expertise at the Cancer Centres in
Regina and Saskatoon. In 2004, over 1,000 patients
made approximately 6,400 visits to COPS centres
for treatment.
Approximately 73 per cent 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 per cent 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 2005–2006 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 2005–2006,
approximately 19,600 MRI tests and approximately
105,000 CT tests were performed.
Canada Health Act Annual Report, 2005–2006
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. In 2005–2006
eight additional sites were added, which brings the
number to 26 sites.
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 surpasses the number of patients on
dialysis. (During the period December 31, 2004 to
December 31, 2005, the number of CRI patients
grew from 813 to 920, an increase of 13.2 per cent.)
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 2005 the program sent out 115,000
result notices and 103,000 recall/reminder letters.
The Provincial Malignant Hematology/Stem Cell
Transplant Program continues to provide transplants
to Saskatchewan residents. In 2005–2006, 38 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
is 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
2003–2004 supported enhanced access to diagnostic
imaging and surgical services.
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Chapter 3 — Saskatchewan
Saskatchewan Health continues to place priority on
promoting surgical access and improving the province’s
surgical system. Saskatchewan Health, with advice from
the Saskatchewan Surgical Care Network (SSCN), is
leading the country in implementing key surgical care
system initiatives.
Saskatchewan has already developed and implemented a
Patient Assessment Process, a Surgical Patient Registry and
Target Time Frames for Surgery as part of Saskatchewan
Health’s Action Plan.
The Patient Assessment Process will increase 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 will allow the surgical care
system to improve the management of surgical access,
assist in determining system capacity and resource
requirements, and reduce wait times for patients.
Target Time Frames for Surgery will allow 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.
access to 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
that works toward the goal of ensuring equitable access
to quality diagnostic imaging services in Saskatchewan.
Through collaboration with participating partners, the
Network acts as a provincial advisory body to assist in
province-wide strategic planning and coordination of the
diagnostic imaging system.
5.3 Access to Insured Physician and
Surgical-Dental Services
As of March 31, 2006, there were 1,719 physicians
licensed to practice in the province and eligible to
participate in the Medical Care Insurance Plan. Of
these, 990 (57.6 per cent) were family practitioners
and 729 (42.4 per cent) were specialists.
As of March 31, 2006, there were approximately 373 practising dentists and dental surgeons located in all major centres
in Saskatchewan. Seventy-eight 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 whereby
enhancing access to insured physician services and
reducing waiting times.
Specialist Programs:
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 web site also provides information on surgeries performed, patients waiting and waiting times, as well as how
the system works and how to access surgical services in
the Province.
Saskatchewan Health is currently working closely with
members of the health regions, physicians and other
health partners to maximize access to diagnostic imaging
services in Saskatchewan. The focus is on improving
120
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
15 bursary spots per year to residents for a
maximum of three years funding with a returnof-service commitment.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
The Foreign Certified Specialists’ initiative implemented in 2004–2005 provides funding to ensure
that these specialists are paid rates equivalent to
Canadian certified specialists.
Rural and Regional Programs:
A pilot 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, 2005–2006
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:
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;
121
Chapter 3 — Saskatchewan
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, 2006,
provided increases in the Physician Payment Schedule
of 8.3 per cent effective October 1, 2003, and 6 per cent
on April 1, 2004 and 2005. Similar increases were applied
to non fee-for-service physicians. Additional improvements
included a total of $11.2 million to bolster recruitment
and retention programs and $3 million per year for
new items and modernization of the Payment Schedule.
Negotiations for a new agreement began in January 2006.
Section 6 of The Saskatchewan Medical Care Insurance
Payment Regulations, 1994, outlines the obligation of the
Minister of Health to make payment for insured services
in accordance with the Physician Payment Schedule and
the Dentist Payment Schedule.
Fee-for-service is the most widely used method of
compensating physicians for insured health services
in Saskatchewan, although sessional payments, salaries,
capitation arrangements and blended methods are also
used. Fee-for-service is the only mechanism used to
fund dentists for insured surgical-dental services. Total
expenditures for in-province physician services and
programs in 2005–2006 amounted to $547.6 million:
$357.4 million for fee-for-service billings; $20.8 million
for Emergency Coverage Programs of which about $6 million was paid through fee-for-service; $150.6 million in
non-fee-for-service expenditures; and $18.8 million for
Saskatchewan Medical Association programs as outlined
in the agreement.
122
5.5 Payments to Hospitals
In 2005–2006, 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
and specialized respiratory services, or for providing
services to residents from other health regions.
Payments to regional health authorities for delivering
services are made pursuant to section 8 of The Regional
Health Services Act. The legislation provides the authority
for the Minister of Health to make grants to regional
health authorities and health care organizations for the
purposes of the Act and to arrange for providing services
in any area of Saskatchewan if it is in the public interest
to do so.
Regional health authorities provide an annual report on
the aggregate financial results of their operations.
6.0 Recognition Given to
Federal Transfers
The Government of Saskatchewan publicly acknowledged
the federal contributions provided through the Canada
Health Transfer(CHT)in the Department of Health
2005–2006 Annual Report, the 2005–2006 Annual
Budget and related budget documents, its 2005–2006
Public Accounts, and the Quarterly and Mid-Year
Financial Reports. These documents were tabled in
the Legislative Assembly and are publicly available to
Saskatchewan residents.
Federal contributions have also been acknowledged
on the Saskatchewan Health website, news releases,
issue papers, in speeches and remarks made at various
conferences, meetings and public policy forums.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
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 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
Canada Health Act Annual Report, 2005–2006
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 which are governed by The Mental
Health Services Act.
Regional health authorities offer podiatry services including
assessment, consultation and treatment. The Chiropody
Services Regulation of The Department of Health Act
provides chiropodists and podiatrists with the ability to
self-regulate their profession.
Regina Qu’Appelle and Saskatoon regional health
authorities provide a Hearing Aid Program. Services
under this program, governed by the Hearing Aid Act
and regulations and the Regional Health Services Act,
include hearing testing, assessments for at-risk infants,
and the selling, fitting and maintenance of hearing aids.
Rehabilitation therapies such as 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. The 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, governed
by the Residential Services Act provide a continuum of
support and living assistance to individuals with long-term
mental illnesses.
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.
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Chapter 3 — Saskatchewan
Alcohol and Drug Services
The provision of Alcohol and Drug services generally
falls under The Regional Health Services Act. Facilities
that provide residential alcohol and drug services are
licensed as listed below. Saskatchewan Health or the
regional health authorities contract with communitybased and non-profit organizations governed by The
Non-profit Corporations Act to provide services.
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 self-help
groups are offered for up to 10 days.
In-patient services are provided to individuals requiring
intensive rehabilitative programming for their own or
others’ use of alcohol or drugs. Services offered include
assessments, counselling, education and support for up
to four weeks or longer depending on individual needs.
Long-term residential services provide maintenance and
transition programs for an extended period to individuals
recovering from chemical dependency and addiction.
These facilities offer counselling, education and relapse
prevention in a safe and supportive environment.
124
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1,024,788
1,024,827
1,007,753
1,018,057
1,021,080
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
2003–2004
2004–2005
2005–2006
66
66
65
66
65
chronic care
0
0
0
0
0
c.
rehabilitative care
1
1
1
1
1
d.
other
e.
total
0
0
0
0
0
67
66
67
66
67
720,174,393 1
not available
811,561,671 2
867,261,000 2
922,675,000 2
b.
chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c.
rehabilitative care
d.
e.
other
total
39,656,384
not applicable
not available
not applicable
not available 3
not applicable
not available 3
not applicable
not available 3
not applicable
759,830,777
not available
811,561,671
867,261,000
922,675,000 2
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
5. Number of insured hospital services provided:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
6. Payments ($):
a. surgical facilities
b.
c.
3.
2002–2003
b.
3. Payments ($):
a. acute care
1.
2.
2001–2002
diagnostic imaging facilities
total
Based on provincial government funding summaries provided to the former health districts.
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 .
Comparable annual information is not available at this time.
Canada Health Act Annual Report, 2005–2006
125
Chapter 3 — Saskatchewan
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
937
696
0
1,633
936
700
0
1,636
946
716
0
1,662
967
718
0
1,685
990
729
0
1,719
8. 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
9. 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
not available
394,831,408
not available
421,709,330
not available
449,108,573
not available
491,805,817
not available
528,759,380
6,760,156
3,700,801
0
10,460,957
6,631,582
3,637,879
0
10,269,461
6,434,620
3,499,069
0
9,933,689
6,397,252
3,573,354
0
9,970,606
6,388,932
3,644,949
0
10,033,881
137,541,402
144,566,069
0
282,107,471
139,410,263
151,061,558
0
290,471,821
147,119,703
157,419,082
0
304,538,785
160,986,686
176,829,943
0
337,816,629
172,656,264
190,228,546
0
362,884,810
7. Number of participating physicians:
a. general practitioners
b. specialists
c. other
d. total
10. Services provided by physicians paid through all
payment methods:
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for service,
by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a. medical
b. surgical
c. diagnostic
d. other
e. total
4.
5.
6.
7.
126
6,017,477 4
994,321 5
2,262,256 6
1,186,903 7
10,460,957
5,788,055 4
984,405 5
2,179,286 6
1,317,715 7
10,269,461
5,841,196 4
998,210 5
2,174,220 6
920,063 7
9,933,689
5,801,265 4
1,015,900 5
2,187,590 6
965,851 7
9,970,606
5,779,846 4
1,020,399 5
2,248,621 6
985,015 7
10,033,881
160,742,594 4
56,027,014 5
44,488,404 6
20,849,458 7
282,107,470
162,032,557 4
58,596,690 5
48,355,683 6
21,486,890 7
290,471,821
170,595,840 4
60,515,275 5
51,280,830 6
22,145,286 7
304,537,231
192,359,771 4
70,671,415 5
57,032,791 6
17,752,650 7
337,816,627
208,290,658 4
75,149,703 5
61,675,211 6
17,769,239 7
362,884,810
Includes visits, hospital care, psychotherapy.
Includes surgeries, surgical assistance, obstetrics, anaesthesia.
Includes x-rays, laboratory services, diagnostics.
Includes surcharges, premiums, on-call physician services.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Saskatchewan
Insured Services Provided to Residents in Another Province or Territory
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
17. Total payments, in-patient ($).
18. Total payments, out-patient ($).
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
4,692
4,422
4,561
4,307
4,566
45,320
50,401
45,510
51,678
55,067
22,037,200
23,447,100
30,528,100
30,461,943
33,671,100
5,836,500
7,144,800
6,405,900
9,345,190
11,044,200
4,696.76
5,302.37
6,693.29
7,072.66
7,374.31
128.78
141.76
140.76
2001–2002
2002–2003
2003–2004
180.83 2
2004–2005
200.56
2005–2006
444,430
458,100
509,784
513,694
542,651
15,520,000
16,948,900
19,477,300
19,868,600
20,541,894
34.92
37.00
38.21
38.68
37.85
2003–2004
2004–2005
2005–2006
Insured Services Provided Outside Canada
Hospitals
2001–2002
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
26. Total payments, in-patient ($).
27. Total payments, out-patient ($).
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
2002–2003
252
287
231
254
248
1,172
1,049
875
1,002
1,194
1,009,400
1,891,800
728,400
730,849
2,033,300
375,900
359,400
373,300
251,957
1,486,500
4,005.56
6,591.64
3,153.25
2,877.36
8,198.79
320.73
342.61
426.63
251.45
1,244.97
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
not available
not available
not available
not available
not available
588,100
1,129,300
583,200
510,600
695,900
not available
not available
not available
not available
not available
2005–2006
Insured Surgical-Dental Services Within Own Province or Territory
33. Number of particpating dentists.
34. Number of services provided.
35. Total payments ($).
36. Average payment per service ($).
Canada Health Act Annual Report, 2005–2006
2001–2002
2002–2003
2003–2004
2004–2005
94
94
94
84
78
18,900
18,500
18,300
19,400
18,511
1,275,400
1,264,200
1,345,900
1,442,800
1,539,420
67.48
68.34
73.55
74.37
83.16
127
128
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
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
Ministry of Alberta 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. Alberta 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 and food-borne, drug and environmental hazards;
(3) providing appropriate information to prevent the onset
of disease and injury; and (4) promoting healthy choices.
The Regional Health Authorities Act makes regional health
authorities responsible to the Minister 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
Canada Health Act Annual Report, 2005–2006
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 Alberta Mental
Health Board advises the Minister on strategic and
policy matters related to mental health programs and
services. Regional health authorities and provincial health
boards are also responsible for assessing needs, setting
local 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:
ww.health.gov.ab.ca/about/minister_legislation.html
Significant Events in 2005–2006
In 2005–2006 Alberta’s health ministry started work on a
new approach to health renewal and reform. The process
began with the fundamental commitment that in Alberta
a person’s ability to pay would never determine their
ability to access health care. Alberta’s approach to health
care renewal is about being open to new options and
choices — choices that strengthen our health care system
and allow us to get on with the things that need to be
done. The approach emphasized improving choice and
access, and addressed the need to curb health care costs
to meet our ultimate goal of providing Albertans with
a sustainable and high performing health system for
the future.
In May 2005, the provincial government hosted the
“Alberta Symposium on Health”. The international
symposium provided a unique opportunity for representatives of Alberta’s health regions, communities,
health organizations and professional groups to
exchange information and experience and to consult
with international experts. Some of the important
lessons learned at the symposium were: (1) there is no
single solution to the challenges in the health system,
but rather improvements must evolve over time;
(2) improvements must focus on the patient and emphasize evidence-based outcomes; and (3) solutions must
meet the expectations and values of the society
in which they take place.
129
Chapter 3 — Alberta
Based on what was learned at the symposium, the Premier
and the Minister announced, in July 2005, a series of
action items in the Getting on with Better Health Care
package. The action items identified ways for improving
the health system in areas such as: disease and injury
prevention, children’s health, mental health, and the
health needs of rural communities. The action items also
referred to important strategies to improve performance
in such areas as primary health care; new quality standards
for long term care; the use of new technology such as
Alberta Netcare (Alberta’s electronic health record) to
improve communications and reduce error; and increase
the number of health system providers. These action
items continue to be a driving force for continued
improvement in the health system.
The first action item was to develop a Health Policy
Framework that would provide clear and consistent
direction to guide the decisions of health system leaders.
The Framework, initially released in February 2006,
opened the discussion about health care sustainability
and was a catalyst for Albertans to provide their ideas
about how the system needs to change. The Framework
will set the stage for a sustainable, flexible and accessible
health system for all Albertans.
Significant investments were made in Alberta Netcare
to support province-wide technology enhancements
and provide health professionals access to the patient
information they need to make the best care decisions.
Through the Diagnostic Imaging Strategy, $51.6 million was provided to digitize X-rays, Computerized
Tomography (CT) and Magnetic Resonance Imaging
(MRI) scans across the province. This helped to improve
the quality of care for Albertans by providing doctors
and patients with faster access to reports and images.
Additional funding was provided to address the recommendations of the MLA Task Force on Continuing Care
Health Services and Accommodation Standards. Funding
was provided to increase the number of nursing hours in
long-term care facilities from 3.1 to 3.4 hours per resident
day, support the implementation of new standards for
medication management and accelerate the implementation of continuing care system projects to improve the
availability of information used in decision making.
In 2005–2006, health facilities infrastructure became a
joint responsibility of the Ministers of Infrastructure and
Transportation, and Health and Wellness. In October 2005,
130
$1.4 billion was announced for 20 capital projects of
which $64.6 million was provided to the health authorities
in 2005–2006.
The Alberta Alcohol and Drug Abuse Commission
(AADAC) received funds which they allocated towards
the development of youth detoxification and residential
programs. AADAC opened 24 new addiction treatment
beds to serve youth aged 12 to 17 years. This includes
two four-bed detoxification programs and two eight-bed
residential programs in Edmonton and Calgary. The
residential program in Edmonton incorporates a group
care model, while the program based in Calgary utilizes
an adventure therapy wilderness model.
This was the first year funding was provided to help
municipalities provide pre-hospital ground ambulance
transportation. In addition, regional health authorities
and the Alberta Mental Health Board received the first
year of funding for 36 new Mental Health Innovation
projects ranging from outreach programs, to day treatment and crisis intervention services. Funding was also
provided to the Alberta Mental Health Board for two
justice related mental health programs. The provincial
Family Violence treatment program provides mandatory
assessment and treatment services for perpetrators of
family violence and the provincial Diversion program
redirects individuals with mental illness who have
committed minor offences from the criminal justice
system into appropriate mental health, social and
support services.
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. 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 Alberta
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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
operation of the Alberta Health Care Insurance Plan.
The Minister of Health and Wellness determines what
services are covered by the Alberta Health Care Insurance
Plan. Alberta Health and Wellness reviews scientific
literature, consults with expert advisors, assesses policy,
and considers funding and training that is required when
deciding which medical products, services or devices will
be covered under the Alberta Health Care Insurance Plan.
Alberta 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. Alberta Health and Wellness 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
sections 13 and 14 of the Government Accountability Act,
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 2005 to 2008 was
tabled in the Alberta Legislature on March 24, 2005.
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 2005–2006
Annual Report of the Alberta Ministry of Health and
Wellness was publicly released September 26, 2006 and
can be accessed at:
www.health.gov.ab.ca/resources/AR06.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 2005–2006 statistical supplement is available.
Under section 16 of the Government Accountability Act,
“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 section 9 of the Regional
Canada Health Act Annual Report, 2005–2006
Health Authorities Act, regional 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 fall 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.
2.0 Comprehensiveness
2.1 Insured Hospital Services
In Alberta, regional health authorities are responsible
to the Minister for ensuring the provision of insured
hospital services with the exception of cancer hospitals,
which are the responsibility of the Alberta Cancer Board.
The Hospitals Act, the Hospitalization Benefits Regulation
(AR 244/1990), the Health Care Protection Act and
the Health Care Protection Regulation (AR 208/2000)
define how insured services are provided by hospitals
or designated surgical facilities. During 2005–2006 no
amendments were made to the legislation regarding
insured hospital services.
According to the legislation, the Minister must approve
all hospitals and surgical facilities. A directory of approved
hospitals in Alberta can be found at:
www.health.gov.ab.ca/regions/hospital_directory.pdf
131
Chapter 3 — Alberta
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
58 non-hospital surgical facilities with accreditation
status. Of these, 26 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;
the proposed surgical services will not have a negative
impact on the province’s public health system;
there will be an expected benefit to the public;
the regional health authority has an acceptable business
plan to pay for the services;
the proposed agreement contains performance
expectations and measures; and
the physicians providing the services will comply with
the conflict of interest and ethical requirements of the
Medical Profession Act and bylaws.
The publicly funded services provided by approved
hospitals in Alberta range from the most advanced levels of
diagnostic and treatment services for in- 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 defined in
the Hospitalization Benefits Regulation (AR244/1990).
The Regulation is available at:
to physician services, a number of other practitioner services are covered under the Alberta Health Care Insurance
Plan. They include services provided by podiatrists, optometrists and chiropractors. In 2005–2006 a change was
made to the Alberta Health Care Insurance Regulation
(sections 30 and 31) which removed the requirement that
people exhaust the provincially funded limit for podiatrist
and chiropractic visits prior to being able to have their
private insurance companies cover a portion of the costs
not covered by the Plan.
As of March 31, 2006, there were 7,108 practitioners
(i.e. podiatrists, chiropractors, dentists and physicians)
enrolled in the Alberta Health Care Insurance Plan.
Before being registered with the Alberta Health Care
Insurance Plan, a practitioner must complete the appropriate registration forms and include a copy of his or
her license issued by the appropriate governing body
or association, such as the College of Physicians and
Surgeons of Alberta. Under section 8 of the Alberta
Health Care Insurance Act, physicians may opt-out
of the Alberta Health Care Insurance Plan. As of
March 31, 2006, there were no opted-out physicians
in the province.
The Medical Benefits Regulation and the Alberta Health
Care Insurance Regulation define which medical services
are insured. These services are documented in the
Schedule of Medical Benefits, which can be accessed at:
www.health.gov.ab.ca/professionals/somb.html
The Schedule of Medical Benefits is continuously revised
and updated; for example, the Obstetric and Gynecological portion of the Schedule was extensively revised
in 2005–2006.
www.health.gov.ab.ca/about/minister_legislation.html
Insured physician services and any changes to the Schedule
of Medical Benefits are negotiated among Alberta Health
and Wellness, the Alberta Medical Association (AMA)
and the regional health authorities. All changes to the
Schedule of Medical Benefits require ministerial approval.
2.2 Insured Physician Services
2.3 Insured Surgical-Dental Services
The Alberta Health Care Insurance Act governs the payment of physicians for insured physician services under
the Alberta Health Care Insurance Plan. 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
In Alberta a dentist may perform a small number of
insured surgical-dental services, but the majority of
procedures can only be billed to the Alberta Health
Care Insurance Plan when performed by a dentist
certified as an oral and maxillofacial surgeon who
meets the requirements stated in the Alberta Health
132
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
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, 2006 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:
www.health.gov.ab.ca/professionals/allied.html
In 2005–2006 there were 230 dentists/oral surgeons providing insured services under the Alberta Health Care
Insurance Plan. Although there is no formal agreement
between dentists and Alberta Health and Wellness, the
department meets with members of the Alberta Dental
Association and College to discuss changes to the Schedule
of Oral and Maxillofacial Surgery Benefits. All changes to
the benefit schedule require ministerial approval.
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Section 12 of the Alberta Health Care Insurance
Regulation defines what services are not considered to
be insured services. Section 4(2) of the Hospitalization
Benefits Regulation provides a list of uninsured hospital
services. Effective September 1, 2005, the Hospitalization
Benefits Regulation was amended to remove preferred
accommodation rates from the regulation and allow the
Boards of regional health authorities to set these rates.
The Health Care Protection Regulation was amended at
the same time to remove the requirement that enhanced
medical goods and services be listed in a schedule to this
regulation and to remove the prescriptive formula used
to calculate charges for enhanced goods or services. The
changes allow regional health authorities to determine, in
keeping with the provisions of the Health Care Protection
Act, the range of enhanced goods or services that each is
prepared to offer in response to patient preferences and
the charges for these enhanced goods or services.
A new provincial policy for Preferred Accommodation
and Non-Standard Goods or Services came into effect
September 1, 2005 and is posted on the AHW website at:
www.health.gov.ab.ca/key/prefacc.pdf
Canada Health Act Annual Report, 2005–2006
The policy describes the province’s expectations of regional
health authorities and guides their decision-making with
respect to provision of preferred accommodation and
enhanced or non-standard goods and services. This policy
framework requires regional health authorities to provide
30 days advance notice to other regional health authorities and the Minister’s designate regarding the categories
of preferred accommodation offered by the health region
and the charges associated with each category. Regional
health authorities are also required to provide 30 days
advance notice to other regional health authorities and
the Minister’s designate regarding any goods or services
that will be provided as non-standard goods or services.
They are also required to provide information about the
associated charge for these goods or services, and when
applicable, the criteria or clinical indications that may
qualify patients to receive it as a standard good or service.
Finally, each regional health authority must publish and
keep current a list of non-standard medical goods or
services; these lists are periodically reviewed by Alberta
Health and Wellness and the regional health authorities.
As of March 31, 2006, no regional health authority had
notified the Minister’s designate of any new enhanced or
non-standard goods or services being provided through
the region or of any changes to the preferred accommodation rates in effect on September 1, 2005.
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.
133
Chapter 3 — Alberta
Residents who are not eligible for coverage under the
Alberta Health Care Insurance Plan include:
3.4 Premiums
The majority of Alberta residents are required to pay
premiums. Exceptions include:
members of the Canadian Forces;
members of the Royal Canadian Mounted Police
(RCMP) who are appointed to a rank in it; and
persons serving a term in a federal penitentiary.
During 2005–2006 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. New residents in Alberta should apply for
coverage within three months of arrival. Family members
are registered on the same account for premium billing
purposes. 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, 2006, there were
3,275,931 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, 2006 there were
294 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 22,033 people covered
under these conditions as of March 31, 2006.
134
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: they are 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:
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
Visit/Vacation: up to 24 months coverage (requests
to extend coverage for a period longer than 24 months
are reviewed on a case-by-case basis);
Work/Business/Missionary Work: up to
48 months; and
Post-secondary Education: no limit (coverage
continues until studies are completed).
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 Alberta 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 and 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. More information on coverage during
temporary absences outside Alberta is available at:
www.health.gov.ab.ca/ahcip/travel.pdf
4.3 Coverage During Temporary Absences
Outside Canada
The Alberta Health Care Insurance Plan provides coverage
for the first six consecutive months of temporary absence
from Canada. Residents who wish to maintain coverage
for a longer period may apply for the following extensions
of coverage:
four years (48 months) if the absence is due to work,
business or missionary service.
two years (24 months) if the absence is due to travel,
personal visits or an educational leave (sabbatical).
duration of studies if absence is due to full-time
attendance at an accredited educational institute.
Individuals who are routinely absent from Alberta every
year normally need to spend a cumulative total of 183
days in a 12-month period in Alberta to maintain continuous coverage. Individuals not present in Alberta for the
Canada Health Act Annual Report, 2005–2006
required 183 days may be considered residents of Alberta
if they satisfy Alberta Health and Wellness that Alberta is
their permanent and principal place of residence.
The maximum amount payable for out-of-country inpatient 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:
www.health.gov.ab.ca/ahcip/travel.pdf
During 2005–2006 no amendments were made to the
legislation regarding the portability of health insurance.
4.4 Prior Approval Requirement
Prior approval is not required for elective insured services
received outside Alberta, except for high-cost items not
included in reciprocal agreements, 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 by the Minister
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 and the Alberta
Mental Health Board cooperate with each other to ensure
that all Albertans have access to needed health services.
There are two major metropolitan regions, the 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.
135
Chapter 3 — Alberta
5.2 Access to Insured Hospital Services
Alberta 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, 2006 there
were 49,640 health workforce practitioners in Alberta.
These professions combined comprise approximately half
of the total workforce employed in the province.
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.
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 2005–2006 (which includes health services,
hospitals, medical equipment and province-wide services)
was $6.2 billion.
The Alberta government made a significant $2.26 billion
commitment to additional capital investment in health
infrastructure in 2005–2006. This will allow Alberta
to continue to preserve and expand infrastructure, thus
improving access to health services. The current provincial
Capital Plan will provide for nearly 2,200 additional acute
care beds at various hospitals throughout the province
over the next ten years as well as targeted growth in
capacity in areas such as surgical, diagnostic, ambulatory
and emergency care.
Alberta mental health services were expanded, through
funding from the three-year Mental Health Innovation
Fund, with the approval of 36 new projects ranging from
outreach programs to day-treatment and crisis intervention
services. The projects will provide a variety of services
across the province, including a seniors’ mental health
136
outreach service in the Chinook Health Region, a program
to address mental health services for high needs children
and their families in the Calgary Health Region, a day treatment and learning centre for youth in Red Deer, and crisis
intervention services in rural and aboriginal communities.
Alberta tracks waiting time information (excluding urgent
patients who are seen without delay) on the Alberta
Waitlist Registry. The registry provides information on
wait times for hip and knee replacement surgery, cataract
surgery, cardiac surgery and MRI and CT examinations
for both hospitals and community providers. The registry
is accessible at:
www.ahw.gov.ab.ca/waitlist/WaitListPublicHome.jsp
The “Access Standards Gating Framework” was developed
as a tool to assist selected health service areas to progressively reduce wait times. This is accomplished through
standards development and new care path pilot testing
and implementation in six service areas: cardiac; children’s
mental health; MRI/CT scans; breast and prostate cancer;
hip and knee replacements and vision restoration. The
implementation is at varying phases for each service.
The “Alberta Hip and Knee Replacement” pilot project
was launched in April 2005. It tested a new care pathway
for providing better access to hip and knee joint replacement surgeries, and for improving the delivery of
orthopaedic care. Capital Health, the Calgary Health
Region and the David Thompson Health Region participated in the pilot along with the Alberta Medical
Association, the Alberta Orthopaedic Society and the
Alberta Bone and Joint Health Institute. Interim findings
showed: decreased wait time for first orthopaedic consult;
decreased wait time between first orthopaedic consult and
surgery; decreased length of stay in hospital; and
improved satisfaction with the care provided among surveyed patients and physicians.
5.3 Access to Insured Physician and
Dental-Surgical Services
Alberta Health and Wellness worked with health authorities
to develop health workforce strategies. Data definitions
have been established and health authorities now report
health workforce information and statistics to help track
and assess health workforce needs. Some of the actions
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
taken by Alberta Health and Wellness to improve access
to physician services and reduce wait times include:
5.4 Physician Compensation
Most physicians are compensated through the Alberta
Health Care Insurance Plan on a traditional, volumedriven, fee-for-service basis. Alternate Relationship Plans
and Primary Care Networks for specialists and family
physicians offer alternative compensation models to the feefor-service payment system and contribute to better health
outcomes by supporting innovative health care delivery.
Grants to the Community Medicine Residency
Training Programs in Alberta were renewed to
support the training of future public health physicians. Training rotations at Alberta Health and
Wellness were offered to students and medical
residents in order to highlight and enhance the
important role of public health, enrich training
within public health, and improve collaboration
between public health and related fields.
Devoting $3 million for the Alberta International
Medical Graduate Program allowing for up to 14
additional residency seats for foreign-trained doctors
now living in the province.
The Telehealth Clinical Services Grant Fund helped
to support 21 telehealth initiatives across Alberta.
The fund supports new telehealth programs that
allow Albertans, regardless of location, to have access
to needed medical professionals and specialists. The
programs that received grants covered a broad spectrum
of medical fields including adolescent psychiatry,
smoking cessation, cardiology, rural health and
chronic disease management.
Physician Locum Services provided weekend and
short-term family physician and specialist replacements in response to more than 1,100 requests
from rural Alberta physicians. Locum physician
replacements help to maintain the continuity and
convenience of medical service for rural Albertans.
As part of its comprehensive program to educate,
recruit and retain physicians for rural Alberta medical
practice, a new program of the Alberta Rural Physician
Action Plan offered 10 bursaries to medical students
from rural areas of Alberta. The program reimburses
tuition costs throughout their medical school training.
Up to 10 bursaries will continue to be offered annually
to rural Alberta students attending medical school
in Alberta in return for a five-year commitment to
practice in rural Alberta upon graduation.
The Alberta Rural Family Medical Network was
expanded by 10 entry positions (to 30 entry positions
annually) to place more medical residents in rural
Alberta, as preparation for rural practice upon
graduation.
Canada Health Act Annual Report, 2005–2006
Physician compensation is negotiated as part of a tri-lateral
agreement involving the Alberta Medical Association,
Alberta Health and Wellness and regional health authorities.
The agreement also contains provisions to improve access
to physician services. Under this agreement, Alternate
Relationship Plans (ARPs) have been established to
enhance specialist physician recruitment and retention,
team-based approaches to service delivery, 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. Currently there are 26 ARPs in operation
in Alberta and 5 Academic Alternate Relationship Plans
(ARPs) have been established in Edmonton and Calgary.
Academic ARPs include compensation for teaching and
other academic services.
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. As
of March 2006 there were 14 Primary Care Networks in
operation, involving approximately 550 family physicians
and providing services to more than 700,000 patients.
Primary Care Networks use a team approach to coordinate
care for their patients. Family physicians work with health
regions to better integrate health services by linking to
regional services such as home care. Family physicians also
work with other health providers such as nurses, dieticians,
pharmacists, physiotherapists and mental health workers
who help to provide services within the Networks.
As with the majority of physicians, dentists performing
oral surgical services insured under the Alberta Health
Care Insurance Plan are compensated through the Plan
on a volume driven, fee-for-service basis. Alberta Health
and Wellness establishes fees through a consultation
process with the Alberta Dental Association and College.
137
Chapter 3 — Alberta
5.5 Payments to Hospitals
The 2005–2006 Annual Report of the Alberta Ministry
of Health and Wellness can be accessed at:
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.
www.health.gov.ab.ca/resources/ar06.html
6.0 Recognition Given to
Federal Transfers
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 long-term care; mental
health services; dental, denturist and eyeglass benefits
for recipients of the Alberta Widows’ pension and
their eligible dependants; palliative care; immunization
programs for children; allied health services such as
optometry (for residents under 19 and over 64 years),
chiropractic and podiatry services; and drugs and other
benefits through Alberta Blue Cross.
The consolidated financial statements in the Ministry’s
Annual Report recognize the federal contributions
provided under the Canada Health Transfer (CHT).
138
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
Registered Persons
1
Number as of March 31st.
1
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
3,072,384
3,124,487
3,165,157
3,210,035
3,275,931
Insured Hospital Services Within Own Province or Territory
2
3
2002–2003
2003–2004
2004–2005
103
100
102
101
101
106
1
110
107
106
103
1
1
1
1
3
3
3
3
3
213
214
213
211
208
Payments ($):
a. acute care
not available
not available
not available
not available
not available
b.
chronic care
not available
not available
not available
not available
not available
c.
rehabilitative care
d.
e.
other
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
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1
not available
not available
not available
not available
not available
2
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
2
Number:
a. acute care
b.
chronic care
c.
rehabilitative care
d.
other
e.
total
Private For-Profit Facilities
4
5
6
1.
2.
2005–2006 1
2001–2002
Public Facilities
Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
2
Number of insured hospital services
provided:
a.
surgical facilities
not available
not available
not available
not available
not available
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
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
Payments ($):
a.
surgical facilities
b.
c.
diagnostic imaging facilities
total
These figures are considered preliminary until the release Alberta Health Care Insurance Plan Statistical Supplement report.
These data are available from the College of Physicians and Surgens of Alberta at www.cpsa.ab.ca/home/home.asp
Canada Health Act Annual Report, 2005–2006
139
Chapter 3 — Alberta
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006 3
2,746
2,333
not applicable
5,079
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
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
7. Number of participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
8. Number of opted-out physicians:
a. general practitioners
b. specialists
c. other
d. total
9. Number of not participating pysicians:
a. general practitioners
b. specialists
c. other
d. total
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
applicable
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
16,132,591
11,710,080
0
27,842,671
16,450,512
12,878,411
0
29,328,923
16,924,877
13,119,523
0
30,044,400
17,973,020
13,710,640
0
31,683,660
18,725,190
14,702,908
0
33,428,098
474,076,958
587,092,735
0
1,061,169,693
543,635,736
681,990,901
0
1,225,626,637
564,936,923
707,843,059
0
1,272,779,982
596,936,029
751,788,155
0
1,348,724,184
651,131,259
821,502,795
0
1,472,634,054
20,647,611
1,396,422
5,798,638
0
27,842,671
21,153,134
2,417,363
5,758,426
0
29,328,923
21,680,907
2,513,638
5,849,855
0
30,044,400
22,640,833
3,043,454
5,999,373
0
31,683,660
23,436,946
3,560,240
6,430,912
0
33,428,098
684,971,654
164,427,152
211,770,887
0
1,061,169,693
788,450,446
190,259,821
246,916,370
0
1,225,626,637
816,374,918
196,291,136
260,113,928
0
1,272,779,982
856,868,540
209,890,970
281,964,674
0
1,348,724,184
936,361,692
226,799,013
309,473,349
0
1,472,634,054
10. Services provided by physicians paid through all
payment methods :
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for
service,
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a.
b.
c.
d.
e.
3.
140
medical
surgical
diagnostic
other
total
These figures are considered preliminary until the release Alberta Health Care Insurance Plan Statistical Supplement report.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Alberta
Insured Services Provided to Residents in Another Province or Territory
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
17. Total payments, in-patient ($).
18. Total payments, out-patient ($).
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006 4
4,205
4,275
4,651
4,550
4,508
61,230
67,975
68,469
72,495
77,438
12,328,205
15,753,884
19,411,517
20,139,919
21,080,232
7,115,105
7,953,195
7,982,851
11,473,142
12,820,959
2,931.80
3,685.12
4,173.62
4,426.36
116.20
117.00
116.59
158.26
2001–2002
2002–2003
2003–2004
2004–2005
493,798
559,503
485,841
444,884
479,029
11,998,825
13,880,981
15,139,409
15,871,755
17,745,928
24.30
24.81
31.16
35.68
37.05
4,676.18
2
165.56
2005–2006 4
Insured Services Provided Outside Canada
2001–2002
2002–2003
2003–2004
2004–2005
24. Total number of claims, in-patient.
4,457
3,698
3,319
4,266
4,124
25. Total number of claims, out-patient.
3,942
3,739
3,405
4,089
3,918
26. Total payments, in-patient ($).
416,635
340,169
300,233
381,217
379,710
27. Total payments, out-patient ($).
309,119
206,684
212,949
227,609
222,896
28. Average payment, in-patient ($).
93.48
91.99
90.46
89.36
92.07
29. Average payment, out-patient ($).
78.42
55.28
62.54
55.66
56.89
2001–2002
2002–2003
2003–2004
2004–2005
22,928
21,289
20,753
26,017
24,944
1,043,997
976,232
963,299
1,208,422
1,049,384
45.53
45.86
46.42
46.45
42.07
Hospitals
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
2005–2006 4
2005–2006 4
Insured Surgical-Dental Services Within Own Province or Territory
33. Number of particpating dentists.
34. Number of services provided.
35. Total payments ($).
36. Average payment per service ($).
4.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006 4
250
234
216
216
230
14,585
16,759
14,802
14,658
17,007
2,167,898
2,394,458
2,404,042
2,843,638
3,275,978
148.64
142.88
162.41
194.00
192.63
These figures are considered preliminary until the release Alberta Health Care Insurance Plan Statistical Supplement report.
Canada Health Act Annual Report, 2005–2006
141
142
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
overall health system performance in Canada, while the
Cancer Advocacy Coalition noted British Columbia provides the timeliest access to cancer drugs and has the best
cancer outcomes in the country.
British Columbia
Activities for 2005–2006
Introduction
Since 2001, British Columbia’s health system has undergone a number of significant changes designed to improve
health services and make the health system sustainable into
the future. These efforts continued throughout 2005–2006.
British Columbia has an 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 health system in British Columbia is
delivered through a regional structure utilizing numerous
health workers and self-regulating professions to provide
quality, accessible and affordable health services to all
British Columbians.
Nation-wide trends are creating unprecedented demands
on health systems across the country, including British
Columbia’s. A lack of physical activity and rising rates
of obesity, along with tobacco use and problematic substance use are affecting the health status of individuals
and increasing demands for health services. In addition,
British Columbia has a growing population that is aging.
As a result the prevalence of chronic diseases is resulting
in increased demand for more complex and expensive
health services.
British Columbia’s five regional health authorities are
responsible for managing and delivering a range of
health services, including health protection and promotion services, primary care, hospital services, home and
community care, mental health and addictions services,
and end-of-life care. In addition to the regional health
authorities, a Provincial Health Services Authority is
responsible for ensuring British Columbians have access
to a coordinated network of high quality specialized
health services, such as cancer care, specialized cardiac
services and transplant operations.
Health authorities are provided three-year funding commitments, updated annually, to enable them to plan and
act with certainty, and are accountable to government
through performance agreements that define expectations
and performance deliverables for three fiscal years. Performance agreements also set out the major changes required
in areas of service such as emergency care, surgical services,
home and community care, public and preventive health
and mental health and addiction services.
Overall, British Columbia has made tremendous progress
in redesigning its health system and in 2005–2006 was
recognized by both the Conference Board of Canada and
Cancer Advocacy Coalition as national leaders in health
care. The Conference Board rated B.C. as having the best
Canada Health Act Annual Report, 2005–2006
Significant reforms and new initiatives have continued
across the health system, as the British Columbia Ministry
of Health works with health authorities and health professionals to meet the health needs of British Columbians.
In 2005–2006, the Ministry introduced, continued or
enhanced a number of strategies across the continuum of
health services, including: population health and safety;
primary care; chronic disease management; prescription
drug coverage; 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 work
on strategies to ensure an adequate supply of skilled
health providers is available to deliver services across
the continuum of care.
To support health reforms and help meet rising demands
for service, health funding in British Columbia increased
in 2005–2006, allowing more surgeries and services to
be delivered in BC’s health system than ever before. While
increased funding is beneficial, the system will not be sustainable, nor will it meet the needs of individuals, unless it
is redesigned to support good health and foster improved
quality. Accordingly, British Columbia has continued to
work to improve its health system to make it patientcentred, accessible and sustainable into the future.
143
Chapter 3 — British Columbia
Significant Achievements in 2005–2006
Working to Keep People Healthy: In 2005–2006, the
Ministry of Health introduced a number of health promotion and disease prevention initiatives designed to
improve the health and wellness of British Columbians:
In 2005–2006, the Ministry:
144
Continued support for ActNow BC, an award-winning
program that cuts across all sectors to promote healthy
lifestyles, prevent disease and mobilize communities.
ActNow BC provides individuals with the information, resources and support they need to make healthy
lifestyle decisions.
Through ActNow BC, invested in health promotion through partnerships with the BC Healthy
Living Alliance ($25.2 million) to pursue recommendations outlined in their report The Winning
Legacy: A Plan for Improving the Health of British
Columbians by 2010, and 2010 Legacies Now
($4.8 million) to support physical activity and
healthy lifestyles.
Through ActNow BC, invested in B.C. School
Sports to help improve the health of B.C. students.
This includes support for Action Schools! BC; the
purchase of new physical activity equipment; the
development of a provincial network of healthy
schools; and funding to support volunteer committees responsible for hosting zone and provincial
championships for more than 400 schools.
Through ActNow BC, invested in a public website
that provides information and resources to help
people make healthy lifestyle choices.
Introduced guidelines for food and beverage
sales in schools to help eliminate junk food
and improve student health and achievement.
Made changes to the Tobacco Sales Act to better prevent
youth access to tobacco products. When adopted, the
legislation will make B.C. the first province to have
an administrative process that can impose financial
penalties for contraventions of tobacco legislation.
Joined with the BC Centre for Disease Control to
design and launch a comprehensive website to help
families, communities and organizations prepare
for pandemic influenza.
Provided support for meat processors to help the
industry meet new requirements for a province-wide
meat inspection system that will ensure food safety
and ongoing public confidence in the food supply.
In January 2005, lowered the eligibility age for
chickenpox vaccine from school entry to around
the time of an infant’s first birthday. Implemented
in 2005–2006, this change will provide enhanced
protection against the disease.
In June 2005, all infants in BC became eligible for
a Meningococcal C vaccine.
Invested an additional $1 million in an awareness
campaign designed to increase the number of women
having mammography screenings.
Provided $5 million to the Union of BC Municipalities
to kick-start local government involvement in building
healthier communities.
Increased the base budget for public health programming by $8 million with planned further increases
of $8 million in fiscal year 2006 and $8 million in
2007 respectively.
Increasing Access: Access has been expanded across the
spectrum of care, from reducing wait times to enhancing
research opportunities.
In 2005–2006, the Ministry:
The Ministry of Health’s spending for 2005–2006
stands at $11.4 billion, which includes a record
$6.6 billion in regional funding for the province’s
six health authorities.
Committed to significant three-year investments
in “eHealth” that will improve patient care and
assist health professionals in delivering faster, more
effective treatments to patients.
Launched a major initiative to reduce wait times
for hip and knee surgeries and maximize the number
of surgeries. The strategy includes a new Centre
for Surgical Innovation at the University of British
Columbia; funding to address backlogs; a Provincial
Surgical Patient Registry; and a Research Centre for
Hip Health at Vancouver General Hospital.
Developed a CPR training program in BC high
schools that has resulted in 5,900 Grade 10 students
learning CPR skills taught by over 120 high school
teachers.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
Committed to providing over $35 million over three
years to improve access to dental treatment for young
children and low-income families.
Funded $3.5 million to expand diagnostic and assessment services for children with special needs, including
those with Fetal Alcohol Spectrum Disorder.
Improving Quality of Health Services in 2005–2006:
A number of important 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 2005–2006, the Ministry:
Provided $78 million for health research through
the work of the Michael Smith Foundation to be
distributed among a record 170 graduate students
and post-doctoral fellows studying across the spectrum of health research, including prevention of
hip fractures, new methods for cancer diagnosis
and better understanding of brain physiology.
Registered British Columbia’s first group of nurse
practitioners and created the College of Registered
Nurses of British Columbia as the governing body
for all registered nurses.
Issued a new version of the BC HealthGuide handbook that includes new and medically reviewed
information and more topics on seniors’ health.
Expanded the Loan Forgiveness Program to include
nurse practitioners who choose to practice in rural
and remote areas of the province.
Provided an additional $8 million to continue the
fight against crystal meth addictions by providing
additional treatment beds and programs.
Other projects are underway, including developing an
electronic health record, which will improve efficiency
and safety by enabling care providers to access clinical
information, such as patient medication profiles, lab
and other testing results, using web-based technology.
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.
Canada Health Act Annual Report, 2005–2006
In 2005–2006, the Ministry:
Invested an additional $ 45 million in the provincial
nursing strategy to educate, recruit and retain more
nurses. Funding will support education for front-line
unit managers, an expanded undergraduate nursing
program to support student nurses on work terms,
specialty education and support to increase the number
of Aboriginal nurses in B.C. and ongoing integration
of nurse practitioners into the B.C. health system.
Completed the $6.9 million renovation and redesign
of in-patient units at B.C. Children’s Hospital, allowing staff to provide safer, more efficient patient care
for children and teens across the province.
Doubled funding to support innovative projects that
help health-care students gain practical experience.
Opened the province’s first publicly funded PET/CT
scanner at the Centre of Excellence for Functional
Cancer Imaging (BC Cancer Agency). This will
allow physicians to more accurately diagnose and
manage disease.
Announced the Okanagan Medical Program which will
further expand the University of British Columbia’s
medical school by an additional 30 seats in 2009–2010.
Invested $400,000 in a partnership that encourages
collaboration among students and practitioners from
different health disciplines to improve patient care.
Funding to the Interprofessional Network of British
Columbia is spread over four years and involves projects
from a wide-range of disciplines including medicine,
nursing, midwifery, pharmacy, rehabilitation services
and social work.
Transferred 25 acute tertiary neuropsychiatric beds
from Riverview Hospital to a new 44-bed mental
health facility in Kamloops.
Continued to plan, build and complete additional
housing and care options including:
$4 million for a 17-unit assisted living facility
in Burns Lake;
$7.7 million for a 30-unit assisted living facility
on Salt Spring Island;
a 154-unit assisted living development in Surrey;
$8 million for a 40-unit assisted living facility in
Powell River;
a 104-unit assisted living development in
Abbotsford;
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Chapter 3 — British Columbia
a 25-unit assisted living facility in Lake
Country (Oyama, Winfield, Carr’s Landing,
and Okanagan Centre);
70 residential care beds at the Residence at
Morgan Heights;
a 36-unit assisted living facility in Haro Park,
Vancouver;
an 87-bed multi-level care facility in Ladysmith;
20 new units of seniors’ housing in Ucluelet;
a 66-unit assisted living development in Chilliwack;
2 new assisted living apartments in Fort St. James;
a 70-unit supportive seniors housing project,
through the $10.6 million redevelopment of
Rose Manor in Victoria;
a 10-bed end-of-life care facility in Richmond; and
a commitment to complete 10 bed hospices in
Chilliwack, Mission, Surrey, Maple Ridge and
Langley.
Information on health and health services in British
Columbia is available at:
www.gov.bc.ca/healthservices
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
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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 the 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.
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).
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
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.
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.
The enabling legislation is:
b) 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.
1.4 Designated Agency
a) 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 government-administered collection actions.
RSBC is required to comply with all applicable laws,
including:
Ombudsman Act (British Columbia).
Business Practices and Consumer Protection Act
(British Columbia).
Financial Administration Act (British Columbia).
Freedom of Information Legislation: 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.
Canada Health Act Annual Report, 2005–2006
Medicare Protection Act (British Columbia),
Part 2 — Beneficiaries section 8.
Medical and Health Care Services Regulation
(British Columbia) Part 3 — Premiums
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
their 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 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 2005–2006.
In 2005–2006, there were a total of 137 facilities designated
as hospitals. This included:
82 acute care hospitals (community hospitals, large
tertiary care and teaching hospitals);
19 chronic care hospitals;
4 rehabilitation hospitals; and
32 other hospitals (including diagnostic and treatment
centres, free-standing abortion clinics, cancer clinics,
etc.) (Note: the overall number of hospitals is the
same as last year, but the groupings have changed
to reflect categories requested by Health Canada).
Hospital services are insured when they are provided
to a beneficiary, in a publicly funded hospital, and are
deemed medically required by the attending physician,
nurse practitioner or midwife. These services are provided
to beneficiaries without charge, with the exception of incremental charges for preferred, but not medically required
medical/surgical supplies, non-standard accommodation
when not medically required, and for residential care
patients in extended care or general hospitals, a daily
fee based on income.
General hospital services, and the conditions under
which they are provided, are described in the Hospital
Insurance Act Regulations, division 5, and include the
following for in-patients: accommodation and meals
at the standard or public ward level; necessary nursing
services; laboratory and radiological procedures and
necessary interpretations together with such other
diagnostic procedures as approved by the Minister in
a particular hospital with the necessary interpretations,
for maintaining health, preventing disease and helping
diagnose and treat illness, injury or disability; drugs,
biologicals and related preparations; routine surgical
supplies; use of operating and case room and anaesthetic
facilities, including necessary equipment and supplies;
use of radiotherapy and physiotherapy facilities, where
available; and other services approved by the Minister.
The following out-patient general hospital services
are also insured: day care surgical services; out-patient
renal dialysis treatments in designated hospitals or
other approved facilities; diabetic day-care services in
designated hospitals; out-patient dietetic counseling
services at hospitals with qualified staff dieticians; psychi-
148
atric out-patient and day-care services; rehabilitation outpatient 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 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 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
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.
The Medical and Health Care Services Regulation of
the MPA was passed during fiscal year 2005–2006.
The Regulation further defines beneficiaries of MSP,
premiums to be paid and payment of benefits.
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 2004–2005, 8,271 physicians (includes only GPs
and Medical Specialists who billed fee-for-service (FFS)
in 2004–2005) were enrolled with MSP and billed feefor-service. In addition, some physicians practice solely
on salary, receive sessional payments, or are on contract
(service agreements) 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 2004–2005 there
were 12,363 practitioners registered with 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.
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.
Canada Health Act Annual Report, 2005–2006
During fiscal year 2005–2006 physician services added
as MSP insured benefits include fee items which reflect
current practice standards in specialties including otolaryngology, internal medicine and interventional radiology,
and evolving technologies, for example: telehealth consultations; upper gastrointestinal endoscopy; video capsule
endoscopy; and sentinel lymph node biopsy.
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
Surgical-dental services are covered by MSP when hospitalization is medically required for the safe and proper
completion of surgery, and when it is 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.
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 228 dentists (includes
only Oral Surgeons, Dental Surgeons, Oral Medicine and
Orthodontists who billed fee-for-service in 2004–2005)
enrolled with the Medical Services Plan and billing fee-forservice in 2004–2005. None have de-enrolled or opted out
of the Medical Services Plan.
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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
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
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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 2005–2006.
3.0 Universality
3.1 Eligibility
Section 7 of the Medicare Protection Act defines the eligibility and enrollment 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 July, coverage is
available October 1. If absences from Canada exceed
a total of 30 days during the waiting period, eligibility
for coverage may be affected.
All residents are entitled to hospital and medical care
insurance coverage. Those residents who are members
of the Canadian Forces, appointed members of the Royal
Canadian Mounted Police, or serving a term of imprisonment in a penitentiary as defined in the Penitentiary Act,
are eligible for federally funded health insurance.
The Medical Services Plan (MSP) provides first-day coverage to discharged members of the Royal Canadian Mounted
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
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 2004–2005 was
4,253,580. 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) 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 (if applicable)
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
Canada Health Act Annual Report, 2005–2006
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 have
permanent resident (landed immigrant) status under
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 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 Regulations of the Medicare Protection Act define
portability provisions for persons temporarily absent from
BC with regard to insured services. In 2005–2006, there
were no amendments to the Medical and Health Care
Services Regulation with respect to the portability provisions. Section 17 of the Hospital Insurance Act empowers
the Minister of Health to enter into an agreement with
any other province or territory to bring about a high
degree of liaison and cooperation concerning hospital
insurance matters, and to make arrangements under which
a qualified person may move his or her home from one
province or territory to the other without ceasing to be
entitled to benefits. Section 24 of the Hospital Insurance
Act states that hospital services rendered outside BC to
beneficiaries must be reimbursed by the Ministry.
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Chapter 3 — British Columbia
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,
the payment is at the inter-provincial and inter-territorial
reciprocal billing rate. Payment for these services, except
for excluded services that are billed to the patient, is
handled though inter-provincial and inter-territorial
reciprocal billing procedures. In 2005–2006, the amount
paid to physicians in other provinces and territories was
$ 25.7 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.
With the amendment to the Medical and Health Care
Services Regulation in 2005, beneficiaries who submit
bills for optometric and podiatric services obtained in
Alberta or the Yukon, when that is the nearest convenient location outside BC, will be reimbursed.
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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 amendments ensure that the regulation is in line
with current policy and are expected to improve the
administration and delivery of Medical Services Plan
(MSP) services. There are also a number of minor
amendments that update terminology and bring the
regulation in line with the Immigration and Refugee
Protection Act (Federal).
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.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
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 and other genetic investigation,
including DNA probes; procedures still in the experimental/developmental phase; and anesthetic 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 Performance Management
and Improvement Division of the Ministry of Health.
All non-emergency procedures performed outside
Canada require approval from the Commission before
the procedure.
5.0 Accessibility
5.1 Access to Insured Health Services
Beneficiaries in BC, as defined in section 1 of the
Medicare Protection Act are eligible for all insured
hospital and medical care services as required.
Canada Health Act Annual Report, 2005–2006
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 2005 was 30,878. BC hospitals also employ
Registered Psychiatric Nurses (RPNs) and Licensed Practical Nurses (LPNs). In 2005, there were 2,137 RPNs and
5,606 LPNs licensed to practice in the province.
In 2005, the BC government provided additional funding to build on successful recruitment, retention and
education nursing strategies. This funding brought the
government’s total commitment to nursing strategies to
$120 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 British Columbia;
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;
compiling nursing data to enhance the Ministry’s
understanding of trends and changing needs in
nursing and health care; 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 2005–2006 included:
Undergraduate Nurses Education, Operating Room
Initiatives, Nurses Specialty Education, Return to Nursing
Fund and Nurse Practitioner Expansion.
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 Health Professions Act as the
regulatory body for registered nurses and also enables
nurse practitioners to be regulated by the new College
and to practice in British Columbia. As part of this
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Chapter 3 — British Columbia
transition, the Nurses (Registered) Act was repealed and
the Registered Nurses’ Association of British Columbia
was dissolved. The University of British Columbia and
the University of Victoria graduated their first nurse
practitioners in 2005. Many of these graduates are
moving into primary health positions throughout the
province. A third nurse practitioner program, offered at
the University of Northern British Columbia in Prince
George, began admitting students in September 2005.
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.
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 10 years which is
particularly beneficial in planning for major infrastructure
such as hospitals that have life-cycles encompassing several
decades. It also gives the health authorities more time to
explore creative ways of addressing capital requirements.
The ministry provides capital funding to health authorities
for maintenance, renovation, replacement and expansion
of health infrastructure that is consistent with regional
and provincial priorities. In 2005–2006 fiscal year, health
authorities used ministry funding (in some cases, in collaboration with other funding partners such as Regional
Hospital Districts, foundations, and auxiliaries) to purchase
equipment, to build new or replacement facilities, and to
convert facilities to uses more consistent with current and
future needs.
Among the projects recently completed or underway are:
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a new 300-bed hospital and cancer centre in
Abbotsford that will provide enhanced programs
and services;
a new Academic Ambulatory Care Centre in Vancouver
that will consolidate out-patient services, medical education facilities, teaching physician/specialist practice
offices, and related activities;
redevelopment of Vancouver General Hospital that
will consolidate hospital services to create a modern
and efficient environment for quality patient care
and accessibility;
redevelopment of the existing facility in Cranbrook as
a regional health care centre with expanded emergency,
ambulatory care and diagnostic imaging departments;
a new 44-bed tertiary mental health facility in
Kamloops that provides patients access to a full range
of services closer to home and in a more home-like
environment;
expansion of Nanaimo Regional General Hospital
that will improve access to surgical services and
maternal programs;
a new 50-bed residential care facility in Vanderhoof; and
expansion of Surrey Memorial Hospital that will
increase acute care beds, and provide a new ambulatory care facility and a new emergency department.
In 2004–2005, the Province committed $27.6 million for
the expansion and upgrading of academic space in teaching hospitals around BC to support increased enrollment
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.
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.
The funding was used by health authorities for equipment
such as:
the province’s first publicly funded PET unit located
at the Vancouver Cancer Agency, which will improve
the management of cancer patients by providing accurate pre-treatment detection of cancerous 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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
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, and health authorities are in the process of planning for the best use of this allocation, to be spent by
2007–2008.
The BC HealthGuide Program, started in 2001, provides
reliable health information and advice 24 hours every day.
This comprehensive self-care program is unique in Canada
and consists of print, Web and telehealth formats:
BC HealthGuide Handbook: This handbook was delivered free to every household in British Columbia in spring
2001. The updated version, published in November 2005,
is available free to all British Columbians at Government
Agents Offices and local pharmacies. The handbook provides information on common health concerns, illness
prevention, home treatment, care options and when to
see a health professional. The updated handbook contains
new information on seniors’ health including healthy
aging and tips for caregivers. A French version of the
handbook was released in June 2004 (Guide-santé —
Colombie-Britannique). Translations into Chinese and
Punjabi will be available in 2007.
The BC First Nations Health Handbook was developed
in partnership with the BC First Nations Chiefs’ Health
Committee and distributed to Aboriginal communities in
January 2003. The handbook provides specific information
on health services available to Aboriginal communities. It
is available on-line at ww.bchealthguide.org/aboriginal.stm.
BC HealthGuide OnLine: Located at www.bchealthguide
.org, this 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 NurseLine: BC NurseLine is a toll-free, 24/7 nursing
tele-triage and health education service. 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. Translation services are
provided in over 130 languages, as well as service for deaf
and hearing impaired. In 2005–2006, the BC NurseLine
Canada Health Act Annual Report, 2005–2006
received over 339,000 calls. As of December 31, 2005,
the service had received over one million calls since
its inception.
The pharmacist enhancement to the BC NurseLine
was implemented in June 2003. Callers can speak with
a pharmacist and ask medication-related questions,
between 5:00 pm and 9:00 am every day.
Since implementation to the end of March 2006, over
28,000 medication-related calls were transferred from the
BC NurseLine to the pharmacist service. Over this period, BC NurseLine pharmacists submitted 670 Adverse
Drug Reaction (ADRs) reports to the British Columbia
Regional ADR Centre, which have been approved for
submission to Health Canada. These reports are used to
monitor adverse effects that are unexpected, serious or
for newly marketed medications. The pharmacist service
is responsible for over 20 percent of all ADR reports
submitted to Health Canada by the British Columbia
Regional ADR Centre, making it a large and integral
contributor to patient safety — not only for British
Columbians, but for all Canadians.
In January 2005, the BC HealthGuide Program partnered
with Fraser Health on a demonstration project to explore
the feasibility of leveraging the BC NurseLine platform to
provide after-hours triage and support to Hospice Palliative
Care (HPC) patients. Patients could call BC NurseLine
for after-hours support from 9 p.m. to 8 a.m. An evaluation of the program has been completed; future options
are being considered.
BC HealthFiles: The BC HealthFiles are easy-tounderstand fact sheets on a wide range of public and
environmental health and safety topics. They are available
at more than 120 health units, departments and other
offices in B.C or on-line at www.bchealthguide.org. Files
on specific topics have been translated into French and
other languages.
Dial-A-Dietitian: Dial-A-Dietitian is a free nutrition
information service that provides easy-to-use nutrition
information for self-care, based on current scientific
sources. Registered dietitians are available 9:00am
to 5pm, Monday to Friday. Food allergy expertise is
available. Referrals are also provided to hospital outpatient dietitians, community nutritionists and other
local services. Translation services are available in over
130 languages.
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Chapter 3 — British Columbia
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 2005–2006, 4,681 enrolled general practitioners,
3,773 enrolled specialists and 238 enrolled dentists provided insured fee-for-service physician and dental-surgical
services. Approximately 2,553 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.
These programs include:
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the Rural Retention Program, which provides eligible
rural physicians (estimated at 1,300) with fee premiums and is available for visiting physicians and locums;
the Northern and Isolation Travel Assistance Outreach
Program, which funded an estimated 2,050 visits by
family doctors and specialists to rural communities;
the Rural General Practitioner Locum Program,
which assisted physicians in approximately 66 small
communities to attend subsidized continuing medical
education and provide vacation relief;
the Rural Specialist Locum Program, which provided
locum support for core specialists in 17 rural communities 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.
Commencing in November 2002, British Columbia
received $73.5 million in federal funding over four
years (2002–2006) to develop sustainable improvements
to primary health care (PHC) and to increase patient
access to comprehensive, high-quality services in physicians’ offices and community clinics — the usual first
points of contact with the health care system. British
Columbia continues to promote the goals estabished
through the federal primary health care transition fund.
The Full-Service Family Practice Incentive Program has
recently been expanded through the 2006 agreement with
physicians and the ministry continues to establish clinical
practice guidelines and protocols to improve patient care.
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. 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 will
double the number of available seats to 256 by 2007.
The latest addition to the medical school expansion, the
Okanagan Medical Program, will add at least another
30 first-year medical school spaces when the program
begins in 2009–2010.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
In addition to the medical school expansion, the government has begun a stepped expansion to post-graduate
medical education. In 2004, 32 first-year residency positions
were added. By 2010, the number of first-year post-graduate
positions will double to 256, up from 128 in 2003.
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.
Funding for physicians accounted for over $2.5 billion
or 22 percent of the Ministry of Health budget in
2005–2006.
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 with a term to
expire Midnight March 31, 2006. If by that date the
parties have not agreed upon a replacement or renewal,
the Second Master remains in full effect until new terms
are agreed upon or 12 months have expired following
either Government or the BCMA receipt of the others
wish to terminate the Agreement.
The Second Master Agreement established the framework
for negotiation and consultation. It required the government and the BCMA to begin to negotiate Working
Agreements and/or Subsidiary Agreements no later than
October 1 of the year immediately preceding the expiry
of the agreements. Working and Subsidiary Agreements
determine physician compensation, on-call issues and
benefit plans. The Working Agreement addresses matters
of common interest to physicians while Subsidiary Agreements address matters of unique interest to a particular
group of physicians.
Negotiations for a 2004 Working Agreement and
Subsidiary Agreements proceeded through a mediation
phase and had entered the conciliation phase when a
negotiated agreement was finally reached. The conciliation panel was adjourned prior to their making an award.
Canada Health Act Annual Report, 2005–2006
The agreements were renewed in June 2004, covering
April 1, 2004 to March 31, 2007.
The 2004 Working Agreement identified a dispute resolution process that required each party to provide written
advice about the details of the dispute after which the parties would meet to try to resolve the dispute. A Dispute
Resolution Committee would attempt to resolve the dispute. If the dispute was not resolved, either party could
refer the dispute for final resolution to arbitration under
the Commercial Arbitration Act.
Under the agreements, there were no generalized increases
in compensation rates for the fiscal years 2004–2005 and
2005–2006, with provision for negotiation, and if necessary arbitration, for a compensation increase in the third
year (2006–2007).
The agreements identified funding for reallocation to
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.
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 principle-based approach. A tentative
Agreement in Principle was reached in March 2006 and
was ratified in May 2006, covering the period from 2006
to 2012.
With respect to dentists, the BC government negotiates
with the British Columbia Dental Association (DABC).
The previous formal negotiation process led to an updated
and modernized contract. The DABC has requested
renegotiation of their current contract; it is expected that
this will commence in the fall of 2006.
Legislation
The Medicare Protection Act, RSBC 1996, c. 286, provides
the authority for the Medical Services Commission to
administer the Medical Services Plan (MSP) of British
Columbia. There were no significant amendments of the
Act or regulations in 2005–2006.
Medical practitioners are licensed under the Medical
Practitioners Act and dentists under the Dentists Act.
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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. In 2005–2006, 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, 72 percent
are distributed through contracts, 24 percent as sessions
(3.5-hour units of service) and 4 percent as salaried
arrangements. The government funds health authorities
for alternative payments, but does not pay physicians
directly.
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
block fund payments made to regional health authorities.
This block funding 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.
The Hospital Insurance Act and its related regulations
govern payments made by the health care plan to health
authorities. This statute establishes the authority of the
Minister to make payments to hospitals, and specifies
in broad terms what services are insured when provided
within a hospital.
No amendments were made during 2005–2006 to legislation or regulations concerning payments for insured
hospital services.
Insured hospital services are funded by way of annual
block funding to regional health authorities, as well as
specific targeted funding from time to time. The basic
amount of the annual grant is determined through a
Population Needs Based Formula, which is modified to
account for specific programs within health authorities.
A total of $6.6 billion was transferred to health authorities in 2005–2006 to provide the full continuum of care
(acute, residential, community care, public and preventive
health, adult mental health, addictions programs, etc.).
Block funding to health authorities does not include
funding for programs directly operated by the Ministry
of Health, like the payments to physicians, payments
for prescription drugs covered under PharmaCare, or
for provincial ambulance services.
While the hospitals portion of the block fund is normally
not specified, the exception to this rule is funding allocated
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.
6.0 Recognition Given to
Federal Transfers
Annual block funding amounts are negotiated between
senior finance officials in the Ministry of Health and
the CEO and Senior Financial Officer in the health
authorities. The final funding amount is conveyed to
health authorities by means of an annual funding letter.
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 2005–2006, these documents included:
The terms of agreement for government funding for
hospitals is part of several larger documents which set
expectations for health authorities. These are the annual
funding letter, annual service plans, and annual performance agreements. 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.
Public Accounts 2004–2005 (tabled June 29, 2005)
www.fin.gov.bc.ca/ocg/pa/04_05/pa04_05.htm
Budget and Fiscal Plan, 2005–2006 to
2007–2008 (tabled February 15, 2005)
www.bcbudget.gov.bc.ca/2005/bfp/default.htm
Estimates, Fiscal Year Ending March 31, 2006
(tabled February 15, 2005)
www.bcbudget.gov.bc.ca/2005/est/toc.htm
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Chapter 3 — British Columbia
Budget and Fiscal Plan, September Update, 2005–2006
to 2007–2008 (tabled September 14, 2005)
www.bcbudget.gov.bc.ca/2005_Sept_Update/bfp/
default.htm
Estimates, September Update, Fiscal Year Ending
March 31, 2006 (tabled September 14, 2005)
www.bcbudget.gov.bc.ca/2005_Sept_Update/
est.toc.htm
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.
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 one-bedroom 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 after-tax 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 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.
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.
Services for Persons With Mental Illness and Substance
Use Disorders
Adults with disabilities can also live independently in
the community in publicly funded group homes. Group
homes are safe, affordable, four-bed to six-bed housing
projects. They offer short- and long-term accommodation, skills training, peer support and counselling. Group
home clients are responsible for living costs, such as food
and rent, not associated with their care. Rental costs vary,
depending on income. The legislation pertaining to group
homes is the Community Care and Assisted Living Act, the
Community Residential Care Facilities
Canada Health Act Annual Report, 2005–2006
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.
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”
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Chapter 3 — British Columbia
towards more independent housing while for others their
stay is long-term. All facilities are licensed under the
Community Care and Assisted Living Act. Clients pay a
standard daily fee for room and board.
Family Care Homes
These private homes, operated by families or individuals,
provide life skills and psychosocial rehabilitation services
for clients unable to live independently, who require
support within a family setting to acquire the skills and
confidence necessary for independent living. Homes are
not licensed or registered but must meet standards set
out by the health authority. Clients pay a standard daily
fee for room and board.
Supported Housing
Supported housing programs include affordable, safe and
secure accommodation and the availability of a range of
psychosocial rehabilitation and home support services,
such as assistance with meal preparation, personal care,
home management, medication support, socialization,
and crises management. Supported Housing programs
include: supported apartments, including satellite apartments/mobile homes, block apartments, and congregate
housing; group homes; and supported hotels.
The legislation pertaining to Supported Housing is the
Landlords and Tenants Act and the Community Care and
Assisted Living Act. Clients usually stay long term (over
two years) in these programs and pay reduced rent based
on income (maximum 35 percent of 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 non-emergency 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.
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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.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
3,994,007
4,017,912
4,099,076
4,182,682
4,216,199
Insured Hospital Services Within Own Province or Territory
Public Facilities
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1
2. Number:
a. acute care
b.
chronic care
c.
rehabilitative care
d.
other
e.
total
3. Payments ($): 2
a. acute care
94
92
92
92
82
18
18
18
18
19
3
3
3
4
4
25
25
24
23
32
140
138
137
137
137
not available
not available
not available
not available
not available
b.
chronic care
not available
not available
not available
not available
not available
c.
rehabilitative care
not available
not available
not available
other
total
not available
not available
not available
d.
e.
not available
not available
not available
not available
not available
not available
not available
not available
not available
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
not available
not available
not available
not available
not available
not available
11
0
11
17
1
18
18
1
19
689
not available
689
612
not available
612
not available
not available
not available
not available
not available
not available
not available
not available
not available
353,100
not available
353,100
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
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
5. Number of insured hospital services
provided: 3
a.
surgical facilities
b.
diagnostic imaging facilities
c.
total
6. Payments ($):
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
For items 1–2: All data is preliminary for 2004–2005. Historical and current data may differ from report to report because of changes in data sources,
definitions and methodology from year to year.
1.
2.
3.
In British Columbia, the categories under which these facilities are reported in this report table do not match those normally used in the
BC Ministry of Health, but facilities have been matched as closely as possible.
— Acute Care includes acute care inpatient facilities, acute care ambulatory facilities and psychiatric inpatient facilities
— Chronic Care includes extended care facilities
— Rehabilitative care includes rehabilitation facilities
— Other includes diagnostic and treatment centres
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.
Payments 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, and $6.21 billion in 2003–2004. Payments to Health
Authorities in 2004-2005, (base and one-time payments), was $6.25 billion.
There are approximately 66 private facilities licensed by the College of Physicians and Surgeons of British Columbia. These facilities provide
mostly non-Canada Health Act services. Under the Medicare Protection Act, they are prohibited from extra-billing for any insured services.
The numbers reported here reflect the number of private surgical facilities contracted with health authorities.
Canada Health Act Annual Report, 2005–2006
161
Chapter 3 — British Columbia
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
4,430
3,380
0
7,810
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
8. Number of opted-out physicians:
a. general practitioners
b. specialists
c. other
d. total
3
3
0
6
3
3
0
6
3
2
0
5
4
2
0
6
4
2
0
6
9. 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
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
22,781,916
36,207,479
not applicable
58,989,395
23,099,248
38,541,400
not applicable
61,640,648
23,930,082
39,828,843
not applicable
63,758,925
23,681,176
42,263,797
not applicable
65,944,973
24,219,060
45,864,883
not applicable
70,083,943
720,487,209
1,076,322,482
not applicable
1,796,809,691
749,877,257
1,154,151,676
not applicable
1,904,028,933
772,944,807
1,194,086,689
not applicable
1,967,031,496
760,104,435
1,196,269,921
not applicable
1,956,374,356
773,230,973
1,259,164,813
not applicable
2,032,395,786
24,989,815
4,317,461
29,682,119
not applicable
58,989,395
25,423,936
4,393,613
31,823,099
not applicable
61,640,648
25,921,410
4,520,151
33,317,364
not applicable
63,758,925
26,078,714
4,590,296
35,275,963
not applicable
65,944,973
26,809,174
5,348,033
37,926,736
not applicable
70,083,943
1,025,581,421
279,710,272
491,517,998
not applicable
1,796,809,691
1,068,484,862
296,852,722
538,691,349
not applicable
1,904,028,933
1,093,649,881
307,628,159
565,753,456
not applicable
1,967,031,496
1,101,606,113
313,878,348
540,889,895
not applicable
1,956,374,356
1,134,825,427
328,946,459
568,623,900
not applicable
2,032,395,786
7. Number of participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
10. Services provided by physicians paid through all
payment methods:
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided through fee for
service, by category:
a.
b.
c.
medical
surgical
diagnostic
d.
e.
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a.
b.
c.
d.
e.
162
medical
surgical
diagnostic
other
total
Canada Health Act Annual Report, 2005–2006
Chapter 3 — British Columbia
Insured Services Provided to Residents in Another Province or Territory
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
8,113
7,618
7,294
7,467
6,517
80,732
83,152
81,911
80,386
77,537
17. Total payments, in-patient ($).
40,898,996
40,195,515
45,318,174
51,869,175
49,899,859
18. Total payments, out-patient ($).
10,604,141
11,223,254
11,105,322
13,574,737
14,089,042
5,041.17
5,276.39
6,213.08
6,946.45
7,656.88
131.35
134.97
135.58
168.87
181.71
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
542,301
617,819
604,745
627,654
668,433
18,880,794
22,403,037
22,516,481
23,622,360
25,664,796
34.82
36.26
37.23
37.64
38.40
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
Insured Services Provided Outside Canada
Hospitals
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
1,964
1,795
1,970
2,294
2,345
637
949
611
761
1,247
26. Total payments, in-patient ($).
9,246,228
2,294,341
2,365,051
3,811,717
4,248,649
27. Total payments, out-patient ($).
119,928
543,969
294,712
741,617
770,215
28. Average payment, in-patient ($).
4,707.86
1,278.18
1,200.53
1,661.60
1,811.79
29. Average payment, out-patient ($).
188.27
573.20
482.34
974.53
617.65
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
51,594
48,457
52,673
65,134
69,741
2,157,483
2,145,121
2,281,820
2,767,854
3,121,999
41.82
44.27
43.32
42.49
44.77
Insured Surgical-Dental Services Within Own Province or Territory
33. Number of participating dentists.
34. Number of services provided.
35. Total payments ($).
36. Average payment per service ($).
Canada Health Act Annual Report, 2005–2006
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
275
249
243
228
238
43,505
36,680
36,809
38,310
41,965
5,401,691
5,379,450
5,170,348
5,268,900
5,833,105
124.16
146.66
140.46
137.53
139.00
163
164
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
Yukon
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:
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.
Insured Health Information System — a new
system has been installed for the processing
of Health Care Registration, Medical Claims,
Hospital Claims as well as for Drug Claims.
Design stage is underway for Medical Travel
Claims component.
Work with the Yukon Medical Association to find
solutions for a number of Yukon residents without
a family physician continues.
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.
The 2005–2006 health care expenditures increased over
the 2004–2005 expenditures as follows:
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
32,226 eligible persons registered with the Yukon health
care plan on March 31, 2006.
Other insured services provided to eligible Yukon residents
include the Travel for Medical Treatment Program; Chronic
Disease and Disability Benefits Program; 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.
Canada Health Act Annual Report, 2005–2006
primary care initiatives are proceeding that will broaden
and strengthen service delivery, modernize and improve
system capabilities. These initiatives include:
Insured Health Services increased by $3,710,900;
Yukon Hospital Services increased by $1,722,477;
Continuing Care increased by $1,714,054;
Community Nursing and Emergency Medical Services
increased by $874,755; and
Community Health Programs increased by $865,898.
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 hightechnology diagnostic and treatment equipment.
165
Chapter 3 — Yukon
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The Health Care Insurance Plan Act, sections 3(2) and 4,
establish the public authority to operate the health medical
care plan. There were no amendments made to these
sections of the legislation in 2005–2006.
The Hospital Insurance Services Act, sections 3(1) and
5, establish the public authority to operate the health
hospital care plan. There were no amendments made
to these sections of the legislation in 2005–2006.
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:
166
develop and administer the hospital insurance plan;
determine eligibility for and entitlement to insured
services;
determine the amounts that may be paid for the cost
of insured services provided to insured persons;
enter into agreements on behalf of the Government
of Yukon with hospitals in or outside the Yukon, or
with the Government of Canada or any province or
an appropriate agency thereof, for the provision of
insured services to insured persons;
approve hospitals for purposes of this Act;
conduct surveys and research programs and obtain
statistics for such purposes;
appoint inspectors and auditors to examine and
obtain information from hospital records, reports
and accounts;
prescribe the forms and records necessary to carry
out the provisions of this Act; and
perform such other functions and discharge such
other duties as may be assigned by the regulations.
1.2 Reporting Relationship
The Department of Health and Social Services is accountable to the Legislative Assembly and the Government of
Yukon through the Minister.
Section 6 of the Health Care Insurance Plan Act and
section 7 of the Hospital Insurance Services Act require
that the Director, Insured Health and Hearing Services,
make an annual report to the Executive Council Member
respecting the administration of the two health insurance
plans. A Statement of Revenue and Expenditures is tabled
in the Legislature and is subject to discussion at that level.
1.3 Audit of Accounts
The Health Care Insurance Plan and the Hospital
Insurance Services Plan are subject to audit by the Office
of the Auditor General of Canada. The Auditor General
of Canada is the auditor of the Government 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
The most recent audit was for the year ended
March 31, 2006.
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 to include the financial statements of the
Corporation and the auditor’s report. The report is to be
provided to the Department of Health and Social Services
within six months of the end of each fiscal year.
1.4 Designated Agency
The Yukon Health Care Insurance Plan has no other
designated agencies authorized to receive monies or to
issue payments pursuant to the Health Care Insurance
Plan Act or the Hospital Insurance Services Act.
2.0 Comprehensiveness
2.1 Insured Hospital Services
The Hospital Insurance Services Act, sections 3, 4, 5 and 9,
establish authority to provide insured hospital services to
insured residents. The Yukon Hospital Insurance Services
Ordinance was first passed in 1960 and came into effect
April 9, 1960. There were no amendments made to these
sections of the legislation in 2005–2006.
In 2005–2006, insured in-patient and out-patient hospital
services were delivered in 15 facilities throughout the
Territory. These facilities include one general hospital,
one cottage hospital and 12 Health Centres. Additional
visiting nursing services are provided from one satellite
health station.
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
Canada Health Act Annual Report, 2005–2006
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 inpatients, namely: accommodation and meals at the
standard or public ward level; necessary nursing service;
laboratory, radiological and other diagnostic procedures
together with the necessary interpretations for the purpose
of maintaining health, preventing disease and assisting
in the diagnosis and treatment of an injury, illness or
disability; drugs, biologicals and related preparations
as provided in Schedule B of the Regulations, when
administered in the hospital; use of operating room,
case room and anaesthetic facilities, including necessary
equipment and supplies; routine surgical supplies; use
of radiotherapy facilities where available; use of physiotherapy facilities where available; and services rendered
by persons who receive remuneration therefore from
the hospital.
Section 2(f ) of the same Regulations defines “out-patient
insured services” as all of the following services to outpatients, 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
167
Chapter 3 — Yukon
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.
A total of $475,000 was dedicated for the purchase of
new hospital equipment, this included a Digital Fluoro
Machine and additional funding to increase the number
of knee replacements performed in Yukon.
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 2005–2006.
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 2005–2006
was 64.
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 2005–2006, no physicians
provided written notice of their election to collect fees
other than from the Yukon Health Care Insurance Plan.
168
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.
Insured services added in 2005–2006 include:
Some examinations performed by optometrists are
now insured. These must be medically necessary and
problem-based and are insured only in the absence
of a resident Ophthalmologist in Yukon.
The process used to add a new fee to the “Relative Value
Guide to Fees” is administered through a committee
structure. This process requires physicians to submit requests
in writing to the joint 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
2005–2006, six dentists billed the Plan for insured dental
services that were provided to Yukon residents. The Plan is
also billed directly for services provided outside the territory.
Dentists are able to opt out of the health care plan in the
same manner as physicians. In 2005–2006, no dentists
provided written notice of their election to collect fees
other than from the Yukon Health Care Insurance Plan.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
Insured dental services are limited to those surgical-dental
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 long-distance 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.
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.
The process used to de-insure services covered by the
Yukon Health Insurance Plan is as follows:
Section 3 of the Yukon Health Care Insurance Plan
Regulations contains a non-exhaustive list of services
that are prescribed as non-insured.
Uninsured hospital services include: non-resident hospital
stays; special/private nurses requested by the patient or
family; additional charges for preferred accommodation
unless prescribed by a physician; crutches and other such
appliances; nursing home charges; televisions; telephones;
and drugs and biologicals following discharge. (These
services are not provided by the hospital.)
Uninsured dental services include: procedures considered
restorative; and procedures that are not performed in a
hospital under general anaesthesia.
Further, the Act states that any service that a person
is eligible for, and entitled to, under any other Act is
not insured.
Canada Health Act Annual Report, 2005–2006
Physician services — the Yukon Health Care Insurance
Plan/Yukon Medical Association Liaison Committee
is responsible for reviewing changes to the “Relative
Value Guide to Fees”, 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, 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 “Relative Value Guide to Fees”
in fiscal year 2005–2006.
Hospital services — an amendment by Order-InCouncil to section 2 (e) (f ) of the Yukon Hospital
Insurance Services Regulations is required. As of
March 31, 2006, no insured in- or out-patient hospital
services, as provided for in the Regulations, were
deinsured. The Director, Insured Health and Hearing
Services, is responsible for managing this process in
conjunction with the Yukon Hospital Corporation.
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Chapter 3 — Yukon
Surgical-dental services — an amendment by Order InCouncil 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:
170
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;
members of the Royal Canadian Mounted Police
(RCMP);
inmates in federal penitentiaries;
study permit holders; 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, 2006, there were 32,226 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 2005–2006.
3.3 Other Categories of Individual
The Yukon Health Care Insurance Plan provides health
care coverage for other categories of individuals as follows
(subject to a waiting period not to exceed three months
— see section 3.1):
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
Returning Canadians — waiting period is applied
Permanent Residents — waiting period is applied
Minister’s Permit — waiting period is applied,
if authorized
Convention Refugees — waiting period is applied
if holding Employment Authorization
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 2005-2006 under the following conditions is:
Returning Canadians — 21
Permanent Residents — 259
Minister’s Permit — 20
Convention Refugees — 20
Armed Forces (retiring member) — 1
RCMP (retiring member) — 1
The estimated number of individuals receiving coverage
in 2005–2006 under the following conditions is:
Foreign Workers — 69
Clergy — 0
3.4 Premiums
The payment of premiums by Yukon residents was
eliminated on April 1, 1987.
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.)
Canada Health Act Annual Report, 2005–2006
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”. However, persons leaving the
Territory for a period exceeding two 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 continuous
months upon receiving a written request from the insured
person. Requests for extensions must be renewed yearly and
are subject to approval by the Director.
For temporary workers and missionaries, the Director,
Insured Health and Hearing Services, may approve
absences in excess of 12 continuous 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 2005–2006.
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
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Chapter 3 — Yukon
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 (in
Canada) for the fiscal year 2005–2006 :
In-patient services — $8,698,387
Out-patient services — $1,735,520
These figures are by date of service and may be subject
to adjustment.
In 2005–2006, payments to out-of-territory physicians
(including out-of-country) totalled $1,873,508.
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 2005–2006.
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”. However, persons leaving the
Territory for a period exceeding two 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.)
172
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, 2005,
was $1,297. This rate is established through Order-inCouncil and is based upon a corresponding Yukon value
for the service.
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 $158 and
is established through Order-in-Council and derived
by the Inter-provincial Health Insurance Agreements
Coordinating Committee (IHIACC).
The following amounts were paid in 2005–2006 for
elective and emergency services provided to eligible
Yukon residents outside Canada:
In-patient services — $43,454
Out-patient services — $8,372
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, 2005–2006
Chapter 3 — Yukon
Access to hospital or physician services not available
locally are provided through the Visiting Specialist
Program, Telehealth Program or with the support
of 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, 2006, 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:
1) 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
Watson Lake
Cottage
Hospital
# of FTEs
# of FTEs
Registered Nurses
74.50
7.50
Licensed Practical
8.00
2.00
Nurse Pract.
0
0
Social Worker
1.00
0
Pharmacist
2.00
0
Facilities
Physiotherapist
4.40
9.00
1) Whitehorse General Hospital:
Occup. Therapist
1.40
0
Psychologist
0
0
Profession
Medical Lab/X-Ray
26.25
0
Dietician
3.75
0
Public Health
0
2.00
Home Care
0
1.00
Canada Health Act Annual Report, 2005–2006
2) Whitehorse General Hospital
competitive salaries;
wage scale recognizes experience;
cooperative work schedules;
on-site fitness centre/24-hour;
monthly clinical skill development;
continuing education/development; and
travel bonus / $2,000 after one year.
As the only major acute care hospital facility in the
Territory, this facility provides in-patient, out-patient
and 24-hour emergency services. Local physicians
provide Emergency Department services on rotation.
Emergency surgery patients at the Whitehorse General
Hospital are normally seen within 24 hours. 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).
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Chapter 3 — Yukon
Surgical services provided include:
minor orthopaedics;
selected major orthopaedics;
gynecology;
paediatrics;
general abdominal;
mastectomy;
emergency trauma;
ear/nose/throat and otolaryngology; and
ophthalmology including cataracts.
Diagnostic services include:
radiology (including ultrasound, computed
tomography, x-ray and mammography);
laboratory; and
electrocardiogram.
Selected rehabilitative services are available through
out-patient therapies.
2) Watson Lake Cottage 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.
3) Health Centres:
Out-patient and 24-hour emergency services are provided
at the remaining 12 community Health Centres by
Community Nurse Practitioners and auxiliary nursing staff.
Patients requiring insured hospital services not available
locally are transferred to acute care facilities in territory
or out-of-territory through the Travel for Medical
Treatment Program.
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:
174
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 most Yukon
communities and outlying rural communities with
access to Whitehorse, and services to Whitehorse with
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.
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, 2006,
(see Statistical table item #7):
General/Family Practitioners — 55
Specialists — 9
Dentists — 6
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
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
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. Two contracted physicians provide resident
services in Faro and 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 lost practice time, mileage, meals and
accommodation, in addition to a sessional rate or
fee-for-service billings.
In addition, the Department of Health and Social
Services and the Visiting Specialist Program provide
local access at the Whitehorse General Hospital, Mental
Health Services or the Yukon Communicable Disease
Unit to non-resident visiting specialist services not
regularly available in the Territory. Visiting specialists
are reimbursed for expenses in addition to a sessional
rate or fee-for-service billings.
The number of specialists providing services under the
Visiting Specialist Program and the Department of Health
and Social Services is:
Ophthalmology — 1
Oncology — 3
Internal Medicine — 2
Otolaryngology — 2
Neurology — 2
Rheumatology — 1
Dermatology — 1
Dental Surgery — 3
Infectious Disease — 1
Psychiatry — 3
Orthopaedics — 3
Visiting Specialist clinics are held between one and eight
times per year depending on demand and availability of
specialists. As of March 31, 2006, the waitlist for non
emergency specialist services was estimated at:
Canada Health Act Annual Report, 2005–2006
Ophthalmology — 12 to 18 months
Orthopaedics — 2 to 24 months
Otolaryngology — 1 to 3 months
Neurology — 3 to 5 months
Rheumatology — 3 to 5 months
Dental Surgery — 2 to 3 months
Dental surgery services are not provided through the
Visiting Specialist as administered by the Whitehorse
General Hospital. Please note that 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 of April 1, 2004.
Other measures taken in 2005–2006 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 Medical Council and the Department of
Health and Social Services promoted a program that
provided clinical assessments for international medical
graduates to ensure they have the necessary skills and
experience to provide a high standard of care to Yukon
patients. One local international medical graduate was
accepted into this program and has successfully completed
the program.
Physicians have indicated that they are interested in
exploring new models for health care provision. The
Government is working with Yukon physicians to
facilitate this.
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Chapter 3 — Yukon
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 is 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 established the terms and
conditions for payment of physicians and established two
new programs: the New Patient Program, and the
Physician Retention Program.
The legislation governing payments to physicians and
dentists for insured services is the Health Care Insurance
Plan Act and the Regulations. No amendments were made
to these sections of the legislation in 2005–2006.
The fee-for-service system is used to reimburse the majority
of physicians and dentists providing insured services to
residents. In 2005–2006, two full-time resident rural
physicians and four resident specialists were compensated
on a contractual basis. Two physicians providing visiting
clinics in outlying communities were paid a sessional rate
for services.
5.5 Payments to Hospitals
The Government of Yukon funds the Yukon Hospital
Corporation (Whitehorse General Hospital) through
global contribution agreements with the Department
of Health and Social Services. Global operations
and maintenance (O&M) and capital funding levels
are negotiated and adjusted based on operational
requirements and utilization projections from prior
years. In addition to the established O&M and capital
funding set out in the agreement, provision is made for
the hospital to submit requests for additional funding
assistance for implementing new or enhanced programs.
176
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 2005–2006.
6.0 Recognition Given to
Federal Transfers
The Government of Yukon has acknowledged the federal
contributions provided through the Canada Health
Transfer (CHT) in its 2005–2006 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
7.0 Extended Health Care Services
Nursing Home Intermediate Care and Adult
Residential Care
Continuing Care Health Services are available to eligible
Yukon residents. In 2005–2006, 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;
respite care; day program; and meals on wheels.
In total, there were 138 continuing care beds in the
Territory in 2005–2006.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
There is no legislated requirement for long-term
residential care services for adults in Yukon. No other
major changes were made in the administration of
these services in 2005–2006.
Home Care Services
The Yukon Home Care Program provides assessment
and treatment, care management, personal support,
homemaking services, social support, respite services
and palliative care. In Whitehorse, services are provided
by home support workers, nurses, social workers and
therapists. Some rural communities have a dedicated
home care nurse, though many rural communities provide nursing services through the community nursing
program. Home support workers assist clients with
personal care, homemaking and respite services. Therapy
services are provided by a travelling regional team of
physiotherapists and occupational therapists. Services
are available Monday through Friday. In Whitehorse,
additional services such as planned weekend and
evening support may be provided. Twenty-four hour
care is not available.
There is no legislated requirement for home care services
in Yukon. No other major changes were made in the
administration of these services in 2005–2006.
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 approved increases to both the subsidy
amount and the mileage reimbursement amounts.
Beginning in 2006–2007, eligible individuals will be
able to collect $75/day starting on the second day they
are on Medical Travel Status. Mileage reimbursement for
those who travel by automobile will increase to $.30/km.
In addition to the services described above, the following
are also available to eligible Yukon residents and are
outside the requirements of the Canada Health Act:
Canada Health Act Annual Report, 2005–2006
The Chronic Disease and Disability Benefits Program
provides benefits for eligible Yukon residents who
have specific chronic diseases or serious functional
disabilities: coverage of related prescription drugs
and medical surgical supplies and equipment.
(Chronic Disease and Disability Benefits Regulation)
The Pharmacare Program and Extended Benefits
programs are designed to assist registered senior
citizens with the cost of prescription drugs, dental
care, eye care, hearing services and medical surgical
supplies and equipment. (Pharmacare Plan Regulation
and Extended Health Care Plan Regulation)
The Travel for Medical Treatment Program assists
eligible Yukon residents with the cost of emergency
and non-emergency medically necessary air and
ground transportation to receive services not available
locally. (Travel for Medical Treatment Act and 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
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 nonlegislated 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 nonlegislated program.
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Chapter 3 — Yukon
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
31,036
30,534
30,917
31,505
32,226
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
2003–2004
2004–2005
2005–2006
2
2
2
2
2
chronic care
0
0
0
0
0
c.
rehabilitative care
0
0
0
0
0
d.
other
13 1
13 1
13 1
13 1
13 1
e.
total
15
15
15
15
15
21,920,937
22,515,448
24,877,479
26,255,596
26,867,501
b.
chronic care
not applicable
not applicable
not applicable
not applicable
not applicable
c.
rehabilitative care
d.
e.
other
total
not applicable
5,997,920 1
not applicable
6,133,453 1
not applicable
6,318,565 1
not applicable
6,509,897 1
not applicable
6,862,368 1
27,918,907
28,648,901
31,196,044
32,765,493
33,729,869
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
c.
diagnostic imaging facilities
total
5. Number of insured hospital services provided:
a. surgical facilities
b.
c.
diagnostic imaging facilities
total
6. Payments ($):
a. surgical facilities
b.
c.
178
2002–2003
b.
3. Payments ($): 2
a. acute care
1.
2.
2001–2002
diagnostic imaging facilities
total
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Includes 12 health centres and one satellite health station.
Amounts include payments for operating and maintenance only. For 2004–2005, payment to facilities offering ‘other’ services has been revised.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
Insured Physician Services Within Own Province or Territory
2003–2004 3
2004–2005 3
2005–2006 3
2001–2002
2002–2003
49
5
0
54
53
6
0
59
55
8
0
63
54
8
0
62
55
9
0
64
8. 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
9. 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
201,437
9,017,141
232,624
10,625,211
235,642
11,769,018
238,797
12,892,522
248,646
13,752,251
160,932
11,881
0
172,813
186,479
11,040
0
197,519
191,002
10,460
0
200,462
207,053
11,978
0
219,031
214,305
11,510
0
225,815
5,692,583
1,143,968
0
6,836,551
6,740,552
971,283
0
7,711,835
7,336,403
984,711
0
8,321,114
8,168,042
1,033,537
0
9,201,579
8,679,497
1,168,494
0
9,847,991
131,004
26,653
15,156
0
172,813
154,591
26,388
16,540
0
197,519
151,825
31,894
16,472
0
200,461
171,657
31,036
16,338
0
219,031
173,754
33,082
18,979
0
225,815
5,550,975
1,057,467
228,109
0
6,836,551
6,386,109
1,029,697
296,029
0
7,711,835
6,802,367
1,257,750
260,997
0
8,321,114
7,722,884
1,289,558
189,137
0
9,201,579
8,065,738
1,466,488
315,764
0
9,847,990
7. Number of participating physicians:
a.
b.
c.
d.
4
general practitioners
specialists
other
total
10. Services provided by physicians paid through all
payment methods:
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through fee for
service, by type ($):
a. general practitioners
b. specialists
c. other
d. total
13. Number of services provided through fee for service,
by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
14. Total payments to physicians paid through fee for
service, by category ($):
a. medical
b. surgical
c. diagnostic
d. other
e. total
3.
4.
Includes on-call payments to physicians.
Includes only resident family physicians and specialists.
Canada Health Act Annual Report, 2005–2006
179
Chapter 3 — Yukon
Insured Services Provided to Residents in Another Province or Territory
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
17. Total payments, in-patient ($).
18. Total payments, out-patient ($).
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
663
666
783
674
714
6,547
7,241
6,938
7,412
8,450
4,299,055
5,861,530
7,587,906
5,857,725
8,698,387
945,804
1,037,692
936,376
1,306,531
1,735,520
6,484.25
8,801.10
9,690.81
8,690.99
12,182.61
144.47
143.31
134.96
176.27
205.39
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
32,461
34,853
34,037
35,401
35,781
1,601,642
1,799,019
1,833,654
1,921,260
1,873,508
49.34
51.62
53.87
54.27
52.36
2005–2006
Insured Services Provided Outside Canada
Hospitals
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
26. Total payments, in-patient ($).
27. Total payments, out-patient ($).
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
2001–2002
2002–2003
2003–2004
2004–2005
15
9
8
14
15
40
26
46
64
55
50,599
9,339
13,536
30,566
43,454
4,431
2,451
5,994
9,965
8,372
3,373.27
1,037.67
1,692.00
2,183.29
2,896.93
110.78
94.27
130.30
155.70
152.22
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
30. Number of services.
not available
not available
not available
not available
not available
31. Total payments ($).
not available
not available
not available
not available
not available
32. Average payment per service ($).
not available
not available
not available
not available
not available
Insured Surgical-Dental Services Within Own Province or Territory 5
33. Number of particpating dentists.
34. Number of services provided.
2001–2002
2002–2003
2003–2004
11
8
6
2004–2005
6
2005–2006
6
214
150
104
30
24
35. Total payments ($).
51,078
37,342
25,093
29,712
25,072
36. Average payment per service ($).
238.69
248.95
241.28
990.40
1,044.67
5.
180
Includes direct billings for insured surgical-dental services received outside the territory.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Yukon
Insured Physician Services Within Own Province or Territory
Visiting Specialists, Locum Doctors and Member Reimbursements 6
37. Number of physician services paid through
fee for service, by type:
a. general practitioners
38
2003–2004
2004–2005
2005–2006
8,229
18,663
21,896
21,109
5,264
specialists
11,323
12,830
6,165
7,771
8,898
c.
total
29,986
34,726
27,274
13,035
17,127
Total
. payments to physicians paid through
fee for service, by type ($):
a. general practitioners
699,718
788,293
819,490
243,203
b.
specialists
885,944
1,192,364
1,020,988
1,252,498
1,470,330
c.
total
1,585,662
1,980,657
1,840,478
1,495,701
1,886,289
14,341
7
415,959
23,431
25,402
23,466
8,999
b.
surgical
4,888
7,510
2,097
2,656
1,482
c.
diagnostic
1,667
1,814
1,711
1,380
1,303
d.
total
29,986
34,726
27,274
13,035
17,126
1,224,899
1,392,766
1,371,373
1,021,817
1,492,628
285,503
481,940
374,435
368,891
294,662
75,261
105,951
94,671
104,993
98,999
1,585,663
1,980,657
1,840,479
1,495,701
1,886,289
40. Total payments to physicians paid through
fee for service, by category ($):
a. medical
7.
2002–2003
b.
39. Number of services provided through fee for
service, by category:
a. medical
6.
2001–2002
b.
surgical
c.
diagnostic
d.
total
Includes Visting Specialists, Member Reimbursements, Locum Doctors, and Optometrist testing paid through fee-for-service. Excludes services
and costs provided by alternative payment agreements.
Reduction for 2004–2005 from prior years is due to a decline in the number of general practitioner locums provided and the transfer of
physician data to the resident physician category.
Canada Health Act Annual Report, 2005–2006
181
182
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Northwest Territories
Northwest Territories
Introduction
The Northwest Territories (NWT) Department of Health
and Social Services, (henceforth the Department) together
with seven Health and Social Services Authorities (HSSAs)
and the Tlicho Community Services Agency (TCSA), plan,
manage and deliver a full 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 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, 2006, there were more than 40,000 people
living in the Northwest Territories, of which half were
Aboriginal1. The NWT continues to have a relatively
young population and a high birth rate. According to
2005 population estimates, approximately 25 percent of
the NWT population is under 15 years of age, compared
with 18 percent in the overall Canadian population2.
During the reporting period, the Department undertook
several important initiatives, including:
1
2.
The implementation of the Midwifery Profession Act,
introducing midwifery as a regulated profession and
insured service. Under this act, midwives are autonomous primary health care providers whom clients may
choose as their first point of entry to the maternity
care system, allowing some women the option of
delivering closer to their home communities.
Access to Health Care and Addressing Wait Times in the
NWT, a report that documents work underway to
address access to primary health care and wait times
for surgical and diagnostic imaging procedures in
the Territories. The report includes a workplan to
continue efforts in improving access to health care
services for all residents.
The implementation of the Tlicho Community Services
Agency Act. This Act deems the Tlicho Community
Services Agency as a Board of Management and
enables the Agency to oversee and deliver Health
and Social Services programs and services in the
Tlicho region.
The passing of the Tobacco Control Act by the Legislative Assembly in March of 2006. This act prohibits
smoking in all public places and controls the sale
and display of tobacco in the NWT. Pharmacies,
recreation facilities, and vending machines will no
longer sell tobacco products. Retailers will not be
allowed to display tobacco products and will be
required to display signs disclosing information
about the health risks of tobacco.
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’s Population Estimates, First Quarter 2006.
Statistics Canada, CANSIM, table 051-0001.
Canada Health Act Annual Report, 2005–2006
183
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 (revised 2005). Changes to the HIHSSA are consequential amendments due to the establishment of the
Tlicho Community Services Agency by the Tlicho
Community Services Agency Act.
1.2 Reporting Relationship
In the Northwest Territories (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 regulations. The Director
reports to the Minister each fiscal year 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. The Boards are established with
the authority to 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. 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 chairperson to provide non-financial reporting.
1.3 Audit of Accounts
The Hospital Insurance Plan and the Medical Care Plan
are administered by the Department of Heath and Social
Services. The Office of the Auditor General of Canada
(OAG) audits the payments made under the Medical
Care Plan and the Hospital Insurance Plan.
2.0 Comprehensiveness
2.1 Insured Hospital Services
Insured hospital services are provided under the authority
of the HIHSSA and the regulations. HIHSSA was amended
in 2005 in order to recognize the newly established Tlicho
Community Services Agency as a Board of Management.
In the same year, the Hospital Standards Regulations
were repealed for the Hospital and Health Care Facility
Standards Regulations.
During 2005–2006, 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 provided to outpatients: laboratory, radiological and other diagnostic
procedures together with the necessary interpretations for
helping diagnose and treat any injury, illness or disability,
184
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Northwest Territories
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 service; 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
or those services from a hospital; radiotherapy services
within insured facilities; and physiotherapy services within
insured facilities.
obstetrical care; eye examinations; and visits to specialists,
even when there is no referral by a family physician.
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:
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.
establishing a medical care plan that provides insured
services to insured persons by medical practitioners
that will in all respects meet the requirements of the
Canada Health Act, and qualify and enable the NWT
to receive payments of cash contributions from the
Government of Canada under the Canada Health
Transfer; 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.
Where insured services are not available in the NWT,
residents receive them from hospitals in other jurisdictions,
provided they are medically necessary. The NWT provides
medical travel assistance and a supplementary health benefit
program (as outlined in the Medical Travel Policy), which
ensures that NWT residents have no barriers to accessing
medically necessary services.
2.2 Insured Physician 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.
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 requirement set out respectively in
the Midwifery Profession Act and the Nursing Profession Act.
As of March 31, 2006, there were 232 licensed physicians
providing insured services in the NWT.
A physician may opt-out and collect his or her 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 2006.
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; necessary surgical services; complete
Canada Health Act Annual Report, 2005–2006
2.3 Insured Surgical-Dental Services
2.4 Uninsured Hospital, Physician and
Surgical-Dental Services
Services provided by hospitals, physicians and dentists,
but not covered by the NWT Health Care Insurance Plan,
include: medical-legal services; third-party examinations;
services not medically required; group immunization;
in vitro fertilization; services provided by a doctor to his
or her own family; advice or prescriptions given over the
telephone; surgery for cosmetic purposes except where
medically required; dental services other than those
specifically defined for oral surgery; dressings, drugs,
vaccines, biologicals and related materials administered
in a physician’s office; eyeglasses and special appliances;
plaster and surgical appliances or special bandages;
treatments in the course of chiropractics, podiatry,
naturopathy, osteopathy or any other practice ordinarily
185
Chapter 3 — Northwest Territories
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.
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.
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 2006, there were 44,082 individuals registered
with the NWT Health Care Plan.
No formal provisions are in place for clients to opt out of
the Health Care Insurance Plan.
3.3 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
3.0 Universality
3.1 Eligibility
The Medical Care Act defines the eligibility of NWT
residents for the NWT Health Care Insurance Plan.
The NWT uses the Interprovincial Agreement on
Eligibility and Portability in conjunction with the
NWT Health Care Plan Registration Guidelines to
define eligibility. There were no changes to eligibility
for the reporting period.
Ineligible individuals for NWT health care coverage are
members of the Canadian Forces, the Royal Canadian
Mounted Police (RCMP), federal inmates and residents
who have not completed the minimum waiting period.
For persons discharged from the Canadian Armed Forces,
RCMP, federal penitentiary, or Canadian citizens returning
to the NWT from living outside Canada, coverage is effective the day permanent residency is established.
3.2 Registration Requirements
Registration requirements include a completed application
form and supporting documentation as applicable; e.g. visas
and immigration papers. The applicant must be prepared
to provide proof of residency, if requested. Registration
186
4.1 Minimum Waiting Period
There are waiting periods imposed on insured persons
moving to the NWT. The waiting periods are consistent
with the Interprovincial Agreement on Eligibility and
Portability. Generally the waiting periods are the first
day of the third month of residency, for those who
move permanently to the NWT, or the first day of the
thirteenth month for those with temporary employment
of less than 12 months, but who can confirm that the
employment period has been extended beyond the
12 months.
4.2 Coverage During Temporary Absences
in Canada
The Interprovincial Agreement on Eligibility and Portability
and the NWT Health Care Plan Registration Guidelines
define the portability of health insurance during temporary
absences within Canada.
Coverage is provided to students who are temporarily out
of the NWT for full-time attendance in a post-secondary
institution, and for up to one year for individuals who are
temporarily absent from the NWT for work, vacation,
etc. Once an individual has completed a Temporary
Absence form and been approved by the Department
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Northwest Territories
as being temporarily absent from the NWT, the full cost
of insured services is paid for all services received in other
jurisdictions. During the 2005–2006 fiscal year, over
$12 Million was paid for in- and out-patient hospital
services received in other provinces and territories.
5.0 Accessibility
The NWT participates in both the Hospital Reciprocal
Billing Agreement and the Medical Reciprocal Billing
Agreement with other jurisdictions.
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.
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
also required if insured services are to be obtained
from private facilities.
Canada Health Act Annual Report, 2005–2006
5.1 Access to Insured Health Services
5.2 Access to Insured Hospital Services
If a bed shortage were to arise, the resident would be
transported to another facility where appropriate beds
exist. NWT hospitals and health centres continued
to face some short-term staffing difficulties that had
negative effects on their operations. However, through
the use of medical travel arrangements, access to services
was maintained throughout 2005–2006.
Facilities in the NWT do offer a range of medical,
surgical, rehabilitative and diagnostic services. The
NWT Medical Travel Program ensures that residents
will have access to necessary services not available in
NWT facilities.
The number of Telehealth sites remained unchanged
during 2005–2006. The Telehealth program has entered
into a three-year strategic planning process, which is
to provide direction on integration and sustainability
for the Telehealth program in relation to the Integrated
Service Delivery Model.
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 fiveyear human resource strategy in 2004 to address these
issues. This strategy outlined alternatives available to
the Department of Health and Social Services and its
HSSAs to increase the supply of health professionals
required to meet 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. The Government of the Northwest
187
Chapter 3 — Northwest Territories
Territories is working with employees, unions and
professional organizations to identify, develop and
implement initiatives supporting the retention and
recruitment of health and social services professionals.
6.0 Recognition Given to
Federal Transfers
5.3 Access to Insured Physician and
Surgical-Dental Services
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.
All NWT residents have access to all facilities operated
by the Government of the Northwest Territories.
The Medical Travel Program provides access to
physicians for residents. The Telehealth program
expands the specialist services available to residents
in isolated communities.
5.4 Physician Compensation
To compensate physicians, the NWT uses two models:
employee contracts, and fee-for-service. The majority
of family physicians are employed through a contractual
arrangement with the GNWT. The remainder provides
services through a fee-for-service arrangement. The
Medical Care Act and part of the Medical Care Regulations
are used in the NWT to govern amounts to be paid to
physicians where insured services are provided on a feefor-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.
Payments to facilities providing insured hospital services
are governed under the HIHSSA and the Financial Administration Act. No amendments were implemented in
2005–2006 to provisions involving payments to facilities.
A comprehensive budget is used to fund hospitals in
the NWT.
For fiscal year 2005–2006, these documents included:
2005–2006 Budget Address;
2005–2006 Main Estimates;
2004–2005 Public Accounts; and
2003–2006 Business Plan for the Department
of Finance.
The 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 the Department of Health and Social Services
Establishment Policy, the HIHSSA and the Hospital and
Health Care Facility Standards Regulations.
Supported living services provide a home-like environment
with increased assistance and a degree of supervision
unavailable through home care services. Current services
in this area include supported living arrangements in
family homes, apartments and group-living homes, where
clients live as independently as possible. Group homes,
long-term care facilities and extended care facilities provide
more complex medical, physical and/or mental supports
on a 24-hour basis.
The NWT Home Care Program is a territory-wide
program established to provide 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
188
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Northwest Territories
admission to institutional care when community living
is no longer a viable alternative. Home Care is based on
need and is available to NWT residents without charge.
The range of Home Care services include: acute care;
post-hospital care; chronic illness care; nutrition services;
palliative care; personal care; and respite care. Home care
services are delivered through the Regional HSSA
and 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.
Registered Persons
2001–2002
1. Number as of March 31st.
2002–2003
42,886 3
40,399
2003–2004
3
43,202
2004–2005
3
2005–2006
44,504 3
44,082
3
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
2001–2002
2002–2003
4
2003–2004
4
2004–2005
4
2005–2006
4
4
b.
chronic care
not applicable
4
not applicable
4
not applicable
4
not applicable
4
not applicable
4
c.
rehabilitative care
not applicable
4
not applicable
4
not applicable
4
not applicable
4
not applicable
4
d.
other
28 5
28 5
28 5
28 5
28 5
e.
total
32
32
32
32
32
3. Payments ($):
a. acute care
not available
not available
b.
chronic care
not applicable
4
not applicable 4
not applicable
4
not applicable
4
not applicable
4
c.
rehabilitative care
not applicable
4
not applicable 4
not applicable
4
not applicable
4
not applicable
4
d.
other
not available
not available
not available
not available
not available
e.
total
43,309,039
48,384,358
51,553,729
56,475,975
55,947,009
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
not available
not available
not available
5. Number of insured hospital services
provided:
a.
surgical facilities
not applicable
not applicable
not applicable
not applicable
not applicable
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
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
6. Payments ($):
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
All data are subject to future revisions.
3. 2001–2002 figure is as of September 18, 2002; 2002–2003 figure is as of September 2, 2003; the 2003–2004 figure is as of August 25, 2004;
2004–2005 figure as of September 1, 2005; and the 2005–2006 figure as of September 6, 2006.
4. 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.
5. Includes Health Centres and Public Health Units.
Canada Health Act Annual Report, 2005–2006
189
Chapter 3 — Northwest Territories
Insured Physician Services Within Own Province or Territory
2001–2002
7.
9.
2003–2004
2004–2005
2005–2006
Number of participating physicians:
a.
b.
c.
d.
8.
2002–2003
24
13
175
212
general practitioners
specialists
other
total
6
37 6
16 6
155 7
208 8
6
7
8
44
15
169
228
6
56
21
139
216
6
7
8
6
56
21
155
232
6
7
8
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
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
199,778
20,125,000
195,511
20,504,000
199,062
28,791,514
203,491
28,761,951
166,754
28,559,951
32,343
5,618
0
37,961
18,494
5,524
0
24,018
20,689
5,636
0
26,325
23,828
4,679
0
28,507
24,204
4,226
0
28,430
1,226,824
616,393
not available
1,843,217
824,506
617,448
not available
1,441,954
814,895
698,510
not available
1,513,405
922,239
648,349
not available
1,570,587
939,212
607,621
not available
1,546,833
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
not
6
6
7
8
10. Services provided by physicians paid through
all payment methods :
a.
b.
number of services
total payments
11. Number of physician services paid through
fee for service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
12. Total payments to physicians paid through
fee for service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
13. Number of services provided throughfee for
service, by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
available
available
available
available
37,961
available
available
available
available
24,018
available
available
available
available
26,325
available
available
available
available
28,507
available
available
available
available
28,430
14. Total payments to physicians paid through
fee
a.
b.
c.
d.
e.
6.
7.
8.
190
for service,by category ($):
medical
surgical
diagnostic
other
total
not available
not available
not available
not available
1,843,217
not available
not available
not available
not available
1,441,954
not available
not available
not available
not available
1,513,405
not available
not available
not available
not available
1,570,587
not available
not available
not available
not available
1,546,833
2001–2002 numbers from Canadian Institute for Health Information, Southam Medical Database; and 2002–2003 and 2003–2004 numbers are
estimates from NWT Department of Health and Social Services. 2004–2005 and 2005–2006 figures are for funded positions.
This is an estimate of the number of locum physicians. For measures 10 and 15, locum physicians are captured within the general practitioners
and specialists categories.
Estimate based on total active physicians for each fiscal year.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Northwest Territories
Insured Services Provided to Residents in Another Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
991
1,237
1,338
1,109
1,007
8,366
9,170
9,538
10,132
10,158
17. Total payments, in-patient ($).
5,881,124
8,580,504
8,741,298
7,854,074
8,916,590
18. Total payments, out-patient ($).
1,407,313
1,833,630
2,082,470
2,539,752
3,285,093
5,934.53
6,936.54
6,533.11
7,082.12
8,854.61
168.22
199.96
218.33
250.67
323.40
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
41,663
42,987
41,126
41,166
42,115
2,245,914
2,753,125
2,928,999
3,119,120
3,258,336
53.91
64.05
71.22
75.77
77.37
Hospitals
15. Total number of claims, in-patient.
16. Total number of claims, out-patient.
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
Insured Services Provided Outside Canada
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
3
2
1
4
5
18
56
23
23
28
26. Total payments, in-patient ($).
38,983
1,258
216
2,176
16,298
27. Total payments, out-patient ($).
16,208
124,218
21,141
7,738
5,777
12,994.27
629.14
215.66
543.88
3,259.56
900.43
2218.19
919.18
336.42
206.34
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
102
135
67
13
4
31. Total payments ($).
18,806
21,450
8,056
519
130
32. Average payment per service ($).
184.37
158.89
120.24
39.93
32.39
Hospitals
24. Total number of claims, in-patient.
25. Total number of claims, out-patient.
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
30. Number of services.
Insured Surgical-Dental Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
33. Number of participating dentists.
not available
not available
not available
not available
not available
34. Number of services provided.
not available
not available
not available
not available
not available
35. Total payments ($).
not available
not available
not available
not available
not available
36. Average payment per service ($).
not available
not available
not available
not available
not available
Canada Health Act Annual Report, 2005–2006
191
192
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nunavut
Nunavut
Introduction
On April 1, 1999, Nunavut became Canada’s third and
newest territory. The Territory spans two million square
kilometres and covers one-fifth of Canada’s total landmass.
There are 25 communities located across three time zones
in Nunavut. The Territory is divided into three regions:
the Baffin, which consists of 12 communities; the Kivalliq,
which consists of eight communities; and the Kitikmeot,
which consists of five communities. According to recent
statistics, the population in Nunavut is 30,446.
Approximately 47 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 French-speaking
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 as Inuit Qaujimajatuqangit, in program and policy development, service design and delivery,
is an expectation placed on all government departments.
The delivery of health services in Nunavut is based
on a primary health care model. There are local health
centres in 22 communities across Nunavut, new regional
Canada Health Act Annual Report, 2005–2006
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.
Full-time family physicians number 17 across Nunavut:
11 in the Baffin region; four in the Kivalliq region; and
two 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. From time to time,
specialists travel to Nunavut to offer clinics in the regional
centres, e.g. eye surgery in Baffin Regional Hospital.
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 2005–2006 was $240,611,000, which includes approximately $25,392,000 allocated for capital projects. This
represents a decrease of $16,774,000 and $33,878,000
respectively from 2004–2005 funding levels.
In 2005–2006, Telehealth was further expanded and is now
available in all 25 communities in Nunavut. Nunavut’s
Telehealth network supports the delivery of a broad range
of health-related services to communities, including the
following: clinical program delivery such as specialist consultation services; health education; continuing medical
education; family visitation; and administrative functions.
Over the last year, the use of Nunavut’s Telehealth
network increased by 40 percent.
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 finds it a challenge to
staff community-based nursing positions on an indeterminate basis. A focused recruitment initiative in 2005–06
saw 34 nurses recruited from overseas, through an agency,
to work in Nunavut. Recruitment and retention of other
health care professionals such as social workers, physicians
and physiotherapists is also a challenge.
193
Chapter 3 — Nunavut
Over one quarter of the Department’s O&M budget is
spent on costs associated with medical travel and treatment
provided in out-of-territory facilities. Due to the very low
population density in this vast territory and limited health
infrastructure (equipment and health human resources),
residents must leave Nunavut to access a range of hospital
and specialist services. In fall 2005, two new regional
health centres, one in Rankin Inlet and one in Cambridge
Bay were opened. In addition, an enhanced regional
hospital facility in Iqaluit is scheduled to open in 2007.
These will enhance the range of services that can be provided within the Territory. These enhancements support
the Department’s strategic vision of “Closer to Home”,
which was approved by Cabinet in January 2005. This
strategy is building capacity so that more care, learning
and jobs are available within the Territory.
With funds from the Primary Health Care Transition
Fund (federal), the Government of Nunavut established
a new family practice clinic in Iqaluit. It is expected that
the clinic, staffed by one family physician and two nurse
practitioners on a community-based health services
delivery model, will reduce pressure on the emergency
and out-patient departments of Baffin Regional Hospital.
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, fetal 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 significant results, including a 12 percent
drop in smoking among youth in Nunavut since 2004.
1.0 Public Administration
1.1 Health Care Insurance Plan and
Public Authority
The health care insurance plans of Nunavut, including
physician and hospital services, are administered by
the Department of Health and Social Services on a nonprofit basis.
The Medical Care Act (NWT, 1988 and as duplicated
for Nunavut by section 29 of the Nunavut Act, 1999)
194
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
2005–2006.
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.
1.3 Audit of Accounts
The Auditor General of Canada is the auditor of the
Government of Nunavut in accordance with section 30.1
of the Financial Administration Act (Nunavut, 1999). The
Auditor General has the mandate to audit the activities of
the Department of Health and Social Services.
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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nunavut
2.0 Comprehensiveness
services in an out-patient facility or in an approved hospital;
and psychiatric and psychology services provided under
an approved hospital program.
2.1 Insured Hospital Services
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.
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 2005–2006.
In 2005–2006, insured hospital services were delivered
in 25 facilities across Nunavut, including a general
hospital located in Iqaluit, two regional health centres
(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, the two regional facilities will be able to offer
in-patient services once staff are in place. They are now
able to offer specialist clinics. 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 also provided at freestanding
Public Health Clinics in Rankin Inlet and Iqaluit.
The Department is responsible for authorizing, licensing,
inspecting and supervising all health facilities and social
services facilities in the Territory.
Insured in-patient hospital services include: accommodation and meals at the standard ward level; necessary nursing
services; laboratory, radiological and other diagnostic
procedures, together with the necessary interpretations;
drugs, biological and related preparations prescribed by
a physician and administered in hospital; routine surgical
supplies; use of operating room, case-room and anaesthetic
facilities; use of radiotherapy and physiotherapy services
where available; psychiatric and psychological services
provided under an approved program; services rendered
by persons who are paid by the hospital; and services
rendered by an approved detoxification centre.
Out-patient services include: laboratory tests and x-rays,
including interpretations, when requested by a physician
and performed in an out-patient facility or in an approved
hospital; hospital services in connection with most minor
medical and surgical procedures; physiotherapy, occupational therapy, limited audiology and speech therapy
Canada Health Act Annual Report, 2005–2006
No new services were added in 2005–2006 to the list of
insured hospital services.
2.2 Insured Physician Services
The Medical Care Act, section 3(1), and Medical Care
Regulations, section 3, provide for insured physician
services in Nunavut. No amendments were made to the
Act or regulations in 2005–2006.
Although the Nursing Act (2004) allows for licensure
of nurse practitioners in Nunavut, only medical doctors
are permitted to deliver insured physician services in
Nunavut at this time. The department is examining
legislative amendments that will give nurse practitioners
an expanded role in the delivery of primary health care
in the communities. It is expected that this legislative
change will take place sometime 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 17 full-time family physician positions in Nunavut
(11 in the Baffin region; four in the Kivalliq region;
and two in the Kitikmeot region), as well as one surgeon
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, 2006, Nunavut had
135 physicians participating in the health insurance plan.
Physicians can make an election to collect fees other
than those under the Medical Care Plan in accordance
with section 12 (2)(a) or (b) of the Medical Care Act
by notifying the Director in writing. An election can be
revoked the first day of the following month after a letter
to that effect is delivered to the Director. In 2005–2006,
no physicians provided written notice of this election.
195
Chapter 3 — Nunavut
All physicians practicing in Nunavut are under contract
with the department.
Insured physician services refers to all services rendered by
medical practitioners that are medically required. Where
the insured service is unavailable in Nunavut, the patient
is referred to another jurisdiction to obtain the insured
service. Nunavut has health service agreements in place
with medical treatment centres in Ottawa, Winnipeg,
Yellowknife and Edmonton. These are the normal outof-territory 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 2005–2006.
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 2005–2006, four oral surgeons were permitted
to bill the Nunavut Medical Care Insurance Plan for
insured dental services.
Insured dental services are limited to those dental-surgical
procedures scheduled in the Regulations, requiring the
unique capabilities of a hospital for their performance,
for example, of orthognathic surgery. Oral surgeons are
brought to Nunavut on a regular basis. 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 2005–2006.
196
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 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nunavut
3.0 Universality
3.1 Eligibility
Eligibility for the Nunavut Health Care Plan is briefly
defined under sections 3(1), (2), and (3) of the Medical
Care Act. The Department also adheres to the InterProvincial Agreement on Eligibility and Portability as
well as internal guidelines. No amendments were made
to the Act or regulations in 2005–2006.
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 the Territory, but does not include a tourist, transient
or visitor to the Territory. 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 the Territory, but first-day coverage is
provided under a number of circumstances (e.g. newborns
whose mothers or fathers are eligible for coverage). As
well, permanent residents (landed immigrants), returning
Canadians, repatriated Canadians, returning permanent
residents and a non-Canadian who has been issued an
employment visa for a period of 12 months or more are
also granted first-day coverage.
Members of the Canadian Armed Forces, the Royal
Canadian Mounted Police (RCMP) and inmates of
a federal penitentiary are not eligible for registration.
These groups are granted first-day coverage under the
Nunavut Health Care Plan upon discharge.
Pursuant to section 7 of the Inter-Provincial Agreement
on Eligibility and Portability, persons in Nunavut who
are temporarily absent from their home province/territory
and who are not establishing residency in Nunavut remain
covered by their home provincial or territorial health
insurance plans for up to one year.
Canada Health Act Annual Report, 2005–2006
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, 2006, 31,172 residents were registered
with the Nunavut Health Care Plan. 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.
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.
197
Chapter 3 — 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 2005–2006 with respect to
coverage outside Nunavut.
Students studying outside Nunavut must notify the
Department and provide proof of enrolment to ensure
continuing coverage. Requests for extensions must
be renewed yearly and are subject to approval by the
Director. Temporary absences for work, vacation or
other reasons for up to one year are approved by the
Director upon receipt of a written request from the
insured person. The Director may approve absences
in excess of 12 continuous months, upon receiving a
written request from the insured person.
The provisions regarding coverage during temporary
absences in Canada fully comply with the terms and
conditions of the Inter-Provincial/Territorial Agreement
on Eligibility and Portability, as of January 1, 2001.
Nunavut participates in Physician and Hospital
Reciprocal Billing. As well, special 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).
198
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 $21,506,142 in the
fiscal year 2005–2006.
4.3 Coverage During Temporary Absences
Outside Canada
The Medical Care Act, section 4(3), prescribes the benefits
payable where insured medical services are provided outside
Canada. The Hospital Insurance and Health and Social
Services Administration Act, section 28(1)(j)(o), provides
the authority for the Minister to set the terms and conditions of payment for services provided to Nunavut residents
outside Canada. Individuals are granted coverage for up
to one year if they are temporarily out of the country
for any reason, although they must give prior notice
in writing. For services provided to residents who have
been referred out of the country for highly specialized
procedures unavailable in Nunavut and Canada, Nunavut
will pay the full cost. For non-referred or non-emergency
services, the payment for hospital services is $1,396 per
diem and $158 for out-patient care. No changes were
made to these rates in 2005–2006.
In 2005–2006, Nunavut paid a total of $3,591 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.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nunavut
5.0 Accessibility
5.1 Access to Insured Health Services
The Medical Care Act, section 14, prohibits extra-billing
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, located in Iqaluit, is
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 has 25 beds
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. 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, general medical care,
maternity and palliative care. Surgical services provided
include minor orthopaedics, gynaecology, paediatrics,
general abdominal, emergency trauma and ENT/otolaryngology. Patients requiring specialized surgeries are
sent to other jurisdictions. Diagnostic services include
radiology, laboratory and electrocardiogram. Rehabilitative
services are limited to Iqaluit.
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 2005–2006. Nunavut is seeking to increase
resources in all areas.
Canada Health Act Annual Report, 2005–2006
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, available in all 25 communities, allows for the
delivery of a broad range of services, including: specialist
consultation services such as ermatology, psychiatry
and internal medicine; rehabilitation services; regularly
scheduled counselling sessions; family visitation; and
continuing medical education. In 2005–2006, Nunavut
had 135 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 centres 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.
199
Chapter 3 — Nunavut
6.0 Recognition Given to
Federal Transfers
Recognition of the Canada Health Transfer by the Government of Nunavut for 2005–2006 will be given when the
“Medical Care Act Annual Report” is tabled in the Nunavut
Legislative Assembly in 2006–2007.
7.0 Extended Health
Care Services
Nursing Home Intermediate Care and
Adult Residential Care
Adult Residential Care Facilities, located in a total of
seven communities with a total of 64 beds, 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 current legislation currently exists in Nunavut to
formally enable the activities provided in the abovementioned 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 para-professional
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.
200
Nursing home services are available at the Elders
Homes in Iqaluit and Arviat. 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 services. Acute care cases are transferred to
the closest hospital.
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 2005–2006, home care in Nunavut included
a full array of services; from nursing and personal care,
respite care, palliative care, elders programs and homemaking 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 and 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
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. Best efforts are made
to be consistent in the services offered in communities
across the Territory.
Ambulatory Health Care Services
In 2005–2006, ambulatory health care services were
not offered across Nunavut.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nunavut
However, to address this, the Government of Nunavut
committed in early 2005–2006 to the design and
construction of two continuing care facilities. To be
located in Igloolik and Gjoa Haven, the facilities
will provide long term care, palliative care, sub-acute care,
respite care, wellness and community care programs. They
should be operational by late 2008.
Registered Persons
1. Number as of March 31st.
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
28,630
29,478
31,660
31,525
31,172
Insured Hospital Services Within Own Province or Territory
Public Facilities
2. Number:
a. acute care
b.
2001–2002
1
2002–2003
1
2003–2004
1
2004–2005
1
2005–2006
1
chronic care
not available
not available
not available
not available
not available
not available
not available
not available
1
25
25
25
25
26
not available
not available
not available
not available
28
c.
rehabilitative care
d.
other
e.
total
3. Payments ($):
a. acute care
0
not available
not available
not available
not available
not available
b.
chronic care
not available
not available
not available
not available
not available
c.
rehabilitative care
not available
not available
not available
not available
not available
d.
other
not available
not available
not available
not available
not available
e.
total
not available
not available
not available
not available
not available
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Private For-Profit Facilities
4. Number:
a. surgical facilities
b.
diagnostic imaging facilities
c.
total
1
5. Number of insured hospital services
provided:
a.
surgical facilities
0
0
0
0
0
b.
diagnostic imaging facilities
c.
total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6. Payments ($):
a. surgical facilities
1.
b.
diagnostic imaging facilities
c.
total
This includes 22 community health centres and two regional health centres located in communities throughout the territory; and a public health
unit and a family practice clinic, located in Iqaluit. The family practice clinic has nurse practitioners (NPs) and a physician offering primary
health care, as it would if located in one of the communities and operating as a community health centre.
Canada Health Act Annual Report, 2005–2006
201
Chapter 3 — Nunavut
Insured Physician Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
81
67
0
148
106
186
75
64
0
139
86
82
0
168
74
61
0
135
8. Number of opted-out physicians:
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9. Number of not participating physicians:
a. general practitioners
b. specialists
c. other
d. total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
39,035
19,733
0
58,768
44,876
20,656
0
43,142
17,419
0
60,561
42,909 2
16,633 2
0
59,542 2
40,609 2
16,754 2
0
57,363 2
1,943,399
1,042,366
0
2,985,765
2,137,218
1,199,648
0
2,023,584
1,524,873
0
3,548,457
2,037,408 2
1,075,253 2
0
3,112,661 2
1,952,282 2
910,793 2
0
2,863,075 2
7. Number of participating physicians:
a.
b.
c.
d.
general practitioners
specialists
other
total
80
0
10. Services provided by physicians paid through all
payment methods:
a.
b.
number of services
total payments
11. Number of physician services paid through fee for
service, by type:
a.
b.
c.
d.
general practitioners
specialists
other
total
65,532
12. Total payments to physicians paid through fee for
service, by type ($):
a.
b.
c.
d.
general practitioners
specialists
other
total
3,336,866
13. Number of services provided through fee for
service, by category:
a.
b.
c.
d.
e.
medical
surgical
diagnostic
other
total
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
not
not
not
not
not
applicable
applicable
applicable
applicable
applicable
14. Total payments to physicians paid through fee for
service, by category ($):
a.
b.
c.
d.
e.
2.
202
medical
surgical
diagnostic
other
total
Nunavut does not pay physicians through fee-for-service. Instead, the majority of physicians are compensated through salaries and alternative
methods. Information on salaried physicians is reported via the shadow billing process. Figures include shadow billed claims.
Canada Health Act Annual Report, 2005–2006
Chapter 3 — Nunavut
Insured Services Provided to Residents in Another Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
15. Total number of claims, in-patient.
1,782
2,524
2,526
2,544
2,721
16. Total number of claims, out-patient.
Hospitals
9,155
10,677
12,112
14,492
16,939
17. Total payments, in-patient ($).
7,681,154
18,640,982
17,202,646
15,851,159
17,909,264
18. Total payments, out-patient ($).
1,525,710
1,740,038
1,552,418
2,521,841
3,596,878
4,310.41
7,385.49
6,981.59
6,438.33
6,581.87
166.65
162.00
138.47
181.95
212.34
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
39,438
43,064
51,050
45,334
57,332
2,335,998
2,674,445
2,955,996
2,816,282
3,471,307
59.23
62.10
58.61
62.40
60.55
19. Average payment, in-patient ($).
20. Average payment, out-patient ($).
Physicians
21. Number of services.
22. Total payments ($).
23. Average payment per service ($).
Insured Services Provided Outside Canada
Hospitals
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
24. Total number of claims, in-patient.
0
0
2
1
1
25. Total number of claims, out-patient.
53
3
2
1
16
0
0
6,300
6,345
954
128,398
982
400
433
2,637
0.00
0.00
3,150.00
6,345.00
953.62
2,422.60
327.28
200.00
433.41
164.80
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
12
1
19
0
36
14,835
8
1,519
0
2,459
1,236.25
7.61
151.91
0.00
68.30
26. Total payments, in-patient ($).
27. Total payments, out-patient ($).
28. Average payment, in-patient ($).
29. Average payment, out-patient ($).
Physicians
30. Number of services.
31. Total payments ($).
32. Average payment per service ($).
Insured Surgical-Dental Services Within Own Province or Territory
2001–2002
2002–2003
2003–2004
2004–2005
2005–2006
33. Number of participating dentists.
not available
not available
not available
not available
not available
34. Number of services provided.
not available
not available
not available
not available
not available
35. Total payments ($).
not available
not available
not available
not available
not available
36. Average payment per service ($).
not available
not available
not available
not available
not available
Canada Health Act Annual Report, 2005–2006
203
204
Canada Health Act Annual Report, 2005–2006
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 Extrabilling and User Charges Information Regulations. These
regulations require the provinces and territories to provide
Canada Health Act Annual Report, 2005–2006
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.
205
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 ser-
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
209
Canada Health Act
Chap. C–6
vices 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 »
210
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”
211
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.
212
« 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
213
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
Portability
214
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”
amounts for the cost of insured health services 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
Accessibility
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.
12. (1) La condition d’accessibilité suppose
que le régime provincial d’assurance-santé :
Accessibilité
215
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
216
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
217
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
218
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
219
Canada Health Act
Chap. C–6
Separate accounting in Public
Accounts
Refund to
province
Saving
When deduction
made
Regulations
Agreement of
provinces
220
(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.
221
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.
225
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.
226
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, 2005–2006
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.
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[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.
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.
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Annex B — Policy Interpretation Letters
Comprehensiveness
The intent of the Canada Health Act is neither to expand nor contract the range of insured services covered under previous federal legislation. The range of insured services encompasses medically necessary hospital care, physician services
and surgical-dental services which require a hospital for their proper performance. Hospital plans are expected to cover
in-patient and out-patient hospital services associated with the provision of acute, rehabilitative and chronic care. As
regards physician services, the range of insured services generally encompasses medically required services rendered
by licensed medical practitioners as well as surgical-dental procedures that require a hospital for proper performance.
Services rendered by other health care practitioners, except those required to provide necessary hospital services, are
not subject to the Act’s criteria.
Within these broad parameters, provinces, along with medical professionals, have the prerogative and responsibility for
interpreting what physician services are medically necessary. As well, provinces determine which hospitals and hospital
services are required to provide acute, rehabilitative or chronic care.
Universality
The intent of the Canada Health Act is to ensure that all 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.
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.
Canada Health Act Annual Report, 2005–2006
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Annex B — Policy Interpretation Letters
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.
Reasonable Accessibility
The Act is fairly clear with respect to certain aspects of accessibility. The Act seeks to discourage all point-of-service
charges for insured services provided to insured persons and to prevent adverse discrimination against any population
group with respect to charges for, or necessary use of, insured services. At the same time, the Act accents a partnership
between the providers of insured services and provincial plans, requiring that provincial plans have in place reasonable
systems of payment or compensation for their medical practitioners in order to ensure reasonable access to users. I want
to emphasize my intention to respect provincial prerogatives regarding the organization, licensing, supply, distribution
of health manpower, as well as the resource allocation and priorities for health services. I want to assure you that the reasonable access provision will not be used to intervene or interfere directly in matters such as the physical and geographic
availability of services or provincial governance of the institutions and professions that provide insured services. Inevitably,
major issues or concerns regarding access to health care services will come to my attention. I want to assure you that my
Ministry will work through and with provincial/territorial Ministers in addressing such matters.
My aim in communicating my intentions with respect to the criteria in the Canada Health Act is to allow us to work
together in developing our national health insurance scheme. Through continuing dialogue, open and willing exchange
of information and mutually understood rules of the road, I believe that we can implement the Canada Health Act without acrimony and conflict. It is my preference that provincial/territorial Ministers themselves be given an opportunity to
interpret and apply the criteria of the Canada Health Act to their respective health care insurance plans. At the same time,
I believe that all provincial/territorial Health Ministers understand and respect my accountability to the Parliament of
Canada, including an annual report on the operation of provincial health care insurance plans with regard to these
fundamental criteria.
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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 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].
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Annex B — Policy Interpretation Letters
Regulations
Aside from the recognition and information regulations referred to above, the Act provides for regulations concerning
hospital services exclusions and regulations defining extended health care services.
As you know, the Act provides that there must be consultation and agreement of each and every province with respect
to such regulations. My consultations with you have brought to light few concerns with the attached draft set of
Exclusions from Hospital Services Regulations.
Likewise, I did not sense concerns with proposals for regulations defining Extended Health Care Services. These help provide greater clarity for provinces to interpret and administer current plans and programs. They do not alter significantly
or substantially those that have been in force for eight years under Part VI of the Federal Post-Secondary Education and
Health Contributions Act (1977). It may well be, however, as we begin to examine the future challenges to health care
that we should re-examine these definitions.
This letter strives to set out flexible, reasonable and clear ground rules to facilitate provincial, as much as federal,
administration of the Canada Health Act. It encompasses many complex matters including criteria interpretations,
federal policy concerning conditions and proposed regulations. I realize, of course, that a letter of this sort cannot
cover every single matter of concern to every provincial Minister of Health. Continuing dialogue and communication
are essential.
In conclusion, may I express my appreciation for your assistance in bringing about what I believe is a generally accepted
concurrence of views in respect of interpretation and implementation. As I mentioned at the outset of this letter, I would
appreciate an early written indication of your views on the proposals for regulations appended to this letter. It is my
intention to write to you in the near future with regard to the voluntary information exchanges which we have discussed
in relation to administering the Act and reporting to Parliament.
Yours truly,
Jake Epp
Attachments
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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 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.
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Annex B — Policy Interpretation Letters
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.
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.
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Annex B — Policy Interpretation Letters
In closing, I would like to quote Mr. Justice Emmett M. Hall. In 1980, he reminded us:
“we, as a society, are aware that the trauma of illness, the pain of surgery, the slow decline to death, are burdens
enough for the human being to bear without the added burden of medical or hospital bills penalizing the patient
at the moment of vulnerability.”
I trust that, mindful of these words, we will continue to work together to ensure the survival, and renewal, of what is
perhaps our finest social project.
As the issues addressed in this letter are of great concern to Canadians, I intend to make this letter publicly available
once all provincial Health Ministers have received it.
Yours sincerely,
Diane Marleau
Minister of Health
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Annex C — Dispute Avoidance and Resolution Process Under the Canada Health Act
Annex C
Dispute Avoidance and Resolution Process
Under the Canada Health Act
In April 2002, the Honourable A. Anne McLellan outlined
in a letter to her provincial and territorial counterparts a
Canada Health Act Dispute Avoidance and Resolution
process, which was agreed to by provinces and territories,
except Quebec. The process meets federal and provincial/
territorial interests of avoiding disputes related to the interpretation of the principles of the Canada Health Act, and
when this is not possible, resolving disputes in a fair, transparent and timely manner.
The process includes the dispute avoidance activities
of government-to-government information exchange;
discussions and clarification of issues, as they arise; active
participation of governments in ad hoc federal/provincial/
territorial committees on Canada Health Act issues; and
Canada Health Act advance assessments, upon request.
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.
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.
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Annex C — Dispute Avoidance and Resolution Process Under the Canada Health Act
Minister of Health
Ministre de la Santé
Ottawa, Canada K1A 0K9
April 2, 2002
The Honourable Gary Mar, M.L.A.
Minister of Health and Wellness
Province of Alberta
Room 323, Legislature Building
Edmonton, Alberta
T5K 2B6
Dear Mr. Mar:
I am writing in fulfilment of my commitment to move forward on dispute avoidance and resolution as it applies to
the interpretation of the principles of the Canada Health Act.
I understand the importance provincial and territorial governments attach to having a third party provide advice
and recommendations when differences occur regarding the interpretation of the Canada Health Act. This feature
has been incorporated in the approach to the Canada Health Act Dispute Avoidance and Resolution process set out
below. I believe this approach will enable us to avoid and resolve issues related to the interpretation of the principles
of the Canada Health Act in a fair, transparent and timely manner.
Dispute Avoidance
The best way to resolve a dispute is to prevent it from occurring in the first place. The federal government has rarely
resorted to penalties and only when all other efforts to resolve the issue have proven unsuccessful. Dispute avoidance
has worked for us in the past and it can serve our shared interests in the future. Therefore, it is important that governments continue to participate actively in ad hoc federal/provincial/territorial committees on Canada Health Act issues
and undertake government-to-government information exchange, discussions and clarification on issues as they arise.
Moreover, Health Canada commits to provide advance assessments to any province or territory upon request.
Dispute Resolution
Where the dispute avoidance activities between the federal government and a provincial or territorial government prove
unsuccessful, either Minister of Health involved may initiate dispute resolution by writing to his or her counterpart.
Such a letter would describe the issue in dispute. If initiated, dispute resolution will precede any action taken under
the non-compliance provisions of the Act.
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Annex C — Dispute Avoidance and Resolution Process Under the Canada Health Act
As a first step, governments involved in the dispute will, within 60 days of the date of the letter initiating the process, jointly:
collect and share all relevant facts;
prepare a fact-finding report;
negotiate to resolve the issue in dispute; and
prepare a report on how the issue was resolved.
If, however, there is no agreement on the facts, or if negotiations fail to resolve the issue, any Minister of Health involved
in the dispute may initiate the process to refer the issue to a third party panel by writing to his or her counterpart.
Within 30 days of the date of that letter, a panel will be struck. The panel will be composed of one provincial/territorial
appointee and one federal appointee who, together, will select a chairperson. The panel will assess the issue in dispute
in accordance with the provisions of the Canada Health Act, will undertake fact-finding and provide advice and recommendations. It will then report to the governments involved on the issue within 60 days of appointment.
The Minister of Health for Canada has the final authority to interpret and enforce the Canada Health Act. In deciding
whether to invoke the non-compliance provisions of the Act, the Minister of Health for Canada will take the panel’s
report into consideration.
Public Reporting
Governments will report publicly on Canada Health Act dispute avoidance and resolution activities, including any
panel report.
I believe that the Government of Canada has followed through on its September 2000 Health Agreement commitments
by providing funding of $21.1 billion in the fiscal framework and by working collaboratively in other areas identified
in the agreement. I expect that provincial and territorial premiers and health ministers will honour their commitment
to the health system accountability framework agreed to by First Ministers in September 2000. The work of officials
on performance indicators has been collaborative and effective to date. Canadians will expect us to report on the full
range of indicators by the agreed deadline of September 2002. While I am aware that some jurisdictions may not be
able to fully report on all indicators in this timeframe, public accountability is an essential component of our effort to
renew Canada’s health care system. As such, it is very important that all jurisdictions work to report on the full range
of indicators in subsequent reports.
In addition, I hope that all provincial and territorial governments will participate in and complete the joint review
process agreed to by all Premiers who signed the Social Union Framework Agreement.
The Canada Health Act Dispute Avoidance and Resolution process outlined in this letter is simple and straightforward.
Should adjustments be necessary in the future, I commit to review the process with you and other Provincial/Territorial
Ministers of Health. By using this approach, we will demonstrate to Canadians that we are committed to strengthening
and preserving medicare by preventing and resolving Canada Health Act disputes in a fair and timely manner.
Yours sincerely,
A. Anne McLellan
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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.
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 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.
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.
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.
Canada Health Act Annual Report, 2005–2006
241
242
Canada Health Act Annual Report, 2005–2006
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 time-limited 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.
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.
Canada Health Act Annual Report, 2005–2006
243
Annex D — Glossary
Term
Description
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 communitybased 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 outof-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).
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.
244
Canada Health Act Annual Report, 2005–2006
Annex D — Glossary
Term
Description
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 out-of-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 optedout 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.
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.
Canada Health Act Annual Report, 2005–2006
245
Annex D — Glossary
Term
Description
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.
246
Canada Health Act Annual Report, 2005–2006
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) 729-6130
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
Department of Health and Social Services
1075 Sainte-Foy Road, 5th Floor
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
www.gov.nu.ca/hss.htm
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