Her Excellency, the Right Honourable Adrienne Clarkson,

Her Excellency, the Right Honourable Adrienne Clarkson,
Minister of Health
Ministre de la Santé
The Honourable/L'honorable Pierre S. Pettigrew
Ottawa, Canada K1A 0K9
December, 2003
Her Excellency, the Right Honourable Adrienne Clarkson,
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, 2003.
Pierre S. Pettigrew
Preface
The late Justice Emmett M. Hall referred to Canada’s Medicare with the words:
“Our proudest achievement in the well-being of Canadians has been in asserting that illness is burden
enough in itself. Financial ruin must not compound it. That is why Medicare has been called a sacred
trust and we must not allow that trust to be betrayed.”
The adoption of the Canada Health Act is an important achievement in the evolution of Canada’s health
care system. The Act puts into words our commitment to a universal, publicly funded health care system
based on the needs of Canadians, not their ability to pay. The five principles of the Act are the
cornerstone of the Canadian health care system, and they reflect the values that inspired our system.
April 1, 2004, will mark the 20th anniversary of the Act.
In 2003, the provincial premiers and territorial leaders reached a historic agreement with Canada’s
former Prime Minister, the Right Honourable Jean Chrétien, to improve the quality, accessibility and
sustainability of our public health care system. On this occasion, the first ministers reaffirmed their
commitment to the five principles of public health insurance in Canada: universality, accessibility,
portability, comprehensiveness and public administration.
Our goal in administering the Act is to work with the provinces and territories in a cooperative, fair and
open manner, to ensure that the principles of our public health insurance system continue to serve
Canadians wherever they may live in Canada.
This report to Parliament on the administration and operation of the Act provides detailed information on
the provincial and territorial health care insurance plans for the fiscal year ending March 31, 2003. While
some concerns exist with respect to compliance with the Act, discussions to address these issues
continue, and I am satisfied that, for the most part, provincial and territorial health care insurance plans
meet the criteria and conditions of the Act. Moreover, I am pleased to confirm that deductions made to
the province of Nova Scotia under section 20 of the Act came to an end in November 2003.
Pierre S. Pettigrew
Minister of Health
Canada Health Act Annual Report, 2002-2003
i
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 Health and Social Services
Nova Scotia Department of Health
New Brunswick Department of Health and Wellness
Ministère de la Santé et des Services sociaux du Québec
Ontario Ministry of Health and Long-Term Care
Manitoba Health
Saskatchewan Health
Alberta Health and Wellness
British Columbia Ministry of Health Services
British Columbia Ministry of Health Planning
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, 2002-2003
iii
Table of Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Table of Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
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 2002-2003 . . . . . . . . . . . . . . . . . 15
Newfoundland and Labrador . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Prince Edward Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Nova Scotia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
New Brunswick. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Quebec . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Ontario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Manitoba. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Saskatchewan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Alberta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
British Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Yukon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Northwest Territories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Nunavut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Annex A – Provincial and Territorial Health Care Insurance Plan Statistics . . . . . . . . . . . . . . . . . . . . . . 181
Newfoundland and Labrador . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Prince Edward Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Nova Scotia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
New Brunswick. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Ontario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Manitoba. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Saskatchewan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Alberta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
British Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Yukon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Northwest Territories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Nunavut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Annex B – Canada Health Act and Extra-Billing and User Charges Information Regulations . . . . . . . . 281
Annex C – Policy Interpretation Letters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Annex D – Dispute Avoidance and Resolution Process under the Canada Health Act . . . . . . . . . . . . . 317
Annex E – Evolution of Federal Health Care Transfers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Annex F – Glossary of Terms Used in the Annual Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
How to Contact Provincial and Territorial Departments of Health . . . . . . . . . . . . . . . . . . . inside back cover
Canada Health Act Annual Report, 2002-2003
v
Introduction
The five principles of the Canada Health Act are the cornerstone of the Canadian health care system,
and reflect the values that inspired Canada’s single-payer, publicly-financed health care system, over 40
years ago. This legislation, passed unanimously by Parliament in 1984, affirms the federal government’s
commitment to a universal, accessible, comprehensive, portable and publicly administered health
insurance system. The Act aims to ensure that all residents of Canada have access to necessary
hospital and physician services on a prepaid basis. The Canada Health Act defines for the provinces and
territories the criteria and conditions that they must satisfy in order to qualify for their full share of federal
transfers under the Canada Health and Social Transfer (CHST).
This report is produced in accordance with the requirement set out in section 23 of the Canada Health Act:
“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.”
Under the Canada Health Act, the federal Minister of Health is required to provide information on the
operation of provincial and territorial health care plans as they relate to the criteria and conditions of the
Act. The approach to this information gathering has been collaborative, where provinces, territories and
the federal government have worked together to supply the information needed by the Minister.
Chapter 1 provides an overview of the Canada Health Act and the associated regulations and policies
that are used in the administration of the Act. Chapter 2 reviews the administration of the Canada Health
Act during 2002-2003, and includes a summary of compliance issues addressed and deductions levied.
Chapter 3 presents descriptions of the provincial and territorial health insurance plans for the year
ending March 31, 2003. The annexes to this report provide additional information relevant to the
administration of the Act and its place in the Canadian health care system.
Annex A presents statistical data for each province and territory on insured hospital, physician and
surgical dental health care services. Annex B is an office consolidation of the Canada Health Act and its
regulations (unofficial version dated June 2001). Annex C presents the text of two key policy statements
that clarify the federal interpretation of the criteria and conditions of the Canada Health Act (text originally
contained in letters from federal Health Minister to provincial and territorial counterparts). Annex D
provides a description of the Canada Health Act Dispute Avoidance and Resolution process which came
into effect in 2002. Annex E describes the evolution of federal transfers for health care in Canada. Annex
F provides a glossary of terminology used in this report. Inside the back cover you will find contact
information for provincial and territorial departments of health.
Canada Health Act Annual Report, 2002-2003
1
Chapter 1 – Canada Health Act Overview
“The principles of the Canada Health Act began as simple conditions attached to federal funding for
medicare. Over time, they became much more than that. Today, they represent both the values
underlying the health care system and the conditions that governments attach to funding a national
system of public health care. The principles have stood the test of time and continue to reflect the
values of Canadians.”
(Roy J. Romanow, Q.C. November, 2002)
In this chapter, the Canada Health Act, its
requirements and key definitions under the Act
are discussed. Also described are the
regulations and regulatory provisions of the
Canada Health Act and the interpretation letters
by former federal Ministers of Health Jake Epp
and Diane Marleau to their provincial and
territorial counterparts that are used in the
interpretation and application of the Act.
Persons excluded under the Canada Health Act
include serving members of the Canadian
Forces or Royal Canadian Mounted Police and
inmates of federal penitentiaries.
What is the Canada Health Act?
Insured health services are medically
necessary hospital, physician and surgicaldental services provided to insured persons.
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 Canada Health 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 and Social Transfer (CHST).
The aim of the Canada Health Act is to ensure
that all eligible residents of Canada have
reasonable access to medically necessary
insured services on a prepaid basis, without
direct charges at the point of service for such
services.
Key Definitions under the CHA
Insured persons are eligible residents of a
province or territory. A resident of a province is
defined in the Canada Health Act as “a person
Canada Health Act Annual Report, 2002-2003
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.”
Insured hospital services are defined under
the Canada Health 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
3
Chapter 1 – Canada Health Act Overview
hospital setting is required to properly perform
the procedure.
Extended health care services as defined in
the Canada Health Act are certain aspects of
long-term residential care (nursing home
intermediate care and adult residential care
services), and the health aspects of home care
and ambulatory care services.
Requirements of the Canada
Health Act
The Canada Health Act contains the following
nine requirements that the provinces and
territories must fulfill to qualify for the full federal
cash contributions:
‰
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 charge provisions that
apply only to insured health services.
The Criteria
1. Public Administration (section 8 of CHA)
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
Canada Health 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 which require a
hospital setting] and, where the law of the
4
province so permits, similar or additional
services rendered by other health care
practitioners.
3. Universality (section 10)
Under the universality criterion, all insured
residents of a province or territory must be
entitled to the insured health services
provided by the provincial or territorial health
care insurance plan on uniform terms and
conditions. Provinces and territories
generally require that residents register with
the plans to establish entitlement.
Newcomers to Canada, such as landed
immigrants or Canadians returning from
other countries to live in Canada, may be
subject to a waiting period by a province or
territory, not to exceed three months, before
they are entitled to receive insured health
services.
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
one 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,
Canada Health Act Annual Report, 2002-2003
Chapter 1 – Canada Health Act Overview
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 their province or territory.
5. Accessibility (section 12)
The intent of the accessibility criterion is to
ensure 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 extrabilling) or other means (e.g., discrimination
on the basis of age, health status or financial
circumstances). In addition, the health care
insurance plans of the province or territory
must provide:
‰
reasonable compensation to physicians
and dentists for all the insured health
services they provide; and
‰
payment to hospitals to cover the cost of
insured health services.
Reasonable access in terms of physical
availability of medically necessary services
has been interpreted under the Canada
Health Act using the “where and as
available” rule. Thus, residents of a province
or territory are entitled to have access on
uniform terms and conditions to insured
health services at the setting “where” the
services are provided and “as” the services
are available in that setting.
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 Canada
Health Act.
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 Extra-billing and User
Charges Information Regulations described
below.
Extra-billing (section 18)
Under the Canada Health 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 surgicaldentist 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.
User Charges (section 19)
The Canada Health 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, the fee would be considered a user
charge. User charges are not permitted under
the Act as, like extra-billing, they constitute a
barrier or impediment to access.
2. Recognition (section 13(b)) — the
provincial and territorial governments shall
recognize the federal financial contributions
toward both insured and extended health
care services.
Canada Health Act Annual Report, 2002-2003
5
Chapter 1 – Canada Health Act Overview
Other Elements of the Act
Regulations (section 22)
Section 22 of the Canada Health Act enables
the federal government to make regulations for
the administration of the Act in the following
areas:
‰
defining the services included in the CHA
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 from a province or territory to qualify
for a full federal transfer;
‰
prescribing how provinces and territories are
required to give recognition to the Canada
Health and Social Transfer in their
documents, advertising or promotional
materials.
The only regulations in force under the Act are
the Extra-billing and User Charges Information
Regulations, which require the provinces and
territories to provide estimates of extra-billing
and user charges prior to the beginning of a
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. (A copy of these regulations is provided
in Annex B).
Penalty Provisions of the Canada Health Act
Mandatory Penalty Provisions
Under the Canada Health Act, provinces and
territories that allow extra-billing and user
charges are subject to mandatory dollar-fordollar deductions from the federal transfer
payments under the CHST. For example, if it
has been determined that a province has
allowed $500,000 in extra-billing by physicians,
the federal transfer payments to that province
would be reduced by that amount.
Discretionary Penalty Provisions
Non-compliance with one of the five criteria or
two conditions of the Canada Health Act is
subject to discretionary penalties. The amount
6
of any deduction from federal transfer payments
under the CHST 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 in the Act, not all
Canadian residents or health services fall under
the scope of the Act. There are two categories
of exclusion for insured services:
‰
services which fall outside the definition of
insured health services (definition on page
3); and
‰
certain services and groups of persons are
excluded from the definitions for insured
services and insured persons.
These exclusions are discussed below.
Non-Insured Health Services
In addition to the medically necessary insured
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 may be 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
Canada Health Act Annual Report, 2002-2003
Chapter 1 – Canada Health Act Overview
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,
persons serving a term of imprisonment within a
federal penitentiary, and persons who have not
completed a minimum period of residence in a
province or territory (a period that must not
exceed 3 months). In addition, the definition of
“insured health services” excludes services to
persons provided under any other Act of
Parliament (e.g., foreign 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 Canada Health 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 Health
Ministers to their provincial and territorial
counterparts. Both letters are reproduced in
Annex C of this report.
Epp Letter
In June 1985, approximately one year following
the passage of the Canada Health Act in
Parliament, then-federal Health Minister Jake
Canada Health Act Annual Report, 2002-2003
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.
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 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.
7
Chapter 1 – Canada Health Act Overview
Dispute Avoidance and
Resolution Process
In April 2002, the Honourable A. Anne McLellan
outlined in a letter to her provincial and territorial
counterparts a Canada Health Act Dispute
Avoidance and Resolution process, which was
agreed to by provinces and territories, except
Quebec. The process meets federal and
provincial/territorial interests of avoiding
disputes related to the interpretation of the
principles of the Canada Health Act, and when
this is not possible, resolving disputes in a fair,
transparent and timely manner.
The process includes the dispute avoidance
activities of government-to-government
information exchange; discussions and
clarification of issues, as they arise; active
participation of governments in ad hoc
federal/provincial/ territorial committees on
Canada Health Act issues; and Canada Health
Act advance assessments, upon request.
Where dispute avoidance activities prove
unsuccessful, dispute resolution activities may
be initiated, beginning with government-togovernment 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.
Please refer to Annex D for a copy of Minister
McLellan’s letter.
8
Canada Health Act Annual Report, 2002-2003
Chapter 2 – Administration and Compliance
Administration
‰
disseminating information on the CHA and
on publicly funded health care insurance
programs in Canada;
In administering the Canada Health Act (CHA),
the Minister is assisted by Health Canada
policy, communications and information officers
located in Ottawa and in regional offices of the
Department and by lawyers with the Department
of Justice.
‰
responding to information requests and
correspondence relating to the CHA; and
‰
conducting issue analysis and policy
research in order to provide policy options
and recommendations to the Minister
concerning the principles of the CHA.
Health Canada takes its responsibilities under
the Canada Health Act seriously. We work with
the provinces and territories to ensure that the
principles of the CHA are respected. Our
preference is always to work with provinces and
territories to resolve issues through consultation,
collaboration and cooperation.
During 2002-2003, the Division reviewed
several new issues concerning provincial and
territorial compliance with the CHA. These
issues of concern are described in the next
section. In addition, the Division was or
continues to be involved in the following:
‰
collaboration with provincial and territorial
health department representatives on the
Interprovincial Health Insurance Agreements
Coordinating Committee (see below);
‰
implementation of the Dispute Avoidance and
Resolution process for addressing issues
related to the interpretation of the CHA
principles;
‰
collaboration with provincial and territorial
health departments on the supply, demand
and delivery of magnetic resonance imaging
and computed tomography services in
Canada;
‰
provide information on the Canadian health
care insurance system in support for various
federal reports and Commissions
(Commission on the Future of Health Care in
Canada; Senate Standing Committee on
Social Affairs, Science and Technology;
Auditor General of Canada Status Report on
Federal Support for Health Care Delivery);
‰
production of a revised electronic edition of
the Additional Benefits Information System,
developed in collaboration with provincial
and territorial officials as a means of sharing
information on publicly-funded health care
services that are outside the scope of the
CHA; and
‰
preparation of responses to ministerial and
other enquiries about the CHA and health
insurance issues received by telephone, mail
and the Internet, from the public, members of
Parliament, government departments,
stakeholder organizations and the media.
During 2002-2003, the Division responded to
The Canada Health Act Division
The Canada Health Act Division (the Division) is
part of the Intergovernmental Affairs Directorate
of the Health Policy Branch at Health Canada
and is responsible for administering the CHA.
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 charge provisions of
the CHA;
‰
working in partnership with provinces and
territories to investigate and resolve CHA
compliance issues and pursue activities that
encourage compliance with the CHA;
‰
informing the Minister of possible noncompliance and recommending appropriate
action to resolve the issue;
‰
developing and producing the Canada
Health Act Annual Report on the
administration and operation of the CHA;
‰
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;
Canada Health Act Annual Report, 2002-2003
9
Chapter 2 – Administration and Compliance
more than 2,000 such enquiries. Media
relations staff within the Branch also
responded to a number of media enquiries
related to the CHA. The Division also makes
information concerning the CHA and other
health insurance topics available via the
Internet at :
http://www.hc-sc.gc.ca/medicare
Interprovincial Health Insurance Agreements
Coordinating Committee
The Canada Health Act Division chairs the
Interprovincial Health Insurance Agreements
Coordinating Committee (previously named the
Federal-Provincial/Territorial Coordinating
Committee on Reciprocal Billing), and acts as a
secretariat for the Committee. The Committee
was formed in 1991 to deal with 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
CHA.
interprovincial/territorial and signing them is not
a requirement of the CHA.
In fall 2001, the committee mandated a working
group to consult with the Canadian Institute for
Health Information (CIHI) to update in-patient
hospital billing rates for reciprocal billing
purposes using the latest financial and statistical
data available. These are the rates provinces
and territories use to process claims for hospital
services provided to out-of-province/territory
residents. The new rates were implemented in
summer 2002 to better reflect actual costs of
hospital services received across the country. In
conjunction with CIHI, a steering committee was
formed in fall 2002 to review technical and
administrative issues pertaining to the
implementation of a Cost Per Weighted Case
Methodology upon which to base interprovincial
billing rates for insured in-patient services. The
IHIACC is also working on revising and updating
out-patient service rates.
Compliance
The Committee members, who are
representatives from Ontario, Quebec, and the
eastern and western provinces (and territories),
meet three times a year. In addition, conference
calls are held as necessary. The Committee
contacts, who are representatives from each
province and territory, meet with the members
once a year. All meetings provide a forum for
both information sharing and collaborative
problem-solving.
Health Canada’s approach to resolving possible
compliance issues emphasizes transparency,
consultation and dialogue with provincial and
territorial health care authorities. In most
instances, issues are successfully resolved
through consultation and discussion based on a
thorough examination of the facts.
The interprovincial/territorial portability
provisions of the CHA are implemented through
a series of bilateral reciprocal billing agreements
between provinces and territories for hospital
and physician services. This generally means
that a patient’s health card will be accepted, in
lieu of payment, when the patient receives
hospital or physician services in another
province or territory. The province or territory
providing the service will then directly bill the
patient’s home province. All provinces and
territories participate in reciprocal hospital
agreements and all, with the exception of
Quebec, participate in reciprocal medical
agreements. The intent of these agreements is
to ensure that Canadian residents do not face
point-of-service charges for medically required
hospital and physician services when they travel
in Canada. However, these agreements are
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.
10
Deductions have only been applied when all
options to resolve the issue have been
exhausted. To date, almost all disputes and
issues related to the administration and
operation of the CHA have been addressed and
resolved without resorting to deductions.
Health Canada officials routinely 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 CHA. Examples of sources of this
Canada Health Act Annual Report, 2002-2003
Chapter 2 – Administration and Compliance
information are: officials representing provincial
and territorial governments; media reports,
provincial and territorial government publications
and correspondence from the public and other
groups and individuals.
Staff in the Compliance Unit, Canada Health Act
Division, assess issues of concern or
complaints on a case-by-case basis. The
assessment process involves compiling all facts
and information related to the issue and taking
appropriate necessary action. Verification of the
facts with provincial and territorial health officials
may reveal issues that are not directly related to
the CHA while others may pertain to the CHA
but are a result of misunderstanding or
miscommunication and are resolved quickly with
provincial assistance. In instances where a CHA
issue has been identified and remains after
initial enquiries, Division officials would 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.
was intervening to stop these charges,
Health Canada asked Quebec to confirm that
the matter had been resolved. Quebec
officials have informed Health Canada that
they were investigating this issue and that, if
necessary, appropriate action would be
taken. Under the CHA, any province that
permits charges to insured persons for
medically necessary hospital and physician
services are in non-compliance and
vulnerable to mandatory dollar-for-dollar
deductions.
‰
In 2002, Health Canada learned that two
specialist referral clinics in British Columbia
had been established. These clinics offer
consultations with physician specialists for a
fee for patients who choose to bypass their
family physicians to obtain a referral for
specialized treatment. These clinics may also
coordinate diagnostic and/or surgical
procedures, which result from the
consultations. In March 2003, a one-time
deduction of $4,610 was made to British
Columbia’s Canada Health and Social
Transfer (CHST) payment in respect of the
two instances of user charges levied at a
private surgical clinic during 2000-2001.
Another patient reportedly paid $6,000 for
surgery at a private surgical clinic in 2003.
This issue is the subject of ongoing
discussion with British Columbia officials.
‰
In 2002, Health Canada learned that a
Saskatchewan doctor was performing bone
density scans following donations to a
foundation. Health Canada is concerned that
patients may be required to make a donation
in order to receive a medically necessary
service. This issue is the subject of ongoing
discussion with Saskatchewan.
‰
Tray or disposable materials fees are direct
charges to patients by physicians for
medical/surgical supplies in the provision of
some medically required services.
Legislation passed in Manitoba in 1999 and
2001 prohibits user charges in accredited
surgical facilities, but continues to permit
charging tray fees in physician offices and
medical clinics. This issue is currently under
review and the subject of ongoing discussion
with Manitoba.
Compliance Issues Arising in 2002-2003
For the following issues, further information and
analysis is required by Health Canada before a
determination of compliance with the CHA can
be made.
Drugs administered in hospital
‰
Health Canada is concerned about patient
payments for drugs administered in hospital
out-patient clinics and their appropriateness
under the CHA. The concern is illustrated by
provincial decisions to cover the drug
Remicade under their provincial pharmacare
program rather than their hospital insurance
program when the drug is administered in
hospital out-patient clinics. In order to better
understand the provincial rationale for their
policy decision, Health Canada officials
initiated a fact-finding process with the
provinces in 2002-2003.
User charges and extra-billing
‰
Health Canada is concerned about private
surgical clinics that allow individuals to
privately pay for medically necessary insured
services and thus jump the queue. Following
media reports indicating that the province
Canada Health Act Annual Report, 2002-2003
In addition to these current issues, Health
Canada is continuing to review, monitor and
assess the impact and implications of a number
of other health issues.
11
Chapter 2 – Administration and Compliance
Deductions and Refunds
During fiscal year 2002-2003, a monthly
deduction of $2,451 was applied to Nova
Scotia’s transfer payments under the CHST. The
province was in a position of CHA noncompliance with the federal policy on private
clinics for refusing to cover the facility fees
charged to patients at an abortion clinic. As well,
a one-time deduction of $4,610 was applied to
the March 2003 CHST payment to British
Columbia, as a result of CHA non-compliance in
respect of user charges at a surgical facility.
History of Deductions under the Canada
Health Act
The CHA, 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
user charges and extra-billing, 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 CHA provided for deductions in
respect of these charges to be refunded to the
province if the charges were eliminated before
April 1, 1987. By March 31, 1987, it was
determined that all provinces, which had extrabilling and user charges, had taken appropriate
steps to eliminate them. Accordingly, by June
1987, a total of $246.7 million in deductions
were refunded to New Brunswick ($6.886M),
Quebec ($14.032M), Ontario ($108.656M),
Manitoba ($1.279M), Saskatchewan ($2.107M),
Alberta ($29.032M) and British Columbia
($84.749M).
Following the CHA’s initial three-year transition
period, under which refunds to provinces and
territories for deductions were possible,
penalties under the CHA 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
12
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 extrabilling under the CHA. For the period between
May 1994 until extra-billing by physicians was
banned when British Columbia’s Medicare
Protection Act came into effect in September
1995, deductions totalling $2.025 million were
applied against British Columbia’s transfer
payments.
In January 1995, then federal Health Minister
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 CHA.
Accordingly, beginning in November 1995,
deductions were made from transfer payments
to Alberta, Manitoba, Nova Scotia and
Newfoundland for non-compliance with the
federal policy on private clinics.
During the period from November 1995 to July
1996, total deductions of $3.585 million were
made from the Alberta transfer 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 $267,000 was deducted
from Newfoundland’s transfer payment before
these charges were eliminated, effective
January 1, 1998. Total deductions from
Manitoba’s transfer payments amounted to
$2,056,000 and ended with the confirmed
elimination of user charges at surgical and
ophthalmology clinics, effective
January 1, 1999.
Including the March 2003 deductions, total
deductions applied to all provinces in
contravention of the federal policy on private
clinics since October 1995 have totalled
Canada Health Act Annual Report, 2002-2003
Chapter 2 – Administration and Compliance
$6,626,766. This includes total deductions of
$362,565 from Nova Scotia.
Many other issues have been resolved over the
years without applying penalties. Examples of
these include: charges at discharge planning
units in British Columbia; de-insurance for nonpayment of premiums in British Columbia; and,
denial of registration for residents without social
insurance numbers in Prince Edward Island. In
each instance, discussion and negotiation at the
official level were instrumental in bringing these
matters to a satisfactory conclusion.
Canada Health Act Annual Report, 2002-2003
13
Chapter 3 – Provincial and Territorial Health
Care Insurance Plans in 2002-2003
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 20022003.
Officials in the provincial, territorial and federal
governments have worked together to provide
and review the information. The information
submitted to Health Canada for this report by
each provincial and territorial department of
health consists of three components:
‰
a narrative description of the provincial or
territorial health care system relating to the
five criteria and the first condition of the
Canada Health Act, which can be found in
the following pages of this chapter;
‰
documents which confirm compliance with
the five criteria and both conditions of the
Canada Health Act; and
‰
statistics identifying trends in the provincial
and territorial health care systems which are
included as part of Annex A of this report.
The first two components are used to assist with
the monitoring and compliance of provincial and
territorial health care plans with respect to the
requirements of the Canada Health Act, while
the last component serves to identify and
analyze current and future trends in the
Canadian health care system.
To assist provinces and territories in determining
what information to include in their submissions
to the report, Health Canada has developed a
Users’ Guide for Submissions to Health
Canada. This guide is revised annually and is
designed to help provinces in meeting the
reporting requirements of Health Canada. This
Guide was developed through discussion with
provincial and territorial officials and specifies
the information requested for each criterion of
the Act. Annual revisions to the guide are based
upon an analysis by Health Canada of health
plan descriptions from previous annual reports
and an assessment of emerging issues relating
Canada Health Act Annual Report, 2002-2003
to insured health services. The Users’ Guide
also provides examples drawn from previous
annual reports to illustrate the organization and
type of information required for each reporting
area.
The process for reporting to Health Canada for
the current annual report was launched in a
federal- provincial-territorial conference call held
in April 2003, where a timetable was established
for providing information to Health Canada and
for the production of the report.
Following the federal-provincial-territorial
teleconference, Health Canada officials
corresponded with health officials in each
provincial and territorial government to identify
particular information areas requiring
improvement in the report. Letters were sent to
all provinces and territories identifying issues
that were to be addressed in their sections of
the report.
Additionally, in spring 2003, Health Canada
officials met with health department officials in
Nova Scotia, Ontario and Manitoba to discuss
the process for the preparation of the Canada
Health Act Annual Report and those areas of
the provincial sections of the report that could
be expanded or improved upon. Health Canada
appreciates the collaboration of these provinces
and hopes to build on that collaboration through
meetings with other provinces and territories in
the coming years.
Insurance Plan Descriptions
For the following chapter, provincial and
territorial officials were asked to provide a
narrative description of their health insurance
plan according to 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 in support of insured and extended
health care services and a section outlining the
range of extended health care services in their
jurisdiction; where extended health care
15
Chapter 3 – Provincial and Territorial Health Care Insurance Plans in 2002-2003
includes nursing home intermediate care
services, adult residential care services, home
care services and ambulatory health care
services.
Provinces and territories were also requested to
include in their narrative a list of published
documents and materials that relate to the five
criteria of the Canada Health Act and to the
recognition condition. These documents, or
Additional Materials, include health care
insurance legislation, regulations, audit and
evaluation reports, annual reports of health
departments and other documents that permit
Health Canada to ensure that provinces and
territories are in compliance with the criteria and
conditions of the Canada Health Act.
Please note that for the Canada Health Act
Annual Report, 2002-2003, Quebec submitted a
description of its health insurance plan
according to the format used previous to fiscal
year 1999-2000. Quebec does not provide
information in the manner and detail requested
by Health Canada, as noted in the preface to
Quebec’s narrative.
‰
the creation of 17 Family Medicine Groups in
Quebec as part of a new approach to
medical practice that will improve access to
family practitioners while ensuring a more
responsible use of the health care system by
individuals;
‰
the continuation of Telehealth Ontario, which
provides access to experienced nurses
delivering health advice and information
across Ontario 24 hours a day, seven days a
week. This helps ensure that emergency
departments are used for real emergencies.
By March 31, 2003, approximately 1.9 million
calls had been made to Telehealth Ontario
since services began in 2001;
‰
the opening of CancerCare in Manitoba.
CancerCare is a 205,000 square foot worldclass facility for treatment, education and
research with an on-site laboratory for the
Manitoba Institute of Cell Biology;
‰
the launch of the Saskatchewan surgical
Web site (www.sasksurgery.ca) in January
2003, where patients can obtain information
on how long they may expect to wait for their
particular procedure;
‰
the implementation of the Provincial Personal
Health Identifier (PPHI) in Alberta. This
identifier is unique to each person and
remains the same over the person’s lifetime.
The PPHI can be used to collect
demographic information and is a key
foundation in the development of Alberta’s
electronic health record system;
‰
the implementation of a comprehensive, coordinated and strategic approach to rural
doctor issues in British Columbia will ensure
equitable access to medical services for
residents, regardless of where they live;
‰
a variety of recruitment and retention
initiatives implemented in Yukon, including a
Physician Relocation Fund which assists with
relocation costs for family physicians
recruited to Yukon, with a return-in-service
commitment to the territory;
‰
the investment of an additional $8.3 million in
human resources for the health and social
services system in the Northwest Territories.
The new resources create 42 new positions
for nurses, physicians, nurse practitioners
and midwives as well as training and
mentorship programs for current health
professionals; and
‰
the upgrade of Nunavut’s five existing
telehealth sites and the addition of 10
Improvements to Accessing Health Care
Services
During 2002-2003, provinces and territories
continued to implement initiatives to ensure and
enhance access by residents to insured health
services. Examples of this include:
‰
contributions of $300,000 in the 2002 budget
from the Newfoundland and Labrador
government to increase the number of
students accepted to the Bachelor of Nursing
Collaborative Program by 32 students;
‰
the introduction of an MRI unit at the Queen
Elizabeth Hospital in Prince Edward Island in
January 2003 and a linear accelerator at the
PEI Cancer Treatment Centre in May 2003;
‰
an increase in funding of $5 million from
Nova Scotia to the Capital District Health
Authority to increase cardiac surgery and
cardiac catheterization capability as a means
of decreasing wait times;
‰
16
continuing strategies in New Brunswick to
increase recruitment of newly licensed family
practitioners and specialists. This strategy
includes the purchase of five additional seats
at the University of Sherbrooke’s medical
school in September 2002;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Provincial and Territorial Health Care Insurance Plans in 2002-2003
telehealth communities to its network
allowing the delivery of a broad range of
services, including: specialist consultation
services such as dermatology, psychiatry
and internal medicine; rehabilitation services;
regularly scheduled counselling sessions,
family visitation, and continuing medical
education.
Canada Health Act Annual Report, 2002-2003
17
Newfoundland and Labrador
Introduction
‰
rising salaries and fees in other provinces
that cause pressure for raises in
Newfoundland and Labrador;
Fourteen regional boards operate most health
services in Newfoundland and Labrador. Of
these, eight are institutional health boards, four
are health and community services boards and
two are integrated boards, delivering both
institutional and community services. Included in
the eight institutional boards are a provincial
board for cancer services and a regional board
for nursing homes, both located in St. John’s.
‰
the need for more investment in early
intervention and prevention in order to
promote wellness;
‰
increased demands for home support
services;
‰
a need to expand community mental health
services; and
‰
high rates of heart disease, cancer and
diabetes together with high rates of smoking,
obesity, alcohol consumption and inactivity.
The provincial government appoints health
boards, whose members serve as volunteers.
These boards are responsible for delivering
health services to their regions and, in some
cases, to the province as a whole, interacting
with the public 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 Newfoundland and Labrador almost 20,000
health care providers and administrators provide
health services to the 512,000 residents.
Healthier Together: A Strategic Health Plan for
Newfoundland and Labrador was released in
September 2002 following extensive provincial
consultation. This plan outlines the objectives
and goals of the health system over the next
four years. The Plan includes a Wellness
Strategy, a Primary Health Care Strategy, a
Mental Health Service Strategy, a Long Term
Care and Supportive Services Strategy and a
Location of Services Strategy.
Planning for the future of the province’s health
care system requires a clear understanding of
the main challenges. These are:
‰
rapidly rising costs that threaten the
affordability of Medicare;
‰
demographic trends including a declining
population, an aging population that
generally requires more services than
younger groups, and a trend toward
migration from rural to urban areas;
‰
the cost of new drugs and advanced
technologies;
Canada Health Act Annual Report, 2002-2003
Healthier Together outlines three priority goals:
wellness, community capacity building and
sustainability, and quality for the health system.
Additional information about Healthier Together
and health care in Newfoundland and Labrador
is available on the Web site of the Department
of Health and Community Services at:
www.gov.nf.ca/health/
Highlights of Initiatives in 2002-2003
The total Health and Community Services
budget for 2002-2003 was $1.5 billion, raising
health and community services expenditures to
approximately 45 percent of all government
program expenditures.
For 2002-2003, expenditures to
March 31, 2003, for major capital projects for
health facilities were $28 million.
The Province continues its investment in
expanding the implementation of Picture
Archiving and Communications System
technology in the province. Other health
information and communication technology
initiatives include a Unique Patient Identifier, a
Client Registry, a Pharmacy Network and the
Client Payment Module.
A total of $1.1 million was committed to
wellness initiatives in keeping with the themes
identified in Healthier Together.
A Primary Health Care Advisory Council was
announced and an Office of Primary Health
19
Chapter 3 – Newfoundland and Labrador
Care was established to develop a provincial
primary care framework.
Government has provided $1.4 million this year
under the Give to Feel Good Campaign with the
St. John’s Health Care Corporation’s Health
Foundation. This funding brings total payments
to $23.6 million towards a $25 million
commitment.
Government appointed the province’s first Child
and Youth Advocate who will focus on public
programs and services that affect children and
youth under 19 years of age.
In 2002-2003 there were total expenditures of
$1.7 million under the Early Childhood
Development and National Child Benefit
initiatives, including further enhancement of
Autism services and Family Resource
Programs.
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
Health care insurance plans managed by the
Department of Health and Community Services
include the Hospital Insurance Plan and the
Medical Care Plan (MCP). Both plans are nonprofit and are audited by the Auditor General of
the Province.
The Hospital Insurance Agreement Act,
amended in 1994, is the legislation that enables
the Hospital Insurance Plan. The Act provides
that the Minister may make Regulations for the
provision of insured services upon 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) was
assented to on December 14, 1999, and came
into force on April 1, 2000. This Act empowers
the Minister to administer a plan of medical care
insurance for residents of the province. It allows
for the development of Regulations to ensure
that the provisions of the statute meet the
requirements of the Canada Health Act as it
relates to the administration of the medical care
insurance plan.
20
There have been no legislative amendments to
the Medical Care Insurance Act (1999) or the
Hospital Insurance Agreement Act in
2002-2003. The Hospital Insurance Regulations
were amended in February 2003 to include
x-ray services ordered by Chiropractors as an
insured service.
The MCP 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 MCP operates in accordance with the
provisions of the Medical Care Insurance Act,
(1999) and Regulations, and in compliance with
the criteria of the Canada Health Act.
1.2
Reporting Relationship
The Department of Health and Community
Services is mandated with the administration of
the Hospital Insurance and Medical Care Plans.
The Department reports on these plans through
the regular legislative processes, e.g. Public
Accounts.
During 2002-2003, work continued on
implementation of the Government’s
Accountability Framework. The focus has been
on developing an appropriate method of
strategic planning, to achieve uniformity in
approach from public bodies and, in the case of
health boards, congruence between their
respective strategic plans and Healthier
Together. Direction has been given, by
March 31, 2005, to fully implement the
Framework by the public bodies that report to
the Government.
Health Scope, Reporting to Newfoundlanders
and Labradorians on Comparable Health and
Health System Indicators was released in
September 2002. It reported to the public on a
wide range of indicators.
1.3
Audit of Accounts
Each year the Province’s Auditor General
performs an independent examination of
provincial public accounts. MCP expenditures
are now considered a part of the public
accounts. The Auditor General has full and
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Newfoundland and Labrador
unrestricted access to the MCP records.
Hospital boards are subject to Financial
Statement Audits, Reviews and Compliance
Audits. Financial Statement Audits are
performed by independent auditing firms that
are selected by the boards under the terms of
the Public Tendering Act. Review engagements,
compliance audits and physician audits are
carried out by personnel from the Department of
Health and Community Services under the
authority of the Newfoundland Medical Care
Insurance Act (1999). Physician records and
professional medical corporation records are
reviewed to ensure that the record supports the
service billed and that the service is insured
under the Medical Care Plan.
Beneficiary audits are performed by personnel
from the Department of Health and Community
Services under the Medical Care Insurance Act
(1999). Individuals are randomly selected on a
bi-weekly basis.
2.0 Comprehensiveness
2.1
Insured Hospital Services
The Hospital Insurance Agreement Act (1990)
and the Hospital Insurance Regulations 742/96
(1996) provide for insured hospital services in
Newfoundland and Labrador.
Insured hospital services are provided for inand out-patients in 32 facilities (15 hospitals and
17 community health centres) and 17 nursing
stations. Insured in-patient services include:
‰
accommodation and meals at the standard
ward level;
‰
nursing services;
‰
laboratory, radiological and other diagnostic
procedures;
‰
drugs, biologicals and related preparations;
‰
medical and surgical supplies, operating
room, case room and anaesthetic facilities;
‰
rehabilitative services (e.g. physiotherapy,
occupational therapy, speech language
pathology and audiology);
‰
out-patient and emergency visits; and
‰
day surgery.
Canada Health Act Annual Report, 2002-2003
Coverage policy for insured hospital services is
linked to the coverage policy for insured
physician services, although there is no
formalized process. Ministerial direction is
required to add to or to de-insure a hospital
service from the list of insured services. The
Department of Health and Community Services
manages the process.
In February 2003, x-ray services ordered by
Chiropractors were added to the list of insured
hospital services covered by the Newfoundland
and Labrador health care insurance plan.
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 include:
‰
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 to practise in
the province.
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,1 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
1
The Medical Care Insurance Act (1999) defines
“participating physician” as a physician who has not
made an election, under subsection 7(3), to collect
payments in respect of insured services rendered by
him or her to residents, otherwise than from the
Minister.
21
Chapter 3 – Newfoundland and Labrador
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).”
For purposes of the Act, the following services
are covered:
‰
all services properly and adequately
provided by physicians to beneficiaries
suffering from an illness requiring medical
treatment or advice;
‰
group immunizations or inoculations carried
out by physicians at the request of the
appropriate authority; and
‰
diagnostic and therapeutic x-ray and
laboratory services in facilities approved by
the appropriate authority that are not
provided under the Hospital Insurance
Agreement Act and Regulations made under
the Act.
There are no limitations on the services
covered, provided they qualify under one or
more of the conditions listed above.
No services were deleted in 2002-2003 from the
list of insured physician services covered by the
Newfoundland and Labrador health care
insurance plan.
22
Ministerial direction is required to add to or to
de-insure a physician service from the list of
insured services. This process is initiated
following consultation by the Department with
various stakeholders, including the provincial
medical association. The Department of Health
and Community Services manages the process
and public consultation is involved.
2.3
Insured Surgical-Dental Services
The provincial Surgical-Dental Program is a
component of the MCP. Surgical-dental
treatments properly and adequately provided to
a beneficiary and carried out in a hospital by a
dentist are covered by the MCP if the treatment
is of a type specified in the Surgical-Dental
Services Schedule.
All dentists licensed to practise in Newfoundland
and Labrador and who have hospital privileges
are allowed to provide surgical-dental services.
The dentist’s licence is issued by the
Newfoundland Dental Licensing Board.
Dentists may opt out of the Plan. These dentists
must advise the patient of their opted-out status,
stating the fees expected, and providing the
patient with a written record of services and
fees charged. One dentist is currently in an
opted-out category.
Because the Surgical-Dental Program is a
component of the MCP, management of the
Program is linked to the MCP with regard to
changes to the list of insured services. The
Department of Health and Community Services
manages the process.
Addition of a surgical-dental service to the list of
insured services must be approved by the
Department of Health and Community Services.
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
prior to admission or upon discharge;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Newfoundland and Labrador
‰
private duty nursing arranged by the patient;
‰
‰
non-medically required x-rays or other
services for employment or insurance
purposes;
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 the purpose
of determining whether new or replacement
glasses or contact lenses are required;
‰
drugs (except anti-rejection and AZT drugs)
and appliances issued for use after
discharge from hospital;
‰
bedside telephones, radios or television sets
for personal, non-teaching use;
‰
fibreglass splints;
‰
services covered by Workers’ Compensation
legislation or by other federal or provincial
legislation; and
‰
the fees of a dentist, oral surgeon or general
practitioner for routine dental extractions
performed in hospital;
‰
services relating to therapeutic abortions
performed in non-accredited facilities or
facilities not approved by the Newfoundland
Medical Board.
‰
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 of Canada;
‰
consultation required by hospital Regulation;
‰
therapeutic abortions performed in the
province at a facility not approved by the
Newfoundland Medical Board;
The use of the hospital setting for any services
deemed not insured by the Medicare Plan would
also be uninsured under the Hospital Insurance
Plan.
For purposes of the Medical Care Insurance Act
(1999), the following is a list of non-insured
physician services:
‰
any advice given by a physician to a
beneficiary by telephone;
‰
‰
the dispensing by a physician of medicines,
drugs or medical appliances and the giving
or writing of medical prescriptions;
sex reassignment surgery, when not
recommended by the Clarke Institute of
Psychiatry;
‰
in-vitro fertilization and OSST (ovarian
stimulation and sperm transfer);
‰
reversal of previous sterilization procedure;
‰
surgical diagnostic or therapeutic procedures
not provided in facilities other than those
listed in the Schedule to the Hospitals Act or
approved by the appropriate authority under
paragraph 3(d); and
‰
other services not within the ambit of section
3 of the Act.
‰
the 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 diagnosis
of the illness proposed to be treated by
acupuncture;
Canada Health Act Annual Report, 2002-2003
All diagnostic services (e.g. laboratory services
and x-ray) are performed within public facilities
in the province. Hospital policy on 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
23
Chapter 3 – Newfoundland and Labrador
the hospitals providing those services in
consultation with service providers.
Surgical-dental and other services not covered
by the Surgical-Dental Program are the
dentist’s, oral surgeon’s or general practitioner’s
fees for routine dental extractions in hospital.
3.0 Universality
3.1
Eligibility
Residents of Newfoundland and Labrador are
eligible for coverage under the provincial health
care program.
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. As the administrator of the
Regulations, the MCP has established rules to
ensure that the Regulations are applied
consistently and fairly in processing
applications.
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 Armed Forces and Royal
Canadian Mounted Police personnel;
‰
inmates of federal prisons; and
‰
armed forces personnel of other countries
who are stationed in the province.
24
3.2
Registration Requirements
Registration under the Medical Care Plan
(MCP) and possession of a valid MCP card are
required in order to access insured services.
New residents are advised to apply for coverage
as soon as possible upon arrival in
Newfoundland and Labrador.
It is the parent’s responsibility to register a
newborn or adopted child. The parents of a
newborn child will be given a registration
application upon discharge from hospital.
Applications for newborn coverage will require,
in most instances, a parent’s valid MCP number.
A birth or baptismal certificate will be required
where the child’s surname differs from the
parents’ surname.
Applications for coverage of an adopted child
will require a copy of the official adoption
documents, the birth certificate of the child, or a
Notice of Adoption Placement from the
Department of Health and Community Services.
Applications for coverage of a child adopted
outside Canada will require Permanent Resident
documents for the child.
As of April 15, 2003, there were 560,644 active
beneficiaries registered with the MCP.
3.3
Other Categories of Individual
Foreign workers, clergy and dependants of
North Atlantic Treaty Organization personnel are
eligible for benefits. Holders of Minister’s
Permits are also eligible, subject to MCP
approval.
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
and the Royal Canadian Mounted Police and
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Newfoundland and Labrador
released inmates of federal penitentiaries. For
coverage to be effective, however, registration is
required under the MCP. Immediate coverage is
provided to persons from outside Canada who
are authorized to work in the province for one
year or more.
4.2
medical and hospital care coverage during
absences include:
‰
prior to leaving the province for extended
periods, a resident must contact the MCP to
obtain an out-of-province coverage
certificate;
‰
beneficiaries leaving for vacation purposes
may receive an initial out-of-province
coverage certificate of up to 12 months’
duration. Upon return, beneficiaries are
required to reside in the province for a
minimum four consecutive months.
Thereafter, certificates will only be issued for
up to eight months’ 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 of up to
12 months’ coverage. Verification of
employment may be required;
‰
persons must not establish residence in
another province, territory or country while
maintaining coverage under the
Newfoundland Medical Care Plan;
‰
for out-of-province trips of 30 days or less,
an out-of-province coverage certificate is not
required, but will be issued upon request;
‰
for out-of-province trips lasting more than 30
days, a certificate is required as proof of a
resident’s ability to pay for services while
outside the province; and
‰
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.
Coverage During Temporary
Absences in Canada
Newfoundland and Labrador is a party to the
Agreement on Eligibility and Portability with
regards to 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
Department of Health and Community Services
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
Province has entered into formal agreements,
i.e. the Hospital Reciprocal 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, highcost procedures and out-patient services are
payable based on national rates agreed to by
provincial and territorial health plans.
With the exception of Quebec, medical services
incurred in all provinces or territories are paid
through the Medical Reciprocal Agreement at
host province or territory rates. Claims for
medical services received in Quebec are
submitted by the patient to the MCP for
payment at host province rates.
In order to qualify for out-of-province coverage,
a beneficiary must comply with the legislation
and MCP rules regarding residency in
Newfoundland and Labrador. A resident must
reside in the province at least four consecutive
months in each 12 month period to qualify as a
beneficiary. Generally, the rules regarding
Canada Health Act Annual Report, 2002-2003
Insured residents moving permanently to other
parts of Canada are covered up to and including
the last day of the second month following the
month of departure. Coverage is immediately
discontinued when residents move permanently
to other countries.
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-
25
Chapter 3 – Newfoundland and Labrador
patient services are covered for emergency,
sudden illness and elective procedures at
established rates. Hospital services will be
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.
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.
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.
5.2
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 of Health and
Community Services. The referring physicians
must contact the Department or the MCP for
prior approval.
Prior approval is not required for physician
services; however, it is suggested that
physicians obtain prior approval from the Plan
so that patients may be made aware of any
financial implications. General practitioners and
specialists may request prior approval on behalf
26
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 coinsurance charges for insured hospital services
and no extra-billing by physicians in the
province.
Access to Insured Hospital Services
As of March 31, 2003, Newfoundland and
Labrador had 1,677 staffed hospital beds in 15
hospitals, 17 community health centres and 17
nursing stations.
The supply of health professionals is a high
priority issue in this province, especially in rural
areas. Through the Provincial Health and
Community Services Human Resource Planning
Committee, a major human resource planning
exercise has been underway for the last few
years. The work of this committee will result in
an integrated human resource plan for the
province. The exercise will identify a planning
model to provide five-year forecasts of the
demand and supply of various health human
resources.
There is a health care workforce of nearly
19,000 individuals in Newfoundland and
Labrador. Half of this workforce belongs to
regulated professional groups.
There are now approximately 50 Nurse
Practitioner positions in the province, with a
small number of specialist positions in tertiary
care.
Nursing initiatives include: a Northern Incentive
package for nurses in remote and northern
locations; a Nurse Practitioner Bursary Program,
which provides funding of up to $5,000 to each
of the nurses enrolled in the Nurse Practitioner
training program; the Rural Nursing Incentive
Program, which offers payment of up to $1,500
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Newfoundland and Labrador
to fourth year Bachelor of Nursing students; and
the annual Government Bursary in Nursing
Administration for Masters of Nursing graduates
in the amount of $500.
Research is ongoing with projects funded by
Human Resources Development Canada and
the Canadian Health Services Research
Foundation. Included are a project on the
impacts of health care restructuring, human
resource studies and operational reviews.
Newfoundland and Labrador is a member of the
Atlantic Consortium for Research Utilization in
Nursing and is participating as a pilot site with
Health Canada to test a human resource
simulation model for Registered Nurses and
Licensed Practical Nurses.
Shortages continue in other professional
groups, such as pharmacy, physiotherapy,
speech language pathology, audiology and
occupational therapy, as well as psychology.
Focussed recruitment and incentive programs
such as bursaries and seat purchases are in
place.
discussion paper, Building a Healthier Future,
the provincial strategic health plan.
With regard to the availability of selected
diagnostic, medical, surgical and treatment
equipment and services in facilities providing
insured hospital services:
‰
Magnetic Resonance Imaging (MRI) is
located in St. John’s;
‰
Computed Tomography (CT) scanners are
available in St. John’s, Carbonear,
Clarenville, Gander, Grand Falls/Windsor,
Corner Brook, St. Anthony and Happy
Valley/Goose Bay;
‰
renal dialysis is provided in St. John’s,
Clarenville, Grand Falls/Windsor, Corner
Brook and Stephenville;
‰
cancer treatment is provided at the
Dr. H. Bliss Murphy Cancer Centre,
St. John’s, and satellite clinics in Gander,
Grand Falls/Windsor, Corner Brook and
St. Anthony;
‰
approximately 80 percent of surgery services
are provided in St. John’s, Gander, Grand
Falls/Windsor, Corner Brook and St. Anthony.
A full range of basic and some sub-specialty
surgical services is available in all locations.
Tertiary surgery, e.g. trauma, cardiac and
neuro, is available in St. John’s only; and
‰
an additional 20 percent of surgery services
is provided in six mid-sized hospitals at
Carbonear, Clarenville, Burin, Stephenville,
Happy Valley/Goose Bay and Labrador City.
These facilities offer basic surgical services.
In Budget 2002, Government provided $300,000
to the Bachelor of Nursing Collaborative
Program, to increase, by at least 32, the
number of students accepted into the program.
Government provided $800,000 to the Health
Care Corporation of St. John’s to establish a
psychiatric assessment/short stay unit in
St. John’s.
$2.7 million has been committed to enable
home support clients and agencies to increase
the wages of home support workers by four
percent.
An additional $1.3 million was allocated to
personal care homes and clients to increase the
number of subsidies for individuals and increase
rates to personal care homes.
Service improvements have been made in
programs such as cardiac care and pediatric
care. Since April 2000, approximately $7 million
has been invested to increase the number of
weekly cardiac surgeries and a second cardiac
catheterization laboratory has been set up to
reduce patient wait times for diagnostic testing
associated with heart disease.
5.3
Access to Insured Physician and
Surgical-Dental Services
The number of physicians practising in the
province is relatively stable. The Department of
Health and Community Services is committed to
working with regional health boards to develop a
human resource plan for physicians based on
the principle of access to services.
Improvement in salary scales and retention
bonuses for salaried physicians reflective of
geography have been implemented to improve
rural recruitment. Premiums on hospital-based
services provided by general practitioners in
rural hospitals have also been applied.
Government announced public consultations on
the Provincial Health Charter, as released in the
Canada Health Act Annual Report, 2002-2003
27
Chapter 3 – Newfoundland and Labrador
Service levels and accessibility (wait time)
issues are monitored by regional health boards
with adjustments made as required, such as
increasing the number of cardiac surgeries
performed weekly.
health services include fee-for-service, salary,
contract and sessional block funding.
During 2002-2003, 11 new physicians in the
province had previously received financial
assistance from either the Travelling Fellowship
Program, the Medical Specialist Resident
Bursary Program, the Medical Student and
Resident Practice Incentive Program or the
Psychiatry Resident Bursary Program. A total of
40 awards were issued to students and
residents in different years of training in that
year.
The Department of Health and Community
Services is responsible for funding regional
boards for ongoing operations and capital
purchases. Funding for insured services is
provided to the boards as an annual global
budget and is distributed in 12 monthly advance
payments. Payments are made to regional
boards in accordance with the Hospital
Insurance Agreement Act (1990) and the
Hospitals Act. As part of their accountability to
the Government, boards 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.
A new Provincial Physician Recruitment office
became operational at the Memorial University
of Newfoundland Medical School.
With regard to surgical-dental services, four
certified dental surgeons and one non-certified
oral surgeon practised in the province. A total of
21 general-practice dentists have hospital
privileges.
5.4
Physician Compensation
The legislation governing payments to
physicians and dentists for insured services is
the Medical Care Insurance Act (1999).
Compensation agreements are negotiated
between the provincial government and the
Newfoundland and Labrador Medical
Association (NLMA), with involvement of the
Newfoundland and Labrador Health Boards
Association, using traditional and formalized
negotiation methods. The Physician Services
Liaison Committee was formed in October 2002
to provide a mechanism whereby medical
issues of mutual concern can be addressed
cooperatively between the Government and the
NLMA. The dispute resolution mechanism
agreed to is mediation. Government and the
Medical Association agreed to binding
arbitration in October 2002 to conclude an
agreement for the next three years. The Medical
Association Agreement Act, passed on
December 19, 2002, required that the decision
of the arbitration board would be final and
binding on the Province and the Association.
5.5
Payments to Hospitals
Throughout the fiscal year, the health boards
may forward additional funding requests to the
Department of Health and Community Services
for changes in program areas or increased
workload volume. These requests will be
reviewed and, if approved by the Department,
funded at the end of each fiscal year. Any
adjustments to the annual funding level, such as
for negotiated salary increases, additional
approved positions or program changes, are
funded based on the implementation date of
such increases and the cash flow requirement in
a given fiscal year.
Boards 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. Boards are continuing to work with
the Department of Health and Community
Services to address these issues and provide
effective, efficient and quality health services.
The current methods of remuneration to
compensate physicians for providing insured
28
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Newfoundland and Labrador
6.0 Recognition Given to Federal
Transfers
Funding provided by the federal government
through the Canada Health and Social Transfer
has been recognized and reported by the
Government of Newfoundland and Labrador
through press releases, government Web sites,
and various other documents. For fiscal
2002-2003, these documents included:
‰
the 2002-2003 Public Accounts Volume I;
‰
the Estimates 2003-2004; and
‰
the Budget Speech 2003.
These reports, tabled by the Government to 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
Newfoundland and Labrador has established
long-term residential and community-based
programs as alternatives to hospital services.
These programs are provided by seven regional
boards. Services include the following:
Nursing Home Services
Long-term residential accommodations are
provided for clients requiring high levels of
nursing care in 18 community health centres
and 19 nursing homes. There are approximately
2,800 beds located in these 37 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 of
Health and Community Services.
Personal Care Homes
Persons requiring protective oversight or
minimal assistance with activities of daily living
can avail themselves of residential services in
Canada Health Act Annual Report, 2002-2003
personal care homes. There are approximately
2,400 beds located in 110 homes across the
province. These homes are operated by the
private for-profit sector. Residents pay a
maximum of $1,110 per month, based on an
individual client assessment using standardized
financial criteria. In 2002-2003, an additional 66
subsidies were provided under a five-year plan
to enable more elderly people to access this
type of residential service.
Home Care Services
Home care services include professional and
non-professional supportive care to enable
people to remain in their own homes for as long
as possible without risk. Professional services
include nursing and some rehabilitative
programs. These services are publicly funded
and delivered by staff employed with six
regional boards.
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 current
ceiling for home support services 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 other equipment.
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 provided
coverage for the ingredient portion of benefit
prescription items. Any additional cost, such as
dispensing fees, are the client’s responsibility.
Income support recipients are eligible for the
Social Services Drug Plan, which covers the full
29
Chapter 3 – Newfoundland and Labrador
cost of benefit prescription items, including a set
markup amount and dispensing fee.
Other Programs
The Department of Health and Community
Services administers the Emergency Air and
Road Ambulance Programs through the
Emergency Health Services Division. The Air
Ambulance Program provides transportation
and medical care to patients within the province,
and to hospitals outside the province where
warranted. Air Ambulance will also transport
patients, medical staff and equipment to and
from isolated communities when required. The
Road Ambulance Program provides medical
care and transportation to residents accessible
by road at a reasonable cost to the user. User
fees are charged for both Road and Air
Ambulance Program use.
covered under the Dental Health Plan must pay
a co-payment amount directly to the dentist for
each service provided (e.g. fillings, extractions,
etc.), with the exception of examinations, dental
cleanings, fluoride applications, radiographs and
retention pins for fillings. In circumstances
where the beneficiary is receiving income
support, the co-payment is paid by the Dental
Health Plan.
8.0 Additional Materials
Submitted to Health Canada
Healthier Together: A Strategic Health Plan for
Newfoundland and Labrador
http://www.gov.nl.ca/health/strategichealthplan/
pdf/HealthyTogetherdocument.pdf
Residents who travel by commercial air to
access medically necessary insured services
that are not available within their area of
residence or within the province, may qualify for
financial assistance under the Medical
Transportation Assistance Program. This
program is administered by the Department of
Health and Community Services. Kidney donors
and bone marrow/stem-cell donors are eligible
for financial assistance, as administered by the
Health Care Corporation of St. John’s, when the
recipient is a Newfoundland and Labrador
resident eligible for coverage under the
Newfoundland Hospital Insurance and Medical
Care Plans.
Public Accounts (2002-2003)
The Dental Health Plan incorporates a children’s
dental component and a social assistance
component. The children’s program covers the
following dental services for all children up to
and including the age of 12: examinations at
6-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 under
the social assistance component to recipients of
social assistance 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 social assistance are eligible for
emergency care and extractions. Beneficiaries
Medical Association Agreement Act
30
http://www.gov.nl.ca/ComptrollerGeneral/pubs.htm
Budget 2002-2003 (address presented
3-21-2002). Supporting documents include:
‰
highlights;
‰
estimates; and
‰
the Economy 2002.
http://www.gov.nf.ca/Budget2003/
Building a Healthier Future: A Public Discussion
Paper on a Provincial Health Charter
http//www.gov.nf.ca/health/pdfiles/
HealthCharter2003.pdf
http://www.gov.nf.ca/hoa/statutes/m04-1.htm
Canada Health Act Annual Report, 2002-2003
Prince Edward Island
Introduction
The Ministry of Health and Social Services is a
very large and complex system of integrated
services that protect, maintain and improve the
health and well-being of Islanders.
The continued sustainability of the system is a
primary concern. Spending on health and social
services has grown rapidly in recent years to 42
percent of total provincial government program
expenditures. At this rate of growth, spending
could reach 50 percent of overall spending
within the next five years. The availability of
health professionals is also affecting our ability
to sustain services.
We are concerned about the high rate of
chronic conditions in our province: conditions
such as cardiovascular disease, cancer,
diabetes and mental illness. Wellness initiatives
will assist Islanders to increase acceptance of
responsibility for their health and to reach their
full health potential. This will be achieved
through community partnerships to promote
healthy lifestyles and reduce risk factors for
chronic disease, and through increased access
to primary health services that support disease
prevention and management.
Recruitment, retention and human resource
planning will remain a priority to ensure an
adequate supply and appropriate mix of health
and social service professionals to meet
changing needs. Retention initiatives are
supported by comprehensive workplace
wellness programs to promote organizational
excellence, positive personal health practices
and safe, positive workplaces.
Overview of the Health and Social
Services 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. Many other
health and social services are funded in whole,
or in part, by the provincial government.
Canada Health Act Annual Report, 2002-2003
The system includes a wide range of integrated
health and social services such as acute care,
addictions, mental health, social assistance and
housing services. Some specialty services such
as cardiac surgery and neurotrauma services
are within the purview of the regional health
care system.
In December 2002, the PEI health system
underwent restructuring. The Provincial Health
Services Agency was created to administer all
acute care hospital services including cancer
treatment, mental health and addictions. The
Eastern Kings and Southern Kings Regional
Health Authorities were merged to form the
Kings Regional Health Authority.
Facilities
PEI has two referral hospitals and five
community hospitals, with a combined total of
474 beds. Along with seven government manors
that house 546 long-term care nursing beds,
Islanders have access to an additional 407 beds
in private nursing homes. The system also
operates several addictions and mental health
facilities, 1,167 seniors’ housing units and 461
family housing units.
Construction of a new $50 million health facility
will be completed in Summerside in fall 2003.
Computed Tomograhpy (CT) scanning and a
wide range of diagnostic imaging services are
available at the referral hospitals. New linear
accelerator and MRI services are now
operational.
Human Resources
The public sector health and social services
workforce has approximately 4,000 employees.
Prince Edward Island has 200 health care
professionals per 10,000 residents, compared
with the national average of 182 per 10,000.1
Structure
The system includes the Department of Health
and Social Services, the Provincial Health
Services Agency (PHSA) and four Regional
1
Canadian Institute for Health Information, 1997.
31
Chapter 3 – Prince Edward Island
Health Authorities, which are governed by the
Regional Health Boards. The Department works
with the Regional Health Authorities and the
PHSA to establish system goals and objectives,
develop policy and outcome standards and
allocate resources. The Regional Health
Authorities plan and deliver primary health care
and social services. The PHSA is responsible
for the delivery of acute care services.
Financial Resources
During the past 10 years, provincial spending on
health and social services increased from $270
million to more than $410 million in 2002-2003,
an average increase of about five percent per
year. Increased costs are due to inflation,
population growth, new technologies and the
increasing use of services by all age groups.
Major health and social services expenditures
are allocated to: Hospital Services, 31 percent;
Social Services, 21 percent; Long Term Care,
10 percent; Physician Services, 12 percent; and
other services such as Provincial Drug
Programs, Public Health Nursing and Addiction
Services, 26 percent.
population growth, the availability of new drugs
and technology and increasing public
expectations. Residents are asking for more
doctors, nurses, drugs, technology and family
services. They want access to care in their own
communities. They are also concerned about
wait-lists for services. While rising expectations
are creating pressure to increase spending on
acute care, they are severely limiting the ability
of the system to innovate and shift resources to
other areas of need.
Increasing public expectation is a very critical
issue. Demand alone cannot drive the system.
The public must become more informed about
reasonable access and the need for real
changes in the way services are delivered,
particularly in primary health services.
Appropriate access to primary health
services
Critical Issues
There is growing evidence that investments in
primary health services have a great impact on
health and sustainability. Primary health
services are those that people access first and
most often, such as family physician services,
public health nursing, screening programs,
addiction services and community mental health
services.
Supply of health professionals
Personal health practices
Maintaining an adequate supply of workers is
one of the most critical issues facing the
system. Recruitment and retention of skilled
employees are expected to be a challenge
throughout the labour market in coming years
due to a major demographic shift. The effect of
this trend is being felt first in the health sector,
which is labour-intensive and depends on a
specialized workforce, and particularly in lesspopulated areas such as Prince Edward Island.
The supply of health professionals is now
decreasing as the workforce ages, the number
of people retiring increases and the supply of
available health care graduates declines. To
address this issue, the system must increase its
focus on workplace wellness and human
resource planning to ensure an adequate supply
and the right mix of health professionals to meet
changing needs.
Public expectation and demand
The demand for services is increasing in almost
every area for a variety of reasons, including
32
Individuals who understand and accept
responsibility for their health are more able to
take control of and improve their health.
People’s capacity to accept responsibility for
their health is influenced by social and
economic conditions. Comprehensive strategies
are needed to address these conditions. It is
critical that the health system increase its
capacity to work with others to assist
individuals, families and communities to accept
responsibility for, and achieve, good health.
Aging population
As baby boomers age, we will experience the
biggest demographic shift in history. It is
expected that the proportion of the population
aged 65 and over in Prince Edward Island will
increase from 13 percent today to 15 percent in
2011 and to 27 percent in 2036. This will affect
the health system in several ways. The
incidence of diseases such as cancer, heart
disease, diabetes and dementia is expected to
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Prince Edward Island
increase. Demand is expected to rise for acute
care, long-term care, home care, mental health
and other services. This issue becomes more
critical when we consider that the health
workforce will be aging at the same time, there
will be fewer family members to support their
aging parents, and the amount of resources
required to sustain services for seniors could
negatively affect other government services that
support health. It is critical that the health
system be prepared to meet these changing
needs.
Disease prevention and management
Many diseases are preventable. For example,
meningitis can be prevented through
vaccination. The spread of sexually transmitted
diseases can be prevented through responsible
sexual behaviour. Many chronic conditions are
also preventable. Risk factors for cardiovascular
disease and cancer can be reduced or
eliminated through education and supports that
result in a change in lifestyle.
The World Health Organization suggests that
diabetes is rising in epidemic proportions
worldwide. Prince Edward Island had 17 new
cases of diabetes diagnosed each month in the
mid-1970s, compared with 45 cases per month
in the mid-1990s. It is projected that this number
will grow to 65 cases per month in 2006. There
is clear and undisputable evidence that effective
blood sugar control can prevent or delay the
onset of serious complications from diabetes,
such as heart disease, blindness and kidney
disease, which have enormous human and
financial costs. The prevalence of cancer and
diabetes in this province is expected to increase
significantly as the population ages. It is
imperative that our system step up its efforts to
assist Islanders to prevent, delay and manage
these conditions.
Diagnostic Services Insurance Act (1988), which
insures services as defined under section 2 of
the Canada Health Act.
Under Part I of the 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;
‰
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
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 and Social
Services, is the vehicle for the delivery of
hospital care insurance in Prince Edward Island.
The enabling legislation is the Hospital and
Canada Health Act Annual Report, 2002-2003
33
Chapter 3 – Prince Edward Island
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;
‰
‰
‰
‰
‰
appoint medical practitioners with the duty
and power to examine and obtain information
from the 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 for the
purchase of 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
respecting the purchasing of 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
respecting the use of such aids and
procedures.
The Health Ministry, through the Department of
Health and Social Services, has the
responsibility for the overall efficiency and
effectiveness of the provincial health system.
Specifically, the Department is responsible for:
‰ setting overall directions and priorities;
34
‰
developing policies and strategies,
legislation, provincial standards and
measures;
‰
monitoring provincial health status;
‰
monitoring and ensuring that the Provincial
Health Services Authority (PHSA) and the
four Regional Health Authorities comply with
Regulations and standards;
‰
evaluating the performance of the health
system;
‰
allocating funds to the PHSA and the four
Regional Health Authorities;
‰
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.
The PHSA and four Regional Health Authorities
are responsible for service delivery as allowed
under the Health and Community Services Act
(1993). The Authorities operate hospitals, health
centres, manors and mental health facilities,
and hire physicians, nurses and other healthrelated workers. Their responsibilities include:
‰ assessing the health needs of residents in
their regions;
‰
providing for the input and advice of their
residents;
‰
allocating and managing resources, setting
priorities, hiring staff and making the best
use of available resources;
‰
consulting with other organizations involved
in the health field;
‰
developing policies, standards and
measures;
‰
planning and coordinating, with the
Department and other authorities, the
delivery of the full range of health services;
‰
promoting health and wellness in their
communities;
‰
making information available to residents on
choices about health and health services;
‰
ensuring reasonable access to health
services; and
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Prince Edward Island
‰
monitoring, evaluating and reporting on
performance to residents and to the Ministry.
In December 2001, Prince Edward Island’s
health regions were awarded accredited status
by the Canadian Council on Health Services
Accreditation. The results of the accreditation
process were announced following a
comprehensive self-assessment process and
surveys conducted in June 2001, by a team of
11 physicians and senior health administrators
from across the country.
1.2
The provincial auditor general, through the Audit
Act, has the discretionary authority to conduct
further audit reviews on a comprehensive or
program-specific basis with respect to the
operations of the Department of Health and
Social Services, as well as the PHSA and each
of the four Regional Health Authorities.
Reporting Relationship
An annual report is submitted by the
Department of Health and Social Services to the
Minister responsible and is tabled by the
Minister in the Legislative Assembly. The Annual
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 PHSA and four Regional Health Authorities
are required under section 24 of the Health and
Community Services Act to submit an annual
report in the fall to the Minister of Health and
Social Services. The Minister has the authority
to request other information as deemed
necessary on the operations of the Regional
Health Authorities and their delivery of health
services in their areas of jurisdiction. Regional
Health Authorities are required to hold annual
public meetings at which information about their
operations and the provision of health services
is presented.
1.3
annually within each region. Audited statements
are also presented to the Legislative Assembly
and included within the published Public
Accounts of the Province of Prince Edward
Island.
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 and Social Services.
Each Regional Health Authority has the
responsibility to engage its own public
accounting firm to conduct annual financial
statement audits. The audited financial
statements are provided to the Ministry and the
Department of the Provincial Treasury. The
reports are presented at public meetings held
Canada Health Act Annual Report, 2002-2003
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, case room and anaesthetic
facilities;
‰
routine surgical supplies; and
‰
radiotherapy and physiotherapy services
performed in hospital.
As of March 2003, there were seven acute care
facilities participating in the province’s insurance
plan. In addition to 454 acute care beds, these
facilities house 20 rehabilitative beds, 19 daysurgery beds, as defined under the Hospitals
Act (1988), and seven insured chronic care
beds. An additional facility, Prince Edward
Home, has 50 insured chronic care beds.
2.2
Insured Physician Services
The enabling legislation that provides for
insured physician services is the Health
35
Chapter 3 – Prince Edward Island
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, 2003, was 204.
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 of 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.
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.
No services were added to the list of insured
physician services in 2002-2003.
The process to add a physician service to the
list of insured services involves negotiation
between the Department of Health and Social
Services and the medical society of the
province.
2.3
Insured Surgical-Dental Services
Dental services are not insured in the 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 office with prior approval as
confirmed by the attending physician.
The addition of a surgical-dental service is
conducted through negotiations with the Dental
Association and the Department of Health and
Social Services.
As of March 31, 2003, no physicians had opted
out of the Health Care Insurance Plan.
2.4
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;
Provincial hospital services not covered by the
Hospital Services Plan include:
‰
‰
‰
36
medically necessary surgical services,
including the services of anaesthetists and
surgical assistants where necessary;
obstetrical services, including pre- and postnatal 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
Uninsured Hospital, Physician and
Surgical-Dental Services
‰
services that persons are eligible for under
other provincial or federal legislation;
‰
mileage or travel, unless approved by the
Department;
‰
advice or prescriptions by telephone, except
anticoagulant therapy supervision;
‰
examinations required in connection with
employment, insurance, education, etc.;
‰
group examinations, immunizations or
inoculations, unless prior approval is
received from the Department;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Prince Edward Island
‰
preparation of records, reports, certificates or
communications, except a certificate of
committal to a psychiatric, drug or alcoholism
facility;
‰
testimony in court;
‰
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
‰
any other services that the Department may,
upon the recommendation of the Medical
Advisory Committee, declare non-insured.
Provincial hospital services not covered by the
Hospital Services Plan include private or special
duty nursing at the patient’s or family’s request;
preferred accommodation at the patient’s
request; hospital services rendered in
connection with surgery purely for cosmetic
reasons; personal conveniences, such as
telephones and televisions; drugs, biologicals,
and prosthetic and orthotic appliances for use
after discharge from hospital; and dental
extractions, except in cases where the patient
must be admitted to hospital for medical
reasons with prior approval of the Department of
Health and Social Services.
The process to de-insure services by the Health
Care Insurance Plan is done in collaboration
with the Medical Society and Department of
Health and Social Services.
All PEI residents have equal access to services.
Third parties such as private insurers or the
Workers’ Compensation Board of Prince Edward
Canada Health Act Annual Report, 2002-2003
Island do not receive priority access to services
through additional payment.
PEI has no formal process to monitor
compliance; however, feedback from physicians,
hospital administrators, medical professionals
and staff allows the Department of Health and
Social Services to monitor usage and service
concerns.
3.0 Universality
3.1
Eligibility
The Health Services Payment Act and
Regulations, section 3, define eligibility to 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 Armed
Forces (CAF), 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 the
following cases: members of the CAF, RCMP
and penitentiary prisoners on discharge, release
or release following the termination of
rehabilitation leave. Where such is granted by
the CAF, the province, where incarcerated or
stationed at time of release or discharge, or the
province where resident on the completion of
rehabilitation leave as may be appropriate, will
provide initial coverage for the customary
waiting period of up to three months. Parolees
37
Chapter 3 – Prince Edward Island
from penitentiaries will be treated in the same
manner as discharged parolees.
Foreign students, tourists, transients or visitors
to Prince Edward Island do not qualify as
residents of the province and are therefore not
eligible for hospital and medical insurance
benefits.
3.2
Registration Requirements
New or returning residents must apply for health
coverage by completing a registration
application from the Department. The
application is reviewed to ensure that all
necessary information is provided. A health card
is issued and sent to the resident within two
weeks. Renewal of coverage takes place every
five years and residents are notified by mail six
weeks prior to renewal.
The number of residents registered for the
health care insurance plan in Prince Edward
Island as of March 31, 2003, was 141,031.
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. There were 61 Kosovar
refugees registered for Medicare as of
March 31, 2003.
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
38
six months plus a day each year in order to be
eligible for sudden illness and emergency
services while absent from the province, as
allowed under section 5.(1)(e) of the Health
Services Payment Act.
The term “temporarily absent” is defined as a
period of absence from the province for up to
182 days in a 12-month period, where the
absence is for the purpose of a vacation, a visit
or a business engagement. Persons leaving the
province under the above circumstances must
notify the Registration Department before
leaving.
Prince Edward Island participates in the Hospital
Reciprocal Billing Agreement and the Medical
Reciprocal Billing Agreement.
The payment rate is $576 per day for hospital
stays. The standard inter-provincial out-patient
rate is $110. The methodology used to derive
these rates is as if the patient had the services
provided on 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.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Prince Edward Island
The amount paid for insured emergency
services outside Canada in 2002-2003 was
$105,531.
4.4
Prior Approval Requirement
Prior approval is required from the Department
before receiving non-emergency out-of-province
medical or hospital services. Prince Edward
Island residents seeking such required services
may apply for prior approval through a PEI
physician. Full coverage may be provided for
(Prince Edward Island-insured) non-emergency
or elective services, provided the physician
completes an application to the Department.
Prior approval is required from the Medical
Director of the Department of Health and Social
Services 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 seven acute care facilities in Prince Edward
Island have a total of 474 (454 acute care and
20 rehabilitative) approved beds. There are also
23 acute care beds providing insured hospital
services in a psychiatric facility. There are no
admission data for these beds. During the
2002-2003 fiscal year, the total number of
in-patient admissions was 16,335. The number
of in-patient days in Prince Edward Island
hospital acute care beds totalled 133,391 days
(excluding newborns), with an average stay of
7.7 days. There are no data available on
admissions, length of stay and in-patient days
for chronic care beds.
Linear Accelerator
In April 2000, the Government announced plans
to expand the range of services that can be
Canada Health Act Annual Report, 2002-2003
provided at the PEI Cancer Treatment Centre,
through the addition of linear accelerator
services. An impact analysis and functional plan
for expanded cancer treatment services has
been completed. Expanded cancer treatment
services are now operational.
Magnetic Resonance Imaging (MRI)
In April 2000, the Government announced that
diagnostic imaging services for Islanders would
be expanded through the purchase of a
Magnetic Resonance Imaging (MRI) unit for the
Queen Elizabeth Hospital. The MRI service
became operational in 2002-2003.
Ambulance Services
Amendments to the Public Health Act related to
emergency medical services and accompanying
Regulations were approved for proclamation
January 1, 2001. This Act provides for
enhancements in administration and delivery of
emergency medical services.
In April 2000, the Government announced the
Out of Province Medical Transport Support
Program to cover a portion of the cost of out-ofprovince ground ambulance transportation. This
program reduces the user fee for eligible Island
residents who need specialized medical care
outside the province.
Accessibility – New Initiatives
The Nurse Recruitment Strategy, announced in
the 2000 PEI Budget, is in its fourth year of the
four-year plan. All strategies have been
implemented in PEI. While the Nurse
Recruitment Strategy addresses all sectors of
health care, priority is given to the institutional
sector, which covers acute and long-term care
services. The Department will be evaluating
results of the strategies.
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 were
undertaken for family physicians, anaesthetists,
radiologists, radiation oncologists, psychiatrists
and a plastic surgeon.
39
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. A three-year agreement is in effect until
March 31, 2004.
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.
5.5
Payments to Hospitals
The PHSA and four Regional Health Authorities
are responsible for the delivery of hospital
services in the province under the Health and
Community Services Act. The financial
(budgetary) requirements are established
annually through consultation with the
Department of Health and Social Services and
are subject to approval by the Legislative
Assembly through the annual budget process.
Payments (advances) to the Regional Health
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 the use of 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 and Social Transfer
in its 2002-2003 Annual Budget and related
budget documents and its 2001-2002 Public
Accounts, which were tabled in the Legislative
40
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, with the exception of the
insured chronic care beds noted in section 2.1.
Extended care services are provided through
the PHSA and four Regional Health Authorities
of the Health and Social Services system.
Nursing home services are available upon
approval from regional admission and
placement committees for placement into
government manors and licensed private
nursing homes. The standardized Services
Assessment Screening Tool is used for
determining service needs of residents for all
admissions to nursing homes. There are 18
government and private nursing home facilities
in the province, with a total of 953 beds,
including respite beds. The Province subsidizes
71 percent of residents in nursing homes as per
the Social Assistance Act Regulations, Part 2.
The federal government subsidizes
approximately eight percent of residents. The
remaining 21 percent of residents finance their
own care. Nursing homes in Prince Edward
Island provide Levels 4 and 5 care.
In addition to nursing home facilities, there are
36 licensed community care facilities in Prince
Edward Island. As of March 31, 2003, the total
number of licensed community care facility beds
was 949. The 35 percent of residents who are
subsidized require a financial assessment as
per the Social Assistance Act, Part 1. The
remaining 65 percent finance their own care.
Community Care facilities provide Levels 1 to 3
care.
Home Care and Support services, also
uninsured, are another component of extended
care. Support services include home care
nursing, visiting homemakers, community
support, adult protection and occupational and
physiotherapy supports. The Senior’s
Assessment 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, but are subject to a budget
cap. Visiting homemaker services are subject to
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Prince Edward Island
a sliding fee scale based on an individual’s
income assessment. The demand for home
care continues to increase in PEI.
8.0 Additional Materials
Submitted to Health Canada
‰
Department of Health and Social Services
Annual Report 2001-2002 (published May
2003)
http://www.gov.pe.ca/photos/original/
hss_ann_2001-02.pdf
‰
Public Accounts 2001-2002
http://www.gov/pe.ca/publications/
findpublications/php3?keyword=public+
account&dept=&month+&year=
‰
Budget 2002-2003
supporting documents include:
-
highlights
-
estimates;
-
papers; and
-
schedules
http://www.gov.pe.ca/budget/
‰
PEI Health Indicators: Provincial and
Regional Common Health Indicators
(published September 2002)
http://www.gov.pe.ca/photos/original/
hss_healthind02.pdf
Canada Health Act Annual Report, 2002-2003
41
Nova Scotia
Introduction
1.0 Public Administration
The management of day-to-day health services
delivery in Nova Scotia is the responsibility of
the Province’s nine District Health Authorities
(DHAs). These DHAs were created under the
Health Authorities Act, which came into effect on
January 1, 2001. The passage of this Act
brought Nova Scotia closer to its goal of
developing an affordable, high-quality,
sustainable health care system.
1.1
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 the implementation of 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
2002-2003 accountability report will be available
in late 2003.
Nova Scotia continues to be committed to the
delivery of medically necessary services that
are consistent with the principles of the Canada
Health Act.
In March 2003, the Department of Health
released a plan for better health care entitled,
“Your Health Matters”. This plan focusses on
health promotion, more doctors and nurses,
shorter wait lists, seniors’ care and health
services within communities.
Additional information related to health care in
Nova Scotia may be obtained from the
Department of Health Web site at:
www.gov.ns.ca/health
Canada Health Act Annual Report, 2002-2003
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, passed by the Legislature
in 1958.
The MSI is administered and operated on a
non-profit basis by an authority consisting of the
Department of Health and Maritime Medical
Care Incorporated (now known as Atlantic Blue
Cross Care), under the legislation previously
mentioned (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, and
that all residents of the province are insured
upon 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.
Maritime Medical Care Incorporated (now
known as Atlantic Blue Cross Care), by virtue of
the 1992 Memorandum of Agreement, is
mandated to:
‰
determine the eligibility of providers
participating in the Plan;
‰
plan and conduct information and education
programs necessary to ensure that all
persons and providers are informed of their
43
Chapter 3 – Nova Scotia
entitlements and responsibilities under the
Plan;
‰
make payments under the Plan for any claim
or class of claims for insured health services
for which the Province is liable; and
‰
develop an audit and assessment system of
claims and payments, to maintain a
continuous audit process and to establish
any other administrative structures required
to fulfill its mandate.
1.2
Reporting Relationship
Atlantic Blue Cross Care is required to submit to
the Province, no later than the 20th day of each
month, monthly expenditure reports, including
such detail as determined by the Province.
Within 30 days of the end of the fiscal quarter,
Atlantic Blue Cross Care is required to provide a
report that includes expenditures to the end of
the quarter and a forecast of expenditures to the
end of the year. Atlantic Blue Cross Care is
required to provide minutes and any information
necessary to keep the Province informed of all
meetings, conferences, etc., that are charged to
the MSI Plan. Reports prepared by Atlantic Blue
Cross Care are forwarded to the respective
Insured Program areas of the Department of
Health for review and follow-up.
Section 17(1)(i) of the Health Services and
Insurance Act, and sections 11(1) and 12(1) of
the Hospital Insurance Regulations, which relate
to 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,
including Pharmacare, the provincial drug
program. The Department of Health’s internal
auditors perform a financial audit of the
administration contract at Atlantic Blue Cross
Care. Atlantic Blue Cross Care also has an
external audit conducted, which includes the
administrative contract. No official audit is
performed on Medicare payments; however, this
is being recommended by the Auditor General’s
office.
44
Under section 34(5) of the Health Authorities
Act, every hospital board is required to submit
st
to the Minister of Health by July 1 each year,
an audited financial statement for the preceding
fiscal year.
The Report of the Auditor General of Nova
Scotia, tabled on December 6, 2002, contained
five audits that are relevant to the Canada
Health Act:
‰
Accountability of District Health Authorities;
‰
Procurement;
‰
Home Care Nova Scotia;
‰
Nova Scotia Health Research Foundation;
and
‰
Audit of Performance Indicators.
1.4
Designated Agency
Atlantic Blue Cross Care administers and has
the authority to receive monies to pay physician
accounts under a Memorandum of Agreement
with the Department of Health. Atlantic 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 the Medical
Society of Nova Scotia and the Department of
Health.
There is no legislation governing the role of
Atlantic Blue Cross Care. Atlantic Blue Cross
Care abides by the terms and conditions of the
1992 contract and its payment mechanism.
Under this contract, Atlantic Blue Cross Care is
required to submit to the Province:
‰
annual audited financial statements;
‰
detailed line-by-line Full-Time Equivalent
counts on budget requests in which the
Department actually approves staffing levels;
‰
line-by-line budgets showing salary, benefits,
travel, postage, etc.; and
‰
a copy of the Annual Report.
All Atlantic 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.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Nova Scotia
2.0 Comprehensiveness
‰
blood or therapeutic blood fractions;
‰
hospital services in connection with most
minor medical and surgical procedures;
2.1
‰
day-patient diabetic care;
‰
services other than medical services
provided by and within the Nova Scotia
Hearing and Speech Clinic;
‰
ultrasonic diagnostic procedures;
‰
home parenterel nutrition; and
‰
haemodialysis and peritoneal dialysis.
Insured Hospital Services
Nine District Health Authorities and the IWK
Health Centre (Women and Children’s Tertiary
Care Hospital) deliver insured hospital services
to both in- and out-patients in Nova Scotia in a
total of 35 facilities.1
Accreditation is not mandatory, but all facilities
are accredited at a facility or regional level. The
enabling legislation that provides for insured
hospital services in Nova Scotia is the Health
Services and Insurance Act, Chapter 197,
Revised Statutes of Nova Scotia, 1989: sections
3(1), 5, 6, 10, 15, 16, 17(1), 18 and 35, passed
by the Legislature in 1958. Hospital Insurance
Regulations were made pursuant to the Health
Services and Insurance Act.
In-patient services include:
‰
accommodation and meals at the standard
ward level;
‰
necessary nursing services;
‰
laboratory, radiological and other diagnostic
procedures;
‰
drugs, biologicals and related preparations,
when administered in a hospital;
‰
routine surgical supplies;
‰
use of operating room, case room and
anaesthetic facilities;
‰
use of radiotherapy and physiotherapy
services, where available; and
‰
blood or therapeutic blood fractions.
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;
In order to add a new hospital service to the list
of insured hospital services, District Health
Authorities are required to submit a New and/or
Expanded Program Proposal to the Department
of Health. This process is carried out annually
through the business planning process. A
Department-developed process format is
forwarded to the Districts for their guidance. A
Department working group reviews and
prioritizes all requests received. Based on
available funding, a number of top priorities may
be approved by the Minister of Health.
2.2
Insured Physician Services
The legislation covering the provision of insured
physician services in Nova Scotia is the Health
Services and Insurance Act, sections 3(2), 5, 8,
13, 13A, 17(2), 22, 27-31, 35 and the Medical
Services Insurance Regulations.
The Health Services and Insurance Act was
amended in 2002-2003 to include section 13B
stating that:
“Effective November 1, 2002, any agreement
between a provider and a hospital, or
predecessors to a hospital, stipulating
compensation for the provision of insured
professional services, for the provider
undertaking to be on-call for the provision of
such services or for the provider to relocate
or maintain a presence in proximity to a
hospital, excepting agreements to which the
Minister and the Society are a party, is null
and void and no compensation is payable
pursuant to the agreement, including
compensation otherwise payable for
termination of the agreement.”
1. The number of facilities reported in other documents
may differ from 35 as a result of using different
definitions.
Canada Health Act Annual Report, 2002-2003
45
Chapter 3 – Nova Scotia
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 2002-2003, 2,026
physicians and 36 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, 2003, 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 2002-2003.
On a quarterly, ongoing basis, new specific fee
codes are approved that represent either
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 the
Medical Society of Nova Scotia, which puts a
suggested value on the proposed new fee.
proposed new fee is forwarded to the
Department of Health for final approval and
Atlantic 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 Health Services and Insurance Act, a
dentist is defined as a person lawfully entitled to
practise dentistry in a place where such practice
is carried on by that person.
To be permitted to provide insured surgicaldental 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, 2003, no dentists had
opted out. In 2002-2003, 36 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 surgical-dental services are
orthognathic surgery, surgical removal of
impacted teeth and oral and maxillary facial
surgery. Additions to the list of surgical-dental
services that are insured are accomplished by
first approaching the Dental Association of Nova
Scotia and having them put forward a proposal
to the Department of Health for the addition of a
new procedure. The Department of Health, in
consultation with specific experts in the field,
renders the decision as to whether or not the
new procedure becomes an insured service.
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 the Medical Society and
Department of Health. When approved by the
Joint Fee Schedule Committee, the approved
46
Canada Health Act Annual Report, 2002-2003
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.
such as the foldable interocular lens or a
fibreglass cast can be purchased, it is required
to fully inform patients about the cost. They are
not to be denied service based on their inability
to pay. The Province provides alternatives to
any of the enhanced goods and services.
The Department of Health also carefully reviews
all patient complaints or public concerns that
may indicate that the general principles of
insured services are not being followed.
The de-insurance of insured physician services
is accomplished through a negotiation process
between the Medical Society of Nova Scotia
and the Department of Health representatives,
who jointly evaluate a procedure or process to
determine its medical necessity. If a process or
procedure is deemed not to be medically
necessary, it is removed from the physician fee
schedule and will no longer be reimbursed to
physicians as an insured service. Once a
service has been de-insured, all procedures and
testing relating to the provision of that service
also become de-insured. The same process
applies to dental and hospital services. The last
time there was any significant amount of deinsurance of services was in 1997.
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.
All residents of the province are entitled to
services covered under the Health Services and
Insurance Act. If enhanced goods and services,
Canada Health Act Annual Report, 2002-2003
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 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.
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 as permanent
residents. 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.
Members of the Royal Canadian Mounted
Police, members of the Canadian Forces,
47
Chapter 3 – Nova Scotia
federal inmates and members of the North
Atlantic Treaty Organization are ineligible for
MSI coverage. When their status changes, they
become eligible on the first day of the third
month following the month in which their
eligibility status changed.
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. Each health card number is
unique and is issued for the lifetime of the
applicant. 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.
They must possess a landed immigrant
document. These individuals, formerly called
“landed immigrants”, are now referred to as
“Permanent Residents”.
Non-Canadians who are married to a Canadian
citizen or a Permanent Resident, and
Convention Refugees who have applied in
Canada for Permanent Residence status, are
eligible for insured services as of the date of
application for Permanent Resident status.
Applicants must possess a letter from
Citizenship and Immigration Canada verifying
their status. A Convention Refugee is a person
designated by the Immigration Refugee Board
to have been found to fear persecution in his or
her country of origin because of race, religion,
nationality, membership in a social group or
political opinion.
Persons from outside Canada, who have
applied for Permanent Resident status, cannot
register until they become Permanent
Residents. Coverage will be retroactive to their
date of arrival in Nova Scotia.
In 2002-2003, there were 18,097 Permanent
Residents registered with the health care
insurance plan.
In 2002-2003, there were 955,475 residents
registered with the health insurance plan.
Employment Authorizations: Persons moving
to Nova Scotia from another country, who
possess an Employment Authorization, are
eligible to apply for MSI on the first day of the
seventh month following the date of arrival as a
worker, provided they have not been absent
from Nova Scotia for 31 consecutive days,
except in the course of employment. MSI
coverage is extended for a maximum of 12
months at a time and only for services received
within Nova Scotia, which is indicated on their
health cards. Coverage is retroactive to the day
of arrival. Each year a copy of their renewed
immigration document must be presented and a
declaration signed. Dependants of such persons
will be granted coverage on the same basis,
once the worker has gained entitlement.
3.3
In 2002-2003, there were 398 individuals with
Employment Authorizations covered under the
health care insurance plan.
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.
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 to Nova Scotia
from another country to live permanently, are
eligible for health care on the date of arrival.
48
Student Authorizations: Persons moving to
Nova Scotia from another country, who possess
a Student Authorization 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. MSI coverage is extended
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Nova Scotia
for a maximum of 12 months at a time and only
for services received within Nova Scotia. Each
year, a copy of their renewed immigration
document must be presented and a declaration
signed. Dependants of such persons will be
granted coverage on the same basis, once the
student has gained entitlement.
In 2002-2003, there were 460 individuals with
Student Authorizations covered under the health
care insurance plan.
Refugees: Refugees are eligible for MSI if they
possess either an employment or student
authorization, or if they have applied for
Permanent Resident status. They are governed
by the eligibility provisions for the type of
immigration document that they possess.
4.0 Portability
4.1
Minimum Waiting Period
Persons moving to Nova Scotia from another
Canadian province or territory will normally be
eligible for MSI on the first day of the third
month following the month of their arrival as
Permanent Residents.
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 who are
temporarily absent from Nova Scotia and in fulltime 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, obtained from the educational
institution that verifies the student’s attendance
there in each year for which MSI coverage is
requested.
Workers who leave Nova Scotia to seek
employment elsewhere will remain covered by
MSI for up to 12 months, provided they do not
Canada Health Act Annual Report, 2002-2003
establish residence in another province, territory
or country. Services provided to Nova Scotia
residents in other provinces or territories, are
covered by reciprocal agreements. Nova Scotia
participates in the Hospital Reciprocal Billing
Agreement and the Medical Reciprocal Billing
Agreement. Quebec is the only province that
does not participate in the medical reciprocal
agreement. Nova Scotia pays for services
provided by Quebec physicians to Nova Scotia
residents and 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 2002-2003, for in- and outpatient hospital services received in other
provinces and territories were: $12,685,659 for
out-of-province, in-patient services and
$4,447,816 for out-of-province, out-patient
services. Nova Scotia pays the host province
rates for insured services in all reciprocal-billing
situations.
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 order to be covered,
procedures of a non-emergency basis must
have prior approval before they will be covered
by MSI.
Students 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.
Workers who leave Nova Scotia to seek
employment elsewhere remain covered by MSI
49
Chapter 3 – Nova Scotia
for up to 12 months, provided they do not
establish residence in another country.
Emergency out-of-country services are paid at a
minimum on the basis of the amount that would
have been paid by Nova Scotia for similar
services rendered in this province. The total
amount spent in 2002-2003 for insured inpatient services provided outside Canada was
$938,092.
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 physician 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 physician. The patient is then
covered under the Reciprocal Billing Agreement
for elective services in another province or
territory. If approval is given to obtain service
outside the country, the full cost of that service
will be covered under MSI.
In fiscal 2002-2003, an additional $5 million was
allocated to the Capital District Health Authority
to increase cardiac surgery and cardiac
catheterization capability to decrease wait times.
5.2
Access to Insured Hospital Services
The Government of Nova Scotia continues to
emphasize the provision of sustainable, quality
health care services to its citizens.
There were a total of 2,853 hospital beds in
Nova Scotia in the most recent count of the
2002-2003 fiscal year.
In 2002-2003, a total of $8.8 million in funding
was provided to train, recruit and retain nurses.
Eighty percent of the nurses from the class of
2002 renewed their licences, compared with
only 51 percent in 2001. This is the highest
retention ratio since 1999.
Table 1 provides a breakdown of key health
professions that are licensed to practise in Nova
Scotia. Not all of these health professionals
were actively involved in delivering insured
health services.
In Nova Scotia in 2002-2003, Telehealth was also
used to provide the services listed in Table 2.
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 either plan.
Nova Scotia continually reviews access
situations across Canada to ensure that it is not
falling behind. In areas where improvement is
deemed necessary, depending on the
Province’s financial situation, extra funding is
generally allocated to that area. The Department
of Health accepted the recommendations of the
Provincial Osteoporosis Committee report,
which included placing new bone density units
in Sydney and Yarmouth and operating the
Truro unit at full capacity. During the 2002-2003
fiscal year, approval was given to purchase an
MRI for Cape Breton to increase access and
reduce wait times.
50
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Nova Scotia
Table 1:
Health Personnel in Nova Scotia (2001)
Health Occupation
Registered/
Licensed to
Practise1
Physicians
Dentists2
Registered Nurses
Licensed Practical Nurses
Medical Radiation Technologists
Respiratory Therapists
Pharmacists
Occupational Therapists
Speech-Language Pathologists
Chiropractors
Opticians
Optometrists
Denturists
Dietitians
Psychologists
2,045a
464
9,165a
3,329a
483
186
1004
234
155
74a
173
76
61
402
371
1
Not all professionals licensed to practise actually work.
2
A limited number of licensed dentists are approved for
insured dental services.
a
Data is for year 2002.
Table 2:
Telehealth Services in Nova Scotia
(2002-2003)
Type of Telehealth Event
Number of
“Events”
Tele-radiology Cases
Education Sessions
(Attendance)
Clinical Consultations
Administrative Meetings
(Attendance)
Clinical Case Conferences
6,169
603
(3,110)
2,549
299
(850)
62
Canada Health Act Annual Report, 2002-2003
5.3
Access to Insured Physician and
Dental-Surgical Services
In 2002-2003, 2,026 physicians and 36 dentists
actively provided insured services under the
Canada Health Act or provincial legislation.
Innovative funding solutions such as block
funding and personal services contracts have
enhanced recruitment.
The Province has increased the capacity for
medical education, coordinates ongoing
recruitment activities and has provided funding
to create a re-entry program for general
practitioners wishing to enter specialty training
after completing two years of general practice
service in the province.
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 the Medical
Society of Nova Scotia and the Nova Scotia
Department of Health. The Medical Society of
Nova Scotia is recognized as the sole
bargaining agent in support of physicians in the
province. When negotiations take place,
representatives from the Medical Society and
the Department of Health negotiate the total
funding and other terms and conditions. The
current master agreement negotiated April 1,
2001, and expiring March 31, 2004, contains an
alternate dispute resolution mechanism.
The agreement lays out what the medical
service unit value will be for physician services
and addresses issues of stand-by or call-back
compensation, members’ benefit fund, Canadian
Medical Protective Association funding and rural
stabilization funding. Fee-for-service is still the
most prevalent method of payment for physician
services, followed by alternative funding
arrangements. Other payment methods include
hourly funding and sessional funding.
In 2002-2003, total payments to physicians for
insured services in Nova Scotia was
$398,328,665. The Department paid an
additional $5,562,125 for insured physician
services provided to Nova Scotia residents
outside the province, but within Canada.
51
Chapter 3 – Nova Scotia
Payment rates for dental services in the
province are negotiated between the
Department of Health and the Dental
Association of Nova Scotia and follow a process
similar to physician negotiations. Dentists are
paid on a fee-for-service basis. The current
agreement expires on March 31, 2004.
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 District
Health Authorities (DHAs), the IWK Health
Centre and other non-DHA organizations.
Approved provincial estimates form the basis on
which payments are made to these
organizations for service delivery.
The Health Authorities Act was given Royal
Assent on June 8, 2000. The Act instituted the
nine DHAs that replaced the former regional
health boards. This change came into effect in
January 2001, under the District Health
Authorities General Regulations. The
implementation of community health boards
under the Community Health Boards’ Member
Selection Regulations was effective April 2001.
The DHAs are responsible (section 20 of the
Act) for overseeing the delivery of health
services in their districts and are fully
accountable for explaining their decisions on the
community health plans through their business
plan submissions to the Department of Health.
Section 10 of the Health Services and Insurance
Act and sections 9 through 13 of the Hospital
Insurance Regulations define the terms for
payments by the Minister of Health to hospitals
for insured hospital services.
In 2002-2003, there were 2,853 hospital beds in
Nova Scotia (3.01 beds per 1,000 population).
Department of Health direct expenditures for
insured hospital services’ operating costs were
increased to $926.8 million. Total separations
from all hospitals decreased slightly to 200,213.
52
6.0 Recognition Given to Federal
Transfers
In Nova Scotia, the Health Services and
Insurance Act RS Chapter 197 acknowledges
the federal contribution in respect of the cost of
insured hospital services and insured health
services provided to provincial residents. The
residents of Nova Scotia are aware, through
press releases and media coverage of ongoing
negotiations between the provinces and the
federal government, that Canada Health and
Social Transfer (CHST) funding partially assists
in providing insured medical services in the
province.
The Government of Nova Scotia also
recognized the federal contribution under the
CHST in various published documents including
the following documents released in 2002-2003:
‰
Public Accounts 2001-2002; and
‰
Budget Estimates 2002-2003 and
2003-2004.
7.0 Extended Health Care
Services
Home Care Services
Broad-based, provincially funded home care
services were introduced in Nova Scotia in
1995. Home care is part of the continuum of
services available through the Department of
Health’s Continuing Care Branch. Home care
services are available to Nova Scotians of all
ages and assist individuals reach and maintain
their maximum level of health and prolong
independent community living. Home care can
be provided to people who are chronically ill,
disabled, convalescent or to individuals with an
acute illness. Services can delay admissions to
long-term care facilities or hospitals as well as
facilitate early release from an acute care
facility. The health care and support services
available to individuals in the community
through home care include nursing care,
assistance with personal care, aid with home
support activities, home oxygen services and
respite. Both chronic services over the longer
term and short-term acute services are provided
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Nova Scotia
through home care. Home care services in
Nova Scotia continue to mature and, as
resources allow, additional services will be
added in the future. These may include services
such as occupational therapy, physiotherapy,
palliative care, pediatric services and others as
deemed necessary.
The Nova Scotia Department of Health has
implemented a Single Entry Access to its
Continuing Care services. Nova Scotians
connect with home care, long-term care
placement and adult protection services through
a single toll-free number.
‰
2002 Performance Report and 2003
Business Plan, Office of Auditor General (in
accordance with section 9A of the Auditor
General Act):
http://www.gov.ns.ca/audg/busplan0203.pdf
Financial Reports
‰
Budget documents for the fiscal year
2003-2004:
http://www.gov.ns.ca/finance/budget03/
‰
Budget documents for the fiscal year
2002-2003:
http://www.gov.ns.ca/finance/budget02/
8.0 Additional Materials
Submitted to Health Canada
‰
http://www.gov.ns.ca/finance/publish/
publicationsb.asp?id=Pub22
‰
Department of Health 2002-2003 Business
Plan:
http://www.gov.ns.ca/health/downloads/
2002plan.pdf
‰
Department of Health 2003-2004 Business
Plan:
http://www.gov.ns.ca/health/downloads/
2003-2004%20DoH%20Business%20Plan.pdf
‰
Office of Health Promotion 2003-2004
Business Plan:
http://www.gov.ns.ca/health/downloads/
2003-2004%20OHP%20Business%20Plan.pdf
‰
Department of Health Annual Accountability
Report for the year 2001-2002:
http://www.gov.ns.ca/health/downloads/
2001-2002AnnualAccountability.pdf
‰
Legislation
‰
Atlantic Blue Cross Care Inc. Act
‰
Health Authorities Act
‰
Health Services and Insurance Act
‰
Provincial Finance Act
Please note that Nova Scotia Statutes and
Regulations are available at:
http://www.gov.ns.ca/legislature/legc/
Other Documents
‰
Province of Nova Scotia’s Annual
Accountability Report for the fiscal year
2001-2002:
http://www.gov.ns.ca/govt/accountability/
Accountability.pdf
Chapters from the annual reports of 19962002 by the Auditor General of Nova Scotia
relating to health:
http://www.gov.ns.ca/audg/health.html
‰
Report of the Auditor General, 2002:
http://www.gov.ns.ca/audg/2002/ag02_all.pdf
Canada Health Act Annual Report, 2002-2003
Strong Leadership, a clear course, three
years later:
http://www.gov.ns.ca/prem/publications/
STRONG3.pdf
‰
Audit Reports
‰
Department of Finance, Fiscal 2003-2004
Forecast Update (and for previous years):
http://www.gov.ns.ca/finance/publish/
publicationsb.asp?id=Pub30
Annual Reports
‰
Public Accounts, 2001-2002:
Making Better Health Care decisions for
Nova Scotia, a Report by the Clinical
Services Steering Committee (February
2001):
http://www.gov.ns.ca/health/downloads/
CSSC_Report.pdf
‰
Your Health Matters, Working Together
Toward Better Care (2003). (This is a plan
for the direction of health care in Nova Scotia
and is a key departmental initiative.):
http://www.gov.ns.ca/health/initiatives.htm
53
Chapter 3 – Nova Scotia
‰
Comprehensive Report on Injuries in Nova
Scotia (May 2002):
http://www.gov.ns.ca/health/downloads/
injuries_technical_rpt.pdf
‰
The Cost of Chronic Disease in Nova Scotia
(October 2002):
http://www.gov.ns.ca/health/downloads/
chronic.pdf
‰
Health Protection Legislative Review:
Discussion Paper (Fall 2003):
http://www.gov.ns.ca/health/downloads/
health_protection_review.pdf
‰
Managing Osteoporosis: A Nova Scotia
Approach (June 2002):
http://www.gov.ns.ca/health/downloads/
Osteoporosis_Report.pdf
‰
Nova Scotia Health Information Management
Strategy Overview (February 2003):
http://www.gov.ns.ca/health/downloads/
HIM_Vision.pdf
‰
Nova Scotia’s Nursing Strategy Update
(March 2003):
http://www.gov.ns.ca/health/downloads/
Nursing_Update_2003.pdf
‰
Nova Scotia Student Drug Use 2002 Survey
(November 2002):
http://www.gov.ns.ca/health/downloads/
2002_NSDrugTechnical.pdf
‰
Primary Health Care Renewal: Action for
Healthier Nova Scotians (May 2003):
http://www.gov.ns.ca/health/phcrenewal/
Final%20Report%20May%202003.pdf
54
Canada Health Act Annual Report, 2002-2003
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 in a
number of ways during the 2002-2003 fiscal
year.
During the year, the Province took action to
make health care more accessible through the
introduction of new health care venues and new
health providers; enhanced accountability
through new reports to its citizens and the
introduction of Canada’s first stand-alone Health
Charter of Rights and Responsibilities; and
made the health system more accessible
through the introduction of new legislation
governing official languages in the province.
Community Health Centres
The Province embarked on a new course
toward community-based, patient-focused
primary health care during 2002-2003 with the
establishment of its first Community Health
Centres. These facilities will offer a new
approach to primary health care, with physicians
working collaboratively with nurses, nurse
practitioners and other health care providers to
serve community health needs. The
establishment of Community Health Centres to
deliver primary health care services was a key
recommendation of the final report of the
Premier’s Health Quality Council, released in
January 2002.
During the spring 2002 session of the
Legislative Assembly, legislators approved
amendments to the Regional Health Authorities
Act to include Community Health Centres in the
definition of health care facilities in the province.
The first four Community Health Centres will be
located in Saint John, Minto, Doaktown and
Lameque. Community health needs
assessments, to determine the health care
needs of the community and the mix of health
professionals to be located at each centre, were
begun during the last quarter of 2002-2003. The
Canada Health Act Annual Report, 2002-2003
first four centres, along with a physician/nurse
practitioner collaborative practice unit in
Fredericton, are to open during 2003-2004.
Nurse Practitioners
During the year, the Province approved
legislation to introduce nurse practitioners to
New Brunswick’s health care team. Nurse
practitioners, who have advanced training in
patient assessment, diagnosis and health care
management, will play a significant role in
enhancing access to primary health care
services in New Brunswick.
The Legislative Assembly approved
amendments to The Nurses Act to establish the
duties of nurse practitioners and provide for
their licensure within New Brunswick, as well as
An Act Respecting Nurses and Nurse
Practitioners, which gave legal standing to
nurse practitioners who will work in the
province’s health care facilities. Both bills
received Royal Assent on June 7, 2002.
In addition to the establishment of nurse
practitioners, this legislation included provisions
to enhance the role of Registered Nurses
delivering primary health care services to New
Brunswickers.
Following the proclamation of the enabling
legislation, the Province hired its first nurse
practitioner in January 2003 to work in the
health care facility in Minto. The Province
expects to hire more nurse practitioners as it
expands its network of Community Health
Centres and collaborative practice facilities to
provide enhanced access to primary health care
services.
Official Languages Act
In June 2002, the New Brunswick Legislative
Assembly unanimously passed a new Official
Languages Act, designed to reaffirm the right of
all New Brunswickers to have access to
services from their government in both of the
province’s official languages. The Act affirms the
right of New Brunswickers to have access in
both English and French to available health care
services through a network of health facilities,
services and programs under the jurisdiction of
55
Chapter 3 – New Brunswick
the Department of Health and Wellness and the
eight Regional Health Authorities(RHAs).
Section 33 (2) of the Act requires that, in
establishing a provincial health plan under the
Regional Health Authorities Act, the Minister of
Health and Wellness shall ensure that the
principles upon which the provision of health
services are based include the delivery of health
services in both of the official languages of the
province.
Regional Health Authorities Act
The Regional Health Authorities Act, which
provides for the delivery and administration of
health services within specified geographic
regions of the province, came into force on
April 1, 2002. The eight RHAs are responsible
for managing and delivering acute care hospital
services, extra-mural services and addictions
services.
The Minister of Health and Wellness appointed
members to serve on the eight new boards for
terms of two to four years. With the expiry of the
two-year terms in May 2004, eight members of
each RHA board will be elected by the voters of
each health region in conjunction with
scheduled municipal and school board
elections. The Minister will continue to appoint
the seven remaining members of each
15-member board.
Health Charter of Rights and Responsibilities
In the Speech From the Throne opening the fifth
session of the 54th Legislative Assembly, the
Government pledged to introduce legislation to
create Canada’s first Health Charter of Rights
and Responsibilities. The Health Charter of
Rights and Responsibilities Act was introduced
in the Legislature on April 8, 2003 by the
Minister of Health and Wellness. The Act would
ensure that all New Brunswickers have a right
to timely access to health care services; to safe,
comfortable and considerate treatment; to take
informed health care decisions; and to have
their complaints investigated. The Act confirms
that New Brunswickers have a responsibility to
use health care services responsibly; to learn
about and make healthy lifestyle choices; to
participate actively in decisions regarding their
health care; and to use complaint mechanisms
appropriately and effectively. The Act would also
establish a Health and Wellness Advocate,
reporting directly to the Legislative Assembly, to
56
help New Brunswickers deal with the health
care system. Following Second Reading, the
Act was referred to the Select Committee on
Health Care for further study.
Reporting To Our Citizens
The Province also took action to make New
Brunswickers better informed on the state of
their own health and the status of their health
care system.
In September 2002, New Brunswick joined with
other jurisdictions in reporting to its population
on a set of common health indicators, as agreed
to by the First Ministers in September 2000. The
First Ministers had identified 14 areas of
comparable reporting on population health and
health service delivery, including life expectancy,
self-reported health, patient satisfaction, access
to first-contact health services, health promotion
and disease prevention. The report showed that
New Brunswickers have a high rate of
satisfaction with the health services they
receive, but performed relatively poorly on
measures related to personal health.
Jurisdictions will issue a follow-up report on
health indicators in fall 2004.
In January 2003, the Province released the first
New Brunswick Health Care Report Card,
reporting to the province’s citizens on the status
of health care services and the overall health of
New Brunswickers. The report examined key
determinants of health within the province’s
population and considered the challenges that
face New Brunswickers in sustaining the health
care services they have come to cherish.
Other Developments
On March 26, 2003, the Minister of Health and
Wellness tabled amendments to the Hospital
Services Act and Medical Services Payment Act
that would provide full hospital privileges to oral
and maxiofacial surgeons providing insured
services in hospital facilities. The amended
legislation received Royal Assent on
April 11, 2003.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
In New Brunswick, the health care insurance
plan is known as the Medical Services Plan.
The public authority responsible for operating
and administering the plan is the Minister of
Health and Wellness, 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 and Wellness 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 Public Health and
Medical Services Division of the Department of
Health and Wellness is mandated with the
administration of the Medical Services Plan. The
Minister reports to the Legislative Assembly
through the Department’s annual report and
through regular legislative processes.
Canada Health Act Annual Report, 2002-2003
The Regional Health Authorities Act, which
came into force on April 1, 2002, sets out the
relationship between the eight Regional Health
Authorities (RHAs) and the Department of
Health and Wellness. Under the Act, RHAs must
prepare regional health and business plans that
are in concert with the provincial health plan
developed by the Department of Health and
Wellness. 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 and Wellness. Under
sections 7(1) and 7(2) of the Act, the Minister of
Health and Wellness shall establish an
accountability framework, drafted in consultation
with RHAs, to specify the responsibilities that
each party has to the other in the provincial
health system.
1.3
Audit of Accounts
Three groups have a mandate to audit in the
area of the Medical Services Plan.
The Auditor-General of New Brunswick
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 and
Wellness. For 2002-2003, all 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 sees fit. During
2002-2003, the Auditor General did not review
Medical Services programs provided by the
Department of Health and Wellness.
The Office of the Comptroller
The Comptroller is the chief internal auditor for
the Province of New Brunswick and carries out
internal audit activity in accordance with
responsibilities and authority set out in the
Financial Administration Act. The objective of an
internal audit is to fulfill the Comptroller’s
mandate as it relates to the Appropriations
Audit, Information Systems Audit, Statutory
Audits and Value-For- Money Audits. The audit
57
Chapter 3 – New Brunswick
work performed by the Office varies, depending
on the nature of the entity audited. During
2002-2003, the Office of the Comptroller
gathered risk assessment data on a number of
programs offered by the Department of Health
and Wellness.
Department of Health and Wellness Internal
Audit
The Department’s Internal Audit Group 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 unit performs program audits to report on
the effectiveness of programs in meeting
departmental objectives. Reviews of program
areas are usually done on a cyclical basis, with
a major program covered once every three to
four years. No reviews were performed on these
programs during 2002-2003.
entitled to the following insured hospital
services:
“(a) In-patient services in a hospital facility
operated by an approved regional health
authority as follows:
(i) accommodation and meals at the
standard ward level,
(ii)
necessary nursing service,
(iii) laboratory, radiological and other
diagnostic procedures, together with the
necessary interpretations for the purpose of
maintaining health, preventing disease and
assisting in the diagnosis and treatment of
any injury, illness or disability,
(iv) drugs, biologicals and related
preparations, as provided for under Schedule 2,
(v) use of operating room, case room and
anaesthetic facilities, including necessary
equipment and supplies,
(vi) routine surgical supplies,
(vii) use of radiotheraphy facilities, where
available,
(viii) use of physiotherapy facilities, where
available, and
2.0 Comprehensiveness
(ix) services rendered by persons who
receive remuneration therefor from the
regional health authority.
2.1
(b) out-patient services in a hospital facility
operated by an approved regional health
authority as follows:
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 to 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
(see Appendix 1). Note that facilities are
categorized as those providing in-patient beds
and those that do not provide in-patient
services.
Under Regulation 84-167 of the Hospital
Services Act, New Brunswick residents are
58
(i) laboratory and diagnostic procedures,
together with the necessary interpretations,
when referred by a medical practitioner or
nurse practitioner, when approved facilities
are available,
(i.1) 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 and
Wellness,
(ii) the hospital component of available outpatient services when prescribed by a
medical practitioner or nurse practitioner and
provided in an out-patient facility of an
approved regional health authority for the
purpose of maintaining health, preventing
disease and assisting in the diagnosis and
treatment of any injury, illness or disability,
excluding the following services:
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
(A) the provision of any proprietary
medicines;
(B) the provision of medications for the
patient to take home;
(C) diagnostic services performed to
satisfy the requirements of third parties,
such as employers and insurance
companies;
(D) visits solely for the administration of
drugs, vaccines, sera or biological
products;
(E) any out-patient service which is an
entitled service under the Medical
Services Payment Act.”
2.2
Insured Physician Services
Physicians in New Brunswick have the option to
opt out totally or for selected services. Optedout 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 opting-out provision may not be invoked in
the case of an emergency or for continuation of
care commenced on an opted-in basis. Opted-in
physicians wishing to opt out for a service must
first obtain the patient’s agreement to be treated
on an opted-out basis, after which they may bill
the patient directly for the service. In these
cases, the following procedure must be adhered
to in every instance. The physician must advise
the patient in advance and:
‰
the charges must not exceed the Medicare
tariff. The practitioner must complete the
specified Medicare claim forms and indicate
the exact total amount charged to the
patient. The beneficiary seeks
reimbursement by certifying on the claim
form that the services have been received
and by forwarding the claim form to
Medicare.
‰
If the charges are to be in excess of the
Medicare tariff, the practitioner must inform
the beneficiary prior to rendering the service
that:
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 84-29 was filed
on February 13, 1984. Regulation 93-143 was
filed on July 26, 1993. Regulation 96-113 was
filed on November 29, 1996 and Schedule 4
(surgical-dental services) Regulation 84-20 was
filed on April 13, 1999.
No changes to this Act and Regulations were
introduced during 2002-2003.
-
they are opting out and charging fees
above the Medicare tariff;
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:
-
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.
‰
to maintain current registration with the New
Brunswick College of Physicians and
Surgeons;
‰
to maintain membership in the New
Brunswick Medical Society;
‰
to hold privileges in a Regional Health
Authority; and
‰
to have signed the Participating Physicians
Agreement.
The number of practitioners participating in New
Brunswick’s Medical Services Plan as of
March 31, 2003, was 1,486.
Canada Health Act Annual Report, 2002-2003
The physician must obtain a signed waiver from
the patient on the specified form and forward
that form to Medicare.
As of March 31, 2003, 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
59
Chapter 3 – New Brunswick
physician or a dental surgeon in a hospital
facility.
2.4
An individual, a physician or the Department of
Health and Wellness 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 of Health and
Wellness. 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 the purposes of maintaining health,
preventing disease and/or diagnosing or treating
an injury, illness or disability. No public
consultation process is used.
Uninsured hospital services include the
following:
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 surgicaldental services that can be provided by a
qualified dental practitioner in a hospital, if the
condition of the patient requires services to be
rendered in a hospital. In addition, a general
dental practitioner may be paid to assist another
dentist for medically required services under
some conditions.
The conditions 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).
Uninsured Hospital, Physician and
Surgical-Dental Services
‰
patent medicines;
‰
take-home drugs;
‰
third-party requests for diagnostic services;
‰
visits for the administration of drugs,
vaccines, sera or biological products;
‰
televisions, 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.
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:
“(a) elective surgery or other services for
cosmetic purposes;
The number of dental practitioners registered
with New Brunswick Medicare is 52, although
many do not provide insured services.
(a.01) correction of inverted nipple;
Dentists have the same opting-out provision as
previously explained for physicians and must
follow the same guidelines. The Department of
Health and Wellness has no data for the
number of non-enrolled dental practitioners in
New Brunswick.
(a.04) removal of minor skin lesions, except
where the lesions are, or are suspected to
be, pre-cancerous;
60
(a.02) breast augmentation;
(a.03) otoplasty for persons over the age of 18;
(a.1) 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;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
(a.2) surgical assistance for cataract surgery
unless such assistance is required because
of risk of procedural failure, other than the
risk inherent in the removal of the cataract
itself, due to the existence of an illness or
other complication;
(b) medicines, drugs, materials, surgical
supplies or prosthetic devices;
(c) vaccines, serums, drugs and biological
products listed in sections 106 and 108 of
New Brunswick Regulation 88-200 under the
Health Act;
(d) advice or prescription renewal by
telephone which is not speficically provided
for in the Schedule of Fees;
(e) examinations of medical records or
certificates at the request of a third party, or
other services required by hospital
regulations or medical by-laws;
(f)
dental services provided by a medical
practitioner;
(f.1) services that are generally accepted
within New Brunswick as experimental or
that are provided as applied research;
(f.2) services that are provided in
conjunction with, or in relation to, the
services referred to above;
(h) testimony in a court or before any other
tribunal;
(i)
immunization, examinations or
certificates for the purpose of travel,
employment, emigration, insurance, or at the
request of any third party;
(j)
services provided by medical
practitioners to members of their immediate
family;
(k)
psychoanalysis;
(l)
electrocardiogram (ECG) where not
performed by a specialist in internal medicine
or paediatrics;
(m) laboratory procedures not included as
part of an examination or consultation fee;
(n)
refractions;
(n.1) services provided within the province
by medical practitioners or dental
practitioners for which the fee exceeds the
amount payable under this Regulation;
(p.1) radiology services provided in the
province by a private radiology clinic;
(q)
acupuncture;
(r) complete medical examinations when
performed for the purposes of a periodic
check-up and not for medically necessary
purposes;
(s)
circumcision of the newborn;
(t)
reversal of vasectomies;
(u) second and subsequent injections for
impotence;
(v)
reversal of tubal ligations;
(w)
intrauterine insemination;
(x)
gastric stapling or gastric by-pass; and
(y) venipuncture for the purposes of the
taking of blood when performed as a standalone 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 surgicaldental services is based upon the conformity of
the service to the definition of “medically
necessary,” a review of medical service plans
across the country and the previous utilization of
the particular service. Once a decision to deinsure 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 is received or until
the period within which the Society was
requested by the Minister of Health and
Wellness to furnish advice and make
recommendations has expired. Subsequent to
the receipt of 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
2002-2003.
(o) the fitting and supplying of eyeglasses
or contact lenses;
(p)
transsexual surgery;
Canada Health Act Annual Report, 2002-2003
61
Chapter 3 – New Brunswick
married to, or in a common-law relationship
with, an eligible New Brunswick resident.
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 of Canada) have a waiting period prior
to 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;
‰
inmates of Federal prisons;
‰
persons moving to New Brunswick as
temporary residents;
‰
a family member who moves from another
province to New Brunswick in advance of
other family members;
‰
persons who have entered New Brunswick
from another province for the purpose of
furthering 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:
‰
62
non-Canadians who are issued an
immigration permit that would not normally
entitle them to coverage are eligible if legally
Provisions when status changes include:
‰
persons who have been discharged or
released from the Canadian Armed Forces,
the RCMP or a federal penitentiary. Provided
that they are residing in New Brunswick at
the time, these persons are eligible for
coverage on the date of their release. They
must complete an application, provide the
official date of release and provide proof of
citizenship.
3.2
Registration Requirements
A beneficiary who wishes to become eligible to
receive entitled services shall register, together
with any 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 prior to 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 receipt of
the completed form, the file is updated and new
card(s) issued bearing a revised expiry date.
Currently in New Brunswick, only those
individuals deemed eligible are registered.
All family members (the beneficiary, spouse and
dependents under the age of 19) are required to
register as a family unit. Residents who are cohabiting, but not legally married, are eligible to
register as a family unit if they so request.
The number of residents registered as of
March 31, 2003, was 738,744.
Residents may opt out of Medicare coverage if
they choose. They are asked to provide written
confirmation of their intention. This information
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
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 remain in
possession of a valid immigration permit. At the
time of renewal, they are required to provide an
updated immigration document. In 2002-2003,
approximately 541 individuals were covered
under immigration permits.
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
to 12 months provided that they do the
following:
‰
do not establish residence in another
province;
‰
do not receive coverage in another province;
and
‰
intend to return to New Brunswick.
If absent longer than 12 months, residents
should apply for coverage in the province or
territory where they are employed and should
be entitled to receive coverage there on the first
day of the 13th 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 directly
from Quebec physicians. Any paid claims
submitted by the patient are reimbursed to the
patient according to New Brunswick
Regulations.
During 2002-2003, New Brunswick paid the
following amounts to other provinces and
territories for insured health services:
Hospital in-patient
The legislation that defines portability of health
insurance during temporary absences in
Canada is the Medical Services Payment Act,
Regulation 84-20, sections 3(4) and 3(5).
Students in full-time attendance at a university
or other approved educational institution who
leave New Brunswick to further their education
in another province are granted coverage for a
12-month period that is renewable provided that
they do the following:
‰
provide proof of enrolment;
‰
contact Medicare once every 12-month
period to retain their eligibility;
‰
do not establish residence outside of New
Brunswick; and
‰
do not receive health coverage in another
province.
Residents temporarily employed in another
province or territory are granted coverage for up
Canada Health Act Annual Report, 2002-2003
$23,477,103
Hospital out-patient
$5,387,946
Medical Services
$9,303,055
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 enrolment;
63
Chapter 3 – New Brunswick
‰
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.
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 of Canada. Any
absence over 182 days, whether it be for work
purposes or vacation, would require Director’s
Approval. This approval can only be up to 12
months in duration and will only be granted
once every three years. Families of workers
temporarily employed outside Canada will
continue to be covered, provided that they
reside in New Brunswick.
Exception to 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. These are
as follows:
‰
copy of 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 (2) 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: inpatient services $100 per day; 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 nonemergency out-of-country services; however,
those who receive such services will assume
responsibility for the total cost. In 2002-2003,
New Brunswick paid the following amounts for
services received outside of Canada:
‰
applications must be submitted in writing;
Hospital in-patient
$351,945 (U.S.)
‰
documentation is required as proof of Mobile
Worker status (e.g., a letter from an
employer or photocopy of an Immigration
Permit);
Hospital out-patient
$226,818 (U.S.)
‰
the worker’s permanent residence must
remain in New Brunswick; and
‰
the worker must return to New Brunswick
during their off-time.
Mobile Worker designation is assigned for a
maximum of two years, after which the resident
must re-apply and re-submit documentation to
confirm their status.
Contract Workers: Any New Brunswick
resident accepting a contract of employment
out-of-country must supply the following
information and documentation:
‰
64
letter of request from the New Brunswick
resident with their signature, detailing their
absence, including Medicare number, New
Brunswick address, date of departure,
destination and forwarding address, reason
for absence and date of return; and
$68,714 (CDN)
$17,399 (CDN)
Medical Services
4.4
$395,061(CDN)
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:
‰
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
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
community and be regarded as scientifically
proven in Canada. Experimental procedures
are not covered.
If the above requirements are met, it is
mandatory to request prior approval from
Medicare in order to receive coverage. A
physician, patient or family member may
request prior approval to receive these services
outside the country, accompanied by supporting
documentation from a Canadian specialist or
specialists.
The following are considered exemptions under
the out-of-country coverage policy:
‰
‰
haemodialysis: patients will be required to
obtain prior approval and Medicare will
reimburse the resident at a rate equivalent to
the interprovincial rate of $220 CDN 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 out-patient visit.
Prior approval is also required for referral of
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 and Wellness.
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. The number of
approved beds is shown in the following table:
Canada Health Act Annual Report, 2002-2003
Approved Beds as of March 2003
Bed Type
Number of Percentage of
Beds
Total Beds
Non-Tertiary:
Acute
2,899
72
Restorative
397
10
Addictions
174
4
2
-
187
5
3,659
91
Oncology
78
2
Cardiac Surgery
26
1
Neurosurgery
46
1
206
5
20
-
376
9
4,035
100
Corrections Canada
Veterans Affairs
Canada
Sub-total
Tertiary:
Tertiary Psychiatry
Tertiary
Rehabilitation
Sub-total
Provincial Total
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, 2003, there were nine (9) 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 a mobile Magnetic Resonance Imaging
(MRI) unit in operation and three fixed-site MRI
systems.
5.3
Access to Insured Physician and
Dental-Surgical Services
A total of 675 general/family practitioners, 731
specialists, eight dentists and three
orthodontists provided insured services in New
Brunswick in 2002-2003.
65
Chapter 3 – New Brunswick
In fiscal 2002-2003, the Department of Health
and Wellness 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 postgraduate 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 2002-2003 marked the first 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.
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 96-113.
The methods used to compensate physicians
for providing insured health services in New
Brunswick are fee-for-service, salary and
sessional or alternate payment mechanisms that
may also include a blended system.
5.5
Payments to Hospitals
The legislative authorities governing payments
to hospital facilities in New Brunswick are the
Hospital Act, which governs the administration
of hospitals and the Hospital Services Act,
which governs the financing of hospitals. The
Regional Health Authorities Act, which provides
for the delivery and administration of health
66
services in defined geographic areas within the
province, came into force on April 1, 2002.
There were no changes during the 2002-2003
fiscal year affecting the hospital payment
process.
The Department of Health and Wellness 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.
The population-based funding distribution
formula, which was enhanced during fiscal
2000-2001, remained in use in fiscal 2002-2003.
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 outpatient 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
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
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.
6.0 Recognition Given to Federal
Transfers
New Brunswick routinely recognizes the federal
role regarding its contributions under the
Canada Health and Social Transfer (CHST) in
public documentation presented through
legislative and administrative processes. These
include the following:
‰
the Budget Papers presented by the Minister
of Finance on December 10, 2002;
‰
the Public Accounts presented by the
Minister of Finance on December 19, 2002;
and
‰
the Main Estimates presented by the Minister
of Finance on December 10, 2002.
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
non-insured 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
Canada Health Act Annual Report, 2002-2003
facilities are available through a variety of
agencies and funding sources within the
province.
Residential and Extended Care Services
The table below identifies residential and
extended care services available in New
Brunswick as of March 31, 2002. Nursing
homes are private, not-for-profit organizations,
with the exception of 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.
Availability of Residential and Extended
Care
Number of
Units or
Beds
Service
Nursing Home Beds
Adult Residential Facilities
(beds)
4,102
1
5,104
Public Housing (units)
2,085
New Brunswick Total
11,291
1
Includes Special Care Homes and Community
Residences.
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 as
used for nursing home admissions.
Public housing units are available for lowincome 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.
Ambulatory Health Care
In New Brunswick, “ambulatory health care”
includes services provided in hospital
emergency rooms, day/night care in hospitals
and in clinics as may be available in hospitals,
health centres and Community Health Centres.
This is considered an insured service under the
provincial Hospital Services Plan.
67
Chapter 3 – New Brunswick
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 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.
8.0 Additional Materials
Submitted to Health Canada
Health Performance Indicators
http://www.gnb.ca/0391/pdf/
HEALTHPerformanceIndicators2002-e.pdf
Health Care Report Card 2003
http://www.gnb.ca/0051/pub/pdf/hrepcard-e.pdf
2002-2003 Budget
http://www.gnb.ca/hw-sm/pub/budgets/02-03
Health Charter of Rights and Responsibilities Act
http://www.gnb.ca/legis/bill/
editform-e.asp?ID=208&legi=54&num=5
68
Canada Health Act Annual Report, 2002-2003
Chapter 3 – New Brunswick
Appendix
New Brunswick Hospital Facilities, 2002-2003 (as of March 31, 2003)
Regional Health Authority
Facilities Providing Insured Health Services
(Location):
Other Facilities / Health Centres
(Location):
Regional Health Authority 1
(South-East):
The Albert County Hospital Inc. (Riverside-Albert)
The Moncton Hospital (Moncton)
The Sackville Memorial Hospital (Sackville)
Petitcodiac Health Centre (Petitcodiac)
Rexton Health Centre (Rexton)
Regional Health Authority 1
(Beausejour): (South-East)
Hopital Docteur Georges L. Dumont (Moncton)
L’Hopital Stella Maris de Kent
(Sainte-Anne-de-Kent)
Centre Medical Regionale de Shediac
(Shediac)
Regional Health Authority 2:
Saint John Regional Hospital (Saint John)
The Charlotte County Hospital (St. Stephen)
Sussex Health Centre (Sussex)
St. Joseph’s Hospital (Saint John)
The Grand Manan Hospital (Grand Manan Island)
1
Centracare Saint John Inc. (Saint John)
Campobello Health Centre
(Campobello Island)
Deer Island Health Centre (Deer Island)
Fundy Hospital Association Ltd.
(Black’s Harbour)
Regional Health Authority 3:
Northern Carleton Hospital (Bath)
Queens North Health Complex (Minto)
L’Hotel-Dieu Saint-Joseph de Perth-Andover Inc.
(Perth-Andover)
Dr. Everett Chalmers Hospital (Fredericton)
The Tobique Valley Hospital (Plaster Rock)
Stan Cassidy Centre for Rehabilitation1
(Fredericton)
The Carleton Memorial Hospital (Woodstock)
MacLean Memorial Hospital (McAdam)
Chipman Health Services Centre
(Chipman)
Upper Miramichi Health Services Centre
(Doaktown)
Upper Miramichi Health Services Centre
(Boisetown)
Stanley Health Services Centre (Stanley)
Fredericton Junction Health Services
Centre (Fredericton Junction)
Harvey Community Hospital
(Harvey Station)
Regional Health Authority 4:
L’Hopital regional d’Edmundston (Edmundston)
Grand Falls General Hospital Inc. (Grand Falls)
L’Hotel-Dieu Saint-Joseph de Saint-Quentin Inc.
(Saint-Quentin)
Centre de Sante de Sainte-Anne-deMadawaska
(Sainte-Anne-de-Madawaska)
Regional Health Authority 5:
L’hopital regional de Campbellton (Campbellton)
Restigouche Hospital Centre Inc.* (Campbellton)
L’Hopital Saint-Joseph de Dalhousie (Dalhousie)
Centre de Sante de Jacquet River
(Belledune)
Regional Health Authority 6:
L’hopital regional Chaleur (Bathurst)
Centre hospitalier de l’Enfant-Jesus Inc.
(Caraquet)
Centre hospitalier de Lameque (Lameque)
Centre hospitalier de Tracadie (Tracadie-Shiela)
Centre de Sante de Paquetville
(Paquetville)
Centre de Sante de Chaleur
(Pointe Verte)
Regional Health Authority 7:
Miramichi Regional Hospital (Miramichi)
Baie-Ste-Anne Health Centre
(Baie-Ste-Anne)
Neguac Health Centre (Neguac)
Blackville Health Centre (Blackville)
Rogersville Health Centre (Rogersville)
Notes: “Insured Health Services” are defined in the Canada Health Act. This list does not identify Addictions Services, Veterans’ Units and
Extra-Mural Program units.
1 indicates provincial tertiary centre
Canada Health Act Annual Report, 2002-2003
69
Quebec
Statement from Quebec
In this report, the information pertaining to Quebec is presented in the same way as in the previous
annual reports prepared by Health Canada to meet the legislative requirements that have existed since
the adoption of the Canada Health Act.
The government of Quebec, owing to its constitutional jurisdiction in the area of health, is accountable to
the National Assembly and to Quebeckers for its management of health services. In that connection, it
regularly makes public various documents and reports on, among other things, the health of the
population, patient satisfaction and the organization of health and social services in its territory. Most of
these documents can be accessed on the Internet site of Quebec’s Ministère de la Santé et des
Services sociaux at www.msss.gouv.qc.ca and that of the Régie de l’assurance maladie du Québec at
www.ramq.gouv.qc.ca.
Federal Response to Quebec
The Federal Minister of Health is accountable to Parliament and to Canadians regarding the monitoring
of compliance by provinces and territories with the Canada Health Act. Section 23 of the Canada Health
Act requires that an annual Report to Parliament be prepared by no later than December 31 of each
year on the Act’s administration and operation for the preceding fiscal year. The annual report is to
include “all relevant information on the extent to which provincial health care plans have satisfied the
criteria, and the extent to which the provinces have satisfied the conditions, for payment under this Act”.
The provincial and territorial governments are the source of the information required for fulfilling this
statutory reporting obligation.
In 1999, the Auditor General of Canada recommended that “in its annual reports to Parliament, Health
Canada should clearly indicate the extent to which each provincial and territorial health care insurance
plan has satisfied the Canada Health Act criteria and conditions. Where it does not provide this
information in the reports, it should clearly explain the reasons.” In responding to the Auditor General’s
recommendation that Canada Health Act monitoring and compliance assessment activities be improved,
Health Canada worked collaboratively with the provinces and territories during 2000 and 2001 to
implement a standardized format for the Canada Health Act Annual Report and expanded the content to
enable a better understanding of whether the Canada Health Act is being complied with by provinces
and territories.
All provinces and territories were advised of the change in format and content requirements, including a
statistical annex that provides a quantitative context for the administration and operation of the Canada
Health Act. Officials from provinces and territories were offered technical advice and assistance in the
completion of their submissions through numerous teleconferences and multilateral meetings. All
provinces and territories, Quebec excepted, agreed to fulfill the revised format and content required.
The federal government is concerned that Quebec is not providing sufficient information to effectively
assess compliance with the Canada Health Act and satisfy the recommendations of the Auditor General.
The federal government will continue to work with Quebec to ensure that information is made available
to demonstrate compliance with the Canada Health Act.
Canada Health Act Annual Report, 2002-2003
71
Quebec
Public Administration
Hospital Insurance and Medical Care
Plans
The hospital insurance plan, the Régime
d’assurance-hospitalisation du Québec, is
administered by the Ministère de la Santé et
des Services sociaux [Quebec department of
health and social services] (MSSS).
The health insurance plan, the Régime
d’assurance-maladie du Québec, is
administered by the Régie de l’assurance
maladie du Québec [Quebec health insurance
board], a public body established by the
provincial government and responsible to the
Minister of Health and Social Services. Both
plans are operated on a non-profit basis, and all
books and accounts are audited by the Auditor
General of Quebec.
Comprehensiveness
Hospital Insurance Plan
The network of institutions under the Ministère
de la Santé et des Services sociaux includes
the hospital centres, certain residential and
long-term care centres (formerly hospital
centres for long-term care)1 and the local
community service centres (CLSCs).
The treatment of physical and mental illness is
provided by the hospital centres and by some of
the residential and long-term care centres.
Insured in-patient services are provided in the
in-patient units of the hospital centres, whereas
insured out-patient services are available mainly
in hospitals and CLSCs.
1
Since October 1, 1992, hospital centres for long-term
care and residential centres have been included in a
single institutional category (the CHSLD—centres
d’hébergement et de soins de longue durée [residential
and long-term care centres]), although no change has
been made to their specific missions.
Canada Health Act Annual Report, 2002-2003
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 anaesthetic 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
centre 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 (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 free of charge to
persons aged 65 or older.
Uninsured hospital services include: plastic
surgery; in-vitro fertilization; private or semiprivate room at the patient’s request; televisions;
telephones; drugs and biologicals ordered after
discharge from hospital; and services covered
by the Act respecting industrial accidents and
occupational diseases or other federal or
provincial legislation.
Medical Care Plan
The services insured by the medical care plan,
the Régime de soins médicaux, include medical
and surgical services provided by physicians, as
well as oral surgery, performed in hospital
centres or in a university institution determined
by regulation, by dental surgeons and
specialists in oral and maxillo-facial surgery.
73
Chapter 3 – Quebec
The following services are not considered
insured:
‰
any examination or service not related to a
process of cure or prevention of illness;
‰
psychoanalysis of any kind, unless such
service is rendered in an institution
authorized for this purposes by MSSS;
‰
any service rendered solely for aesthetic
purposes;
‰
any refractive surgery, except in cases where
there is documented failure for 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 the 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 eyeglasses 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
centre in certain cases;
‰
all acupuncture procedures;
‰
injection of sclerosing substances and the
examination done at that time;
‰
thermography or mammography used for
screening purposes, unless this service is
delivered on a doctor’s order in a place
designated by the Minister, in either case, to
a recipient who is age 35 or older, on
condition that such an examination has not
been performed on the recipient in the
previous year;
74
‰
tomodensitometry, magnetic resonance
imaging and use of radionuclides in vivo in a
human, 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 anaesthetic 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 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.
In addition to the basic insured services, the
Régie 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, orthopaedic 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 Régie covers, over and above its
regular clientele (employment assistance
recipients and persons 65 years of age or
older), individuals who do not have access to a
private drug insurance plan. The new drug
insurance plan covers 3.2 million insured
persons.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Quebec
Universality
Hospital Insurance and Medical Care
Plans
Registration with the hospital insurance plan is
not required. Registration with the Régie de
l’assurance maladie du Québec or proof of
residence is sufficient to establish eligibility. All
persons who reside or stay in Quebec must be
registered with the Régie de l’assurance
maladie du Québec to be eligible for health
insurance programs. Services received by
regular members of the Canadian Forces,
members of the Royal Canadian Mounted
Police and inmates of federal penitentiaries are
not covered by the plan. No premium payment
exists.
Portability
Hospital Insurance and Medical Care
Plans
Minimum Period of Residence
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 the Province of origin, provided they
register with the Régie.
If outside Quebec for 183 days or more,
students and full-time unpaid trainees may
retain their status as residents of Quebec, in the
first case for four consecutive calendar years at
most, and in the second case for two
consecutive calendar years at most. Quebec
government civil servants, employees of nonprofit organizations with head offices in Canada
who are employed abroad in international aid or
cooperation programs recognized by the
Minister of Health and Social Services, and the
spouses and dependants of all such persons
maintain their status as residents of the
Province, provided they notify the Régie of their
absence.
This is also the case for persons living in
another province for the purpose of holding
Canada Health Act Annual Report, 2002-2003
temporary employment or working on contract
there. Their resident status can be maintained
for no more than two consecutive calendar
years.
Persons employed or working on contract
outside Quebec for a company or corporate
body having its headquartered or 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 Régie of the
absence.
Certain categories of resident, notably
permanent residents under the Immigration Act
and persons returning to Canada to live,
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 Royal Canadian Mounted
Police who have not acquired the status of
Quebec resident become eligible upon their
arrival, and inmates of federal penitentiaries
become eligible upon release. Immediate
coverage is provided to certain seasonal
workers, repatriated Canadians, persons from
outside Canada who are living in Quebec under
an official bursary or internship program of the
Ministère de l’Éducation [Quebec department of
education], and refugees. Persons from outside
Canada who have work permits and are living in
Quebec for the purpose of holding an office or
employment for a period of more than six
months become eligible for the plan following a
waiting period.
Payment for Services in Canada
Hospital costs incurred in another province or in
a territory of Canada are paid in accordance
with the terms and conditions of the
interprovincial agreement on reciprocal billing in
the area of hospital insurance that was 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
75
Chapter 3 – Quebec
procedures are paid at approved standard
interprovincial/territorial rates. However, since
November 1, 1995, Quebec reimburses the
Ottawa hospital at a maximum amount of $450
per day of hospitalisation when an Outaouais
resident is hospitalized in a hospital in Ottawa
for non-urgent care or services available in the
Outaouais.
The costs of medical services incurred in
another province or a territory of Canada are
reimbursed at the amount actually paid or the
rate that would have been paid by the Régie for
such services in Quebec, whichever is less.
However, Quebec has negotiated a permanent
arrangement with Ontario to pay Ottawa doctors
at the Ontario fee rate for emergency care and
when the specialized services provided are not
offered in the Outaouais region. This agreement
became effective November 1, 1989. A similar
agreement was signed in December 1991
between the Témiscamingue health centre and
North Bay.
Payment for Services Outside Canada
As of September 1, 1996, hospital services
provided outside Canada in cases of emergency
or sudden illness are reimbursed by the Régie,
usually in Canadian funds, to a maximum of
C$100 per day if the patient was hospitalized
(including day surgery) or to a maximum of
C$50 per day for out-patient services.
However, haemodialysis treatments are covered
to a maximum of C$220 per treatment. In such
cases, the Régie reimburses the associated
professional services. The services must be
dispensed in a hospital or hospital centre
recognized and accredited by the competent
authorities. No reimbursements are made for
nursing homes, spas or similar establishments.
Students, unpaid trainees, Quebec government
officials posted abroad and employees of nonprofit organizations working under programs of
international aid or cooperation recognized by
MSSS must contact the Régie to ascertain their
eligibility. If the Régie recognizes them as
having special status, they receive full
reimbursement of hospital costs in case of
emergency or sudden illness, and 75 percent
reimbursement in other cases.
Costs for insured services provided by
physicians, dentists, oral surgeons and
optometrists are reimbursed at the rate that
76
would have been paid by the Régie to a health
professional recognized in Quebec, up to the
amount of the expenses actually incurred. The
costs of all services insured in the Province are
reimbursed at the Quebec rate, usually in
Canadian funds, when they are incurred abroad.
Beneficiaries requiring medical services in
hospital abroad for services unavailable in
Quebec or elsewhere in Canada are reimbursed
100 percent with prior consent 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.
Permanent Moves out of the Province
Insured persons who leave Quebec to settle in
other parts of Canada are covered for up to
three months after leaving the Province.
Coverage is discontinued as of the day of
departure for insured residents who move
permanently to another country.
Accessibility
Hospital Insurance and Medical Care
Plans
Reasonable Access
Everyone has the right to receive adequate
health care services without any kind of
discrimination.
There is no extra-billing by Quebec physicians.
While the majority of physicians practise within
the provincial plan, Quebec allows two other
options: professionals who have withdrawn from
the Plan and practise outside the Plan, but
agree to remuneration in accordance with the
provincial fee schedule; and non-participating
professionals who practise outside the Plan
entirely, so that neither they, nor their patients,
receive reimbursement from the Régie.
On March 31, 2003, Quebec had 123
institutions operating as hospital centres for a
clientele suffering from acute illness, with
21,794 acute and psychiatric care beds for
persons with physical or psychiatric ailments
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Quebec
allotted to these institutions. From April 1, 2001,
to March 31, 20022, Quebec hospital institutions
had nearly 706,400 admissions for short stays
and close to 286,300 registrations for day
surgeries. These hospitalizations and
registrations accounted for more than
represented a total number of more than
5,000,000 patient-days.
In 2002-2003, the Régie paid $2,894.9 million to
doctors in the povince, while the amount
evaluated for medical services outside the
province reached $9.0 million.
Payment to Hospital Centres
Intermediate care, adult residential care and
home care services are available, with
admission coordinated on a regional level and
based on a single assessment tool. The local
community service centres (CLSCs) receive
individuals, evaluate their care requirements
and either arrange for the provision of such
services as day-centre programs or home care,
or refer them to the appropriate agencies.
The funding of a hospital centre by the Minister
of Health and Social Services is done by means
of payments in respect of the cost of insured
services provided.
3
The payments made in 2001-2002 to
institutions operating as hospital centres for
insured health services provided to persons
living in Quebec amounted to more than $6.4
billion; payments to hospital centres outside
Quebec amounted to approximately $65 million.
Payment for Medical Care
Physicians are paid in accordance with the
negotiated fee schedule. Physicians who have
withdrawn from the health insurance plan are
paid directly by the patient in accordance with
the fee schedule after the patient has collected
from the Régie. Non-participating physicians are
paid directly by the patients according to the
amount charged.
Extended Health Care Services
MSSS offers some home care services,
including nursing care and assistance,
homemaker services and medical surveillance.
Residential facilities and long-term care units in
acute-care hospitals focus on the maintenance
of their clients’ autonomy and functional
capacities of their clients by providing them with
a variety of programs and services, including
health care services.
Reasonable Compensation
Provision is made in law for reasonable
compensation for all insured health services
rendered by health professionals. The Minister
may enter into, with the organizations
representing any class of health professional,
an agreement prescribing 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.
2
Latest year for which figures are available.
3
Latest year for which figures are available.
Canada Health Act Annual Report, 2002-2003
77
Ontario
Introduction
Ontario has one of the largest and most
complex publicly funded health care systems in
the world, which is administered by the
province’s Ministry of Health and Long-Term
Care (MOHLTC) and was supported by
$25.9 billion in spending for 2002-2003.
MOHLTC is responsible for providing services to
the Ontario public through such programs as:
which changed the name or public authority of
OHIP.
1.2
Reporting Relationship
OHIP is administered by MOHLTC, which
regularly reports to the public. For example, as
a core business, activities associated with
Ontario health insurance are included in
MOHLTC’s annual Business Plan.
‰
health insurance;
1.3
‰
drug benefits;
‰
assistive devices;
‰
mental health services;
‰
home care;
MOHLTC is audited annually by the Provincial
Auditor. The Provincial Auditor’s 2003 Annual
Report, which was released on December
2, 2003, examined the ministry’s public health
activities.
‰
community support services;
‰
public health; and
‰
health promotion and disease prevention.
MOHLTC also regulates and funds hospitals
and long-term care facilities (nursing homes and
homes for the aged), operates psychiatric
hospitals and medical laboratories, and funds
and regulates or directly operates emergency
health services.
Audit of Accounts
MOHLTC’s accounts and transactions are
published annually in the Public Accounts of
Ontario. The 2002-2003 Public Accounts of
Ontario was released on November 21, 2003.
2.0 Comprehensiveness
2.1
Insured Hospital Services
1.0 Public Administration
Insured in-patient and out-patient hospital
services in Ontario are prescribed under the
Health Insurance Act and Regulation 552 under
that Act.
1.1
Insured in-patient hospital services include:
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.
There were no amendments to the Health
Insurance Act or its regulations in 2002-2003,
Canada Health Act Annual Report, 2002-2003
‰
accommodation and meals at the standard
ward level;
‰
necessary nursing services;
‰
laboratory, radiological and other diagnostic
procedures;
‰
drugs, biologicals and related preparations;
and
‰
use of operating rooms, obstetrical delivery
rooms and anaesthetic facilities.
Insured out-patient services include:
‰
laboratory, radiological and other diagnostic
procedures;
79
Chapter 3 – Ontario
‰
use of radiotherapy, occupational therapy,
physiotherapy and speech therapy facilities,
where available;
‰
use of diet counseling services;
‰
use of home renal dialysis and home
hyperalimentation equipment, supplies and
medication;
‰
provision of equipment, supplies and
medication to haemophiliac patients for use
at home;
‰
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 treatment of 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; and
‰
the administration of a rabies vaccine.
In 2002-2003 there were 154 public hospital
corporations (excluding specialty hospitals,
private hospitals, provincial psychiatric hospitals,
federal hospitals and long-term care facilities)
staffed and in operation in Ontario. This includes
139 acute care hospital corporations, 11 chronic
care hospitals and four general and special
rehabilitation units.
Hospitals are categorized by major activity,
though they provide a mix of services. For
example, many acute care hospitals offer
chronic care services, just as many chronic care
facilities also offer rehabilitation.
The Public Hospitals Act is the enabling
legislation for public hospitals in Ontario and
includes Regulation 964 on the Classification of
Hospitals and Regulation 965 on Hospital
Management.
When insured physician services are provided in
licensed facilities outside of 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
80
Independent Health Facilities Act (IHFA). Facility
fees cover the cost of the premises, equipment,
supplies and personnel utilized to render an
insured service. Under the IHFA, patient charges
for facility fees are prohibited.
Facility fees are charged to the government only
by facilities that are licensed under the IHFA.
Examples of facilities that are licensed under
the IHFA 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 rendered by
a physician in Ontario is an insured service if it
is medically necessary, contained in the
Schedule of Benefits and rendered in such
circumstances or under such conditions as
outlined in the Schedule of Benefits.
Physicians provide primary health care services
as well as medical, surgical and diagnostic
services. Services are provided in a variety of
settings including private physician offices,
health service organizations, community health
centres, hospitals, mental health facilities,
independent health facilities, walk-in clinics and
long-term care facilities.
In general terms, insured physician services
include:
‰
diagnosis and treatment of medical
disabilities and conditions;
‰
medical examinations and tests;
‰
surgical procedures;
‰
maternity care;
‰
anæsthesia;
‰
radiology and laboratory services in
approved facilities; and
‰
immunizations, injections and tests.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Ontario
The Schedule of Benefits is continually
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 Central Tariff Committee of the Ontario
Medical Association.
Physicians may submit claims for all insured
services rendered to insured persons directly to
OHIP, in accordance with section 15 of the
Health Insurance Act, or they may bill the
insured person, as specified in section 15 of the
Act (see also the Health Care Accessibility 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.
Physicians must be registered to practice
medicine in Ontario by the College of
Physicians and Surgeons of Ontario.
There were approximately 21,000 physicians
who submitted claims to OHIP in 2002-2003.
2.3
Insured Surgical-Dental Services
Insured surgical-dental services are prescribed
under section 16 and the Dental Schedule of
Benefits under Regulation 552 of the Health
Insurance Act. These services, for which
hospitalization is medically necessary, include
the following:
‰
repair of traumatic injuries;
‰
surgical incisions;
‰
excision of tumours and cysts;
‰
treatment of fractures;
‰
homeografts;
‰
implants;
‰
alloplastic reconstructions; and
‰
all other specified dental procedures.
Approximately 320 dentists and dental/oral
surgeons provided insured surgical-dental
services in Ontario in 2002-2003.
Canada Health Act Annual Report, 2002-2003
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. Section
24 of Regulation 552 details those services that
are specifically prescribed as uninsured.
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;
‰
cosmetic surgery under most circumstances;
‰
provision of medications for patients to take
home from hospital, with certain exceptions;
and
‰
in-province hospital visits solely for the
administration of drugs, subject to certain
exceptions.
Uninsured physician services include:
‰
services that are not medically necessary;
‰
toll charges for long-distance telephone calls;
‰
preparing or providing 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);
‰
preparation and transfer of records at the
insured person’s request;
‰
a service that is received wholly or partly for
the production or completion of a document
or the transmission of information to a “third
party” in specified circumstances;
‰
the production or completion of a document
or the transmission of information to any
person other than the insured person in
specified circumstances;
‰
provision of a prescription when no
concomitant insured service is rendered;
‰
cosmetic surgery;
‰
acupuncture procedures;
81
Chapter 3 – Ontario
‰
psychological testing;
‰
group screening programs; and
‰
research and survey programs.
The Health Care Accessibility Act prohibits
physicians from charging patients or accepting
payments from patients for more than the
amount payable by OHIP for the insured
service. A physician may charge for services
that are not insured under OHIP. MOHLTC does
not regulate charges for uninsured services.
However, the Ontario Medical Association
publishes a schedule of suggested fees for
uninsured services.
citizenship or immigration status as prescribed
under Regulation 552, such as refugee
claimants (who are not Convention Refugees).
Other categories of individuals such as federal
penitentiary inmates are generally not provided
with coverage if they are entitled to services
under federal legislation as prescribed under
Regulation 552. Persons previously ineligible for
coverage but whose status has changed (e.g.
change in immigration status or release from a
federal penitentiary) may, upon application, be
eligible for OHIP coverage subject to the
requirements of Regulation 552.
3.2
3.0 Universality
3.1
Eligibility
With certain exceptions in which the waiting
period is waived, all Ontario residents are
eligible for OHIP coverage, subject to a threemonth waiting period. Regulations under the
Health Insurance Act define those types of
persons who are residents of Ontario, as well as
those who are and are not subject to the threemonth waiting period.
To be considered a resident of Ontario for the
purpose of obtaining OHIP coverage, a person
must:
‰
hold prescribed citizenship or immigration
status;
‰
make his or her permanent and principal
home in Ontario; and
‰
generally speaking, be physically present in
Ontario for at least 153 days in any 12month period.
With certain exceptions set out in Regulation
552, most new and returning residents are
subject to a three-month waiting period.
MOHLTC will determine whether or not an
individual is subject to the three-month waiting
period at the time of the application for health
insurance. Former federal inmates and newly
determined Convention Refugees are among
those who are exempt from the waiting period.
Among those who are ineligible for Ontario
health coverage are individuals without
82
Registration Requirements
Every resident of Ontario who seeks OHIP
coverage is required to register for health
insurance.
A health card is issued to eligible residents upon
application to the General Manager of OHIP,
pursuant to sections 2 and 3 of Regulation 552.
Eligible persons should apply for coverage upon
establishing permanent residence 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 proof of citizenship or immigration status,
residency and identity. Original documents from
each category are to be provided by the
applicants upon registration. Once eligibility has
been determined, applicants over the age of
15½ are generally required to have their
photographs and signatures captured for their
photo health cards.
Each photo health card has a card
renewal/expiry date in the bottom right-hand
corner of the card. MOHLTC mails renewal
notices to registrants approximately six weeks
before the card’s renewal date.
MOHLTC is the sole payer for insured health
services. An eligible Ontario resident may not
register with or obtain any benefits from another
insurance plan for any insured service covered
by OHIP.
Approximately 12 million Ontario residents were
registered with OHIP and held valid and active
Health Cards as of as of December 3, 2002.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Ontario
3.3
Other Categories of Individual
MOHLTC provides coverage to several
categories of individuals other than Canadian
citizens and landed immigrants/permanent
residents. Generally, these individuals are
required to provide acceptable documentation to
support the category to which they belong,
along with residency and identity information in
the same manner as individuals with permanent
resident status who apply for Ontario health
coverage. Clients applying for coverage under
any of these categories should contact their
local OHIP office for details. A general overview
of eligibility for applicants in other categories is
included below.
The following categories of individuals who are
ordinarily resident in Ontario will be eligible in
accordance with Regulation 552 and prevailing
Ministry policy:
Applicants for Landing/Applicants for
Permanent Residence – Applicants for
Landing/Applicants for Permanent Residence
are persons who are being processed toward
landing by Citizenship and Immigration Canada
(CIC) and, generally speaking, have met CIC
medical requirements. An immigrant who has
been “landed” is a permanent resident of
Canada.
Convention Refugees – The Immigration and
Refugee Board designates a person as a
Convention Refugee when that person has
been found to fear persecution in his or her
country of origin because of race, religion,
nationality, membership in a social group, or
political opinion.
Minister’s Permit/Temporary Resident Permit
Holders – Minister’s Permits/Temporary
Resident Permits are documents that indicate
that the holder has not met immigration
requirements to remain permanently in Canada.
Holders of case types 80 (adoption only), 86,
87, 88, or 89 Minister’s Permits/Temporary
Resident Permits who are ordinarily residing in
Ontario are eligible for OHIP coverage for the
duration of their immigration documents.
Holders of case type 90 Minister’s
Permits/Temporary Resident Permits are not
eligible for OHIP.
Clergy, Foreign Workers and their
Accompanying Family Members – An eligible
foreign clergy person is a person who is
sponsored by a religious organization or
Canada Health Act Annual Report, 2002-2003
denomination who has finalized an agreement
to minister full-time to a religious congregation
in Ontario for a period of at least six consecutive
months.
A foreign worker is a person who has a finalized
contract of employment or an agreement of
employment with a Canadian employer situated
in Ontario and has been issued an Employment
Authorization/Work Permit by CIC that names
the Canadian employer, states the person’s
prospective occupation, and has been issued an
Employment Authorization/Work Permit for a
period of at least six months.
Eligible accompanying family members are the
spouses, same sex partners and dependent
children (under 19 years of age) of an eligible
foreign member of the clergy or an eligible
foreign worker who is to be employed for at
least three consecutive years and who is
ordinarily a resident of Ontario.
Live-in Caregivers – Live-in Caregivers are
persons who have been issued an Employment
Authorization/Work Permit under the Live-in
Caregivers in Canada Program (LCP) or the
Foreign Domestic Movement (FDM)
administered by CIC. An eligible Live-in
Caregiver is a person who possesses an
Employment Authorization/Work Permit issued
by Citizenship and Immigration Canada that
indicates LCP or FDM and who is ordinarily a
resident of Ontario. The Employment
Authorization/Work Permit for LCP or FDM
workers does not have to list the three specific
employment conditions required by all other
foreign workers, however, the three-month
waiting period applies to Live-in Caregivers.
The following category of workers who may or
may be not ordinarily resident in Ontario will be
eligible in accordance with Regulation 552 and
prevailing Ministry policy:
Migrant Farm Workers – Migrant farm workers
are persons who have been issued an
Employment Authorization/Work Permit 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
not required to present residency documents
generally required to establish eligibility for
OHIP coverage. Members of this group are also
exempt from the three-month waiting period.
83
Chapter 3 – Ontario
4.0 Portability
4.1
Minimum Waiting Period
In accordance with subsection 3(3) of
Regulation 552 under the Health Insurance Act
and Ministry policy, individuals who move to
Ontario are entitled to OHIP coverage beginning
three months after establishing residency in the
province, unless listed as an exception in
section 3(4).
4.2
Coverage During Temporary
Absences in Canada
Out-of-province services are covered under
sections 28, 30(1) and 32 of Regulation 552 of
the Health Insurance Act.
Ontario adheres to the terms of the
Interprovincial Agreement on Eligibility and
Portability. In accordance with that agreement,
insured residents who are outside Ontario
temporarily 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 will 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 will
continue to be covered 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, are
eligible for continuous health coverage for the
duration of their 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 letters 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
84
while accompanying students for the duration of
their studies.
Ontario participates in reciprocal agreements
with all other provinces and territories for
insured hospital in- and out-patient services.
Payment is at the in-patient rate of the plan in
the province or territory where hospitalization
occurs. Ontario pays the standard out-patient
charges authorized by the Coordinating
Committee on Reciprocal Billing.
In addition, section 28 of Regulation 552 of the
Health Insurance Act sets out payment for
insured hospital services outside Ontario but
within Canada that are not billed through the
reciprocal arrangements.
Ontario also participates in reciprocal billing
arrangements with all other provinces and
territories, except Quebec (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 Quebec can
submit their receipts to the Ministry of Health
and Long-Term Care for repayment.
4.3
Coverage During Temporary
Absences Outside Canada
Coverage during temporary 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 OHIP
eligibility for absences of longer than 212 days
in a 12-month period. In most cases, applicants
must provide MOHLTC with a document
explaining the reason for their absence from
Ontario to qualify for an approved absence. In
accordance with the regulations and Ministry
policy, most applicants must also have been
present for at least 153 days in each of the two
consecutive 12-month periods prior to the
expected date of departure in order to be
approved for an extended absence.
Approved absences vary in duration depending
on the reason for the absence. Please refer to
the table below for further details.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Ontario
Reason
OHIP Coverage
medical services amounted to $37.4 million for
emergency services.
Study
Duration of a full-time
academic program
(unlimited)
4.4
Work
Five-year terms
Missionary
Work
Duration of missionary
activities (unlimited)
Vacation/
Other
Up to two years in total in a
lifetime
Family members may also qualify for continuous
OHIP eligibility while accompanying the primary
applicant on an approved absence and should
contact their local OHIP office for details.
Out-of-country services are covered under
section 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 Canadian for in-patient
services;
‰
a maximum $50 Canadian for out-patient
services (except dialysis); and
‰
a maximum $210 Canadian per dialysis
treatment.
Emergency medically necessary out-of-country
physician and other eligible practitioner services
(chiropractors, dentists, optometrists, podiatrists
and osteopaths) are reimbursed only at the
rates listed in the physician Schedule of
Benefits, Regulation 552, or the amount billed,
whichever is less. Charges for medically
necessary emergency out-of-country in-patient
and out-patient services are reimbursed only
when rendered in a licensed or approved
hospital or health facility. Medically necessary
out-of-country laboratory services when done on
an emergency basis by a physician are
reimbursed in accordance with the formula set
out in section 29(1)(b) of the Regulation or the
amount billed, whichever is less; and when
done on an emergency basis by a laboratory, in
accordance with the formula set out in section
31 of the Regulation.
In 2002-2003 payments for out-of-country inpatient and out-patient insured hospital and
Canada Health Act Annual Report, 2002-2003
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 elective
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 of out-of-country health
services.
Under section 28.5 of Regulation 552 of the
Health Insurance Act, laboratory tests performed
outside of Canada are paid for, with prior
approval from MOHLTC, if the following
conditions are met:
‰
the kind of service or test is not performed in
Ontario;
‰
the service or test is generally accepted in
Ontario as appropriate for a person in the
same circumstances as the insured person;
‰
the service or test is not experimental; and
‰
the service or test is not performed for
research purposes.
In 2002-2003, total payments for prior approved
treatment outside of Canada were $33.4 million.
There is no formal prior approval process for
services provided to Ontario residents outside of
the province but within Canada. The
Interprovincial Agreement on Eligibility and
Portability includes a schedule for high-cost
services. In rare circumstances where this
schedule does not cover the costs in another
province, Ontario may be asked to guarantee
payment before the service is provided.
5.0 Accessibility
5.1
Access to Insured Health Services
All insured hospital, physician and surgicaldental services are available to Ontario
residents on uniform terms and conditions.
85
Chapter 3 – Ontario
All insured persons are entitled to all insured
hospital and physician services, as defined in
the Health Insurance Act.
Priority services include:
‰
bone marrow transplantation;
‰
selected cardiovascular services;
Public hospitals in Ontario are not permitted to
refuse to provide services in life-threatening
situations by reason of the fact that the person
is not insured.
‰
selected cancer services;
‰
end stage renal disease; and
‰
selected organ transplants.
Under the Health Care Accessibility Act and
Health Insurance Act, extra billing is prevented
because physicians (both opt-in and opt-out)
are prohibited from charging more than the
amount for an insured service prescribed in the
Schedule of Benefits for Physician Services.
Under that same legislation, hospitals are also
prohibited from charging insured residents for
insured services.
In addition, the Ministry supports a number of
major provincial strategies, including:
‰
The Ontario Stroke Strategy;
‰
Organ and Tissue Donation and
Transplantation Action Plan;
‰
Visudyne Therapy Service;
‰
Ontario Joint Replacement Registry (OJRR);
‰
Telemedicine;
MOHLTC implemented Health Number/Card
Validation to aid health care providers and
patients with access to health services and
claim payment. Providers may subscribe for
validation privileges to verify their patient
eligibility and health number/version code status
(card status). If patients require access to health
services and do not have a health card in their
possession, the provider may obtain the
necessary information by submitting to
MOHLTC a Health Number Release Form
signed by the patient. An accelerated process
for obtaining health numbers for patients who
are unable to provide a health number and
require emergency treatment is available to
emergency room facilities through the Health
Number Look Up service.
‰
Provincial Cancer Plan & Ontario Cancer
Quality Council; and
‰
Paediatric Oncology.
5.2
Through the UAP, a number of programs
enhance access to health care services for
residents of northern and rural remote areas of
Ontario:
Access to Insured Hospital Services
In 2002-2003, there were 154 public hospital
corporations staffed and in operation in Ontario,
which included chronic, general and special
rehabilitation units. There were 7,497,394 acute
patient days, 2,218,358 chronic patient days
and 749,159 rehabilitation patient days
delivered by public hospitals during fiscal year
2002-2003.
Priority services are designated highly
specialized hospital-based services that
respond to life-threatening conditions. These
services are often high-cost and rapidly growing
which makes access of concern. Generally,
these programs are managed provincially and
are designed to ensure equitable access.
86
5.3
Access to Insured Physician and
Dental-Surgical Services
The Underserviced Area Program (UAP) is one
of a number of supports provided by MOHLTC
to help communities across Ontario recruit and
retain health care professionals. It offers
recruitment and retention tools (financial
incentives) to underserviced communities. In
order to access the UAP’s recruitment and
retention benefits, a community must be
designated as underserviced.
‰
the Community Sponsored Contracts provide
alternative funding arrangements that pay a
group of physicians a global amount (not
fee-for-service) for primary care services;
‰
the Incentive Grant Program for Physicians
provides financial incentives to general
practitioners and specialists who establish
practice in designated underserviced areas;
‰
the Free Tuition Program provides up to
$40,000 in tuition reimbursement to eligible
final-year medical students, residents and
newly graduated physicians in exchange for
a three or four-year full-time return-of-service
commitment in an underserviced community;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Ontario
‰
‰
the Northern Physician Retention Initiative
provides eligible family practitioners and
specialists who have maintained practices in
northern Ontario for at least four years with a
retention incentive and also provides access
to funding for continuing medical education;
and
the Northern Health Travel Grant helps to
defray transportation costs for the 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
the use of specialist services located in
northern Ontario, which encourages more
specialists to practice and remain in the
north.
Currently, there are 132 communities in Ontario
designated as underserviced for general/family
practitioners and 15 communities designated as
underserviced for specialists.
Under the Physician Outreach Program,
regularly scheduled primary care clinics may be
provided to remote communities which have
UAP-funded nursing stations and to provide
telephone back-up to the nurse/nursepractitioners working at the nursing station.
During 2002-2003 Ontario continued to be at
the forefront of Primary Care Renewal. Ontario
has a number of innovative primary care
delivery models, during this year the province
began to align its new and existing primary care
models to ensure that they all provide the same
key elements including: comprehensive and
preventative care, 24/7 access through
telephone advisory services, and increased after
hours coverage.
5.4
Physician Compensation
Physicians are paid for the services they
provide through a number of mechanisms. Most
physician payments are provided through feefor-service arrangements, with remuneration
based on the Schedule of Benefits under the
Health Insurance Act. Other physicians are paid
through Alternate Payment Plans, such as
capitation, global budget and volumes-based
arrangements. In partnership with the Ontario
Medical Association, the MOHLTC is
implementing new payment mechanisms
through primary care reform initiatives, such as
Canada Health Act Annual Report, 2002-2003
Family Health Networks and Family Health
Groups.
MOHLTC negotiates payment rates and other
changes to the Schedule of Benefits with the
Ontario Medical Association. The current fouryear Physician Services Agreement with the
Ontario Medical Association expires on March
31, 2004. The Agreement provided an annual
increase of 1.95 percent, effective April 1, 2000
and two percent for each of the following three
years. The Agreement also introduced new fees
aimed at easing the pressure on hospital
emergency wards, providing improved access to
specialists, facilitating the expansion of in-home
health services and providing better care to an
aging population. In addition, the Agreement
included provisions for maternity benefits for
female physicians.
The Physician Services Agreement reached
between MOHLTC and the Ontario Medical
Association committed the parties to meet in
March 2003 regarding the fourth year
commitments. A Memorandum of Agreement
was reached in April 2003. The Memorandum of
Agreement provided for additional investment
beyond the previously committed funding.
With respect to insured surgical-dental services,
MOHLTC negotiates changes to the Schedule
of Benefits with the Ontario Dental Association.
In 2002-2003, MOHLTC and the Ontario Dental
Association agreed upon a new multi-year
funding agreement for dental services which
became effective on April 1, 2003.
5.5
Payments to Hospitals
Hospitals submit annual Hospital Planning Brief
Submissions that are the product of a broad
consultation within the facilities (e.g. all levels of
staff, unions, physicians and board) and within
the community and region. The business plan is
first and foremost a planning document but it
also has a substantial budget component, both
financial and statistical. The District Health
Council and MOHLTC staff then review this
business plan. MOHLTC’s review is conducted
by regional staff, specialized program staff and
senior management, and follows standard
guidelines. It may involve extensive discussions
and clarification with the facility.
Payments made by the health care plan to
hospitals for insured services come under the
87
Chapter 3 – Ontario
Health Insurance Act and are calculated on an
annual budget basis. The Ontario budget
system is a prospective reimbursement system
that reflects the effects of workload increases,
costs related to provincial priority programs 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.
MOHLTC reviews chronic care co-payment
regulations and rates annually, taking into
account changes in the Consumer Price Index,
Old Age Security, Guaranteed Income
Supplement and Guaranteed Annual Income
Supplement each year, and determines whether
revisions to the regulations and rates are
appropriate.
MOHLTC is beginning to measure and reward
relative cost efficiency in hospitals through the
Integrated Population-Based Allocation model.
Payments are made to those hospitals that
spend less than expected, taking into
consideration the individual characteristics of
the hospital.
In addition, specialized methodologies are used
for incremental funding for specific policy and
program initiatives (i.e. Nursing Enhancements,
60-hour post-partum guarantee length of stay).
Funding for hospital operations was in excess of
$10 billion for 2002-2003.
6.0 Recognition Given to Federal
Transfers
The Government of Ontario publicly
acknowledged the federal contributions provided
through the Canada Health and Social Transfer
in its 2002-2003 publications.
7.0 Extended Health Care
Services
7.1
Nursing Home Intermediate Care
and Adult Residential Care Services
MOHLTC funds 563 long-term care facilities and
over 68,000 beds. MOHLTC also conducts the
compliance monitoring program for long-term
care facilities, which includes monitoring
resident health and well-being, safety, security,
environmental and dietary services to determine
compliance with legislation, regulations and
standards. MOHLTC receives and monitors the
implementation of corrective action plans to
achieve compliance, where necessary.
7.2
Home Care Services
Ontario home and community care programs
provide a range of services that support
independent community living. These services
are available through Community Care Access
Centres (CCAC), Community Support Service
(CSS) agencies, and Children’s Treatment
Centres (CTC).
CCACs provide simplified access for eligible
Ontario residents of all ages to communitybased health care and support services. CCACs
assess individual care needs and arrange
professional and personal support services in
the home or school. CCACs also provide
information and refer persons to other
community services and arrange admission to
institutional care when necessary.
Community Support Service (CSS) agencies
provide support services, including
homemaking, attendant care, adult day
programs, caregiver support, meal services,
home maintenance and escorted transportation.
These services complement in-home and other
health services and the assistance provided by
family and friends.
Children receive out-patient rehabilitative and
habilitative therapy services from Children’s
Treatment Centres. All CTCs provide
occupational therapy, physiotherapy, and
speech-language pathology services. A wide
range of other services may be provided,
depending on community needs and the
88
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Ontario
availability of other services locally. Children too
ill to leave home are served through CCAC inhome services.
Please note that Ontario statutes and
regulations are available at
http://www.e-laws.gov.on.ca
8.0 Additional Materials
Submitted to Health Canada
Business Plan:
‰
Ministry of Health and Long-Term Care
2002-2003 Business Plan
http://www.health.gov.on.ca/english/public/
pub/ministry_bplans/bplan02/bplan02.html
Performance Reports:
‰
Ontario’s Health System Performance
Report, September 2002
http://www.health.gov.on.ca/english/public/pub
/ministry_reports/pirc/pirc_mn.html
‰
Hospital Report 2002: Acute Care
http://www.health.gov.on.ca/english/public/con
tact/hosp/hosprep.html
Financial and Audit Reports:
‰
2003 Ontario Budget
www.gov.on.ca/FIN/english/
budeng.htm#Budget
‰
Public Accounts 2002-2003
http://www.gov.on.ca/FIN/english/pacct/
2003/03_are.htm
‰
2002 Annual Report of the Office of the
Provincial Auditor of Ontario
http://www.gov.on.ca/opa/english/r02t.htm
Legislation
‰
Health Insurance Act and Regulations
‰
Public Hospitals Act and Regulations
‰
Independent Health Facilities Act and
Regulations
‰
Health Care Accessibility Act and
Regulations
‰
Health Cards and Numbers Control Act and
Regulation
‰
Long-Term Care Act and Regulations
Canada Health Act Annual Report, 2002-2003
89
Manitoba
Introduction
The mission of Manitoba Health is to provide
leadership and support to protect, preserve and
promote the health of all Manitobans. In
2002-2003, Manitoba Health implemented an
administrative restructuring plan to shift from a
service provider role to a leadership role in
policy, program and standards development and
fiscal and program accountability and
evaluation. The new organizational structure
reflects five distinct but interrelated functional
areas: Finance; Regional Affairs; Provincial
Health Programs; Health Accountability, Policy
and Planning; and Health Workforce. The
mandate(s) of these functional areas are
derived from established legislation and policy
pertaining to health and wellness issues.
Health services are delivered through 10
Regional Health Authorities, hospitals and other
health care facilities.
Manitoba Health remains committed to the
ongoing implementation of the five point plan to
end hallway medicine (opening new beds,
improving admission and discharge procedures,
expanding community- based services,
strengthening prevention programs such as flu
immunization and increasing home care and
adult day-care programs).
Primary health care reform has been a major
focus of the Department of Health. A policy
framework, which creates common definitions
and key goals and objectives to guide reform in
this area, has been approved. A number of
provincial strategies have been initiated (e.g.,
expansion of the Provincial Health Call Centre,
enhanced emergency Medical Services training,
development of necessary technology tools to
enable the sharing of information and to remove
the technical barriers between existing,
disparate information systems, development of
a formal and sustainable model for collaborative
practice training in Manitoba and development
and implementation of a comprehensive public
education and awareness initiative regarding
primary health care reform. In addition, a formal
request for proposals was held with Regional
Canada Health Act Annual Report, 2002-2003
Health Authorities and their partners. Seventeen
proposals addressing the themes of:
‰
advancing primary care access;
‰
community capacity building;
‰
RHA organizational strengthening;
‰
creating integrated service delivery systems;
and
‰
Primary Health Care capital investments;
were approved and are currently underway.
Mental Health Renewal has focused on
improved integration of mental health services
within the primary health care system as well as
enhanced consumer and family participation in
the design and delivery of mental health
services.
Manitoba’s Pharmacare Program has been
enhanced by the addition of new drugs to the
formulary, streamlining administration and
interaction with other provinces regarding
common approaches, such as a common drug
review mechanism.
Patient safety and quality care continue to be
high priorities for Manitoba Health. An integrated
patient safety strategy based on priorities
identified by the National Patient Safety Steering
Committee and the recommendations of the
1
2
Sinclair Inquiry and Thomas Report is under
development.
Overall, Manitoba Health is building a culture of
accountability for both the work of the
Department of Health and the work of various
stakeholders in the health care system.
1. The Sinclair Inquiry (Pediatric Cardiac Surgery Inquest)
was tasked with conducting an inquiry into the deaths of
12 infants in cardiac care in Winnipeg. Associate Chief
Justice Murray Sinclair headed the inquiry and wrote
the recommendations contained in the Pediatric Cardiac
Surgery Inquest Report.
2. University of Manitoba Prof. Paul Thomas headed the
Review and Implementation Committee that was
appointed to respond to the recommendations of the
Sinclair Inquiry.
91
Chapter 3 – Manitoba
The Role of Manitoba Health
Manitoba Health is a line department within the
government structure and operates under the
provisions of statutes and responsibilities
charged to the Minister of Health. The formal
mandates contained in legislation, combined
with mandates resulting from responses to
emerging health and health care issues,
establish a framework for the planning and
delivery of services.
It is the mission of Manitoba Health to provide
leadership and support to protect, preserve and
promote the health of all Manitobans. This
mission is accomplished through a structure of
comprehensive envelopes encompassing
program, policy and fiscal accountability; by the
development of a healthy public policy; and by
the provision of appropriate, effective and
efficient health and health care services.
Services are provided through regional delivery
systems, hospitals and other health care
facilities. The Department also makes payments
for insured health benefits on behalf of
Manitobans related to the costs of medical,
hospital, personal care, Pharmacare and other
health services.
Health under The Health Services Insurance
3
Act, R.S.M. 1987, c. H35. The Act 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 services and other
health services referred to in acts of the
Legislature or regulations thereunder. The Act
was amended on January 1, 1999, to provide
insurance for out-patient services in relation to
insured medical services provided in surgical
facilities.
The Minister of Health is responsible for the
administration and operation of the Plan. Under
section 3(2), the Minister has the power:
“(a) 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;
(b) 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;
It is Manitoba Health’s vision to lead the way in
quality health care, built with creativity,
compassion, confidence, trust and respect to
empower Manitobans through knowledge,
choices and access to the best possible health
resources, and to build partnerships and
alliances for health and supportive communities.
(c) 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 as the minister considers
necessary to ensure that adequate standards
are maintained;
It is also the role of Manitoba Health to foster
innovation in the health care system. This is
accomplished through developing mechanisms
to assess and monitor quality of care, utilization
and cost effectiveness; fostering behaviours and
environments that promote health; and
promoting responsiveness and flexibility of
delivery systems and alternative, less expensive
services.
(d) 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;
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
92
(e) 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
3
Where reference is made to “the Act” in the text, this
refers to The Health Services Insurance Act (1999).
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Manitoba
required by the Government of Canada are
submitted; and
(f) in cases where residents do not have
available medical and other health services,
to take such measures as 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 the
Minister considers necessary for the purposes
of the Act. He or she may also make grants to
any person or group for the purposes of the Act
on such terms and conditions as 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 2002-2003 fiscal
year that affected the public administration of
the Plan.
1.2
Reporting Relationship
Section 6 of the Act requires the Minister to
have audited financial statements of the Plan
showing separately the expenditures for hospital
services, medical services and other health
services. The Minister is required to have an
annual report prepared, which must include the
audited financial statements, and to table the
report before the Legislative Assembly within 15
days of receiving it, if the Assembly is in
session. If the Assembly is not in session, the
report must be tabled within 15 days of the
beginning of the next session.
1.3
Audit of Accounts
Section 7 of the Act requires that the Office of
the Auditor General of Manitoba (or another
auditor designated by the Office of the Auditor
General of Manitoba) audit the accounts of the
Plan annually and prepare a report of that audit
for the Minister. The most recent audit reported
to the Minister and available to the public is for
the 2002-2003 fiscal year and is contained in
the Manitoba Health Annual Report, 2002-2003.
Canada Health Act Annual Report, 2002-2003
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, 2003, there were 97 facilities in
Manitoba 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 radiotherapy, physiotherapy,
occupational and speech therapy facilities,
where available.
All hospital services are added to the list of
available hospital services through the health
planning process.
Manitoba residents maintain high expectations
for quality health care and insist that the best
available medical knowledge and service be
applied to their personal health situations.
Manitoba Health 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
93
Chapter 3 – Manitoba
under The Medical Act. As of March 31, 2003,
there were 2,095 physicians on the Manitoba
Health Registry.
A physician, by giving notice to the Minister in
writing, may elect to collect the fees for medical
services rendered to insured persons other than
from the Minister, in accordance with section 91
of the Act and section 5 of the Medical Services
Insurance Regulation. The election to opt out of
the health insurance plan takes effect on the
first day of the month following a 90 day period
from the date the Minister receives the notice.
Before rendering a medical service to an
insured person, physicians must give the patient
reasonable notice that they propose to collect
any fee for the medical service from them or
any other person except the Minister. The
physician is responsible for submitting a claim to
the Minister on the patient’s behalf and cannot
collect fees in excess of the benefits payable for
the service under the Act or Regulations. To
date, no physicians have opted out of the
medical plan in Manitoba.
The range of physician services insured by
Manitoba Health 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,
rendered to an insured person by a physician,
that are not excluded under the Excluded
Services Regulation (M.R. 46/93) of the Act.
During fiscal year 2002-2003, 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 proposals are
forwarded to the Manitoba College of
Physicians and Surgeons for review to ensure
the service is scientifically valid and not
developmental or experimental. 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
Insured surgical and dental services are listed in
the Hospital Services Insurance and
Administration Regulation (M.R. 48/93) under
94
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 in respect of 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, 2003, 576 dentists were registered
with Manitoba Health.
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, 2003.
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 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;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Manitoba
‰
reversal of sterilization procedures; and
‰
psychoanalysis.
The Hospital Services Insurance and
Administration Regulation states that hospital inpatient services include routine medical and
surgical supplies, thereby ensuring reasonable
access for all residents. The Regional Health
Authorities and Manitoba Health monitor
compliance.
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.
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.
No services were removed from the list of those
insured by Manitoba Health in 2002-2003.
3.0 Universality
3.1
Eligibility
The Health Services Insurance Act defines the
eligibility of Manitoba residents for coverage
under the health care insurance plan of the
Province. Section 2(1) of the Act states that a
resident is a person who is legally entitled to be
in Canada, resides 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
Minister’s permit under the Immigration Act
(Canada), unless the Minister determines
otherwise, or is a visitor, transient or tourist.
The Residency and Registration Regulation
(M.R. 54/93) extends the definition of residency.
The extensions are found in sections 7(1) and
8(1). Section 7(1) allows missionaries,
individuals with out-of- country employment and
Canada Health Act Annual Report, 2002-2003
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 fulltime attendance at an accredited educational
institution. Section 8(1) extends residency to
individuals who are legally entitled to work in
Manitoba and have an employment
authorization 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 Manitoba Health Services Insurance Plan
excludes residents covered under the following
federal statutes: Aeronautics Act; Civilian Warrelated Benefits Act; Government Employees
Compensation Act; Merchant Seaman
Compensation Act; National Defence Act;
Pension Act; Royal Canadian Mounted Police
Act or under legislation of any other jurisdiction
(Excluded Services Regulations subsection
2(2)). The excluded are residents who are
members of the Armed Forces, the Royal
Canadian Mounted Police and federal inmates.
These residents become eligible for Manitoba
Health coverage upon discharge from the
Canadian Armed Forces; the RCMP; or an
inmate of a penitentiary who 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)).
3.2
Registration Requirements
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
certificate for the individual and all qualifying
dependants.
95
Chapter 3 – Manitoba
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 hospital and medical service claims for that
individual and all designated dependants. A
nine-digit Personal Health Identification Number
(PHIN) is used for the provincial drug program.
During 2002-2003, there were 1,156,217
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, subsection 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.
In 2002-2003, 1,693 individuals with work
permits were covered under the Manitoba
Health Services Insurance Plan.
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). Twenty-nine individuals were covered
under Minister’s permits in 2002-2003.
No legislative amendments to the Act or the
Regulations in the 2002-2003 fiscal year
affected universality.
4.0 Portability
4.1
Minimum Waiting Period
The Residency and Registration Regulation
(M.R. 54/93, section 6) identifies the waiting
period for other insured persons from another
province or territory. A resident who lived in
another Canadian province or territory
96
immediately before arrival in Manitoba is entitled
to benefits upon the first day of the third month
following the month of arrival.
4.2
Coverage During Temporary
Absences in Canada
The Residency and Registration Regulation
(M.R. 54/93 section 7(1)) defines the rules for
portability of health insurance during temporary
absences in Canada.
Students are considered residents and will
continue to receive health coverage for the
duration of their full-time enrolment at any
accredited educational institution. The additional
requirement is that they intend to return and
reside in Manitoba upon completion of their
studies.
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
upon completion of 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.
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.
With the exception of 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 2002-2003, Manitoba Health made payments
totalling approximately $16,701,176 for hospital
services and $7,691,159 for medical services
provided in Canada.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Manitoba
4.3
Coverage During Temporary
Absences Outside Canada
The Residency and Registration Regulation
(M.R. 54/93, sub-section 7(1)) defines the rules
for portability of health insurance during
temporary absences from Canada.
Residents on full-time employment contracts
outside Canada will receive Manitoba Health
coverage for up to 24 consecutive months.
Individuals must return and reside in Manitoba
upon completion of 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
upon completion of 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 upon completion of their leave.
Coverage for all these categories is subject to
amounts detailed in the Hospital Services
Insurance and Administration Regulation
(M.R. 48/93). Hospital services received outside
Canada due to an emergency or a sudden
illness, while temporarily absent, are paid as
follows:
In-patient services are paid based on a perdiem rate according to hospital size:
‰
1-100 beds:
$280
‰
101-500 beds:
$365
‰
over 500 beds:
$570
Out-patient services are paid at a flat rate of
$100 per visit or $215 for haemodialysis.
The calculation of these rates is complex due to
the diversity of hospitals in both rural and urban
areas.
Manitobans requiring medically necessary
hospital services unavailable in Manitoba or
elsewhere in Canada may be eligible for costs
incurred in the United States by providing
Canada Health Act Annual Report, 2002-2003
Manitoba Health with a recommendation from
their specialist stating that the patient requires a
specific, medically necessary service. Physician
services received in the United States are paid
at no less than 100 percent of the equivalent
Manitoba rate for similar services. Hospital
services are paid at up to 75 percent of the
hospital’s charges for insured services. Payment
for hospital services is made in U.S. funds (the
Hospital Services Insurance and Administration
Regulation, sections 15-23).
Manitoba Health made payments totalling
approximately $2,762,161 for hospital care
provided in hospitals outside Canada in the
2002-2003 fiscal year. In addition, Manitoba
Health made payments totalling approximately
$607,066 for medical care.
In instances where Manitoba Health has given
prior approval for services provided outside
Canada and payment is less than 100 percent
of the amount billed for insured services,
Manitoba Health will consider additional funding
based on financial need.
4.4
Prior Approval Requirement
Prior approval is not required for services
provided in other provinces or territories. 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.
No legislative amendments to the Act or the
Regulations in the 2002-2003 fiscal year had an
affect 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 in relation to
insured medical services.
97
Chapter 3 – Manitoba
In July 2001, The Health Services Insurance
Act, The Private Hospitals Act and The
Hospitals Act were amended to strengthen and
protect public access to the health care system.
The amendments include:
‰
changes to definitions and other provisions
to ensure that no charges can be made to
individuals who receive insured surgical
services, or to anyone else on that person’s
behalf; and
‰
ensuring that a surgical facility cannot
perform procedures requiring overnight stays
and thereby function as a private hospital.
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 continues to experience a shortage of
nurses in all geographic areas, with some
improvement in the past year noted, especially
in larger urban centres or areas near Winnipeg.
Interest in nursing education continues to be
high.
Manitoba also has a wide range of other health
care professionals. Shortages in some of the
technology fields such as radiation therapy,
ultrasound technology, Magnetic Resonance
Imaging (MRI) technology and lab technology
are also an issue.
Manitoba currently has access to three MRI
machines for clinical testing. All units are in
Winnipeg. The first unit was installed in 1990 by
the St. Boniface Research Foundation and
replaced in October 1998. The second, located
at the Health Sciences Centre, became
operational in September 1998. This unit was a
joint initiative with the National Research
Council (NRC). The third MRI unit, located in
Winnipeg, became operational in January 2000.
Manitoba has 16 Computerized Tomography
(CT) Scanners – three (one for paediatric
patients) at the Health Sciences Centre, two at
St. Boniface General Hospital, one each at
Victoria General Hospital, Dauphin Regional
98
Health Centre, Thompson General Hospital,
Brandon Regional Health Centre, Boundary
Trails Health Centre, Misericordia Health
Centre, Seven Oaks, Grace and Concordia
Hospitals, and newly installed scanners in
Steinbach and Selkirk. One of the scanners at
the Health Sciences was replaced and one
scanner was upgraded, both by 16-slice
scanners. As well, ultrasound scanners are
located in Winnipeg health facilities and rural
and northern regions. Bone density testing is
funded by Manitoba Health on two machines
located in Winnipeg and Brandon.
In March 2003, CancerCare Manitoba
completed the opening of their 205,000 square
foot world-class facility for treatment, education
and research with an on-site laboratory for the
Manitoba Institute of Cell Biology. Eight students
graduated in September 2002 from the
Manitoba School of Radiation Technology, which
now has classroom space in the new
CancerCare facility. In June 2002, funding was
provided for equipment to implement 3D
Conformal Radiation Therapy.
Manitoba’s conversion of the Pan Am Clinic into
a non-profit facility under the public umbrella is
an exciting innovation that shows how Medicare
can and should adapt to the rapid changes in
health care today. The Pan Am Clinic is a day
surgery centre in Winnipeg that has established
itself as a preferred medical environment
offering cutting-edge treatments and state-ofthe-art technology for muscular- skeletal
medicine, including primary care, orthopaedics,
rheumatology and other related services. Since
the acquisition in 2001, the number of monthly
cases at the Pan Am Clinic has steadily
increased, from 199 cases in April 2002 to 304
cases in April 2003. Expansion plans were
approved for orthopaedic and plastic surgery,
expanded surgical recovery room space,
physiotherapy and a third operating theatre to
be used for Minimally Invasive Surgery.
Manitoba Health allocated funding to a Cardiac
Critical Shortages Fund to send patients, if they
so choose, out of province for cardiac surgery.
No patients on the cardiac surgery wait list
chose the option of being sent out of province.
Manitoba Health has established a Task Force
with Regional Health Authority participation to
address access and waiting time issues. The
work is ongoing. Targeted funding was provided
to Regional Health Authorities to address
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Manitoba
specific capacity issues including funding to
increase diagnostic procedures. Manitoba is a
partner in the Western Canada Waiting List
project. The Winnipeg Regional Health Authority
is implementing and evaluating two of the tools
developed through this project: the Children’s
Mental Health tool and the General Surgery
tool.
In January 2003 the Department of Health
released a new guide to assist Manitobans in
accessing and understanding their health care
system. The Infohealth Guide is broken down
into three specific sections. They are:
‰
At a Glance – a quick reference to key
phone numbers and emergency information;
‰
Health Services – information on the type of
health care services provided within the
province’s health care system; and
‰
Health Care Rights – information on the
rights, responsibilities and protections
available through the health care system.
5.3
Access to Insured Physician and
Dental-Surgical Services
In 2002-2003, Manitoba Health continued to
implement initiatives to improve access to
physicians in rural and northern areas of the
province. In June 2002 a medical director was
appointed to the Office of Rural and Northern
Health, which will be located in Dauphin. The
Office will provide infrastructure support for the
Rural Physician Action Plan. This plan includes
the promotion of medicine as a career to rural
and northern students, expansion of training
opportunities in these areas for undergraduates
and postgraduates and restructuring rural and
northern continuing education opportunities.
Further increases in enrolment in medical
school and residency positions are planned for
2004.
Manitoba continues to experience small
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 for students and residents. In
return for financial assistance during their
training, the student or resident agrees to work
in Manitoba for a specific period after
graduating. The program was introduced in May
2001. There are plans to expand the program to
include family doctors from outside Manitoba
Canada Health Act Annual Report, 2002-2003
and family doctors who have left the province
and want to return. The Province continues to
support the Medical Licensure Program for
International Medical Graduates, which was
introduced in 2001. Starting in 2002, foreigntrained physicians are able to receive financial
support to assist them in completing the process
that will enable them to practice medicine in
Manitoba. Annual costs of the program are
approximately $1 million.
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 provincewide.
5.4
Physician/Dentist Compensation
On June 2, 2002, Manitoba Health and the
Manitoba Medical Association (MMA) entered
into an Interest Arbitration Agreement (the
“Agreement”) with respect to both fee-forservice (FFS) and alternate funded physicians
represented by the MMA. The specific highlights
are:
‰
The Agreement provides a mechanism for
determination of fee increases for all fee-forservice and alternate funded physicians
represented by the MMA for the period
October 1, 2002 to March 31, 2005.
‰
Either party may require that a new
arbitration process be undertaken to
determine fee increases subsequent to
March 31, 2005.
‰
The Agreement establishes a
Maternity/Parental Benefits Fund of
$1 million annually.
‰
The Agreement establishes a Physician
Retention fund of $5 million annually.
‰
The Agreement continues a Professional
Liability Insurance fund of $5 million
annually.
99
Chapter 3 – Manitoba
‰
The Agreement continues a Continuing
Medical Education Fund in the amount of
$1 million annually.
‰
There shall be no service withdrawals by
medical practitioners for the duration of the
Agreement.
‰
The MMA will administer the Professional
Liability Insurance and the continuing
Medical Education reimbursement funds for
both fee-for-service and alternate funded
physicians.
‰
The Arbitration Agreement provides for a
separate arbitration mechanism with a sole
arbitrator for 16 issues deemed outstanding
from the previous agreement. In 2002-2003,
the arbitrator rendered a decision with
respect to five of the outstanding issues.
Under the main arbitration process outlined in
the Agreement, a three-person Board has been
constituted to issue one overall award for feefor-service physician services. Upon receipt of
the fee-for-service award, all alternate funding
agreements are to receive an interim award of
one-half the percentage increase granted to feefor-service. Each party is then to select two
alternate funding agreements for separate
arbitration. Following the determination of the
separate awards, the Board is to issue an
overall award for the remaining alternate
funding agreements. The arbitration process for
the fee-for-service envelope commenced on
February 26, 2003.
Insured services provided by physicians are
remunerated through a combination of fee-forservice payments, alternative service
arrangements, independent contracts, etc. In
2002-2003, Manitoba had no capitation
arrangements in place. However, Manitoba and
the MMA agreed on a maximum global
expenditure for private laboratories over the
duration of the Arbitration Agreement. For
2002-2003, the maximum global expenditure for
private laboratories was set at $23 million.
The Payments for Insured Medical Services
Regulation made under The Health Services Act
governs fee- for-service payments to physicians.
This Regulation is usually re-promulgated for
each fiscal year.
Manitoba and the Manitoba Dental Association
(MDA) entered into a Memorandum of
Agreement effective April 1, 1998 to
March 31, 2002. The Agreement, which has
100
since expired, provided for an overall increase
in funding of 13 percent over the four years.
Discussions are proceeding between Manitoba
and the MDA for a new agreement.
Insured services provided by certified oral and
maxillofacial surgeons or licensed dentists are
compensated on a fee-for-service basis for
specified oral/dental/maxillofacial surgical
procedures performed in hospital facilities only.
The Hospital Services Insurance and
Administration Regulation (M.R. 48/93) made
under The Health Services Insurance Act
governs payments to dentists for insured dental
services. The Regulation was amended in the
2001-2002 fiscal year to reflect payments in
effect as of April 1, 2001.
No amendments to The Health Services
Insurance Act during 2002-2003 had an impact
on Physician/Dentist Compensation.
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.
The Regional Health Authorities have concluded
the required agreements. The operating
agreements between the Winnipeg Regional
Health Authority and the health corporations
operating facilities in Winnipeg will expire
March 31, 2006. The operating agreements
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Manitoba
enable the Authority to determine funding based
on objective evidence, best practices and
criteria that are commonly applied to
comparable facilities.
In addition to the Winnipeg Regional Health
Authority, there are two other Regional Health
Authorities that continue to have hospitals
operated by health corporations in their health
regions. In all other regions, the hospitals are
operated by the Regional Health Authorities or
the federal government. The agreements in
place between the Authorities and the health
corporations do not have expiry dates. The
Authorities are empowered to determine the
funding to be provided each year.
The allocation of resources by Regional Health
Authorities for the provision of 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
Manitoba Health Services Insurance Plan 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 2002-2003 had an affect 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 and Social Transfer in public
documents.
Canada Health Act Annual Report, 2002-2003
7.0 Extended Health Care
Services
Manitoba has established community-based
service programs as an appropriate alternative
to hospital services. These service programs
are provided by Manitoba Health through the
Regional Health Authorities. These services
include the following:
Personal Care Home Services
The Personal Care Services Insurance and
Administration Regulation under The Health
Services Insurance Act authorizes the provision
of services to personal care home residents.
Both proprietary and non-proprietary homes are
licensed by Manitoba Health. Residents of
personal care homes also pay a residential
charge. The total Manitoba Health operating
expenditures for personal care services during
fiscal year 2002-2003 amounted to
$377,448,184, supporting a total of 9,636
licensed set-up personal care beds. In addition,
there were estimated capital and equipment
expenditures of $19,510,077.
Home Care Services
Manitoba Home Care is a province-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
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. Services may be coordinated by a case
coordinator or self-managed and may include
personal care assistance, home support, health
care, family relief, respite care, supplies and
equipment, adult day programs and/or volunteer
services.
Ambulatory Health Care Services
The Health Services Insurance Act includes a
provision authorizing the designation of nonprofit publicly administered ambulatory health
101
Chapter 3 – Manitoba
(primary care) centres as institutions within the
meaning of the Act.
Adult Residential Care Services
Residential care facilities are community-based
facilities that provide room and board, 24-hour
on-site care and supervision and assistance
with activities to ensure that the needs of
individual residents are met. These facilities are
classified by size: approved homes have up to
three adults and licensed facilities have
occupancies of four or more adults. The
facilities are further differentiated between forprofit and not-for-profit facilities.
‰
Manitoba 2003 – Budget Speech.
‰
Manitoba 2003 – Budget Papers.
‰
Manitoba 2003 – The Manitoba Advantage.
‰
Manitoba 2003 – Manitoba’s Action Strategy
for Economic Growth.
Residential care facilities are required to be
licensed under The Social Services
Administration Act and Manitoba Care Facilities
Licensing Regulation (484/88 R) and are
required to meet standards established by the
Residential Care Licensing Branch of the
Department of Family Services and Housing.
The Regulations mandate the licensing of
facilities for three adult disability categories
(mentally ill, mentally disabled and infirm aged).
There are approximately 102 licensed and
approved residential care facilities for individuals
with mental illness in Manitoba, for a total of 520
bed spaces. There are also 57 mixed facilities,
for a total of 235 bed spaces. There are 12
licensed and approved facilities for individuals
with the infirmities of aging, for a total of 164
bed spaces. The majority of residential care
facilities are located in Winnipeg and Brandon.
8.0 Additional Materials
Submitted to Health Canada
‰
Manitoba Health Annual Report, 2002-2003.
‰
Manitoba Health Auditor’s Report,
2002-2003.
‰
Supplementary Information for Legislative
Review, 2002-2003.
‰
Consolidated Legislation and Regulations.
‰
Infohealth Guide to Health Services in
Manitoba.
‰
Annual Statistics, 2002-2003.
‰
Manitoba 2003 – What Manitoba’s Budget
Means to You.
102
Canada Health Act Annual Report, 2002-2003
Saskatchewan
Introduction
health care system. The Plan also outlines four
key strategic goals in support of this vision:
‰
provide better access to quality health care;
Saskatchewan is the birthplace of Medicare.
Insured hospital services were first provided in
Saskatchewan in 1947. Insured physician
services followed in 1962, further reinforcing the
principle that health services should be provided
to individuals based on their health need, not on
their ability to pay.
‰
increase effective health promotion and
disease prevention;
‰
improve health workplaces and address
shortages of key health providers; and
‰
increase emphasis on efficiency and
accountability in the health care system.
Today, in the face of continued debate over the
future direction of health care in Canada,
Saskatchewan remains committed to this
principle. It is recognized, however, that within
the boundaries of the publicly funded health
care system, there is a need for continued
evolution to a more sustainable system that
ensures healthier people and healthier
communities.
Saskatchewan Health’s 2002-2003 Annual
Report outlines the progress that is being made
in achieving these goals. The Department took
steps to improve the management of surgical
waiting lists to ensure fair, timely access to
surgery for Saskatchewan people. The
Saskatchewan Surgical Care Network (SSCN),
an advisory committee to the Saskatchewan
Minister of Health, was introduced in
March 2002. It is dedicated to creating a better
surgical care system. Since then, significant
progress has been made toward the full
implementation of a province-wide surgical
waitlist registry. A Web site provides information
to the public on waiting times for certain
procedures and on how the surgical care
system works.
In this context, Saskatchewan was one of the
first provinces in Canada to undertake an indepth review of health care delivery. The
recommendations of the Fyke Commission on
Medicare formed the basis of several months of
careful study and consultation. During these
consultations, the Government heard from a
wide range of health community partners, as
well as residents from across the province.
There was a clear message: Saskatchewan
people believe strongly in the continuation of a
public Medicare system, but recognize the need
for change to maintain a strong, responsive
system into the future.
As a result of this examination, the Government
released Saskatchewan. Healthy People. A
Healthy Province: The Action Plan for
Saskatchewan Health Care in December 2001.
This plan provides a long-term blueprint to
improve the health of Saskatchewan people,
while ensuring the best value for every health
dollar.
In keeping with the Action Plan’s strategic focus,
Saskatchewan Health released, for the first
time, a public performance plan. The 2002-2003
Performance Plan, released in August 2002,
sets out the Department’s vision for health care
renewal, focusing on increasing access to
quality care and improving accountability in the
Canada Health Act Annual Report, 2002-2003
www.sasksurgery.ca
Other initiatives such as a 24-hour telephone
advice line, introduced in August 2003, further
support the Department’s performance plan.
Such initiatives are also a significant
development in the Province’s detailed strategy
to provide better primary health care services.
To facilitate innovation and improvements to the
quality of care, Saskatchewan Health
established Canada’s first independent Health
Quality Council in November 2002. The Council
provides objective, timely, evidence-based
information and advice to government, regional
health authorities, providers, professional and
regulatory bodies and others for achieving the
best possible health care within available
resources. The council reviews care standards,
the use of health-care technologies and
prescription drugs, and strategies to improve
health system quality and safety.
Saskatchewan Health’s goal to increase the
effectiveness of health promotion and disease
103
Chapter 3 – Saskatchewan
prevention resulted in the development of a
strategy for summer 2003 to reduce the risk of
West Nile Virus. Key actions included enhanced
surveillance efforts including the hiring of a West
Nile Virus coordinator and a public education
campaign emphasizing personal protection
measures to reduce the risk.
During 2002-2003, the Department built a
strong foundation for moving forward with its
Action Plan. Saskatchewan Health redesigned
the system of health care governance by
creating 12 new regional health authorities to
replace the 32 former health districts. The
Regional Health Services Act was proclaimed
on August 1, 2002 with the new regional
authority names taking effect on November 1,
2002. In spring 2003 each regional health
authority received its first accountability
document along with the 2003-2004 budget plan
that set out clear targets and expectations for
health services.
The new regional health authorities are working
closely with the Department to ensure a
coordinated, effective and accountable health
system that offers a consistent quality and level
of service across the province. Specifically,
regional health authorities are now taking a lead
role in assessing local health needs as well as
planning and delivering health services to meet
those needs.
Regional health authorities are key partners in
the health system and provide a wide range of
hospital, physician, public health, mental health,
rehabilitation and addictions services. Other
partners in the system include affiliated
agencies, fee-for-service physicians,
pharmacists and other health care providers.
The provincial government is the major funder
of Saskatchewan’s health care system,
providing approximately $2.3 billion in
2002-2003.
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.
104
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 that 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 the
provision and operation of 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 as the Minister considers
necessary; and
‰
make grants or provide subsidies for the
purpose of stimulating and developing public
health research and the conducting of
surveys and studies in the field of public
health.
Sections 8 and 9 of The Saskatchewan Medical
Care Insurance Act provide authority for the
Minister of Health to establish and administer a
plan of medical care insurance for residents.
The Regional Health Services Act provides
authority for the establishment of 12 regional
health authorities, replacing the former 32
district health boards.
Sections 5 and 11 of The Cancer Foundation
Act (1997) provide for the establishment of a
Saskatchewan Cancer Agency and for it to
coordinate a program for the diagnosis,
prevention and treatment of cancer.
The mandates of the Department of Health,
regional health authorities and the
Saskatchewan Cancer Agency for 2002-2003
are outlined in The Department of Health Act,
The Regional Health Services Act and The
Cancer Foundation Act, as described above.
1.2
Reporting Relationship
The Department of Health is directly
accountable to and regularly reports to the
Minister of Health on the funding and
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
administration of funds for insured physician,
surgical-dental and hospital services.
regional health authority, to the Minister of
Health.
Section 36 of The Saskatchewan Medical Care
Insurance Act prescribes that the Minister of
Health submit an annual report of the medical
care insurance plan to the Legislative Assembly.
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 Regional Health Services Act prescribes
that a regional health authority shall, within
three months after the end of each fiscal year,
submit to the Minister of Health:
‰
a report of 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 Saskatchewan Cancer
Agency and to physicians and dental surgeons
for insured physician and surgical-dental
services. The Provincial Auditor may also
conduct audits of regional health authority
boards. The Provincial Auditor independently
determines the scope and frequency of its
audits based on accepted professional
standards.
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
Canada Health Act Annual Report, 2002-2003
2.0 Comprehensiveness
2.1
Insured Hospital Services
The Regional Health Services Act was
proclaimed 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 provides authority
so that the Minister may 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 prescribes standards
for the delivery of services in those facilities by
regional health authorities and health care
organizations, which have entered into service
agreements with a regional health authority.
The Act sets out new accountability
requirements for regional health authorities and
health care organizations. These requirements
include submission of annual operational and
financial and health service plans for Ministerial
approval (sections 50-51), establishment of
community advisory networks (section 28) and
the reporting of 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 bylaws (sections 42-44).
Funding for hospitals is included in the funding
provided to regional health authorities.
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Chapter 3 – Saskatchewan
As of March 31, 2003, the following facilities
were providing insured hospital services to both
in- and out-patients:
‰
66 acute care hospitals provided in- and outpatient 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.
The Hospital Standards Act and The Hospital
Standards Regulations, 1980, established
minimum standards for care and certain
administrative requirements for hospitals.
With the passage of The Regional Health
Services Act, Saskatchewan plans to
incorporate those provisions relating to hospital
organization and program standards under the
new Act, thereby allowing for the repeal of The
Hospital Standards Act and The Hospital
Standards Regulations, 1980.
A comprehensive range of insured services is
provided by hospitals, which 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
administered in hospital; and
‰
services rendered by individuals who receive
remuneration from the hospital.
The Action Plan for Saskatchewan Health Care
establishes new hospital categories and outlines
a standard array of services that should be
available in each hospital. Hospitals will be
grouped into the following five categories:
Community Hospitals, Northern Hospitals,
District Hospitals, Regional Hospitals and
Provincial Hospitals.
106
One of the elements of the Action Plan is to
provide reliable, predicable 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 are always there when
needed.
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, considering 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. Depending upon the
specific service request, consultations could
involve 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 2002, 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 and changes in payment
levels for selected services.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
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, 2003, there were 1,636
physicians licensed to practise in the province
and eligible to participate in the medical care
insurance plan. This increase over previous
years is partly the result of including locum
registrations previously excluded from the active
physician counts.
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 reimbursement 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, 2003, 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 3,000 different
insured physician services as of
March 31, 2003.
Insured physician services are added to the
Medical Services Plan through a process of
formal discussion with the Saskatchewan
Medical Association. The Executive Director of
the Medical Services Branch manages the
process of adding a new service. When a new
insured physician service is covered by the
Medical Services Plan, a regulatory amendment
is made to the Physician Payment Schedule. A
number of new services were added in
April 2002.
Although formal public consultations are not
held, any member of the public may make
Canada Health Act Annual Report, 2002-2003
recommendations about physician services to
be added to the Plan.
2.3
Insured Surgical-Dental Services
Dentists registered with the College of Dental
Surgeons of Saskatchewan and designated by
the College as specialists able to perform dental
surgery may provide insured surgical-dental
services under the Medical Services Plan. As of
March 31, 2003, 94 dental specialists were
providing such services.
Amendments were made in January 2003, to
The Saskatchewan Medical Insurance Branch
Payment Schedule for Insured Services
Provided by a Dentist. Those amendments
provided for the addition of new insured
services and 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, 2003.
Insured surgical-dental services are those that
are medically necessary and must be carried
out in a hospital. Such services include:
‰
oral surgery required in hospital as a result
of trauma;
‰
treatment for infants with cleft palate;
‰
hospital-based dental care to support
medical/surgical care (e.g., extractions when
medically necessary); and
‰
surgical treatment for temporomandibular
joint dysfunction.
Surgical-dental services can be added to the list
of insured services covered under the Medical
Services Plan through a process of discussion
and consultation with provincial dental
surgeons. The Executive Director of the Medical
Services Branch manages the process of
adding a new service.
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Chapter 3 – Saskatchewan
Although formal public consultations are not
held, any member of the public may recommend
that surgical-dental services be added to the
Medical Services Plan.
2.4
Uninsured Hospital, Physician and
Surgical-Dental Services
Uninsured hospital, physician and surgicaldental services in Saskatchewan include:
Insured hospital services could be de-insured by
the Government if determined no longer
medically necessary. The process is based on
discussions among regional health authorities,
practitioners and officials from the Department
of Health.
Insured surgical-dental services could be deinsured if determined not medically necessary
or not required to be carried out in a hospital.
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.
‰
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;
Formal public consultations about de-insuring
hospital, physician or surgical-dental services
may be held if warranted.
‰
non-emergency cataract and non-emergency
diagnostic imaging services provided outside
Saskatchewan without prior written approval;
No health services were de-insured in
2002-2003.
‰
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 or are not required to
be performed in a hospital; and
‰
services covered by the Saskatchewan
Workers’ Compensation Board.
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.
108
Insured physician services could be de-insured
if determined not medically required. The
process is based on consultations with the
Saskatchewan Medical Association and
managed by the Executive Director of the
Medical Services Branch.
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 all residents to register for provincial
health coverage. There were no changes to this
legislation during 2002-2003.
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 of
establishing residency in Saskatchewan.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
Returning Canadian citizens, the families of
returning members of the Canadian Forces,
international students and international workers
are eligible for coverage on establishing
residency in Saskatchewan, provided that
residency is established before the first day of
the third month following their admittance to
Canada.
The following persons are not eligible for
insured health services in Saskatchewan:
‰
members of the Canadian Forces and the
Royal Canadian Mounted Police; federal
inmates; refugee claimants; and Kosovar
refugees who are covered under the Interim
Federal Health Program;
‰
visitors to the province; and
‰
persons eligible for coverage from their
home province or territory for the period of
their stay in Saskatchewan (e.g., students
and workers covered under temporary
absence provisions from their home province
or territory).
Such people become eligible for coverage as
follows:
‰
discharged members of the Canadian Forces
and the Royal Canadian Mounted Police, if
stationed in or resident in Saskatchewan on
their discharge date;
‰
released federal inmates (includes those
prisoners who have completed their
sentences in the federal penitentiary and
those prisoners who have been granted
parole and are living in the community);
‰
refugee claimants, on receiving Convention
Refugee status (immigration documentation
is required); and
‰
Kosovar refugees, on expiration of their
coverage under the Interim Federal Health
Program (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;
Canada Health Act Annual Report, 2002-2003
‰
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 December 2005.)
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, 2002,
was 1,024,827.
3.3
Other Categories of Individual
Other categories of individual who are eligible
for insured health service coverage include
persons allowed to enter and remain in Canada
under authority of either 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 either an
employment/student permit, Minister’s permit or
permanent resident, i.e., landed immigrant
record.
As of June 30, 2002, there were 3,906 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
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Chapter 3 – Saskatchewan
spouse; or b) the first day of the thirteenth
month following the establishment of residency
by the first spouse.
Payments/reimbursement to Quebec physicians,
for services to Saskatchewan residents, are
made at Saskatchewan rates (Saskatchewan
Physician Payment Schedule).
4.2
In 2002-2003, expenditures for insured
physician services in other provinces were
$16.95 million. Insured hospital services in other
provinces were $30.59 million.
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 this legislation in 2002-2003.
Continued coverage during a period of
temporary absence is conditional upon the
registrant’s intent to return to Saskatchewan
residency immediately on expiration of the
approved absence period as follows:
‰
education: for the duration of studies at a
recognized educational facility (written
confirmation by a Registrar of full-time
student status is required annually);
‰
employment: up to 12 months (no
documentation required); and
‰
vacation and travel: up to 12 months.
Section 6.6 of The Department of Health Act
provides the authority for payment of in-patient
hospital services to Saskatchewan beneficiaries
temporarily residing outside the province.
Section 10 of The Saskatchewan Medical Care
Insurance Payment Regulations, 1994 provides
for the payment of 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. Physician bills are submitted and
Saskatchewan Health pays for insured services
provided in Quebec at Saskatchewan rates.
However, the physician fees will be paid at
Quebec rates with prior approval.
110
4.3
Coverage During Temporary
Absences Outside Canada
Section 3 of The Medical Care Insurance
Beneficiary and Administration Regulations of
The Saskatchewan Medical Care Insurance Act
describes 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
expiration of the approved period as follows:
‰
students: 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 24 months (written
confirmation from the employer is required);
and
‰
vacation and travel of up to 12 months.
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 2002-2003, $1,891,800 was paid for inpatient hospital services and $359,400 was
spent on out- patient hospital services outside
Canada. In 2002-2003, expenditures for insured
physician services outside Canada were
$1,129,300.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
4.4
Prior Approval Requirement
5.0 Accessibility
Out-of-Province
Saskatchewan Health covers most hospital and
medical care received by its residents in
Canada through a reciprocal billing
arrangement. This arrangement means that
residents do not need prior approval and may
not be billed for most services received in other
provinces or territories while travelling within
Canada. The cost of travel, meals and
accommodation are not covered.
Prior approval is required for the following
services provided out-of-province:
‰
alcohol and drug, mental health and problem
gambling services; and
‰
cataract surgery services, bone densitometry
(outside of hospitals), and non-urgent
Magnetic Resonance Imaging (MRI),
because Saskatchewan Health does not
normally cover these services out-ofprovince.
Before the Department of Health funds nonurgent services for a Saskatchewan resident in
another province or territory, prior approval from
the Department must be obtained by the
patient’s specialist.
Out-of-Country
Prior approval is required for the following
services provided outside Canada:
‰
‰
If a specialist physician refers a patient
outside Canada for treatment not available in
Saskatchewan or another province, the
referring specialist must seek prior approval
from the Medical Services Plan of
Saskatchewan Health. Requests for out-ofcountry cancer treatment must be approved
by the Saskatchewan Cancer Agency. If
approved, Saskatchewan Health will pay the
full cost of treatment, excluding any items
that would not be covered in Saskatchewan.
Saskatchewan Health does not normally
cover elective (non-emergency) hospital,
physician, optometric and chiropractic
services; therefore, prior approval is
required.
Canada Health Act Annual Report, 2002-2003
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 the provision of public
services, which include insured health services,
on the basis of race, creed, religion, colour, sex,
sexual orientation, family status, marital status,
disability, age, nationality, ancestry or place of
origin.
5.2
Access to Insured Hospital Services
As of March 31, 2003, Saskatchewan had 3,129
staffed hospital beds in 66 acute care hospitals,
including 2,544 acute care beds, 241 psychiatric
beds and 344 other beds.
The Wascana Rehabilitation Centre had 43
rehabilitation beds and 205 extended care beds.
Rehabilitation services are also provided in a
Geriatric Rehabilitation Unit in one acute care
hospital and in two special care facilities.
The Department does not collect information on
acute care beds used for out-patient services.
Keeping and attracting key health providers
such as nurses continues to be a top priority for
Saskatchewan Health. Tracking the actual
number of people who work within the health
professions can be difficult, as people move and
change jobs, hours of work or even careers.
One way to measure our health workforce is to
count how many providers are registered in the
province. The professional regulatory bodies in
Saskatchewan do this every year. Much of this
information is reported to the Canadian Institute
for Health Information (CIHI), allowing
comparisons with other provinces.
According to the three professional regulatory
bodies for nursing in Saskatchewan, in 2002
there were 11,940 nurses in Saskatchewan, an
overall increase from the 11,914 nurses
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Chapter 3 – Saskatchewan
reported in 2001. The number of nurses and
ratio of nurses to the provincial population has
stabilized over the past five years. This is a
positive trend. Other trends such as the aging of
the nursing workforce indicate we need to
continue efforts at retaining and recruiting
nurses.
There are signs of progress that show nursing
graduates are more enthusiastic about
remaining in Saskatchewan. Over the past
couple of years, our province has retained about
80 percent of graduates from our nursing
education program.
The number of Registered Nurses (RN) per
capita in Saskatchewan in 2002 (81.8 per
10,000 population) is higher than the Canadian
average (73.4 per 10,000 population). This also
represents a slight decrease from 1998 for
Saskatchewan (82.4). There is also
considerable variation in RN per population
ratios across Canada, from a low of 65 per
10,000 in Ontario to a high of 117.6 in the NWT.
Listed below are some of the 2002-2003
initiatives implemented to improve the retention
and recruitment of nurses.
‰
A nursing bursary program of $500,000 was
provided to students training to be future
Registered Nurses, Licensed Practical
Nurses and Registered Psychiatric Nurses.
The province introduced Primary Care Nurse
Practitioner bursaries for individuals studying
to become nurse practitioners in
Saskatchewan.
in other locations in the province were added
to the program.
‰
Saskatchewan Health funded a project to
develop senior nurses who mentor nursing
students receiving clinical experience. This
involves a workshop for senior nurses,
workload relief for the nurses while they are
working with students and an appropriate
recognition program.
‰
Saskatchewan Health provided funding to
explore the challenges and opportunities for
practical nurses to achieve job satisfaction
and career advancement through career
laddering.
‰
The Province hosted a daylong
Saskatchewan Communication Network
(SCN) workshop entitled “Creating High
Quality Health Care Workplaces”. More than
600 people participated at 30 sites across
the province.
‰
The Province provided $1.25 million for a coordinated approach to continuing education
and development for health providers with
the focus on clinical education, specialized
training and leadership development.
‰
Saskatchewan Health’s “I Choose
Saskatchewan” recruitment campaign
appeared in a number of publications during
the fiscal year.
‰
Regional health authorities implemented a
number of retention and recruitment
strategies for nurses.
‰
Provincial health human resource planning
guidelines were developed and serve as a
foundation for building future strategies and
initiatives. Human resource performance
expectations and indicators were developed
and will form the basis of accountability
frameworks between major third parties and
the Province.
‰
A northern nursing program for Aboriginal
students delivered through the First Nations
University of Canada was introduced and
adds 40 training sets to the existing Nursing
Education Program of Saskatchewan
(NEPS).
‰
Access to NEPS has been enhanced
through distance delivery with the entire first
year of the program available by distance
learning. The development of a Bachelor of
Science in Nursing second-degree program
is being explored.
‰
Saskatchewan Health worked with
Saskatchewan Government Relations and
Aboriginal Affairs and a variety of nursing
partners to expand the Saskatchewan
Immigrant Nominee Program to include the
nursing professions.
‰
Over the past three years a total of $860,000
has been provided for projects related to
quality workplaces, nursing workforce
casualization and the retention of nursing
graduates. The Quality Workplace Program
pilot projects were evaluated and new sites
‰
A number of initiatives to support Aboriginal
students in the health disciplines, including
the Northern Access to Nursing Program and
the nursing career pathways initiative
continued.
112
Aside from nurses and physicians, there is a
wide range of other health care professionals
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
who are also vital to the provision of quality
care. Registration data for these professionals –
including technologists, therapists and
pharmacists – indicates the number of these
professionals working in Saskatchewan has for
the most part increased over the past decade.
With regard to the availability of selected
diagnostic, medical, surgical and treatment
equipment and services in facilities providing
insured hospital services:
‰
Magnetic Resonance Imaging (MRI)
machines are located in Saskatoon (2) and
Regina (1).
‰
Computed Tomography (CT) scanners are
available in Saskatoon (3), Regina (3),
Prince Albert (1) and Swift Current/Moose
Jaw (1).
‰
Renal dialysis is provided at Saskatoon,
Regina, Lloydminster, Prince Albert, Tisdale,
Yorkton and Swift Current.
‰
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 2002-2003, approximately 4,300 new
patients began treatment for cancer and
about 50,000 cancer treatments were
provided to both new and review patients.
‰
Twenty-one sites are involved in the
Community Oncology Program 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.
‰
Approximately 71 percent of surgery services
are provided in Saskatoon and Regina,
where there are specialized physicians and
staff and the equipment to perform a full
range of surgical services. An additional 23
percent is provided in six mid-sized hospitals
in Prince Albert, Moose Jaw, Yorkton, Swift
Current, North Battleford and Lloydminster,
with the remaining surgery performed in
smaller hospitals across the province.
‰
Telehealth 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.
Canada Health Act Annual Report, 2002-2003
A number of measures were taken in 2002-2003
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 during 2002-2003.
In that year, approximately 13,000 MRI tests
and approximately 72,000 CT tests were
performed.
‰
Access to renal dialysis services continues to
improve, with an anticipated opening in fall
2003 of the dialysis satellite at the
Battlefords Union Hospital.
‰
On June 30, 2000, the 12-month Northern
Telehealth Network (NTN) pilot project was
completed. The NTN is a partnership
between Saskatchewan Health and six
health districts. An external evaluation
concluded that the network improved access
to services for patients and clients,
particularly for child psychiatry and
dermatology patients. The number of
specialist clinics held in the North has
remained stable, which means that the NTN
has increased access to specialists without
increasing their travel.
‰
The NTN has proven an effective tool for
clinical consultation and continuing education
in northern Saskatchewan. Saskatchewan
Health continues to support the network and
was successful in securing funding
(approximately $1 million) from Health
Canada under the Canadian Health
Infostructure Partnership Program (CHIPP)
for further development of the Telehealth
program in the province. As of
March 31, 2003, the telehealth network has
been established at 12 sites in 10
communities.
‰
The Chronic Renal Insufficiency Clinics that
were established in the Regina 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 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 has the highest
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Chapter 3 – Saskatchewan
participation rate in Canada with 36,000 to
40,000 women served annually.
‰
The Cancer Agency is in the process of
developing and implementing the cervical
screening program. This program will consist
of the following components:
-
a comprehensive information system;
-
recruitment and recall strategies;
-
results notification;
-
quality patient/client management; and,
-
quality assurance processes.
While some components of the program are
expected to be complete in 2003, the
program is expected to be fully operational in
2004.
‰
The Provincial Stem Cell Transplant Program
continues to grow. In 2001-2002, the
Program was expanded to include allogenic
transplantation (i.e., infusion of tissuecompatible stem cells from a related donor).
The provision of this specialized service
ensures that more cancer patients can be
effectively treated closer to home, reducing
the financial and emotional burden of
travelling long distances to receive treatment.
‰
Saskatchewan Health continues to dedicate
considerable time and resources to
addressing waitlist issues.
‰
Saskatchewan Health continues to
participate in the Western Canada Waiting
List (WCWL) Project along with 19 partner
organizations from the four western
provinces. The Project works closely with
physicians, the public, regional health
authorities and governments to develop and
test clinical assessment tools. These tools
will help physicians to consistently prioritize
patients waiting for total hip or knee
replacement, cataract surgery, general
surgery, children’s mental health services
and diagnostic MRI scans. Each tool has
undergone pilot testing in a regional health
authority in Western Canada, the primary
purpose being to gain a better understanding
of the validity and the potential for
implementation of each tool.
‰
114
The importance and potential of the five
assessment tools that have been developed
through the WCWL partnership has been
widely recognized. Their use by clinicians,
health authorities and ministries is being
actively considered in all western Canadian
jurisdictions.
‰
Preliminary findings and recommendations
from the report “Surgical Wait List
Management; A Strategy for Saskatchewan”
formed the basis of the waitlist strategy
outlined in the Government’s Health Action
Plan released in December, 2001.
‰
The goal of the wait-list strategy outlined in
the new Action Plan is to ensure that patients
who are waiting for surgery in Saskatchewan
receive the care they need within clinically
appropriate time frames and in a fair and
equitable manner.
‰
The Saskatchewan Surgical Care Network
(SSCN), established in March 2002 to
ensure that a variety of perspectives are
applied to the important tasks of assessing
and determining how to address surgical
access issues across the province, has been
actively overseeing the development of
several surgical care system initiatives.
‰
In January 2003, the Saskatchewan surgical
Web site was launched
(www.sasksurgery.ca) and allows patients
to obtain information on how long they may
expect to wait for their particular procedure.
Also announced were surgical care
coordinators for Regina/Qu’Appelle and
Saskatoon regional health authorities. A
surgical care coordinator provides a means
of communication between the region,
patients and their referring physician. Other
health regions have identified key surgical
contacts for their communities.
‰
In 2002-2003, work proceeded toward the
development of a province-wide surgical
patient registry information system. A pilot of
this registry was initiated in January 2003 in
Five Hills Health Region. By fall 2003, this
registry will track all patients needing surgery
in the province and will produce reports with
accurate data that will be used by
physicians, health regions and
Saskatchewan Health for decision making.
‰
A new Patient Assessment Process is being
finalized and will be implemented provincewide to improve consistency and fairness for
all surgical patients in Saskatchewan.
‰
In 2002-2003, the provincial government
continued to provide funds to the Province’s
four largest health regions from the
$13 million surgical wait-list fund that was
initiated in August 1999, to address waitlist
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
issues and reduce waiting times for insured
services. These funds are used to: purchase
additional capital equipment; increase
available operating room time; fund staff
recruitment, retention and training initiatives;
and implement coordination and utilization
management initiatives.
5.3
Access to Insured Physician and
Dental-Surgical Services
As of March 31, 2003, there were 1,636
physicians licensed to practice in the province
and eligible to participate in the Medical Care
Insurance Plan. Of these, 936 (57.2 percent)
were family practitioners and 700 (42.8 percent)
were specialists. This shift to more specialists in
the last two years is the result of provincial
review and certification of foreign trained
specialists and their inclusion in the category
previously occupied by only Canadian certified
specialists.
As of March 31, 2003, there were approximately
346 practising dentists and dental surgeons
located in all major centres in Saskatchewan.
Ninety-four provided services insured under the
Medical Services Plan.
A number of new or continuing initiatives were
underway in 2002-2003 to enhance access to
insured physician services and reduce waiting
times.
‰
A Long-term Service Retention Program
rewards physicians who work in the province
for 10 or more years.
‰
Effective July 1, 2001, a specialist
emergency room coverage program was
established to compensate specialist
physicians who made themselves available
to provide emergency coverage to acute
care facilities.
‰
‰
‰
A Re-entry Training Program provides two
grants annually to rural family physicians
wishing to enter specialty training, and
requires a return service commitment.
New Specialist Recruitment and Retention
Funding provides funding for new initiatives
in addition to the existing funding of the
Regina and Saskatoon regional health
authorities.
A Physician Recruitment Coordinator is
assisting rural regions and physicians in
recruiting physicians.
Canada Health Act Annual Report, 2002-2003
‰
Rural physicians are supported through an
integrated Emergency Room Coverage and
Weekend Relief Program that compensates
physicians providing emergency room
coverage in rural areas, and assists those
communities with fewer than three
physicians to gain access to other physicians
to provide weekend relief.
‰
The Rural Practice Establishment Grant
Program makes 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 Medical Resident Bursary Program
provides bursaries of $18,000 to three family
medicine residents to assist them with
medical educational expenses in return for a
rural service commitment.
‰
The Undergraduate Medical Student Bursary
Program provides an annual grant of
$25,000 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 Continuing Medical
Education Program provides funds to rural
physicians for certification and re-certification
of skills in emergency care and risk
management. Approved physicians are
required to provide service in rural
Saskatchewan after completing an
educational program.
‰
The Resident Weekend Relief Program
matches second-year family medicine
residents with physicians in larger rural
communities who are seeking weekend
relief.
‰
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.
‰
Support is provided to initiatives for
physicians to use allied health professionals
and enhance the integration of medical
services with other community-based
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Chapter 3 – Saskatchewan
services through the Alternate Payments and
Primary Health Services Program.
‰
‰
The Northern Medical Services Program is a
tripartite endeavour of Saskatchewan Health,
Health Canada and the University of
Saskatchewan to assist in stabilizing 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.
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 commence
discussion on a new agreement;
‰
each party shall appoint no more than six
representatives to the Committee;
‰
the objective of the Committee is to prepare
an agreement respecting insured services
that is satisfactory to both parties;
‰
in the case that a satisfactory agreement
cannot be reached, the matter may be
referred to the Medical Compensation
Review Board, consisting of an appointee by
either party who in turn select a third
member; and
‰
the Board has the authority to make a
decision binding on the parties.
In December, 2000, a new three-year
agreement (retroactive to April 1, 2000) was
successfully negotiated with the Saskatchewan
Medical Association. It provides an increase in
116
the Physician Payment Schedule of three
percent in each year of the contract. Similar
increases were applied to non fee-for-service
physicians. Increased funding was also provided
for new items and modernization of the payment
schedule.
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-forservice is the only mechanism used to fund
dentists for insured surgical-dental services.
5.5
Payments to Hospitals
In 2002-2003 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 the
provision of specialized hospital programs (e.g.,
renal dialysis, specialized medical imaging
services, specialized respiratory services), or for
the provision of 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 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
the provision of services in any area of
Saskatchewan if it is in the public interest to do
so.
Designated funds to address surgical waitlist
issues were provided to the four largest health
regions in 2002-2003. Each region was asked to
outline a maximum expenditure on capital
equipment and a plan for allocating equipment,
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Saskatchewan
with the remainder of the allocated funds to be
spent on operational initiatives to increase
surgical capacity and throughput. Regions were
required to report all expenditures and changes
in service volumes resulting from the additional
funding.
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 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 for immunization of
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.
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 and Social Transfer
in the Department of Health 2002-03 Annual
Report, the 2002-2003 Annual Budget and
related budget documents, its 2002-2003 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.
Home Care Services
‰
Federal contributions have also been
acknowledged on the Saskatchewan Health
Web-site, news releases, issue papers, in
speeches and remarks made at various
conferences, meetings and public policy forums.
Federal assistance was also recognized in The
Action Plan progress reports released in both
the spring and fall of 2002.
7.0 Extended Health Care
Services
As of March 31, 2003, 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.
Canada Health Act Annual Report, 2002-2003
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 a recently
announced option of the Home Care
Program. This option provides funding
directly to people so they can arrange and
manage their own supportive services. The
Home Care Program is governed by The
Regional Health Services Act.
Ambulatory Health Care Services
‰
Saskatchewan regional health authorities
provide a full range of mental health and
alcohol and drug services in the community.
Mental health services are governed by The
Mental Health Services Act.
‰
Regional health authorities offer podiatry
services. Services include assessment,
consultation and treatment. The Chiropody
Services Regulation of The Department of
117
Chapter 3 – Saskatchewan
Health Act provides chiropodists and
podiatrists with the ability to self-regulate
their profession.
‰
‰
Regina/Qu’Appelle and Saskatoon regional
health authorities provide a Hearing Aid
Program. Services include hearing testing,
assessments for at-risk infants, and the
selling, fitting and maintenance of hearing
aids. The Hearing Aid Act and Regulations
and The Regional Health Services Act
govern these programs.
Rehabilitation therapies, including
occupational and physical therapies and
speech and language pathology, are offered
by the regional health authorities and help
individuals of all ages to improve their
functional independence. Services are
provided in hospitals, rehabilitation centres,
long-term care facilities, community health
centres, schools and private homes and
include assessment, consultation and
treatment. The Regional Health Services Act
and The Community Therapy Regulations,
which are under the authority of The
Department of Health Act, govern these
programs.
‰
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. The Adult and Youth Group Homes
Regulations of The Housing and Specialcare Homes Act govern licensure of
detoxification services.
‰
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. The Adult
and Youth Group Homes Regulations of The
Housing and Special-care Homes Act govern
licensure for in-patient services.
‰
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. The Adult and Youth
Group Homes Regulations of The Housing
and Special-care Homes Act govern
licensure for long-term residential services.
Adult Residential Care Services
Mental Health Services
‰
Apartment Living Programs and Group
Homes provide a continuum of support and
living assistance to individuals with long-term
mental illnesses. These programs are
governed by The Residential Services Act.
‰
Saskatchewan Health, in partnership with the
Heartland Regional Health Authority, offers a
rehabilitation program for people and families
struggling with eating disorders. BridgePoint
Centre delivers this program and is currently
governed by The Non-profit Corporations Act
(1995) and The Co-operatives Act (1996).
8.0 Additional Materials
Submitted to Health Canada
‰
Saskatchewan Health Annual Report,
2002-2003 (which includes the 2003-04
Performance Plan).
‰
Healthy People. A Healthy Province. The
Action Plan for Saskatchewan Health Care.
‰
It’s For Your Benefit: A Guide to Health
Coverage in Saskatchewan.
Alcohol and Drug Services
‰
118
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 community-based and nonprofit organizations governed by The Nonprofit Corporations Act to provide services.
Canada Health Act Annual Report, 2002-2003
Alberta
Introduction
Alberta’s commitment to public health
care: understanding your public health
care insurance plan
Alberta has a commitment to building a better
publicly-funded health care system for
Albertans. The province provides medically
necessary services in a public system that
follows the principles of the Canada Health Act:
publicly administered, comprehensiveness,
universality, portability and accessibility.
Medically necessary services are hospital,
physician and specific services provided by oral
surgeons and other dental professionals.
Alberta also provides full and partial coverage
for health care services not required by the
Canada Health Act, including:
‰ home care and long-term care;
‰
mental health services;
‰
dental and eyeglass benefits for recipients of
the Alberta Widow’s Pension and their
eligible dependents;
‰
palliative care;
‰
immunization programs for children;
‰
allied health services such as optometry (for
residents under 19 and over 64 years) and
chiropractic and podiatry services; and
‰
drug benefits through Alberta Blue Cross.
Alberta Health and Wellness Vision:
“Citizens of a healthy Alberta achieve
optimal health and wellness.”
The slogan “Healthy Albertans in a healthy
Alberta” reflects this vision.
The Government of Alberta wants Albertans to:
‰ realize their full health potential in a safe
environment with appropriate income,
housing, nutrition and education; and
‰
play a valued role in family, work and their
community.
Canada Health Act Annual Report, 2002-2003
Alberta Health and Wellness contributes to that
effort by ensuring Albertans have equitable
access to affordable, effective and appropriate
health and wellness services, when they need
them.
The vision also requires individuals to take
responsibility for their own health.
Alberta Health and Wellness Mission
“To maintain and improve the health of
Albertans by leading and working
collaboratively with citizens and
stakeholders.”
Two core business lines support this mission:
1. Deliver quality health services to Albertans.
2. Encourage and support Albertans to lead
healthy lives.
Progress on health reform in 2002-2003
Alberta waitlist registry
Pilot testing of the Alberta waitlist registry has
begun. By fall 2003, the registry will put waitlists
for selected procedures on the Internet to help
Albertans and their physicians plan where they
can go for surgical and diagnostic procedures.
Pharmaceutical Information Network
Two Pharmaceutical Information Network pilot
projects were successfully conducted in
Westlock and Leduc. The projects demonstrated
that use of electronic medication information
results in more effective decisions about drug
prescriptions for patients.
Provincial Personal Health Identifier
The Provincial Personal Health Identifier (PPHI)
identifies each person who receives health
services in Alberta. The identifier is unique to
each person and remains the same over the
person’s lifetime. The PPHI can be used to
collect demographic information and is a key
foundation in the development of Alberta’s
electronic health record system.
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Chapter 3 – Alberta
Rural health strategy
An MLA appointed committee has been
reviewing standards for assessing emergency
and acute care services, primary health care
services, health workforce needs and the use of
technology in rural communities.
Collaboration and innovation
The Alberta government accepted 49 of the 50
recommendations of the Committee on
Innovation and Collaboration report to make
Alberta’s regional health authorities more
collaborative, innovative and accountable. New
multi-year performance agreements will be
established that will require regional health
authorities to improve collaboration and
innovation, develop new models of care, create
centres of specialization and contract with a
blend of providers to offer a range of services.
Accessible, quality care
The Ministry and its partners explored ways to
make the best use of health care professionals
and improve access to health care:
‰
a comprehensive workforce plan is being
developed to attract and retain health
professionals;
‰
a $8.25 million allocation to new alternative
funding plans will allow more than 190
academic physicians to spend more time
teaching students, conducting research and
caring for patients; and
‰
more than 75 foreign-trained health
professionals have been given permanent
resident status through the Provincial
Nominee Program, a program that expedites
the immigration process for foreign
professionals.
Protection, promotion and prevention
Actions to help Albertans live healthy lives and
avoid injury and disease were a critical focus
this year.
Healthy U campaign
A public information and education campaign
was launched to encourage Albertans to lead
healthier lifestyles. The Healthy U campaign
included television and radio advertisements, a
120
newspaper supplement, and a website that
directs visitors to reliable health information.
Ten-year health targets and strategies
Targets to lower the rate of chronic disease
such as heart disease, cancer, and chronic
obstructive pulmonary disease, have been
established. Strategies to reach the targets by
2012 have been identified.
Alberta diabetes strategy
A new strategy was developed to provide
financial assistance for low-income Albertans,
improve screening for diabetes and address
complications for Aboriginal people living off
reserve. This plan also proposes prevention
initiatives and new approaches for the care and
management of diabetes.
Two new vaccines
Two new vaccines were added to Alberta’s
routine immunization program for children,
starting at age two months. These vaccines
protect children from meningitis, serious blood
infections and pneumonia at a cost of $20
million annually.
Tobacco reduction strategy
The Alberta Alcohol and Drug Abuse
Commission (AADAC) launched an information
campaign to reduce tobacco use in Alberta. The
To Tell the Truth campaign included television,
radio advertisements and a magazine that
carried facts about the dangers of tobacco. A
toll-free Smoker’s Help Line was established to
help Albertans quit smoking.
The Prevention of Youth Tobacco Use Act was
proclaimed to make it illegal for anyone under
the age of 18 to use or possess tobacco in a
public place.
Accountability to Albertans
The Canadian Institute for Health Information
confirmed that Albertans receive high quality
care in its Health Care in Canada 2002 report.
Alberta performed better than the Canadian
average in several areas, including per-person
health spending, joint replacement surgery and
heart attack survival rates.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Alberta
Alberta’s Report on Comparable Health
Indicators finds Albertans experience lower
rates of in-hospital mortality rates for heart
attacks and strokes, lower potential years of life
lost for lung cancer, colorectal cancer, heart
attack and stroke, and lower hospital readmission rates for heart attacks.
Who administers and reports on the plan?
The Annual Health Survey asks Albertans to
rate how well their health care system is
performing each year. Copies of the annual
survey and other publications on health care
system measures can be accessed at:
Each September, the department issues an
annual report that documents the ministry’s
activities and consolidated financial statements
for the previous fiscal year. The annual report
provides information about the actions, key
achievements and results for all key
performance measures included in the 20022003 Business Plan.
www.health.gov.ab.ca/reading/publications.html
Health Services Utilization and Outcomes
Commission
A survey conducted by the Health Services
Utilization and Outcomes Commission found the
majority of Albertans give good marks to the
quality of their health care system. Albertans
also said improvement needs to be made in
emergency services, getting access to
specialists, receiving satisfaction in how
complaints are addressed and managing patient
safety issues.
The commission is studying practice patterns of
family physicians and the use of drugs in the
health care system.
1.0 Public Administration
What is the Alberta Health Care Insurance
Plan?
Since 1969, the Alberta Health Care Insurance
Plan, as defined by the Alberta Health Care
Insurance Act, has provided Albertans with
medically necessary hospital services, and
medically necessary services provided by
physicians, oral surgeons and other dental
professionals.
The Alberta Health Care Insurance Plan is
operated through the Department of Health and
Wellness. The plan is operated on a non-profit
basis and is administered by the Minister of
Health and Wellness.
The Alberta Health and Wellness annual report
can be accessed at:
www.health.gov.ab.ca/public/document/AR02_03/
The department also issues an annual statistical
supplement report on data related to the Alberta
Health Care Insurance Plan. The Statistical
Supplement report can be accessed at:
www.health.gov.ab.ca/reading/publications.html#4
Who ensures that reports are accurate?
The Auditor General of Alberta audits the
records and financial statements of the Ministry
of Health and Wellness. In addition, each health
authority must provide its own audited financial
statements to be included in the Ministry’s
annual report.
How much is spent on the plan each
year?
In 2002-2003, the Alberta Health Care
Insurance Plan issued a total of $1,225,626,637
in fee-for-service payments to Alberta
physicians and a total of $61,714,5341 to Alberta
allied health practitioners (dental surgeons,
dentists, chiropractors, optometrists, podiatrists)
for basic health services.
Alberta’s health legislation and regulations can
be accessed at the following internet address:
www.health.gov.ab.ca/system/minister/legislation.
html
1
Canada Health Act Annual Report, 2002-2003
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
121
Chapter 3 – Alberta
2.0 Comprehensiveness
What Alberta legislation covers hospital
services in the province?
The Hospitals Act, the Hospitalization Benefits
Regulation (AR244/90), the Health Care
Protection Act and Health Care Protection
Regulation define how insured services are
provided by hospitals or designated surgical
facilities in Alberta.
Alberta Health Care Insurance Plan
Statistics
Community Care Facilities There are three
community care facilites in Alberta: La Crete Health
Centre; Paddle Prairie Community Health Centre;
and Rainbow Lake Community Health Centre
There are two other types of “non-hospital”
facilities:
‰ Non-hospital surgical facilities Facilities that
offer health care services involving medical
operative procedures that do not require an
overnight stay in the facility for post-operative
recovery or observation – including private
cataract, abortion, dental and ophthalmology
clinics. According to the College of Physicians and
Surgeons of Alberta, there are currently 53 nonhospital day surgical facilities accredited under the
college bylaws.
‰ Non-hospital diagnostic facilities Non-hospital
diagnostic facilities offer health care services for
procedures that do not require an overnight stay
and detect and determine various diseases or
health conditions. A total of 157 non-hospital
diagnostic facilities received fee-for-service
payments from the Alberta Health Care Insurance
Plan in 2002-2003.
Physicians, Practitioners and Residents
In the 2002-2003 fiscal year, there were 5,206
physicians and 1,777 allied health practitioners
who were registered with and received payment
from the Alberta Health Care Insurance Plan.
There were 3,124,487 residents registered with
the Alberta Health Care Insurance Plan.2
Facilities
There are 214 health care facilities in Alberta,
excluding psychiatric hospitals and nursing
homes:
There are 100 Acute Care Facilities that offer health
services provided to persons suffering from serious
and sudden health conditions that require ongoing
professional nursing care and observation
There are 110 Continuing Care Centres that offer
health services to residents who require treatment for
long-term or chronic illnesses, diseases or infirmities.
Rehabilitative Facilities offer health care services
for persons requiring professional assistance to
restore physical skills and functionality following an
illness or injury. These services are offered at the
Glenrose Rehabilitative Centre.
What Alberta legislation covers these
types of facilities?
The Health Care Protection Act defines rules for
the operation of surgical facilities and protection
of the publicly funded and administered health
care system. Under section 7 of this Act,
surgical facilities are allowed to provide insured
surgical services when they are accredited,
have an agreement with a health authority and
the facility is designated by the Minister.
Under section 11, the Minister may designate a
surgical facility to provide specified insured
surgical services where the Minister has
approved a proposed agreement with a health
authority, and the Minister is satisfied that the
surgical facility either is, or will be, accredited to
provide those surgical services.
Section 8(3) states that the Minister “shall not
approve an agreement” unless:
‰ the insured surgical services are consistent
with the principles of the Canada Health Act;
‰
2
122
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
there is a current and will likely be a future
need for surgical services in the
geographical area to be served;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Alberta
‰
the proposed surgical services will not have
a negative impact on the province’s public
health system;
How is a hospital service insured in
Alberta?
‰
it is expected the public will benefit from the
insured surgical services being provided;
‰
the 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 conflict of interest and ethical
requirements within the Medical Profession
Act and bylaws.
Section 25(1)(h) of the Health Care Protection
Act gives Cabinet the authority to determine
whether a particular good or service is a
standard or an enhanced good or service. The
Health Care Protection Regulation defines major
surgical services, minor surgical procedures,
and standard and enhanced medical goods and
services. An amendment to the regulation must
be made to add or remove an insured service.
How are Albertans protected by the
Health Care Protection Act?
Under this Act:
‰ operation of private hospitals is prohibited
(section 1);
‰
operation of non-hospital surgical facilities is
prohibited unless they are approved
(section 2);
‰
“queue jumping” is prohibited (section 3);
‰
non-hospital surgical facilities cannot charge
facility fees to patients who receive insured
surgical services (facility fees are payable by
health authorities) (section 4);
‰
no person can charge or collect payment for
enhanced medical goods or services above
the actual cost to provide them (section 5);
and
‰
no person can charge or collect payment for
enhanced medical goods or services unless
the nature of the goods or services offered
and the charges for them are fully explained.
How is a hospital approved in Alberta?
Acute care hospitals and auxiliary hospitals
must receive department and ministerial
approval. A new hospital must undergo a
regional needs assessment, have a program
and service plan developed and conduct a
hospital functional programming study.
What Alberta legislation covers physician
services?
Insured physician services are paid for 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 physician services
under the Alberta Health Care Insurance Plan.
Before being registered with the department, a
practitioner must complete the appropriate
registration forms and include a copy of his/her
licence issued by the appropriate governing
body or association, such as the College of
Physicians and Surgeons of Alberta or the
Alberta Dental Association and College.
As of March 31, 2003, there were 5,206
physicians in Alberta who were registered with
and received payment from the Alberta Health
Care Insurance Plan of which 2,841 were
general practitioners and 2,365 were
3
specialists.
Can physicians opt out of the plan?
Yes, 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, 2003, there were no opted-out
medical practitioners in the province.
3
Canada Health Act Annual Report, 2002-2003
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
123
Chapter 3 – Alberta
Are surgical-dental services insured?
The province insures a number of medically
necessary oral surgical procedures that are
listed in the Schedule of Oral and Maxillofacial
Surgery Benefits. A dentist or dental surgeon
may perform a small number of these
procedures, but the majority of the procedures
can be billed to the Alberta Health Care
Insurance Plan only when performed by an oral
and maxillofacial surgeon.
Total payments to oral surgeons and dentists for
insured surgical-dental services in 2002-2003
were $2,394,458.4
There were 234 oral surgeons and dentists
registered with the Alberta Health Care
Insurance Plan who billed the plan for insured
5
dental services as of March 31, 2003.
Can dentists and oral surgeons opt out of the
plan?
Under section 7 of the Alberta Health Care
Insurance Act, dentists and oral surgeons may
opt out of the Alberta Health Care Insurance
Plan. As of March 31, 2003, there were no
opted-out dentists or oral surgeons in Alberta.
What medical benefits are insured?
The Medical Benefits Regulation defines which
medical services are insured. These services
are documented in the Schedule of Medical
Benefits, which is prepared and published by
the department and approved by the Minister.
A complete list of medical benefits can be
accessed at:
www.health.gov.ab.ca/professionals/somb.htm
Schedule of Medical Benefits require ministerial
approval after joint negotiations between the
department and the AMA have concluded.
What is not insured?
Section 4(1) of the Hospitalization Benefits
Regulation provides a list of uninsured hospital
services. Uninsured services include drugs,
services and products that have been deemed
medically unnecessary and services provided by
a facility outside of Canada, unless prior
approval of the Minister is obtained.
The Minister of Health and Wellness determines
what services the Alberta Health Care Insurance
Plan covers. The department reviews scientific
literature, consults expert advice and assesses
policy, funding and training in considering
medical products, services or devices for
insured coverage.
Section 21 of the Alberta Health Care Insurance
Regulation defines what services are not
considered insured services.
Can Albertans be billed for any services?
Physicians may bill a patient for services that
are not medically required and not included in
the Schedule of Medical Benefits. The
department does not regulate physicians’
billings for uninsured services. The College of
Physicians and Surgeons of Alberta has
developed and enforces a policy on this issue
entitled Charging for Uninsured Services, and
the AMA provides the Guide to Direct Billing for
Uninsured Services to physicians.
There were no medical services de-insured or
de-listed in 2002-2003.
How are changes to the list made?
Insured physician services and any changes to
the Schedule of Medical Benefits are discussed
between the department and the Alberta
Medical Association (AMA). All changes to the
4
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
5
Ibid.
124
3.0 Universality
Who is eligible for coverage in Alberta?
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
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Alberta
province his or her home and is ordinarily
present in Alberta. The term “resident” does not
include a tourist, transient or visitor to Alberta.
non-group Blue Cross, can be provided to all
members of the family unit.
There were 3,124,487 residents of Alberta
registered with the Alberta Health Care
Insurance Plan as of March 31, 2003.6
Who is required to pay premiums for
health care in Alberta?
Who is not eligible for coverage in
Alberta?
Residents who are not eligible for coverage
under the Alberta Health Care Insurance Plan
are:
‰
members of the Canadian Forces;
‰
members of the Royal Canadian Mounted
Police (RCMP) who are appointed to a rank;
and
‰
persons serving a term in a federal
penitentiary. (However, family members are
eligible for coverage.)
Are people who have moved to Alberta
from other countries covered?
People from outside Canada who move to
Alberta to establish permanent residence are
eligible for coverage if they are landed
immigrants, returning landed immigrants or
returning Canadian citizens. Temporary
residents arriving from outside Canada, who
may be deemed residents, include persons on
Visitor Records, Student or Employment
Authorizations and Minister’s Permits. As of
March 2003, there were 17,107 people covered
under these conditions.
How do people new to Alberta apply for
health coverage?
All new Alberta residents are required to register
themselves and their eligible dependents with
the Alberta Health Care Insurance Plan. New
residents to Alberta should apply for coverage
within three months of arrival. Family members
are registered on the same account for billing
purposes and to ensure that benefits, such as
6
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
Canada Health Act Annual Report, 2002-2003
All Alberta residents, except dependents and
individuals excluded from registration, are
required to pay premiums. Exceptions include
individuals enrolled in special groups (such as
Alberta Widows’ Pension or Support for
Independence), or people entitled to full
premium assistance.
Two programs assist lower-income, non-senior
Albertans with the cost of their premiums: the
Premium Subsidy Program and the Waiver of
Premiums Program.
Seniors are required to pay premiums at the
same rates as non-seniors, although seniors
may be eligible for premium assistance as
determined through the Alberta Seniors Benefit
Program.
Money raised through premiums in 2002-2003
Alberta spent $6.8 billion on health care costs in
2002-2003. Premium payments raised $937
million which covered only 14 percent of the
total.
Can Albertans be denied coverage if they
are unable to pay their premiums?
No. Although Albertans are required to pay
premiums, no resident is denied coverage due
to an inability to pay.
4.0 Portability
Eligibility: Coverage when you move to
Alberta
Are out-of-province residents insured when
they move to Alberta?
Persons moving permanently to Alberta from
another part of Canada are eligible for coverage
on the first day of the third month following their
125
Chapter 3 – Alberta
arrival, provided they register within three
months of arrival.
which allows for the processing of hospital costs
provided by the host province.
Are people from outside of Canada insured
when they move to Alberta?
Alberta also participates in the Medical
Reciprocal Billing Agreement with provinces and
territories (except Quebec), which allows for the
processing of medical costs provided by
practitioners in the host province. Payments are
paid at the host province or territorial rates.
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, provided their Canada entry
documents are valid for at least 12 months.
Portability: Coverage when you move out
of Alberta or out of Canada
Is there coverage for Albertans living
temporarily in another province?
The Alberta Health Care Insurance Plan
provides the following coverage:
‰
Visit/Vacation – up to 24 months coverage.
‰
Work/Business/Missionary Work – up to 48
months.
‰
Post Secondary Education – no limit.
Covered until studies are completed.
Extension requests for longer than 24 months
will be reviewed on a case-by-case basis.
Individuals who are routinely absent from
Alberta every year will need to spend a
cumulative total of 183 days in a 12-month
period in Alberta to maintain continuous
coverage.
If individuals will not be present in Alberta for
the required 183 days, they may be considered
residents of Alberta if they satisfy Alberta Health
and Wellness that Alberta is their permanent
and principle place of residence.
More information on coverage during temporary
absences outside of Canada or Alberta is
accessible at:
www.health.gov.ab.ca/coverage/ahcip/travel.html
Is there coverage for people receiving
medical attention in another province?
Alberta participates in the Hospital Reciprocal
Agreement with other provinces and territories,
126
Is there coverage for people living
temporarily outside Canada?
The Alberta Health Care Insurance Plan
provides coverage for the first six consecutive
months of absence outside Canada. Residents
who wish to maintain coverage for a longer
period may request an extension of coverage
for a maximum of 24 consecutive months from
the month of departure.
Extension requests for longer than 24 months
will be reviewed on a case-by-case basis and
will be responded to the same as for Albertans
living temporarily in another province.
The maximum amount payable for out-ofcountry in-patient hospital services is $100
(Canadian) per day, (not including day of
discharge). The maximum hospital out-patient
per 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
Out-of-province payments
in 2002-2003 within Canada
Number of
Services
Total Paid
In-patient and
out-patient
insured hospital
services provided
to Alberta
residents
72,250
$23,707,079
Insured physician
services provided
to Alberta
residents
559,503
$13,880,981
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003. Is approval needed to receive
services outside Alberta?
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Alberta
$220 per visit, with a limit of one visit per day.
Physician and allied health practitioner services
are paid according to Alberta rates.
‰
an increase of $247 million or 6.9 per cent to
regional health authorities and provincial
boards;
‰
an increase of approximately $21 million for
province-wide services for key life-saving
procedures primarily done in Edmonton and
Calgary; and
‰
an increase of $177 million for physician
compensation, as part of the agreement
negotiated with the Alberta Medical
Association.
Is approval needed to receive services
outside Alberta?
Prior approval is not required for elective
services received outside Alberta, except for the
treatment of alcohol and substance abuse,
eating disorders and similar addictive or
behavioural disorders. Approval by the Minister
must be received before these services can be
covered.
Out-of-country payments
in 2002-2003
Number of
Services
Total Paid
In- and outpatient insured
hospital services
provided to
Alberta residents
7,437
$546,853
Insured physician
services provided
to Alberta
residents
21,289
$976,232
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
5.0 Accessibility
Who has access to insured health
services?
How is Alberta increasing access to
insured physician and dental-surgical
services in Alberta?
The Alberta International Medical Graduate
(AIMG) Program and the Alberta Rural Family
Medicine Network (ARFMN) continued to have
funding extended during this period. There are
currently 17 residents training in the AIMG
Program. The ARFMN Program has a total of 40
family medicine residents. As well, $920,000
was provided to the University of Alberta to
support the continuance of the School of
Dentistry.
What other initiatives aimed at increasing
access are underway?
In response to the Premier’s Advisory Council
on Health report, the Alberta government has
committed to the following:
‰
launch a website posting information on wait
times for selected procedures;
‰
establish a centralized booking system for
selected procedures to allow patients to find
a surgeon and facility that matches their
needs;
‰
increase the use of care groups, which
involve a range of health professionals and
new approaches to care for people with
chronic diseases; and
‰
work with physicians and health authorities
to identify appropriate access standards for
selected health services.
All Alberta residents have access to insured
health services in Alberta.
How is Alberta increasing access to
insured hospital services in Alberta?
The 2002-2003 budget included:
‰ an increase of 7.3 percent or $468 million,
with total Alberta Health and Wellness
spending in 2002-2003 of $6.837 billion;
Canada Health Act Annual Report, 2002-2003
127
Chapter 3 – Alberta
Number of practitioners who were
registered with and received payment from
the Alberta Health Care Insurance Plan as
of March 31, 2003
Health Occupation
Registered/
Licensed to
Practise
Opticians
31
Podiatrists
50
Denturists
102
Optometrists
340
Oral Surgeons/Dentists
453
Chiropractors
801
Physicians
5,206
total
6,983
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
How are physicians paid?
Most physicians in Alberta are paid on a fee-forservice basis for providing insured services. The
department and the Alberta Medical Association
are working with health authorities, facilities and
physicians to develop a number of new
alternate payment plan projects as alternatives
to fee-for-service payment.
These alternate payment plans and alternate
funding plans were expanded in 2002-2003 with
approximately 225 physicians involved in such
arrangements. A number of other plans,
involving approximately 1,000 primary care
specialist and academic physicians, are in
development.
Who determines what physicians are
paid?
Alberta Health and Wellness (AHW) negotiates
payment agreements with the Alberta Medical
Association (AMA), the professional association
representing physicians and surgeons in
Alberta. Negotiations are currently underway to
establish a new agreement between AHW and
128
the AMA. Regional health authorities (RHAs)
are represented in these negotiations for the
first time. AHW, RHAs and the AMA will sign this
new agreement.
In 2002-2003, total fee-for-service payments to
physicians for insured physician services were
$1,225,626,637 (for general practitioners and
7
specialists).
What role do regional health authorities
play?
The Regional Health Authorities Act defines the
roles and responsibilities for regional health
authorities in delivering hospital and health
services.
Alberta Health and Wellness uses a populationbased funding formula to fund regional health
authorities. The formula calculates the total
population, age, gender and socio-economic
composition of the region, as well as the
services provided to residents, to determine
how much funding is provided to each region.
In 2002-2003, $3.9 billion in population-based
funding was provided to the regional health
authorities.
Edmonton and Calgary health authorities also
receive funding to provide specialized tertiary
services (province-wide services) to all
Albertans. Province-wide services received
$418 million in 2002-2003, an increase of
approximately six per cent over the previous
year.
6.0 Recognition Given to Federal
Transfers
The Alberta Government has publicly
acknowledged the federal contributions provided
through the Canada Health and Social Transfer
in publications released during 2002-2003.
7
These figures will be considered preliminary until the
release of the Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan, Statistical
Supplement 2002-2003.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Alberta
8.0 Additional Materials
Submitted to Health Canada
‰
Schedule of Medical Benefits, April 1, 2003.
‰
Schedule of Oral and Maxillofacial Surgery
Benefits, August 1, 2001.
‰
Reports of the Auditor General of Alberta for
2002/2003.
‰
Alberta Ministry of Health and Wellness
Annual Report, 2002/2003.
‰
Ministry of Health and Wellness Three-Year
Business Plan, 2003-2006.
‰
Alberta Budget, 2002/2003.
‰
Alberta Ministry of Health and Wellness’
Alberta Health Care Insurance Plan,
Statistical Supplement 2003/2003.
These publications are available from the
Alberta Health and Wellness website at:
www.health.gov.ab.ca/reading/
publications.html
Office consolidations of all health care
insurance legislation, together with all relevant
regulations:
‰
Alberta Health Care Insurance Act
‰
Alberta Health Care Insurance Regulation
‰
Government Accountability Act
‰
Health Care Protection Act
‰
Health Care Protection Regulation
‰
Health Insurance Premiums Act
‰
Health Insurance Premiums Regulation
‰
Hospitalization Benefits Regulation
‰
Hospitals Act
‰
Hospital Foundation Regulation
‰
Medical Benefits Regulation
‰
Medical Profession Act
‰
Nursing Homes Act
‰
Nursing Homes General Regulation
‰
Regional Health Authorities Act
‰
Regional Health Authorities Regulation.
Ministry and Commission Contacts
Minister of Health and Wellness
Gary G. Mar, Q.C.
MLA, Calgary Nose Creek
427-3665
Deputy Minister
Dr. Roger Palmer
422-0747
Health Facilities Review
Committee Chair
Bob Maskell
MLA, Edmonton-Meadowlark
427-3101
Alberta Alcohol and Drug Abuse
Commission Chair
LeRoy Johnson
MLA, Wetaskiwin-Camrose
427-2837
Mental Health Patient Advocate
Jay McPhail
422-1812
Alberta Health and Wellness
10025 – Jasper Avenue
Edmonton, Alberta
T5J 2N3
(780) 427-7164
310-4455 (toll free anywhere in Alberta)
www.health.gov.ab.ca
All Alberta Statutes and Regulations are
available online at
http://qpsource. gov.ab.ca
Canada Health Act Annual Report, 2002-2003
129
British Columbia
Introduction
British Columbia has a progressive and
integrated health care system. The British
Columbia health system includes insured
services under the Canada Health Act as well
as services funded wholly or partially by the
Government of British Columbia and services
regulated by, not funded by, the government. It
is based on regional delivery and self-regulating
professions providing quality, accessible and
affordable health care. Health authorities are
responsible for the delivery and management of
health services in each community of British
Columbia. As of March 31, 2003, there were five
regional health authorities plus a Provincial
Health Services Authority.
Health care is a top priority for the Government
and people of British Columbia.
Activities for 2002-2003
The 2002-2003 fiscal year marked the second
year of activity directed to meeting
government’s goal of creating a patient-centred
public health care system that provides
accessible, high-quality services, improves
health and wellness, and is sustainable over the
long term.
Building on the work started in 2001-2002 to
consolidate health authorities, clarify roles and
responsibilities, and establish clear
accountability for outcomes, the ministries
worked this year to strengthen the current
health system, while making it more adaptable
to changing needs. Over the past decade,
health spending increased from about 33
percent to 41 percent of the provincial budget,
and in 2002-2003, health spending increased by
12 percent to $10.4 billion. Increases of this
magnitude are not sustainable.
Under the structure established in June 2001,
the Ministry of Health Services provides funding,
strategic direction and leadership to support the
delivery of health care, preventive health and
health promotion services in British Columbia.
The Ministry of Health Planning supports the
development of long-term planning necessary to
Canada Health Act Annual Report, 2002-2003
sustain British Columbia’s public health care
system in the years ahead.
Five regional health authorities are responsible
for managing and delivering a range of health
services, including acute and hospital care,
home and community care, mental health,
addictions, and public health services. These
five regional health authorities encompass 15
health services delivery areas, which were
established to reflect natural patient referral
patterns. In addition to the regional health
authorities, the Provincial Health Services
Authority coordinates and delivers highly
specialized services that cannot be offered in all
regions, and facilitates coordination of provincial
initiatives. Health authorities receive three-year
budgets, which assists in planning, and have
greater accountability through performance
agreements that define expectations and
performance deliverables for three fiscal years.
The performance agreements also set out the
major change requirements in areas of service
such as emergency care, surgical services,
home and community care, public and
preventive health, and mental health. A new
population-needs-based funding formula was
developed in 2001-2002 and implemented in
2002-2003.
Service redesign efforts this year focused on
shifting the mix of services and care providers
to ensure patient care is delivered at the most
appropriate level and setting. These efforts will
help create an integrated network of services
that will allow patients to get the care they need
and to move seamlessly between settings and
providers. To facilitate this, in April 2002, BC’s
new health authorities released health service
redesign plans outlining their strategies to begin
creating a seamless high-quality and
sustainable network of care for patients in their
communities. Acute care access standards
developed by the Ministry of Health Planning
were used by health authorities in the redesign
of hospital services. The standards specify the
maximum travel time for accessing emergency
services, in-patient services and core specialty
services. They also ensure that the majority of
British Columbians, in all regions, have
reasonable access to these services.
A number of measures were undertaken in
2002-2003 to improve access for insured
131
Chapter 3 – British Columbia
hospital services. To assist the health authorities
to ensure appropriate utilization and
maintenance of hospital facilities and equipment
to meet the needs of patients and providers, the
Ministry of Health Service’s three-year capital
spending plan for 2002/03 included:
‰
$100 million for converting existing facilities
to more appropriate uses consistent with the
new regional priorities;
‰
$138 million to implement the Mental Health
Plan (e.g. Tertiary Mental Health Facilities in
Kamloops); and
‰
$115 million per year to maintain and
improve facilities, and to purchase
equipment.
A wide range of capital projects was funded to
provide new and improved health care facilities.
In December 2002, $21.5 million was made
available to educate, recruit and retain nurses,
including $10.7 million from the Ministry of
Advanced Education. These dollars fund several
initiatives, including new nursing education
seats, grants for 192 nurses to take upgrading
or refresher courses to return to the nursing
profession, and specialty or continuing
education opportunities for 3,000 nurses. Also
this year, health science education seats were
increased for allied health workers such as
medical imaging technologists, medical
laboratory technologists and respiratory
therapists. As well, new education spaces were
provided for midwifery and resident care
attendants.
In February 2003, a $58.5 million benefits and
incentives package was rolled out to attract
doctors to rural communities and improve
access for patients living there.
Planning was undertaken to implement the
commitment, announced in March 2002, of
$134 million to expand medical school facilities
at the University of British Columbia and
establish satellite medical programs at the
University of Northern British Columbia and the
University of Victoria. This will almost double the
number of medical school places by 2005.
The November 2002 release of The Picture of
Health: How We Are Modernizing British
Columbia’s Health Care System provided the
public and health care community with a
detailed description of the direction British
Columbia’s health care system will be moving
132
over the coming years. In 2002-2003, the
Ministry of Health Planning concentrated on
working with health care providers, plus diverse
health experts and academics, patients and
interest groups, and decision-makers at all
levels, to determine the best paths to follow to
achieve that direction. In February 2003, in
further support for evidence-based health care,
$8 million was provided to the Michael Smith
Foundation for Health Research to conduct
research for improving the effectiveness of
health care reforms.
Information on health and health care in British
Columbia is available from the following
website:
www.gov.bc.ca/healthservices
www.gov.bc.ca/healthplanning
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
On January 1, 1949, the British Columbia
provincial government commenced making
payments to hospitals for treatment provided to
qualified residents under the authority of the
Hospital Insurance Act. Hospital services are
funded, on a non-profit basis, through the
Performance Management and Improvement
Division of the Ministry of Health Services. This
program is responsible to the provincial
government for the ongoing funding of the
province’s public hospitals, delivered via funding
and transfer agreements with the six health
authorities, under the terms of the Hospital Act,
the Hospital Insurance Act (section 9), and the
Hospital District Act (section 20). This entails
expenditures and commitment controls for the
operation of hospitals, provision of funds for
hospital construction and equipment and
payment of out-of-province hospital costs for
qualified British Columbia residents.
Section 9 of the Hospital Insurance Act
previously required that the Minister pay
hospitals directly to cover the costs of publicly
insured hospital services. Section 9 was
amended in 2003 (Bill 33, 2003, the Health
Services Statutes Amendment Act, 2003) to
reflect the fact that hospitals are no longer
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
funded directly by government. This amendment
came into force September 22, 2003. Funding
of insured hospital services is now provided to
hospitals through the funding of health
authorities.
The Medical Services Plan of British Columbia
is administered and operated on a non-profit
basis by the Medical Services Commission. The
Medical Services Commission is responsible to
the Minister of Health Services and facilitates, in
the manner provided for under the Medicare
Protection Act (1996), reasonable access to
insured benefits under British Columbia’s
Medical Services Plan by beneficiaries
(residents). The day-to-day administration is
carried out by the employees of the Medical
Services Plan of the Ministry of Health Services.
Section 3 of the Medicare Protection Act
establishes both the Medical Services Plan and
the Medical Services Commission.
The Commission’s powers (set out under
section 5 of the Medicare Protection Act)
include determining benefits, registering
beneficiaries, enrolling practitioners, processing
and paying practitioners’ bills for benefits
rendered, registering diagnostic facilities,
establishing advisory committees, authorizing
research and surveys related to the provision of
benefits, auditing claims for payment and
patterns of practice or billings submitted and
hearing appeals from practitioners and
beneficiaries.
There were no amendments to the Medicare
Protection Act or the Medical and Health Care
Services Regulation made under the Medicare
Protection Act in 2002-2003 that changed the
name of the plan or its public authority.
1.2
Reporting Relationship
Health authorities are required to report health
information data respecting hospitals in their
jurisdictions to the Ministry of Health Services in
accordance with provincial policy. The
Performance Management and Improvement
Division reports to government through the
Ministry of Health Services Annual Report.
The Medical Services Commission reports
annually to the Minister of Health Services in a
separate Financial Statement. The 2002-2003
Financial Statement was tabled in October
2003.
Canada Health Act Annual Report, 2002-2003
In their annual performance reports, the
Ministries of Health Planning and of Health
Services provide extensive information on the
performance of British Columbia’s publiclyfunded health care system. Tracking and
reporting this information is consistent with the
Ministries’ increasingly strategic approach and
responsibilities for performance planning and
reporting, under the Budget Transparency and
Accountability Act, which was passed in 2000.
1.3
Audit of Accounts
The Performance Management and
Improvement Division and the Medical Services
Commission are subject to audit of their
accounts and financial transactions through
three types of auditor. Internally, the Ministry of
Health Services Finance and Decision Support
Unit reviews Ministry operations.
The Office of the Comptroller General’s Internal
Audit and Advisory Services is the provincial
government’s internal auditor and 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 findings. The Comptroller General
determines the scope of the internal audits and
timing of the audits in consultation with the audit
committee of the Ministry of Health. The
Ministry’s Senior Financial Officer determines
the scope and timing of reviews conducted by
the Finance and Decision Support Unit.
2.0 Comprehensiveness
2.1
Insured Hospital Services
The Hospital Insurance Act establishes public
insurance coverage for general hospital
services. Eligibility is defined by the
Regulations, which include both a residency
requirement and a waiting period. Insured
hospital services are provided in facilities
specified in section 1 of the Hospital Insurance
Act. In 2002-2003 there were 92 acute care
hospitals, three rehabilitation hospitals, 18 free-
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Chapter 3 – British Columbia
standing extended care hospitals and 25
diagnostic and treatment and other health
centres.
Insured hospital services are provided as
recommended by the attending physician or
midwife. These services, and the conditions
under which they are provided, are listed in the
Hospital Insurance Act Regulations, Division 5.
Insured in-patient services provided by hospitals
are:
‰
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;
‰
clinically approved drugs, biologicals and
medical supplies, when administered in a
general hospital specified in the Hospital
Insurance Act;
‰
routine surgical supplies;
‰
use of operating room and case room
facilities;
‰
anaesthetic equipment and supplies;
‰
use of radiotherapy, physiotherapy and
occupational therapy facilities, where
available; and
‰
other services approved by the Minister that
are rendered by persons who receive
remuneration from the hospital.
Beneficiaries not requiring in-patient hospital
care may receive emergency treatment for
injuries or illness and operating room or
emergency room services for surgical day care
and minor surgery, including the application and
removal of casts.
Listed hospital out-patient benefits include:
‰
out-patient renal dialysis treatments in
designated hospitals or other approved
facilities;
‰
diabetic day-care services in designated
hospitals;
‰
out-patient dietetic counselling services at
hospitals with qualified staff dieticians;
‰
psychiatric out-patient and day-care services;
physiotherapy and rehabilitation out-patient
day care, and services;
‰
cancer therapy and cytology services;
134
‰
out-patient psoriasis treatment;
‰
abortion services; and
‰
MRI services.
Insured hospital services are provided at no
charge to beneficiaries. Incremental charges for
preferred medical/surgical supplies are made on
the basis of a patient’s request. The patient is
not required to pay the incremental charge if the
preferred service is deemed medically
necessary by the attending physician.
Ambulance services are provided within the
province by the British Columbia Ministry of
Health Services through the Emergency Health
Services Commission, with a partial charge to
the patient.
In 2002-2003, no new services were added to
the list of insured hospital services covered by
the Hospital Insurance Act. General hospital
services are set out in sections 5 and 8 of the
Hospital Insurance Act. The hospital services
listed in the Regulations are both
comprehensive and generic. Changes to listed
items can be made through a regulatory
amendment which must be approved by
Cabinet.
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, it does not
require routine review and updating.
2.2
Insured Physician Services
Insured physician services are provided under
the authority of the Medicare Protection Act
(1996). Section 13 of the Medicare Protection
Act (MPA) provides that practitioners (including
medical practitioners and health care
practitioners, such as dentists) 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.
The Medical Services Plan (MSP) provides for
medically required services of medical
practitioners. Unless specifically excluded, the
following medical services are insured as MSP
benefits under the MPA and in accordance with
the Canada Health Act:
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
‰
medically required services provided to
“beneficiaries” (residents of British Columbia)
by a medical practitioner enrolled with MSP;
and
‰
medically required services performed in an
approved diagnostic facility under the
supervision of an enrolled medical
practitioner.
To practise 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 the MSP.
There were 7,892 physicians enrolled and billing
fee-for-service in fiscal year 2002-2003. In
addition, some physicians practice solely on
salary, receive sessional payments, or are on
contract (service agreements) arrangements
under alternative payments. Most physicians
paid by alternative mechanisms also practise on
a fee-for-service basis.
A physician may choose not to enrol or to deenrol with the Medical Services Commission.
Enrolled physicians may cancel their enrolment
by giving 30 days’ written notice to the
Commission. Services provided by un-enrolled
physicians are not benefits and patients are
responsible for the full cost of the service. There
was one previously enrolled physician who had
de-enrolled as of March 31, 2003.
Enrolled physicians can elect to be paid directly
by beneficiaries by giving written notice to
Commission. The Commission will specify the
effective date between 30 and 45 days following
receipt of the notice. In this case, beneficiaries
may apply to the MSP for reimbursement of the
fee for insured services rendered. Only six
physicians had opted out as of March 2003.
The Medicare Protection Act was amended in
April 2002 (Health Services Statutes
Amendment Act, 2002) with respect to insured
physician services. The amendments: repeal
section 13.1 to eliminate mandatory deenrollment of physicians from billing the MSP at
age 75; amend section 37 to provide for
surcharge and interest charges against
physicians who receive money from the
Commission for services they did not provide;
and amend section 37 to allow the Commission
to order interest on inappropriate billings
retroactive to the billing period. The
amendments were brought into force on July 4,
2002.
Canada Health Act Annual Report, 2002-2003
Under the Master Agreement between the
Commission and the British Columbia Medical
Association (BCMA), additions, deletions, fee
changes or other modifications to the
Commission Payment Schedule are made by
the Commission, upon advice from the BCMA.
Physicians who wish to have modifications to
the Schedule considered submit their proposals
to the BCMA Tariff Committee through the
appropriate section. On recommendation of the
BCMA Tariff Committee, interim listings may be
designated by the Commission for new
procedures or other services for a limited period
of time to allow definitive listings to be
established, if appropriate.
Several new fee items were added in 20022003, as follows:
‰
abdominal aortic aneurism repair using
endovascular stent graft – Vascular surgery
component;
‰
telephone advice to a Community Health
Representative in First Nations Communities;
‰
cortical or deep brain localization with SSEP
or simulation in an awake patient;
‰
craniotomy and insertion of subdural grid
electrodes with or without additional strip
electrodes – unilateral;
‰
re-opening of craniotomy for removal of
subdural grid electrodes – unilateral;
‰
craniotomy and microsurgical
hemispherotomy for epilepsy;
‰
stereotactic localization during neurosurgery
in association with craniotomy – extra;
‰
clinical immunology and allergy consultation;
‰
paediatric clinical immunology and allergy
consultation;
‰
repeat or limited clinical immunology and
allergy consultation;
‰
Clinical Immunology and Allergy – continuing
care by consultant (directive care,
subsequent office visit, subsequent hospital
visit, emergency visit when specially called);
‰
microelectrode recording (MER) –
electrophysiological (EP) mapping of the
basal ganglia and thalamus, intra-operatively
– extra;
‰
consultation for complex behavioural,
developmental or psychiatric condition in a
child;
‰
34 new laboratory fee items;
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Chapter 3 – British Columbia
‰
HIV/Aids Primary Care Management, advice
about a patient in Community Care, hospital
visit – first routine visit of the day laboratory
tests for several psychiatric and anti-epileptic
drugs;
‰
diagnostic vaginoscopy under GA;
‰
variocele and/or uterine artery embolization;
and
‰
tropinin (laboratory test).
A number of new clinical practice guidelines
were also approved by the Commission:
‰
detection and treatment of helicobacter pylori
infection in adult patients;
‰
investigation and management of iron
deficiency;
‰
clinical management of chronic Hepatitis C;
‰
clinical management of chronic Hepatitis B;
‰
diabetes care;
‰
otitis media with effusion; and
‰
acute otitis media.
2.3
Insured Surgical-Dental Services
The Medical Services Plan provides for
specified dental or oral surgery when it is
medically or dentally necessary for it to be
performed in hospital by a dental or oral
surgeon. Surgical-dental services are covered
by the Medical Services Plan when
hospitalization is medically required for the safe
and proper performance of the surgery and the
procedure is listed in the Dental Payment
Schedule. The Medicare Protection Act defines
patient eligibility and provider criteria. Additions
and/or changes to the list of insured services
are managed by the Medical Services Plan on
the advice of the Dental Liaison Committee,
which has equal representation from the Dental
Association and the Ministry of Health Services.
Additions and changes must be approved by the
Medical Services Commission. Included as
insured surgical-dental procedures are those
related to the remedying of 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.
136
Any dental or oral surgeon in good standing with
the College of Dental Surgeons and enrolled in
the Medical Services Plan may provide insured
surgical-dental services in hospital. There were
249 dentists enrolled and billing fee-for-service
in 2002-2003. None have de-enrolled and none
have opted out of the Medical Services Plan.
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 are:
‰
diagnostic out-patient services not
associated with emergency services;
‰
the 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;
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
‰
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 surgery.
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 beneficiaries for
services that would be benefits if performed by
a practitioner. Section 17 of the Act prohibits
persons from charging a beneficiary for a
benefit or for “materials, consultations,
procedures, 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
Services responds to complaints made by
patients and is prepared to take appropriate
actions to correct situations identified to the
Ministry.
In September 2002, the Ministry of Health
Services issued a Policy Communiqué to all
health authorities on Hospital-Based Revenue
Generation. Among the categories of services
covered by this policy is use of hospital facilities
to provide services covered by third party
insurers, such as the Workers’ Compensation
Board. The policy specifies that health
authorities’ primary obligation is to provide
insured health services to beneficiaries, and that
revenue generating practices must not occur at
the expense of providing appropriate and timely
service to beneficiaries. It also reinforces that
health authorities must follow the requirements
of the Canada Health Act, as well as relevant
provincial legislation. Health authorities are
required to report new initiatives of this type
within their annual Health Service Plans, and
the Ministry of Health Services monitors
compliance with the policy within the overall
performance monitoring plan and service design
plans.
The Medical Services Commission determines
which services are benefits and has the
authority to de-list insured services. Proposals
to de-insure services must be made to the
Commission. Consultation may take place
Canada Health Act Annual Report, 2002-2003
through a sub-committee of the Commission
and usually includes a review by the British
Columbia Medical Association’s Tariff
Committee.
3.0 Universality
3.1
Eligibility
Provincial policy on eligibility for hospital
services is set out in Chapter 2 of the Ministry of
Health Service’s Acute Care Policy Manual.
Section 7 of the Medicare Protection Act defines
the eligibility and enrolment of beneficiaries for
insured services. Part 2 of the Medical and
Health Care Services Regulation made under
the Medicare Protection Act details residency
requirements. A person must be a resident of
British Columbia in order 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, and
is physically present in British Columbia at least
six months in a calendar year. The definition of
resident includes a person who is deemed
under section 2 of the Medical and Health Care
Services Regulations to be a resident but does
not include a tourist or visitor to British
Columbia.
All residents, excluding those eligible for
compensation from another source, are entitled
to hospital and medical care insurance
coverage. The Medical Services Plan provides
first-day coverage to discharged members of
the Royal Canadian Mounted Police and the
Canadian Forces, and to released inmates of
federal penitentiaries. However, if discharged
outside British Columbia, they must wait the
prescribed period.
3.2
Registration Requirements
As of April 1, 1998, residents must be enrolled
in the Medical Services Plan to receive insured
hospital and physician services. Those who are
eligible for coverage are required to enrol. Once
enrolled, there is no expiration date for
coverage. New residents are advised to make
application immediately upon arrival in the
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Chapter 3 – British Columbia
Province. Each person who enrols with the
Medical Services Plan is issued a CareCard.
Renewal of cancelled enrolment can usually
take place over the telephone, by calling the
Medical Services Plan.
Beneficiaries may cover their dependants,
provided the dependants are residents of the
province. Dependants include the account
holder’s spouse (either married to or living and
cohabiting in a marriage-like relationship), any
unmarried child or legal ward under the age of
19 supported by the beneficiary, or a child under
the age of 25 and in full-time attendance at a
school or university.
The number of residents registered with the
Medical Services Plan as of March 31, 2003,
was 4.11 million. Enrolment in the Medical
Services Plan is mandatory. Only those adults
who formally opt out of all provincial health care
programs are exempt. As of March 31, 2003,
231 people had opted out.
3.3
Other Categories of Individual
Refugee claimants are not generally eligible.
Individuals who are approved for refugee status
and who are, therefore entitled to reside in
Canada on a permanent basis, are eligible.
Under specific circumstances, special
consideration is given to these individuals
regarding the effective date of benefits. Holders
of Minister’s Permits are eligible for benefits
where deemed to be residents under the
Medical and Health Care Services Regulation. A
waiting period applies.
3.4
Premiums
Enrolment in the Medical Services Plan is
mandatory, and payment of premiums is
ordinarily a requirement for coverage. However,
failure to pay premiums is not a barrier to
coverage for those who meet the basic
enrolment eligibility criteria. Effective May 1,
2002, monthly premiums for the Medical
Services Plan were $54 for one person, $96 for
a family of two, and $108 for a family of three or
more. Residents with limited incomes may be
eligible for premium assistance. There are five
levels of assistance, ranging from 20 percent to
100 percent of the full premium. Premium
assistance is available only to beneficiaries
who, for the last 12 consecutive months, have
138
been resident in Canada and a Canadian citizen
or holder of permanent resident (landed
immigrant) status.
There are no additional premiums for insured
hospital services. However, there is a daily
charge for extended-care hospital services for
patients over the age of 19. The client rate,
representing the cost of accommodation and
meals, is established once a year. As of March
31, 2003, the maximum non-subsidized rate
was $50 a day. Residents with limited means
are eligible for assistance, on a sliding scale. In
certain circumstances there is a provision to
waive a portion of the fee. Client rates of less
than $50 per day are reviewed quarterly and
patients are advised one month before any
changes are made.
4.0 Portability
Persons moving permanently to another part of
Canada are entitled to coverage to the end of
the second month following the month of
departure. Such persons may be extended
coverage, not to exceed three months, for a
reasonable period of travel.
Persons moving permanently outside Canada
are entitled to coverage to the end of the month
of departure.
4.1
Minimum Waiting Period
The minimum residence requirement for hospital
insurance and medical care coverage is a
waiting period ending at midnight on the last
day of the second month following the month in
which the individual becomes a resident.
Coverage is available to landed immigrants who
have completed the waiting period. Also after
the waiting period, coverage is available to
persons from outside Canada who are in the
Province on work permits or student visas,
provided the permits or visas are valid for at
least six months, and have been issued at the
time of admission to Canada.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
4.2
Coverage During Temporary
Absences In Canada
Sections 3, 4 and 5 of the Medical and Health
Care Services Regulations define portability
provisions for persons temporarily absent from
British Columbia in Canada with regard to
insured services. In 2002-2003, there were no
amendments to the Medical and Health Care
Services Regulation, made under the Medicare
Protection Act, 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 among the Provinces 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.
Individuals who leave the province temporarily
on extended vacations or for temporary
employment may be covered for up to 12
months. Approval is limited to once in five years
for such absences exceeding six months in a
calendar year. Residents who spend part of
every year outside British Columbia must be
physically present in Canada for at least six
months in a calendar year and continue to
maintain their homes in British Columbia.
Students attending a recognized school in
another province or territory on a full-time basis
are entitled to coverage for the duration of their
studies.
According to inter-provincial and inter-territorial
reciprocal billing arrangements, physicians,
except in Quebec, bill their own medical plans
directly for services rendered to eligible British
Columbia residents, on presentation of a valid
Medical Services Plan Card (CareCard). British
Columbia then reimburses the province or
territory at the rate of the fee schedule in the
province or territory in which services were
rendered. For in-patient hospital care, charges
are paid at the standard ward rate actually
charged by the hospital. For out-patient
services, the payment is at the interprovincial
and interterritorial reciprocal billing rate.
Payment for these services, except for
excluded services that are billed to the patient,
is handled though interprovincial and
interterritorial reciprocal billing procedures.
Canada Health Act Annual Report, 2002-2003
As Quebec does not participate in reciprocal
billing agreements, claims for services provided
to British Columbia beneficiaries by Quebec
physicians must be handled individually.
Reimbursement may be made either to the
physician providing the service, or directly to the
beneficiary who received the service, whichever
submits the claim.
The Financial Administration section of the
Acute Care Policy Manual sets out the specific
details of the current interprovincial or territorial
reciprocal billing agreement for insured hospital
services. Each provincial hospital insurance
plan will process hospital in- and out-patient
accounts on behalf of the residents of the other
provinces and territories, with the exception of
Quebec, which is not a signatory to the
Agreement. The Agreement covers benefits
rendered within provincial or territorial
boundaries and makes provision for the periodic
settling of accounts between provinces and
territories.
In addition, there is a BC-Yukon Accord which
covers several aspects of health services,
including provision of air ambulance services,
abortion services and physician services. There
are no other special bi-lateral agreements in
place between the Province of British Columbia
or Health Authorities and adjacent jurisdictions
respecting the servicing of border communities
4.3
Coverage During Temporary
Absences Outside Canada
The Hospital Insurance Act Regulations, division
4 and sections 3, 4, and 5 of the Medical and
Health Care Services Regulations define
portability of insured hospital and physician
services during temporary absences outside
Canada. In 2002-2003, there were no
amendments to the Medical and Health Care
Services Regulation with respect to portability
provisions.
A qualified person leaving British Columbia to
attend university, college or other educational
institutions recognized by the Medical Services
Commission, on a full-time basis, retains
eligibility during the absence for study until the
last day of the month in which the person
ceased full-time attendance at that educational
institution, or if studying outside Canada, the
last day of the sixtieth month since the date of
departure from British Columbia.
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Chapter 3 – British Columbia
A qualified person who is absent from British
Columbia for vacation or work for more than six
months is deemed a resident for the purpose of
determining beneficiary status for up to the
initial 12 consecutive months of absence, if this
person obtains prior approval from the Medical
Services Commission, does not establish
residency outside British Columbia and has not
been granted approval for a similar absence
during the preceding 60 months.
With prior authorization, coverage is provided
for hospital services not available in Canada at
the hospital’s usual and customary rate. In other
circumstances, with prior authorization, inpatient coverage is at the established standard
ward rate. Renal dialysis day care is available at
the interprovincial and interterritorial Canadian
rate. In all other cases, including emergency or
sudden illness during temporary absences from
the Province, in-patient hospital care is paid up
to $75 Canadian per day for adults and children,
and $41 Canadian per day for newborns.
Out-of-country medical services are covered for
emergency or sudden illness during temporary
absences from the province. These are paid up
to the same fee payable for that service, had it
been performed in British Columbia. Cases preauthorized because of extenuating
circumstances, however, are paid at the rate
applicable where the service is rendered. With
prior authorization, payment for non-emergency
medical services outside the country may be
made at usual and customary rates, when the
appropriate treatment is not available in the
province or elsewhere in Canada.
4.4
Prior Approval Requirement
No prior approval is required for elective
procedures that are covered under the
interprovincial reciprocal agreements with other
provinces. Prior approval from the Medical
Services Commission is required for procedures
that are not covered under the reciprocal
agreements. Some treatments may require the
approval of Performance Management and
Improvement Division (e.g., treatment for
anorexia). All non-emergency procedures
performed outside of Canada require approval
from the Commission prior to the procedure.
140
5.0 Accessibility
5.1
Access to Insured Health Services
British Columbia believes that all residents have
reasonable access to hospital and medical care
services. Beneficiaries, as defined in section 1
of the Medicare Protection Act and the Ministry
of Health Services’ Acute Care Policy Manual,
are eligible for all insured hospital and medical
care services as required. To ensure equal
access to all, regardless of income, the
Medicare Protection Act, Part 4, prohibits extrabilling by enrolled practitioners.
5.2
Access to Insured Hospital Services
In 2002-2003, there were 7,093 occupied acute
care beds in 92 acute care facilities, and 150
rehabilitation beds in acute care or rehabilitation
hospitals. In addition, there were 25 diagnostic
and treatment centres and six Red Cross
Outpost hospitals.
The Province also provides access to care
services for extended care patients. In
2002-2003, there were 18 free-standing
extended care facilities, and a total of 7,421
extended care beds.
The number of practising Registered Nurses as
of December 2002 was 29,775. British
Columbia hospitals also employ Registered
Psychiatric Nurses (RPNs) and Licensed
Practical Nurses (LPNs). In 2002 there were
2,161 RPNs and 4,957 LPNs. In 2002-2003, a
further $21.5 million was allocated to nursing
strategies, for a total of $42.5 million over two
years. British Columbia’s nursing strategies are
identified, developed and implemented by the
Ministry of Health Planning with input from
nurses and other stakeholders. They are
intended to improve the recruitment, retention,
education and workplace needs of British
Columbia nurses and nursing students. The
strategies in 2002-2003 included more
education seats (1,266 new nursing spaces
created since 2001); initiatives to encourage
British Columbia nurses who are not working in
their profession to return to the health system;
new opportunities for nurses to upgrade their
skills; and Aboriginal nursing strategies.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
Telehealth continues to provide improved
access to services in British Columbia. March
31, 2003 marked the conclusion of the federal
funding period through the Canada Health
Infostructure Partnerships Program (CHIPP),
and the regional Health Authorities now support
the equipment and infrastructure deployed
during CHIPP. Services established through the
different projects continue to be delivered, and
new applications are being implemented on an
ongoing basis. Pediatric echocardiograms and
ultrasounds are transmitted live from remote
locations in the province to specialists at British
Columbia Children’s Hospital, providing timely
access to care for patients in their own
communities. Videoconferencing allows for
clinical consultations in the areas of oncology,
maternal fetal medicine, genetic counseling,
psychiatry, child rehabilitation and development,
pediatrics, trauma management, nutrition –
these are some examples of the types of
services which have been and continue to be
provided via telehealth.
The Ministry of Health Planning has prepared
acute care access standards that are being
used by health authorities in the redesign of
hospital services. The standards specify the
maximum travel time for accessing emergency
services, in-patient services and core specialty
services. They also ensure that the majority of
British Columbians, in all regions, have
reasonable access to these services. Within the
Ministry of Health Services Service Plan
2002/2003 – 2004/2005, performance measures
were included regarding waiting times for key
services (radiotherapy and chemotherapy). For
2002-2003, the target for chemotherapy was
met, but the target for radiotherapy was not
achieved, although significant and steady
improvement over 2000-2001 levels was noted.
In May 2002, the British Columbia government
established a new capital asset management
framework, which articulates the Province’s
minimum standards for capital asset
management. The framework encourages
agencies to prepare capital asset management
plans and to review all options for addressing
infrastructure needs. The Ministry of Health
Services is working with health authorities to
implement the new framework. In this respect,
an implementation plan has recently been
completed which includes the prioritization of
key elements for which Ministry policy and/or
tools to support best practices in capital asset
management are required.
Canada Health Act Annual Report, 2002-2003
To support the health authorities and the
Ministry of Health Services in preparing capital
asset management plans, a health care facility
inventory and assessment project started in
2002-2003.
Since the restructuring of health authorities and
the introduction of service plans and
performance agreements in 2001-2002, health
authorities have the ability and incentive to
ensure appropriate utilization and maintenance
of hospital facilities and equipment to meet the
needs of patients and providers.
To assist the health authorities with this, the
Ministry of Health Service’s three-year capital
spending plan for 2002-2003 included:
‰
$100 million for converting existing facilities
to more appropriate uses consistent with the
new regional priorities. At March 31, 2003,
$25.47 million had been approved from this
allocation;
‰
$138 million to implement the Mental Health
Plan (e.g. Tertiary Mental Health Facilities in
Kamloops). At March 31, 2003, $21.13
million had been approved from this
allocation; and
‰
$115 million per year to maintain and
improve facilities, and to purchase
equipment.
A number of capital construction projects
completed in 2002-2003 provided new and
improved health care facilities for British
Columbians. The major projects completed
included:
‰
The $2.45 million, operating room upgrade at
the Richmond General Hospital completed in
May 2002.
‰
The $31.1 million Mount Saint Mary Hospital,
in Victoria, opened in March 2003. This new
state of the art facility is a 200-bed, five-story
residential care facility for persons with
complex care needs. The facility is unique in
that it is designed as a community, with 16
houses of 12 to 13 rooms, including rooms
typically found in a home. The common area,
which offers various services, is designed to
create the atmosphere of a village street.
‰
The $1.5 million upgrade to the pathology
laboratory at the Children’s and Women’s
Health Centre of BC completed in October
2002.
141
Chapter 3 – British Columbia
‰
Construction was completed in January 2002
on the $6.3 million phase one redevelopment
at Fort St. John General Hospital.
‰
In April 2002, construction was completed on
the $1.5 million upgrading of the acute care
tower at Langley Memorial Hospital.
‰
The $9 million Rotary Manor 44-bed long
term care complex opened in December
2002.
‰
The $1.13 million, 10-bed expansion to the
Iris House was completed in March 2003.
The specialized mental health facility on the
grounds of Prince George Regional Hospital
will help house and care for people with
serious or persistent mental illness, providing
assessment, treatment and rehabilitation.
The BC HealthGuide Program, started in 2001,
has a comprehensive approach to self-care
unique in Canada, and is based on information
delivered in a variety of formats:
‰
BC HealthGuide Handbook - delivered free
to every household in BC, it contains tips for
prevention and early identification of
illnesses, when to see a doctor, self-care
“home treatment” tips, and information on
managing chronic diseases.
‰
BC First Nations Health Handbook was
developed in partnership with the BC First
Nations Chiefs’ Health Committee – the
handbook provides specific information on
health services available to aboriginal
communities. The BC First Nations Health
Handbook was distributed to aboriginal
communities in January 2003. The handbook
provides aboriginal communities with tools
and information necessary to help improve
their health.
‰
BC HealthGuide OnLine - expands on the
information in the Handbook with more than
35,000 medically reviewed pages covering
2,500 detailed health topics on symptoms
and conditions. The website,
www.bchealthguide.org is updated quarterly.
‰
BC NurseLine - toll-free 24 hour a day, 7
days a week nursing triage and health
education by telephone. Registered nurses
are specially trained to use medically
approved protocols for acute and chronic
health symptoms and conditions. The Line
gives people the information they need,
when they need it, where they need it, and
includes services for people who are deaf
and hearing impaired as well as translation
142
services in over 130 different languages improving access for all British Columbians.
In 2002-2003, the BC NurseLine received
over 170,000 calls.
‰
BC Health Files – a series of over 146 onepage, easy-to-understand fact sheets about
a wide range of public and environmental
health and safety issues. The fact sheets are
available in the province’s 120+ health units
and departments and certain other offices
(Government Employee Health Services,
Native Health Centres, physicians
offices/clinics and nursing stations).
5.3
Access to Insured Physician and
Dental-Surgical Services
There were 4,471 general practitioners, 3,421
specialists and 249 dentists who provided
insured fee-for-service physician and dentalsurgical services in 2002-2003.
The Ministry of Health Services implemented
several new programs under the new 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. The Rural
Retention Program provides eligible rural
physicians (approximately 1,200) with fee
premiums and is now available for visiting
physicians and locums. Through the Northern
and Isolation Travel Assistance Outreach
Program, funding was provided for an estimated
1,355 visits by family doctors and specialists to
rural communities. The Northern and Rural
Locum Program assisted physicians practising
in approximately 50 small communities to
secure subsidized continuing medical education
and vacation relief. A one-year interim Rural
Specialist Locum Program provides locum
support for core specialists in 16 rural
communities while physician recruitment efforts
are underway. The Rural Education Action Plan
supported the training of physicians in rural
practice through several components, including
rural practice experience for medical students
and enhanced skills for practising physicians.
The Rural Loan Forgiveness Program
decreases BC student loans by 20 percent for
each year of rural practice for physicians,
nurses, midwives and pharmacists.
Several additional measures were taken in
2002-2003 to improve access to physician
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
services. In November 2002, British Columbia
received $74 million in a federal funding
commitment over four years to develop
sustainable improvements to Primary Health
Care and increase patient access to
comprehensive, high-quality services in doctors’
offices and community clinics — the usual first
points of contact with the health care system.
In February 2003, a $58.5 million benefits and
incentives package was rolled out to attract
doctors to rural communities and improve
access for patients living there.
Planning was undertaken to implement the
commitment, announced in March 2002, of
$134 million to expand medical school facilities
at the University of British Columbia and
establish satellite medical programs at the
University of Northern British Columbia and the
University of Victoria. This will almost double the
number of medical school places by 2005.
5.4
Physician Compensation
The Province of British Columbia negotiates
with the British Columbia Medical Association to
establish the conditions, benefits and overall
compensation for both fee-for-service
physicians and physicians paid under alternative
payment mechanisms, including salaried
physicians.
The Government of British Columbia and the
British Columbia Medical Association signed a
Memorandum of Understanding (MOU) on
March 26, 2002, to provide for retroactive fee
increases for 2001-2002, as well as a process
for resolving outstanding issues. The three-year
agreement provided for an increase of $392
million per year in physician compensation plus
utilization increases. In addition, a dispute
resolution mechanism was put in place that
provides for conciliation and binding arbitration.
The resulting Working and Subsidiary
Agreements signed in November of 2002
provided retroactive payments equivalent to 6.2
percent for the period April 1 to October 31,
2001 and 11.6 percent for the period November
1, 2001 to March 31, 2002. The MOU increased
the overall specialist on-call program by $80
million thus provided for payments up to $125
millions per year. The Working Agreement ends
March 31 2004 and the MOU terminates March
31, 2005 while the Second Master Agreement is
in place until March 31 2006. Negotiations for
Canada Health Act Annual Report, 2002-2003
renewal of the Working Agreement began in
October 2003.
During 2002-2003, the Medical Services Plan’s
(MSP) payments to physicians in the Province
totalled approximately $1.904 billion. The MSP
paid approximately approximately $17.1 million
in reciprocal payments to other provinces or
territories for medical services provided outside
the province.
Section 13 of the Medicare Protection Act
provides that practitioners (including medical
practitioners and health care practitioners, such
as dentists) who are enrolled under the Act and
who render benefits to a beneficiary are eligible
to be paid for services rendered in accordance
with the appropriate payment schedule. The
Association of Dental Surgeons of BC and the
Ministry recently completed a revision of the
dental fee schedule, to ensure that insured
services remain within the Available Amount
however a renewed agreement remains
outstanding. Section 13.1 of the Act which
required mandatory de-enrolment of physicians
from billing the Medical Services Plan at age 75,
was repealed in 2002 under the Health Services
Statutes Amendment Act, 2002. That
amendment came into force on July 4, 2002.
Payment for medical services delivered in the
Province is made through the MSP to individual
physicians, based on billings submitted. The
patient is not normally involved in the payment
system. Ninety-eight percent of claims are
submitted electronically through the Teleplan
System, while the remaining two percent are
submitted on claim cards by low-volume
physicians and other health care practitioners.
The Medical Services Commission also funds
comprehensive programs of health care
services through contracted physician
arrangements. The Ministry of Health Services’
Alternative Payments Program (APP) provides
program-specific funding to British Columbia’s
six health authorities and the Nisga’a, which in
turn, contract with physicians for their services
or time through service contracts or sessional
payments. A number of provincial agreements,
negotiated as subsidiaries to the Master and
Working agreements between the Government
of British Columbia and British Columbian
Medical Association, set the terms and
conditions of physician compensation when
delivering government-funded services,
including those funded by the APP.
143
Chapter 3 – British Columbia
Approximately 2305 physicians are supported
through APP funding arrangements.
5.5
Payments to Hospitals
Section 9 of the Hospital Insurance Act used to
require that the Minister pay hospitals directly to
cover the costs of publicly insured hospital
services. Effective December 12, 2001, as part
of its health care restructuring initiative to
increase efficiencies and accountabilities for
health authorities, Government restructured
British Columbia’s regional health authorities by
amalgamating 52 health authorities into five
regional health authorities. Section 9 of the
Hospital Insurance Act was amended in 2003
(the Health Services Statutes Amendment Act,
2003) to reflect the fact that hospitals are no
longer funded directly by government. Funding
of insured hospital services is now provided to
hospitals through the funding of health
authorities.
In 2002-2003, the total funding provided to
Health Authorities was $6.1 billion, including
funds for hospital, continuing care, public and
preventive health, and adult mental health
programs. Payments to out-of-province hospitals
within Canada for insured services (both in- and
out-patient) provided to British Columbia
residents totalled $51.4 million, while payment
to hospitals outside the country totalled $2.8
million in 2002-2003.
6.0 Recognition
Funding provided by the federal government
through the Canada Health and Social Transfer
has been recognized and reported by the
Government of British Columbia through various
government websites and provincial government
documents. For the fiscal year 2002-2003,
these documents included the following:
‰
Public Accounts 2001/02 (Tabled July 11,
2002);
‰
Public Accounts 2002/03 (Tabled June 27,
2003);
‰
Budget and Fiscal Plan, 2003/04 to 2005/06
(Tabled February 18, 2003);
‰
Estimates, Fiscal Year Ending March 31,
2004 (Tabled February 18, 2003).
144
7.0 Extended Health Care
Services (EHCS)
The Performance and Management
Improvement Division of the Ministry of Health
Services funds and provides a comprehensive
range of community-based supportive care
services to assist people whose ability to
function independently is affected by long term
health-related problems or who have acute care
needs that can be met at home. Services
include case management; in-home support
services (home support, community home care
nursing, physiotherapy, occupational therapy,
nutrition counselling, social worker services and
meals programs); assisted living; residential
care services (family care homes, group homes
and residential care facilities); community
palliative care; residential hospice; and special
support services (adult day centres, respite care
and assessment and treatment centres).
Services are delivered at the community level
through the health authorities.
Residential care services provide care and
supervision in a protective, supportive
environment for adults who can no longer be
looked after in their own homes.
Community home care nursing services provide
professional nursing care to people of all ages
in their own homes. These services are
available on a non-emergency basis and include
assessment, teaching and consultation, care
coordination and direct nursing care for clients
with chronic, acute, palliative or rehabilitative
needs.
Home support services provide assistance with
activities of daily living and personal care. Adult
day centres offer a centre-based program of
health, social and recreational activities.
Assisted living services provide a housing
arrangement that consists of a private housing
unit with a lockable door, hospitality services
and personal care services.
A Palliative Care Benefits Program was
implemented in 2001 to provide home-based
palliative care clients with medication for pain
and symptom relief and medical supplies and
equipment, at no charge.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – British Columbia
8.0 Additional Materials
Submitted to Health Canada
Annual Reports
‰
‰
Ministry of Health Services 2002/03 Annual
Service Plan Report
www.bcbudget.gov.bc.ca/annualreports/
hs/hs.pdf
Medical Services Commission Payment
Schedule
www.healthservices.gov.bc.ca/msp/infoprac/
physbilling/payschedule/index.html
‰
Ministry of Health Planning 2002/03 Annual
Service Plan Report:
www.bcbudget.gov.bc.ca/annualreports/
hp/hp.pdf
‰
Other Documents
MSC for BC Residents (on-line information
regarding eligibility, enrolment, and benefits)
www.healthservices.gov.bc.ca/msp/infoben/
index.html
‰
The Picture of Health: How we are
modernizing British Columbia’s health care
system (December 2002)
www.healthplanning.gov.bc.ca/cpa/
publications/picture_of_health.pdf
Audit Reports
‰
A Review of Performance Agreements
Between the Ministry of Health Services and
the Health Authorities, Office of the Auditor
General of British Columbia, 2003/04 Report
1 - May 2003
www.bcauditor.com/PUBS/2003-04/
Report1/Health/May2003.pdf
(This report was issued in 2003-04, but
reviews the performance agreements for
2002/03 to 2004/05)
Financial Reports
‰
2002/03 Public Accounts, Ministry of Finance
www.fin.gov.bc.ca/ocg/pa/02_03/
PA_2003_all.pdf
‰
Medical Services Commission Financial
Statement 2003
www.healthservices.gov.bc.ca/msp/
financial_statement.html
‰
Budget Papers: British Columbia Budget
2003
www.bcbudget.gov.bc.ca/
‰
Ministry of Health Services Service Plan
2003/04 - 2005/06
www.bcbudget.gov.bc.ca/sp2003/hs/hs.pdf
‰
Ministry of Health Planning Service Plan
2003/04 – 2005/06
www.bcbudget.gov.bc.ca/sp2003/hp/hp.pdf
Legislation
‰
All Statutes and Regulations referred to in
the BC submission are posted alphabetically
by Statute title
www.qp.gov.bc.ca/statreg/
Canada Health Act Annual Report, 2002-2003
145
Yukon
Introduction
The health care insurance plans operated by
the Government of the Yukon Territory are the
Yukon Health Care Insurance Plan (YHCIP) and
the Yukon Hospital Insurance Services Plan
(YHISP). The Yukon Health Care Insurance
Plan is administered by the Director, as
appointed by the Executive Council Member
(Minister). The Yukon Hospital Insurance
Services Plan is administered by the
Administrator, as appointed by the
Commissioner in Executive Council
(Commissioner of the Yukon Territory). The
Director of the YHCIP and the Administrator of
the YHISP are hereafter referred to as the
Director, Insured Health and Hearing Services.
References in this text to the “Plan” refer to
either the Yukon Health Care Insurance Plan or
the Yukon Hospital Insurance Services Plan.
There are no regional health boards in the
Territory.
The objective of the Yukon health care system
is to ensure access to, and portability of,
insured physician and hospital services
according to the provisions of the Health Care
Insurance Plan Act and the Hospital Insurance
Services Act. Coverage is provided to all eligible
residents of the Yukon Territory on uniform
terms and conditions. The Minister, Department
of Health and Social Services, is responsible for
the delivery of all insured health care services.
Service delivery is administered centrally by the
Department of Health and Social Services.
There were 30,558 eligible persons registered
with the Yukon health care plan on March 31,
2003.
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.
Health care initiatives in the Territory target
areas such as access and availability of
services, recruitment and retention of health
Canada Health Act Annual Report, 2002-2003
care professionals, primary health care, systems
development and alternative payment and
service delivery systems, specifically:
‰
telehealth continues to expand and link
patients and health care providers;
‰
primary care initiatives are underway that will
broaden and strengthen service delivery and
modernize and improve system capabilities;
‰
an increasing number of continuing care
beds;
‰
a new medical imaging program;
‰
increased numbers of family physicians;
‰
increased numbers of specialists; and
‰
stabilized numbers of registered nurses.
The 2002-2003 budget increased health care
expenditures over the 2001-2002 forecast as
follows:
‰
Insured Health Services increased by
$950,000.
‰
Yukon Hospital Services increased by
$558,000.
‰
Continuing Care increased by $4,416,000.
‰
Community Nursing and Emergency Medical
Services increased by $229,000.
‰
Community Health Programs increased by
$102,000.
Some of the major challenges facing the
advancement of insured health care service
delivery in the Territory are:
‰
effective linkages and co-ordination of
existing services and service providers;
‰
recruitment and retention of qualified health
care professionals;
‰
increasing costs related to service delivery,
for example pharmaceuticals, facilities, public
demand and labour;
‰
increasing costs to maintain and administer
insured health services and extended benefit
programs;
‰
increasing costs related to changing
demographics; and
‰
acquiring and maintaining new and advanced
high-technology diagnostic and treatment
equipment.
147
Chapter 3 – Yukon
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
The Health Care Insurance Plan Act, adopted
April 1, 1972, sets out the legislative framework
for the payment of insured physician services to
eligible Yukon residents. The Hospital Insurance
Services Act, adopted April 9, 1960, sets out the
legislative framework for payment to hospitals,
i.e., amounts in respect of the cost of insured
services provided by hospitals to insured
persons.
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:
Subject to the Hospital Insurance Services Act
(section 6) and Regulations, the mandate and
function of the Director, Insured Health and
Hearing Services, is to:
‰
develop and administer the hospital
insurance plan;
‰
determine eligibility for and entitlement to
insured services;
‰
determine the amounts that may be paid for
the cost of insured services provided to
insured persons;
‰
enter into agreements on behalf of the
Government of the 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.
‰
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;
There were no amendments made to the
legislation in 2002-2003.
‰
conduct actions and negotiate settlements in
the exercise of the Government of the
Yukon’s right of subrogation under this Act to
the rights of insured persons;
1.2
‰
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.
There were no amendments made to the
legislation in 2002-2003.
148
Reporting Relationship
The Department of Health and Social Services
is accountable to the Legislative Assembly and
the Government of Yukon through the Minister
Section 6 of the Health Care Insurance Plan Act
and section 7 of the Hospital Insurance Services
Act require that the Director, Insured Health and
Hearing Services, make an annual report to the
Executive Council Member respecting the
administration of the two health insurance plans.
A Statement of Revenue and Expenditures is
tabled in the Legislature and is subject to
discussion at that level.
The Statement of Revenue and Expenditures for
the health care insurance programs of the
Health Services Branch is tabled annually in the
fall session of the Legislature. The report, to be
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
tabled December 2003, covers the fiscal years
1997-1998 to 2002-2003.
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 the 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 the Yukon. Further, the Auditor
General of Canada is to report to the Yukon
Legislative Assembly any matter falling within
the scope of the audit that, in his or her opinion,
should be reported to the Assembly.
The most recent audit was for the year ended
March 31, 2003.
With regard to 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
Adopted on April 9, 1960, the Hospital
Insurance Services Act, sections 3, 4, 5 and 9
and sections 2, 4, 5, 9 and 11 of the Hospital
Insurance Services Regulations, establish
authority to provide insured hospital services.
There were no amendments made to the
legislation in 2002-2003.
Canada Health Act Annual Report, 2002-2003
In 2002-2003, insured hospital services to both
in- and out-patients were delivered in 15
facilities throughout the Territory. These facilities
include one general hospital, one cottage
1
2
hospital and 12 Health Centres. Visiting
nursing services are provided from one satellite
health station.3
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 establish and maintain a quality
assurance program. Currently, the Yukon
Hospital Corporation is operated under a full
three-year accreditation through the Canadian
Council on Health Services Accreditation.
The Yukon government assumed responsibility
for operating Health Centres from the federal
government in April 1997. These facilities,
including the Watson Lake Cottage Hospital,
operate in compliance with the adopted Medical
Services Branch Scope of Practice for
Community Health Nurses/Nursing Station
Facility/Health Centre Treatment Facility, and
the Community Health Nurse Scope of Practice.
The General Duty Nurse Scope of Practice was
completed and implemented in February 2002.
Pursuant to the Hospital Insurance Services
Regulations, sections 2(e) and (f), services
provided in an approved hospital are insured.
Section 2(e) defines in-patient insured services
as all of the following services to in-patients,
namely:
“(i) accommodation and meals at the standard
or public ward level,
1
This facility provides 24-hour emergency treatment,
short-term admissions and respite care.
2
Community Nurse Practitioners, in the absence of a
physician, provide daily clinics for medical treatment,
community health programs and 24-hour emergency
services.
3
Community Nurse Practitioners provide itinerant
services on a regularly scheduled basis.
149
Chapter 3 – Yukon
(ii)
necessary nursing service,
(iii) 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,
(iv) drugs, biologicals and related preparations
as provided in Schedule B of the
Regulations, when administered in the
hospital,
(v) use of operating room, case room and
anaesthetic facilities, including necessary
equipment and supplies,
(vi) routine surgical supplies,
(vii) use of radiotherapy facilities where
available,
(viii) use of physiotherapy facilities where
available,
(ix) services rendered by persons who receive
remuneration therefor from the hospital.”
Section 2(f) of the same Regulations defines
“out-patient insured services” as all of the
following services to out-patients, when used for
emergency diagnosis or treatment within 24
hours of an accident, which period may be
extended by the Administrator, provided the
service could not be obtained within 24 hours of
the accident, namely:
“(i) necessary nursing service,
(ii)
laboratory, radiological and other diagnostic
procedures, together with the necessary
interpretations for the purpose of assisting
in the diagnosis and treatment of an injury,
(iii) drugs, biologicals and related preparations
as provided in Schedule B, when
administered in a hospital,
(iv) use of operating room and anaesthetic
facilities, including necessary equipment
and supplies,
(v) routine surgical supplies,
(vi) services rendered by persons who receive
remuneration therefor from the hospital,
(vii) use of radiotherapy facilities where
available,
(viii) use of physiotherapy facilities where
available.”
Pursuant to the Hospital Insurance Services
Regulations, all in- and out-patient services
150
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 new Yukon Computed Tomography Scan
Program was implemented at the Whitehorse
General Hospital in fall 2002. The Government
provided $1.5 million toward the purchase of a
computed tomography scanner and picture
archiving system. The program has been very
successful and provides Yukon residents with
local access to a standard diagnostic service.
These measures will help reduce the Territory’s
reliance on out-of-territory services.
No services were discontinued in 2002-2003.
2.2
Insured Physician Services
Adopted on April 1, 1972, sections 1 to 8 of the
Health Care Insurance Plan Act and sections 2,
3, 4, 7,10 and 13 of the Health Care Insurance
Plan Regulations provide for insured physician
services. There were no amendments made to
the legislation in 2002-2003.
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 as of March 31, 2003, was 59.
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
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
election. In 2002-2003, no physicians provided
written notice of their election to collect fees
other than from the Yukon Health Care
Insurance Plan.
Insured physician services in the Yukon are
defined as medically required services rendered
by a medical practitioner. Services not insured
by the Plan are listed in section 3 of the
Regulations. Services not covered by the Plan
include advice by telephone, medical-legal
services, preparation of records and reports,
services required by a third party, cosmetic
services and services determined to be not
medically required.
From April 1, 2002 to March 31, 2003, the
following services were added to the list of
insured physician services covered by the
Yukon Health Care Insurance Plan:
‰
complicated pre-anesthetic check;
‰
laparscopic excision of endometriosis; and
‰
management of prolonged third-stage labour.
The process used to add a new fee to the
4
relative Value Guide to Fees is administered
through a committee structure. This process
requires physicians to submit requests in writing
to the Yukon Health Care Insurance Plan/Yukon
Medical Association Liaison Committee.
Following review by this committee, a decision
is made to include or exclude the service. The
relevant costs or fees are normally set in
accordance with similar costs or fees in other
jurisdictions. Once a fee-for-service value has
been determined, notification of the service and
the applicable fee is provided to all Yukon
physicians. Public consultation is not required.
Alternatively, new fees can be implemented as a
result of the fee negotiation process between
the Yukon Medical Association and the
Department of Health and Social Services. The
Director, Insured Health and Hearing Services,
manages this process and no public
consultation is required.
4
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 for the purpose of billing the Yukon
Health Care Insurance Plan for the provision of
insured dental services. In 2002-2003, four oral
surgeons, two dental surgeons and two
orthodontists billed the Plan for insured dental
services provided to Yukon residents.
Dentists are able to opt out of the health care
plan in the same manner as physicians. In
2002-2003, no dentists provided written notice
of their election to collect fees other than from
the Yukon Health Care Insurance Plan.
Insured dental services are limited to those
surgical-dental procedures listed in Schedule B
of the Regulations and require the unique
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;
‰
medico-legal services including examinations
and reports;
Physician’s fee guide manual
Canada Health Act Annual Report, 2002-2003
151
Chapter 3 – Yukon
‰
cosmetic services;
‰
acupuncture; and
‰
experimental procedures.
Section 3 of the Yukon Health Care Insurance
Plan Regulations contains a non-exhaustive list
of services that are prescribed as non-insured.
Uninsured hospital services include:
‰
non-resident hospital stays;
‰
special/private nurses requested by the
patient or family;
‰
additional charges for preferred
accommodation unless prescribed by a
physician;
‰
crutches and other such appliances;
‰
nursing home charges;
‰
televisions;
‰
telephones; and
‰
drugs and biologicals following discharge.
(These services are not provided by the
hospital.)
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, thirdparty examinations, some elective services, tray
fees 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:
‰
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.
No services were removed from the Relative
Value Guide to Fees in fiscal year 2002-2003.
‰
Hospital services – an amendment by
Order-In-Council to section 2 (e)(f) of the
Yukon Hospital Insurance Services
Regulations would be required. As of
March 31, 2003, no insured in-patient or outpatient hospital services, as provided for in
the Regulations, have been de-insured. The
Director, Insured Health and Hearing
Services, is responsible for managing this
process in conjunction with the Yukon
Hospital Corporation.
‰
Dental-surgical services – an amendment
by Order-In-Council to Schedule B of the
Regulations Respecting Health Care
Insurance Services is required. A service
could be de-insured if determined not
medically necessary or if it is no longer
required to be carried out in a hospital under
general anaesthesia. The Director, Insured
Health and Hearing Services, manages this
process.
All Yukon residents have equal access to
services. Third parties such as private insurers
or the Workers’ 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.
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 deinsure certain services. In consultation with
the Yukon Medical Advisor, decisions to deinsure 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.
Physicians in the Territory may bill patients
directly for non-insured services. Block fees are
152
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
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 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”. No changes affecting
eligibility were made to the legislation in
2002-2003.
The following persons are not eligible for
coverage in the Yukon:
‰
persons entitled to coverage from their home
province or territory (e.g., students and
workers covered under temporary absence
provisions);
‰
visitors to the Territory;
‰
refugee claimants;
‰
members of the Canadian Forces;
‰
members of the Royal Canadian Mounted
Police;
‰
inmates in federal penitentiaries;
‰
study permit holders; and
‰
employment authorizations of less than one
year.
‰
become a landed immigrant; 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 Interprovincial 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, 2003, there were 30,534
residents registered with the Yukon Health Care
Insurance Plan.
3.3
Other Categories of Individual
The Yukon Health Care Insurance Plan provides
health care coverage for other categories of
individuals as follows:
The above persons may become eligible for
coverage if they meet one or more of the
following conditions:
‰
establish residency in the Territory;
Canada Health Act Annual Report, 2002-2003
153
Chapter 3 – Yukon
Category
Coverage
Returning
Canadians
Landed
Immigrants
Minister’s
Permit
Convention
Refugees
No waiting period is applied.
Foreign
Workers
Clergy
1
4.0 Portability
4.1
No waiting period is applied.
No waiting period is applied
authorized.
No waiting period is applied
holding Employment
Authorization.1
No waiting period is applied
holding Employment
Authorization.1
No waiting period is applied
holding Employment
Authorization.1
if
if
if
The estimated number of new individuals
receiving coverage in the Yukon during
2002-2003 under the following conditions is:
Returning Canadians
Landed Immigrants
Minister’s Permit
Convention Refugees
Number of
Individuals
27
36
1
0
The estimated number of individuals receiving
coverage in the Yukon as of March 31, 2003,
under the following conditions is:
Category
Foreign Workers
Clergy
3.4
Number of
Individuals
33
0
Premiums
The payment of premiums by Yukon residents
was eliminated on April 1, 1987.
154
Persons moving to the Yukon from another
province or territory are entitled to coverage
pursuant to section 4(1) of the Yukon Health
Care Insurance Plan Regulations and the Yukon
Hospital Insurance Services Regulations. The
Regulation states that “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.”
if
Employment Authorization must be in excess of 12
months
Category
Minimum Waiting Period
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. No
amendments to the legislation were made in
2002-2003.
The Regulations state that “where an insured
person is absent from the Territory and intends
to return, he is entitled to insured services
during a period of 12 months continuous
absence.” Persons leaving the Territory for a
period exceeding 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 the cancellation of
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
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
subject to approval by the Director, Insured
Health and Hearing Services.
4.3
The provisions regarding coverage during
temporary absences in Canada fully comply
with the terms and conditions of the Interprovincial Agreement on Eligibility and
Portability effective February 1, 2001.
Definitions are consistent in Regulations,
policies and procedures.
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 the legislation in
2002-2003.
The Yukon participates fully with the Interprovincial Medical Reciprocal Billing
Agreements and Hospital Reciprocal Billing
Agreements in place with all other provinces
and territories with the exception of Quebec,
which does not participate in the medical
reciprocal billing arrangement. Persons
receiving medical (physician) services in
Quebec may be required to pay directly and
submit claims to the Yukon Health Care
Insurance Plan for reimbursement.
The Hospital Reciprocal Billing Agreements
provide for payment of insured in-patient and
out-patient hospital services to eligible residents
receiving insured services outside the Yukon,
but within Canada.
The Medical Reciprocal Billing Agreements
provide for payment of insured physician
services on behalf of eligible residents receiving
insured services outside the Yukon, but within
Canada. Payment is made to the host province
at the rates established by that province.
Insured services provided to Yukon residents
while temporarily absent from the Territory are
paid at the rates established by the host
province. The following amounts were paid to
out-of-territory hospitals for the fiscal year
2002-2003.
In-patient Services
Out-patient Services
$5,861,530
$1,037,692
Note:
Figures are by date of service and subject to
adjustment.
In 2002-2003 payments to out-of-territory
physicians totaled $1,799,019. This figure
includes out-of-Canada costs and is by payment
5
date.
5
Out-of-country costs are reported under lines 22 and 23
in the Yukon section of Annex A – Provincial and
Territorial Health Care Insurance Plan Statistics.
Canada Health Act Annual Report, 2002-2003
Coverage During Temporary
Absences Outside Canada
Sections 5 and 6 state that “Where an insured
person is absent from the Territory and intends
to return, he is entitled to insured services
during a period of 12 months’ continuous
absence”.
Persons leaving the Territory for a period
exceeding 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 the cancellation of
coverage.
The provisions for portability of health insurance
during out-of-country absences for students,
temporary workers and missionaries are the
same as for absences within Canada. (See
section 4.2.)
Insured physician services provided to eligible
Yukon residents temporarily outside the country
are paid at rates equivalent to those paid had
the service been provided in the Yukon.
Reimbursement is made to the insured person
by the Yukon Health Care Insurance Plan or
directly to the provider of the insured service.
Insured in-patient hospital services provided to
eligible Yukon residents outside Canada are
paid at the rate established in the Standard
Ward Rates Regulation for the Whitehorse
General Hospital. The standard ward rate for
the Whitehorse General Hospital as of April 1,
2003, was $1,165. This rate dropped to $1,100
per day effective August 1, 2003. These rates
are established through Order-in-Council and
are derived as follows:
‰
Standard Ward Rate = (total operating
expenses - non-related in-patient costs related newborn costs - associated outpatient costs) / (total patient days - patient
days for other services, ex. non- Canadians).
155
Chapter 3 – Yukon
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 outpatient rate is currently $110 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 2002-2003
for elective and emergency services provided to
eligible Yukon residents outside Canada:
In-patient Services
$9,339
Number of
Beds
Facility
Whitehorse General Hospital
49a
$2,451
Watson Lake Cottage Hospital
12
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
In 2002-2003, the following staffed beds in
facilities providing insured hospital services
were available as of March 31, 2003:
Out-patient Services
Note: Figures are by service date and subject to
adjustment.
4.4
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
the two acute care facilities.
Access to Insured Health Services
There are no user fees or co-insurance charges
under the Yukon Health Care Insurance Plan or
the Yukon Hospital Insurance Services Plan. All
services are provided on a uniform basis and
are not impeded by financial or other barriers.
Access to hospital or physician services not
available locally are provided through the
Visiting Specialist Program, Telehealth Program
or the Travel for Medical Treatment Program.
These programs ensure that there is minimal or
no delay in receiving medically necessary
services.
(For additional information on the number and type of
hospital beds in the Yukon see the related Statistical
Annex, items 3 and 4.)
a
Eight additional acute-care beds can be made
available at the Whitehorse General Hospital, should
future occupancy trends indicate a need.
Decisions on the number of acute care beds in
a facility are made by the Whitehorse General
Hospital and Community Nursing and are based
on utilization patterns and staffing compliments.
Based on the population of the Yukon, the
current number of hospital beds is considered
sufficient.
The Yukon has no rehabilitative beds. Patients
are referred out-of-territory for these services –
usually to Vancouver or Edmonton.
The estimated number of full-time equivalent
(FTEs) nurses and other health care
professionals working in facilities providing
insured hospital services in the Yukon as of
March 31, 2003, is:
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
156
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
Profession
Whitehorse
General
Hospital
# of FTE’s
Watson Lake
Cottage
# of FTE’s
‰
Wage scale recognizes experience
‰
Cooperative work schedules
‰
On-site fitness centre/24-hour
‰
Monthly clinical skill development
Registered Nurses
72
8
‰
Continuing education/development
Licensed Practical
8
n/a
‰
Travel bonus/$2,000 after one year
Nurse Pract.
0
n/a
‰
Northern Living Allowance/Up to $5,400
Social Worker
1
n/a
Facilities
Pharmacist
2
n/a
Physiotherapist
4.4
n/a
Occup. Therapist
1
n/a
Psychologist
1
n/a
Whitehorse General Hospital: As the only
major acute care hospital facility in the Territory,
this facility provides in-patient, out-patient and
24-hour emergency services. Emergency
Department services are provided on rotation by
local physicians.
21
n/a
Medical Lab/X-ray
3.5
Dietician
n/a
Public Health
n/a
2
Home Care
n/a
1
The Whitehorse General Hospital and
Community Nursing manage the supply of
nurses and health care professionals in the
Territory’s two hospitals with the Department of
Health and Social Services. Shortfalls in staffing
are covered by temporary, casual or auxiliary
workers to ensure residents have continued
access to insured services.
Recruitment and Retention
Recruitment and retention initiatives include:
Community Nursing
‰
A Yukon Advisory Committee on Nursing was
struck to advise the Department of Health
and Social Services on nursing issues.
Recommendations will help the Yukon recruit
and retain nurses in both the long and short
term.
Surgical services provided include:
‰
minor orthopaedics;
‰
selected major orthopaedics;
‰
gynecology;
‰
paediatrics;
‰
general abdominal;
‰
mastectomy;
‰
emergency trauma;
‰
ear/nose/throat/otolaryngology; and
‰
ophthalmology including cataracts.
Diagnostic services include:
‰
radiology (including ultrasound, computed
tomography, x-ray and mammography;
-
competitive salaries
‰
laboratory; and
-
recruitment and retention bonuses
‰
electrocardiogram.
-
participation at job fairs
-
training and educational opportunities
Selected rehabilitative services are available
through out-patient therapies.
-
relief positions
Whitehorse General Hospital
‰
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).
Competitive salaries
Canada Health Act Annual Report, 2002-2003
Watson Lake Cottage Hospital: A second
acute care facility is located in Watson Lake.
Medical services include emergency trauma,
maternity, minor orthopaedics, cellulitis, failure
157
Chapter 3 – Yukon
to thrive and respite care. Diagnostic services
include x-ray, laboratory and electrocardiogram.
This is a 12-bed facility and there is no waitlist
for admission.
The only other facility in the Yukon to provide inpatient services is located in Dawson City and is
limited to 48-hour care. Out-patient and 24-hour
emergency services are provided by the
remaining 12 Community Health Centres. One
or more Community Nurse Practitioners and
auxiliaries staff Health Centres.
Patients requiring insured hospital services not
available locally are transferred to acute care
facilities in-territory or out-of-territory through the
Travel for Medical Treatment Program.
Measures to improve Access
A number of measures have been taken to
better manage access to insured hospital
services. The Department of Health and Social
Services continues to work with the Yukon
Hospital Corporation and Community Nursing to
ensure the current waiting time for insured
hospital services in the Territory is reduced or
maintained at existing levels. For example:
‰
Heart defibrillators were made available in all
rural Yukon Health Centres. This provides an
important tool to Community Nurse
Practitioners and improves local access to
cardiac care.
‰
Officials from the Department attend nursing
recruitment fairs across Canada. Information
on working in the Territory was provided 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 the initiation, elimination,
expansion or reduction of programs or
services.
‰
Telehealth continued to provide real-time
video to support access and delivery of
services between outlying rural communities
with Whitehorse, and Whitehorse with
outside centres in British Columbia or
Alberta. Funding was provided through the
Canada Health Infostructure Partnerships
Program (CHIPP) to October 31, 2003.
Telehealth sessions have occurred regularly
between Whitehorse and rural Yukon as well
as between Whitehorse and British
158
Columbia. These sessions have been
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
Dental-Surgical 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, 2003 (see Statistical Annex item
#30):
Number of
Practitioners
Practise
General Practitioners/
Family Practitioners
53
Specialists
6
Dentists
8
Outside the usual distribution of physicians and
specialists in the Territory, uniform access to
insured physician and dental services is
ensured through the Travel for Medical
Treatment Program. This program covers the
cost of medically necessary transportation,
allowing eligible persons to access services that
are not available in their home communities.
Eligible persons are routinely sent to
Whitehorse, Vancouver, Edmonton or Calgary to
receive services.
Most physicians in the Yukon are located in
Whitehorse. Outside 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
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
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:
Number of
Specialists
Specialty
Ophthalmology
1
Oncology
3
Orthopaedics
3
Internal Medicine
1
Otolaryngology
2
Neurology
1
Rheumatology
1
Dermatology
Dental Surgery
1
1
Infectious Disease1
Psychiatry
1
1
Specialist service
Ophthalmology
1
Orthopaedics
1-22 months
Otolaryngology
1-12 months
Neurology
3-5 months
Rheumatology
3-5 months
Dental Surgery1
2-3 months
Services not provided through the Visiting Specialist
as administered by the Whitehorse General Hospital.
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 to increase the
number of resident and locum physicians in the
Territory, including:
‰
Resident Support Program: assists with
travel, accommodation and vehicle expenses
for residents in a family practice program and
for medical students in the Yukon.
‰
Locum Support Program: assists with
travel and accommodation expenses for
physicians providing locum services to
resident physicians.
‰
Physician Relocation Fund: assists with
relocation costs for family practice physicians
recruited to the Yukon. A return-in-service
commitment is required.
‰
Office Start-Up Fund: assist physicians
relocating to the Yukon in an area
designated by the Joint Management
Committee as requiring additional physician
resources.
‰
Education Support Program: supports
Yukon physicians who leave the Territory for
specialized training. A return-in-service
commitment is required.
‰
Rural Training Fund: supports rural
physicians to maintain emergency skills
through specialized course work.
1
Services not provided through the Visiting Specialist
as administered by the Whitehorse General Hospital.
Visiting Specialist clinics are held between one
and eight times per year depending on demand
and availability of specialists. As of March 31,
2003, the waitlist for non-emergency specialist
services was estimated at:
0-3 months
Note: There is no waitlist for visiting services not
included in the above listing. Patients are seen on the
next scheduled visit (i.e., Oncology, Internal Medicine,
Dermatology, Infectious Disease and Psychiatry).
3
3
Waitlist
Amendments were made to the Medical
Professions Act in 2002-2003 to provide for the
Canada Health Act Annual Report, 2002-2003
159
Chapter 3 – Yukon
issuance of special licenses in response to a
demonstrated need. The candidate must have
already been offered a position in the Territory
subject to special licensing and the Minister of
Health and Social Services must state in writing
that a demonstrated need exists within an area
of practice.
5.4
Physician Compensation
The Department of Health and Social Services
seeks its negotiating mandate from the
Government of Yukon, before entering
negotiations with the Yukon Medical Association
(YMA). The YMA and the Government each
appoint members to the negotiating team.
Meetings are held as required until an
agreement has been reached. The YMA’s
negotiating team then seeks approval of the
tentative agreement from the YMA membership.
The Department seeks ratification of the
agreement from the Government of Yukon. The
final agreement is signed with the concurrence
of both parties.
The most recent fee negotiations were
concluded on March 26, 2002. The resulting
Memorandum of Understanding is effective from
April 1, 2002 through March 31, 2004. The
MOU establishes the terms and conditions for
payment of the following:
‰
Fee-for-service physicians;
‰
Alternative payment physicians;
‰
Continuing Medical Education;
‰
Medical Practice Insurance; and
‰
Benefit Programs.
The legislation governing payments to
physicians and dentists for insured services are
the Health Care Insurance Plan Act and the
Health Care Insurance Plan Regulations. No
amendments were made to the legislation in
2002-2003.
The fee-for-service system is used to reimburse
the majority of physicians and dentists providing
insured services to residents. In 2002-2003, two
full-time resident rural physicians and two
resident specialists were compensated on a
contractual basis. Three physicians providing
visiting clinics in outlying communities were paid
a flat sessional rate for services.
160
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 and M) and capital funding
levels are negotiated and adjusted based on
operational requirements and utilization
projections from prior years. The current oneyear contribution agreement is in effect to
March 31, 2003.
In addition to the established O and M and
capital funding set out in the agreement,
provision is made for the hospital to submit
requests for additional funding assistance for
implementing new or enhanced programs.
Only the Whitehorse General Hospital is funded
directly through a contribution agreement. The
Watson Lake Cottage Hospital and all Health
Centres are funded through the Yukon
Government’s budget process.
The legislation governing payments made by
the health care plan to facilities that provide
insured hospital services is the Hospital
Insurance Services Plan Act and Regulations.
The legislation and Regulations set out the
legislative framework for payment to hospitals
for insured services provided by that hospital to
insured persons. No amendments were made to
the legislation in 2002-2003.
6.0 Recognition Given to Federal
Transfers
The Government of the Yukon has
acknowledged the federal contributions provided
through the Canada Health and Social Transfer
(CHST) in its 2002-2003 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. These documents are
available to Health Canada as part of the
Additional Materials section.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Yukon
7.0 Extended Health Care
Services
Residential Care Services
Continuing Care Health Services are available
to eligible Yukon residents. In 2002-2003, there
were three facilities providing services in the
Yukon. These facilities provide one or more of
the following services:
‰
personal care;
‰
extended care services;
‰
nursing home intermediate care;
‰
special care;
‰
respite;
‰
day program; and
‰
meals on wheels.
are provided through Community Nursing or
public health. All residents have equal access to
services.
The above services are not provided for in
legislation.
In addition to the services described above, the
following are also available to eligible Yukon
residents outside the requirements of the
Canada Health Act:
‰
The Chronic Disease and Disability
Benefits Program provides benefits for
eligible Yukon residents who have specific
chronic diseases or serious functional
disabilities: coverage of related prescription
drugs and medical-surgical supplies and
equipment. (Chronic Disease and Disability
Benefits Regulation)
‰
The Pharmacare Program and Extended
Benefits Programs are designed to assist
registered senior citizens with the cost of
prescription drugs, dental care, eye care,
hearing services and medical- surgical
supplies and equipment. (Pharmacare Plan
Regulation and Extended Health Care Plan
Regulation)
‰
The Travel for Medical Treatment Program
assists eligible Yukon residents with the cost
of emergency and non-emergency medically
necessary air and ground transportation to
receive services not available locally. (Travel
for Medical Treatment Act and Travel for
Medical Treatment Regulation)
‰
The Children’s Drug and Optical Program
is designed to assist eligible low-income
families with the cost of prescription drugs,
eye exams and eye glasses for children 18
and younger. (Children’s Drug and Optical
Program Regulation)
‰
Mental Health Services provide
assessment, diagnostic, individual and group
treatment, consultation and referral services
to individuals experiencing a range of mental
health problems. (Mental Health Act and
Mental Health Act Regulations)
‰
Public Health is designed to promote health
and well-being throughout the Territory
through a variety of preventive and education
programs. This is a non-legislated program.
‰
The Ambulance Services Program is
responsible for the emergency stabilization
and transportation of sick and injured
persons from an accident scene to the
A new continuing care facility was opened in
summer 2002 with 72 beds staffed and in
operation. Twenty-four additional beds can be
made available should future occupancy trends
indicate a need.
In total there were 113 continuing care or
extended care beds in the Territory in
2002-2003.
No other major changes were made in the
administration of these services in 2002-2003.
Home Care Services
The Yukon Home Care Program provides
assessment and treatment, personal support,
social support, respite services and palliative
care. In Whitehorse, services are provided by
home support workers, nurses, social workers
and therapists. In rural communities, auxiliary
home support workers assist clients with
personal care and respite services. Services are
available Monday through Friday. In Whitehorse,
additional services such as planned weekend
and evening support may be provided to 9:00
pm during end-stage palliative care. Twenty-four
hour care is not provided.
Ambulatory Health Care Services
The Yukon Home Care Program provides the
majority of ambulatory health care services
outside institutional settings. Most other services
Canada Health Act Annual Report, 2002-2003
161
Chapter 3 – Yukon
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, through the
provision of routine and diagnostic hearing
evaluations and community outreach. This is
a non-legislated program.
‰
Dental Services provides a comprehensive
diagnostic, prevent and restorative dental
service to children from pre-school to grade
eight in Whitehorse and Dawson City. All
other Yukon communities receive services
for pre-school to grade 12. This is a nonlegislated program.
8.0 Additional Materials
Submitted to Health Canada
‰
Listing of uninsured hospital, physician and
surgical-dental services
‰
Health Care Insurance Plan Act and
Regulations (office consolidation of Act)
‰
Hospital Insurance Services Act and
Regulations (office consolidation of Act)
‰
Medical Professions Act and Regulations
‰
Hospital Act and Regulations
‰
Mental Health Act and Regulations
‰
Dental Professions Act and Regulations
‰
Statement of Revenue and Expenditures:
Health Care Insurance Programs (1997-1998
to 2002-2003)
‰
Yukon Public Accounts – Excerpt of the
Auditor General’s Report, 2002-2003
‰
Yukon Public Accounts – Excerpt of
consolidated Financial Statements,
2002-2003
‰
Yukon Budget, 2002-2003
‰
Program Brochures:
-
162
Health Care Outside the Yukon;
Medical Treatment Travel;
Hospital Services and Health Care in the
Yukon;
Seniors Health Benefits;
Chronic Disease and Disability Benefits;
and
Children’s Drug and Optical Program
Canada Health Act Annual Report, 2002-2003
Northwest Territories
Introduction
The Northwest Territories (NWT) Department of
Health and Social Services, together with seven
Health and Social Services Authorities (HSSAs),
plan, manage and deliver a full spectrum of
community and facility-based services for health
care and social services. Community health
programs include daily sick clinics, public health
clinics, home care, school health programs and
educational programs. Visiting physicians and
specialists routinely visit the communities.
Services also include early intervention and
support to families and children, mental health,
and addictions.
Boards of trustees for each HSSA provide NWT
residents with the opportunity to shape priorities
and service delivery for their communities.
Nurses are the largest group of health care
practitioners in the NWT.
Changing Demographics
As of April 1, 2003, there were an estimated
41,719 people in the Northwest Territories, of
which half were Aboriginal people.1 The NWT
continues to have a relatively young population
and a high birth rate. According to 2002
population estimates, approximately 26 percent
of the NWT population is under 15 years of age,
compared with 18.5 percent in the overall
Canadian population.2 This population profile
supports the continued need to invest in
services that target children, youth and young
families.
Although the territorial population is
comparatively young, it is nonetheless aging. It
is expected that in less than 20 years, the
number of seniors 65 years of age and older will
rise from approximately 1,700 to about 4,600,
representing an increase of 170 percent. In
contrast, it is expected that the population under
20 years of age will increase by approximately
11 percent over the same period.3 The demand
for health resources among seniors is
approximately eight times that of the population
under 65.4 This relates to higher rates of cancer,
circulatory diseases, nervous system and sense
organ diseases, injuries and respiratory
Canada Health Act Annual Report, 2002-2003
diseases. This growing number of aging
residents has a significant impact on services
for the elderly such as home and long-term
care.
Changing Economic Conditions
Changes in the economic situation in the North
continue to have an impact on the health and
well-being of residents. Increased employment
opportunities, especially in the areas of mining
and oil and gas exploration, are having a
positive impact on the economy. With this
comes increased disposable income, which can
result in improved nutrition, safety and security
for families. However, the changes in economic
conditions have also led to increases in social
problems such as abuse of alcohol and
gambling.
Studies have shown that the unemployed have
a reduced life expectancy and suffer more
health problems than the employed. In the
NWT’s smaller communities, low household
income levels and reduced employment
opportunities combined with overcrowded
housing conditions create stress and unhealthy
living conditions. There is also a continued
urbanization process occurring, specifically the
migration of individuals and families from
smaller communities to regional centres,
including Yellowknife, in search of employment.
Incidence of Preventable Illness, Injury
and Death
Compared with the rest of Canada, the
incidence of preventable illness, injury and
death continue to be high in the Northwest
Territories (1999 Health Status Report). Adverse
outcomes such as family violence, Fetal Alcohol
1
Statistics Canada, Quarterly Population Estimates and
Statistics Canada, 2001 Census.
2
Statistics Canada, CANSIM II, Table 051-0001,
June 2003.
3
NWT Bureau of Statistics, Custom Population
Projections, 2000.
4
Health Canada, Health Expenditures in Canada by Age
and Sex, 1980-81 to 2000-01 (August 2001).
163
Chapter 3 – Northwest Territories
Spectrum Disorder and many forms of cancer
are linked to poor lifestyle choices made by
individuals regarding diet, degree of physical
activity or the use of alcohol, tobacco and
drugs. Injuries and deaths associated with
injuries are often the result of risky behaviour.
The underlying causes of many acute and longterm care needs are linked to poverty, low
educational achievements, unemployment and
low self-esteem, all of which can lead to poor
coping skills.
Even though there is a downward trend in the
rest of Canada, tobacco use continues to be a
serious public health concern in the NWT.
Smoking rates in the NWT are among the
highest in Canada. The implications for health
care costs and human costs in terms of death
and disability are significant and rising.
Increases in Health Care and Social
Services Costs
Many factors continued to affect the demand for
resources. These factors include, but are not
limited to, demographics, recruitment and
retention of health professionals, compensation
packages, new technologies, pharmaceuticals
and medical practices, increased incidence of
chronic and new diseases and public
expectations. Increasing costs continue to place
pressure on the system.
Maintaining a Sustainable System
In February 2002, the Minister of Health and
Social Services released the Health and Social
Services System Action Plan 2002-2005. The
Action Plan is based on reports and evaluations
conducted over the past eight years and builds
on the principles and vision of the Department’s
1998 strategic plan, Shaping Our Future. The
Action Plan outlines 45 action items, with
specific commitments, timelines and
deliverables.
Public status reports have been issued every six
months. As of March 2003 (fiscal year-end), 18
of the 45 action items were completed. The
specific deliverables and timelines for
improvements are in the following areas:
‰
services to people;
‰
support to staff;
‰
system-wide management;
164
‰
support to trustees; and
‰
system-wide accountability.
Information Technology
Considering the relatively small population
distributed over a large and isolated area, the
NWT is using new information technologies as a
means to improve communications between
communities. However, these are the same
factors that make it costly and difficult to provide
and maintain technological solutions in the
NWT.
Data quality and integrity continue to be a
challenge in the NWT. It has become
increasingly important that new integrated
information systems created for the Department
and the HSSA’s be developed recognizing
issues related to client privacy. Vendors are
responding to these challenges by improving
the access and security facilities in new
applications and infrastructures. The NWT is
moving forward to harness these new
opportunities as quickly as its financial
resources permit.
1.0 Public Administration
1.1
Health Care Insurance Plan and
Public Authority
The name of the plan in the NWT is The
Northwest Territories Health Care Plan, which
includes the Medical Care Plan and the Hospital
Insurance Plan. The public authority responsible
for the administration of the Medical Care Plan
is the Director of Medical Insurance as
appointed under the Medical Care Act. The
Minister administers the Hospital Insurance Plan
either through Boards of Management
established under section 10 of the Hospital
Insurance and Health and Social Services
Administration Act (HIHSSA) or pursuant to
section18 of the same Act, which allows the
Minister to approve a contract for the
management of health and social services
facilities.
Legislation that enables the Plan in the
Northwest Territories includes the Medical Care
Act (revised 1988) and the Hospital Insurance
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Northwest Territories
and Health and Social Services Administration
Act (revised 2002). In October 2002, minor
amendments were made to both the Medical
Care Act and the Hospital Insurance and Health
and Social Services Administration Act to clarify
subrogation provisions. In January 2001,
sections of the Medical Care Act Regulations
pertaining to fee schedules were amended to
reflect the negotiated contract between the
NWT Medical Association and the Department
of Health and Social Services. Contract
negotiations, which began in October 2002, will
result in amendments to the fee schedule in
2003.
The powers of the Minister are outlined in
section15 of the Hospital Insurance and Health
and Social Services Administration Act and the
Minister’s mandate is further described in the
Establishment Policy for the Department of
Health and Social Services.
1.2
Reporting Relationship
In the Northwest Territories, the Minister of
Health and Social Services appoints a Director
of Medical Insurance. The Director is
responsible for the administration of the Medical
Care Act and the regulations. The Director must
report to the Minister each fiscal year respecting
the operation of the Medical Care Plan.
The Minister also appoints members to a Board
of Management for each facility located
throughout the Northwest Territories. Boards of
Management are established under section 10
of the Hospital Insurance and Health and Social
Services Administration Act or under the
Societies Act. The Boards are established with
the authority to manage, control and operate
health and service facilities and, subject to the
Financial Administration Act (revised 2002),
exercise any powers necessary and incidental
to these duties. The Boards’ chairpersons hold
office during the pleasure of the Minister, while
the remaining members typically hold office for
a term of three years, to a maximum of three
consecutive terms.
Pursuant to the Financial Administration Act, an
annual audit of accounts is done at each Board
of Management. The Minister has regular
meetings with chairpersons of the Boards of
Management. This forum allows the chairperson
to provide non-financial reporting.
Canada Health Act Annual Report, 2002-2003
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 Auditor
General of Canada (AGC) has the mandate to
audit the payments made under the Medical
Care Plan. As part of the Public Accounts Audit,
the AGC also audits the Hospital Insurance
Plan.
2.0 Comprehensiveness
2.1
Insured Hospital Services
Insured Hospital Services are provided under
the authority of the Hospital Insurance and
Health and Social Services Administration Act
and the Regulations. During 2002-2003, four
hospitals and 28 health centres delivered
insured hospital services to both in- and outpatients.
The Northwest Territories provides a full range
of insured hospital services. Boards of
Management have the authority to provide
services above those considered medically
necessary, although those services are not
covered by the insurance plans. NWT 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.
165
Chapter 3 – Northwest Territories
The NWT also provide 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 Hospital Insurance
Regulations states that “out-patient insured
services” means the following services and
supplies are given to out-patients:
‰
laboratory, radiological and other diagnostic
procedures together with the necessary
interpretations for the purpose of assisting in
the diagnosis and treatment of any injury,
illness or disability, but not including simple
procedures such as examinations of blood
and urine, which ordinarily form part of a
physician’s routine office examination of a
patient;
Where insured services are not available in the
Northwest Territories, NWT residents can
receive them from hospitals in other
jurisdictions. These services must be medically
necessary and can include hospital-to-hospital
transfer as well as referral from physicians. The
NWT provides medical travel assistance, a
supplementary health benefit program outlined
in the Medical Travel Policy, which ensures that
NWT residents can have access to medically
required services.
2.2
Insured Physician Services
The NWT Medical Care Act and the NWT
Medical Care Regulations provide for insured
physician services. Only medical doctors, as
medical practitioners, are allowed to deliver
insured physician services in the NWT. The
physician must be licensed to practice in the
NWT.
A wide range of medically necessary services
are provided in the NWT. No limitation will be
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 nursing service;
‰
necessary surgical services;
‰
drugs, biologicals and related preparations
as provided in Schedule B, when
administered in the hospital;
‰
complete obstetrical care;
‰
eye examinations; and
‰
visits to specialists, even when there is no
referral by a family physician.
‰
use of operating room and anaesthetic
facilities including necessary equipment and
supplies;
‰
routine surgical supplies;
‰
services rendered by persons who receive
remuneration for those services from the
hospital;
‰
use of radiotherapy facilities; and
‰
use of physiotherapy facilities.
The Minister may add insured hospital services
to the Regulations. As such, on the Minister’s
recommendation, the Commissioner may make
Regulations prescribing the in- and out-patient
services that insured persons are eligible for
and entitled to. The Minister also determines if
any public consultation will occur prior to making
changes to the list of insured services.
166
Following negotiations between the NWT
Medical Association and the Director of Medical
Insurance, additional medical services may be
considered for inclusion to the fee schedule
Regulation. It is the responsibility of the Director
of Medical Insurance to manage the process of
adding or deleting a medical service and to
determine if public consultations are appropriate
before changes are made to the approved
schedules. However, it is the Minister who
makes the determination to add or delete
insured hospital services to the Regulations. On
the recommendation of the Minister, the
Commissioner may approve Regulations as
follows:
‰
“establishing a Medical Care Plan for
providing to insured persons insured
services by medical practitioners that will in
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Northwest Territories
other practice ordinarily carried out by
persons who are not medical practitioners as
defined by the Medical Care Act and
Regulations;
all respects qualify and enable the Territories
to receive payments of contributions from the
Government of Canada under the Canada
Health Act;
‰
“prescribing rates of fees and charges that
may be paid in respect of insured services
rendered by medical practitioners whether in
or outside the Territories, and the conditions
under which the fees and charges are
payable.”
2.3
Insured Surgical-Dental Services
Insured services and those related to oral
surgery, injury to the jaw or disease of the
mouth/jaw are eligible. Only oral surgeons may
submit claims for billing. During the reporting
period, there was no oral surgeon in the NWT.
As a result, the NWT used the Province of
Alberta Schedule of Oral and Maxillofacial
Surgery Benefits as a guide.
2.4
Uninsured Hospital, Physician and
Surgical-Dental Services
Services provided by hospitals, physicians and
dentists, but not covered by the health care
insurance plan of the NWT, 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
Canada Health Act Annual Report, 2002-2003
‰
physiotherapy and psychology services
received from other than an insured outpatient 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 approvals of uninsured
medical goods or services provided in
conjunction with an insured health service must
adhere to the procedure in place. The
procedure includes seeking advice from the
Medical Advisor. The Medical Advisor is
appointed to provide medical expertise to the
Director of Medical Insurance. This approach
does not compromise reasonable access to
insured services for NWT residents.
The NWT Medical Care Act includes Medical
Care Regulations as well as a Physician Fee
schedule. This Act also provides for the
authority to negotiate changes or deletions to
the Physician Fee Schedule. The process was
described in section 2.2 of this report.
3.0 Universality
3.1
Eligibility
The Medical Care Act is the legislation that
defines the eligibility of Northwest Territories
residents to the NWT Health Care Insurance
Plan.
The Northwest Territories uses the
Interprovincial Agreement on Eligibility and
Portability in conjunction with the Northwest
Territories Health Care Plan Registration
Guidelines to define eligibility. No changes to
eligibility have been implemented in 2002-2003.
Ineligible individuals for Northwest Territories
health care coverage are members of the
Canadian Forces, the Royal Canadian Mounted
Police, federal inmates and residents who have
not completed the minimum waiting period.
167
Chapter 3 – Northwest Territories
3.2
Registration Requirements
Registration requirements include a completed
application form and supporting documentation
as applicable, e.g. visas and immigration
papers. The applicant must be prepared to
provide proof of residency if requested.
Registration should optimally occur prior to the
actual eligibility date of the client. Health care
cards are renewed every two years. There is a
direct link between registration and eligibility for
coverage. Claims are not paid for clients who do
not have valid registration.
As of August 18, 2003, there were 39,714
individuals registered with the Northwest
Territories Health Care Plan. The registered
number is from the NWT Department of Health
and Social Services health care plan registration
database. At any point in time, it is possible for
more people to be registered than actually live
in the NWT. For example, people do not always
immediately inform the Department when they
have moved out of the NWT.
4.2
Coverage During Temporary
Absences In Canada
The Interprovincial Agreement on Eligibility and
Portability and the Northwest Territories 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 Northwest Territories for
full-time attendance in a post-secondary
institution, and for up to one year for individuals
who are temporarily absent from the Northwest
Territories for work, vacation, secondments, etc.
Once an individual has completed a Temporary
Absence form and been approved by the
Department of Health and Social Services as
being temporarily absent from the Northwest
Territories, the full cost of insured services is
paid for all services received in other
jurisdictions.
No formal provisions are in place for clients to
opt out of the health care insurance plan.
The Northwest Territories participates in both
the Hospital Reciprocal Billing Agreements and
the Medical Reciprocal Billing Agreements with
other jurisdictions.
3.3
4.3
Other Categories of Individual
Holders of employment visas, student visas
and, in some cases, visitor visas are covered if
they hold valid visas for a period of 12 months
or more.
4.0 Portability
4.1
Minimum Waiting Period
There are waiting periods imposed on insured
persons moving to the Northwest Territories.
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.
168
Coverage During Temporary
Absences Outside Canada
The Northwest Territories 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 will be required to cover their own
costs and seek reimbursement upon their return
to the NWT. The rates are the same as those
contained in the Fee Schedule for physicians
and the hospital out- or in-patient rate.
Individuals may be granted coverage for up to a
year if they are outside the country, with prior
approval. During the reporting period, no one
was granted authorization to continue with their
NWT Health care coverage while remaining
outside Canada for up to one year. In the
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Northwest Territories
eligibility rules, NWT residents may continue
their coverage 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. Because
there was no one covered by this clause, no
payments were required. The rates are the
same as those contained in the Fee Schedule
for physicians and the hospital out- or in-patient
rate.
4.4
Prior Approval Requirement
The NWT requires prior approval if coverage is
to be considered for elective services in other
provinces, territories and outside the country.
Prior approval is also required if insured
services are to be obtained from private
facilities.
5.0 Accessibility
5.1
Access to Insured Health Services
The Medical Travel Supplementary Health
Benefit Program ensures that economic barriers
are reduced for all Northwest Territories
residents. As per section 14 of the Medical Care
Act, extra-billing is not allowed.
5.2
Access to Insured Hospital Services
Beds were accessible during the reporting
period. If bed shortage was 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 operations. However, through the use
of medical travel arrangements, access to
services was maintained throughout 2002-2003.
Facilities in the NWT do offer a range of
medical, surgical, rehabilitative and diagnostic
services. The NWT medical travel program
ensures that residents may have access to
necessary services not available in NWT
facilities.
In order to improve access to insured hospital
services, the NWT continued its expansion of
the telehealth program in 2002-2003. A number
Canada Health Act Annual Report, 2002-2003
of steps were taken to ensure that installation of
equipment and the upgrading of the three
existing WestNet sites (Inuvik, Fort Smith and
Yellowknife) and the addition of four
communities (Deline, Fort Simpson, Hay River
and Holman) were completed. In addition, four
sites were equipped in 2002-2003 to support
telecare to three communities (Fort Resolution,
Lutse’ke and Yellowknife).
In December 2002, the Government of the NWT
announced an investment of an additional
$8.3 million in human resources for the health
and social services system. The new resources
were dedicated to the creation of 42 new
positions for nurses, physicians, nurse
practitioners and midwives as well as training
and mentorship programs for current health
professionals. This investment builds on a
Recruitment and Retention Plan for NWT Allied
Health Professionals, Nurses and Social
Workers (released in November 2002) to
enhance professional development and
educational opportunities, as well as employee
supports.
5.3
Access to Insured Physician and
Surgical-Dental Services
All residents of the Northwest Territories have
access to all facilities operated by the
Government of the Northwest Territories.
The medical travel program provides access to
physicians for residents and the telehealth
program has provided an expansion of
specialist services to residents in isolated
communities.
5.4
Physician Compensation
The Medical Care Act and the Medical Care
Regulations are used in the Northwest
Territories to govern payments to physicians. To
compensate physicians, the NWT uses two
models: fee-for-service and employee contracts.
The majority of family physicians are employed
through a contractual arrangement with the
Northwest Territories, the remaining provide
services through a fee-for-service arrangement.
Physician compensation is determined for
physician contracts and fee-for-service
scheduled through negotiations between the
Northwest Territories Medical Association and
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Chapter 3 – Northwest Territories
the Department of Health and Social Services.
The Director of Medical Insurance and his or
her designates negotiate on behalf of the
Department. The Northwest Territories Medical
Association chooses a negotiation team from
within their membership. The NWT Fee
Schedule, General Practitioner contract and the
specialists contract for the Stanton Territorial
Heath Authority are set to expire March 31,
2004.
5.5
Payments to Hospitals
Payments made to hospitals are based on
contribution agreements between the Boards of
Management and the Department of Health and
Social Services. Amounts allocated in the
agreements are based upon 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 Hospital
Insurance and Health and Social Services
Administration Act and the Financial
Administration Act. No amendments were
implemented in 2002-2003 to provisions
involving payments to facilities. A global budget
is used to fund hospitals in the Northwest
Territories.
6.0 Recognition Given to Federal
Transfers
Federal funding received through the Canada
Health and Social Transfer has been recognized
and reported by the Government of the
Northwest Territories through press releases
and various other documents. For fiscal year
2002-2003, these documents included:
‰
2002-2003 Budget Address;
‰
2002-2003 Main Estimates;
‰
2001-2002 Public Accounts; and
‰
2002-2005 Business Plan for the Department
of Finance
7.0 Extended Health Care
Services
7.1
Nursing Home Intermediate Care
and Adult Residential 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 Hospital Insurance and Health and
Social Services Administration Act and the
Hospital Standards Regulations.
Supported living services provide a home-like
environment with increased assistance and a
degree of supervision unavailable through home
care services. Current services in this area
include supported living arrangements in family
homes, apartments and group living homes,
where clients live as independently as possible.
Group homes, long-term care facilities and
extended care facilities provide more complex
medical, physical and/or mental supports on a
24 hour basis.
The NWT Home Care Program is a territorialwide 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
admission to institutional care when community
living is no longer a viable alternative. Home
care services are delivered through the
Regional Health and Social Services Authorities
and include a broad range of services based on
a multi-disciplinary assessment of individual
needs. The Home Care Program is currently
offered by six of the Health and Social Services
Authorities: Yellowknife; Hay River; Fort Smith;
Inuvik; Deh Cho; and Dogrib.
The Estimates noted above represent the
financial plan of the Government and is
presented each year by the Government to the
Legislative Assembly.
170
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Northwest Territories
8.0 Additional Materials Supplied
to Health Canada
The NWT health and social services system has
been extensively reviewed over the past ten
years. This includes the Legislative Assembly’s
Special Committee on Health and Social
Services (1993), the Med-Emerg Review (1997)
and the Minister’s Forum on health and Social
Services. During the reporting period, the
Minister of Health and Social Services took into
account these reviews in the actions identified in
the NWT Health and Social Services System
Action Plan. Copies of the Action Plan, six
month status reports and other materials
produced by the NWT Department of Health
and Social Services can be found at:
www.hlthss.gov.nt.ca
In addition, NWT legislation, regulations and
other documents, such as the Main Estimates,
can be found at:
www.gov.nt.ca
As well, NWT health legislation and regulations
can be found on the Department of Health and
Social Services Web site at:
www.hlthss.gov.nt.ca
Other documents, such as the Business Plans,
Main Estimates and Public Accounts, can be
found on the financial Management Board
Secretariat Web site at:
www.gov.nt.ca/FMBS/
Canada Health Act Annual Report, 2002-2003
171
Nunavut
Introduction
Nunavut was formed as a Territory on April
1,1999. The Territory covers one-fifth of
Canada’s total landmass. There are twenty-six
communities situated across three time zones.
The Territory is divided into three regions: the
Baffin, which consists of 13 communities; the
Kivalliq, which consists of eight communities;
and the Kitikmeot, which consists of five
communities. According to recent statistics, the
population of Nunavut is 29,384. Approximately
40 percent of the population is under the age of
25. Inuit make up the majority at about 85
percent of the residents. There is a small
French-speaking population of about four to six
percent residing on Baffin Island, predominantly
in the capital city of Iqaluit. Nunavut has a highly
transient workforce, in particular skilled
labourers and other 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 Nunavut Act
(1999). Over the coming years, the Department
of Health and Social Services plans to review all
existing legislation to ensure its relevancy and
appropriateness for the Government of Nunavut
as set out in the objectives of the Bathurst
Mandate. The Bathurst Mandate outlines the
Government’s agenda to achieve healthy
communities, simplicity and unity, self-reliance
and continuous learning. The incorporation of
traditional Inuit values, known as Inuit
Qaujimajatuqangit, in program policy
development, service design and delivery, is an
expectation placed on all departments.
The delivery of health services in Nunavut is
based on a primary health care model. There is
a local health centre in each of the 25
communities across Nunavut, as well as one
regional hospital in Iqaluit. The primary health
care providers are nurses with expanded
scopes, with the exception of 14.5 full-time
family physicians; eight in the Baffin region; 4.5
in the Kivalliq region; two in the Kitikmeot
region. Nunavut relies heavily on the Northern
Medical Unit of the University of Manitoba,
Ottawa Health Services Network Inc. and
Canada Health Act Annual Report, 2002-2003
Stanton Regional Hospital in Yellowknife for the
majority of its physician and specialist services.
The management and delivery of health
services in Nunavut were integrated into the
overall operations of the Department on
March 31, 2000, when the former boards
(Baffin, Kitikmeot and 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,
which 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 2002-2003 was $166,133,000,
including approximately $15 million allocated for
capital. Only the Department of Education has a
higher budget.
In 2002-2003, Nunavut upgraded its five
existing telehealth sites and added an additional
10 telehealth communities to its network with
funds from the Canadian Health Infostructure
Partnership Program. The Department of Health
and Social Services will soon learn if it will
receive an additional $2.7 million from the
Primary Health Care Transition Fund. This
would allow for the addition of seven
communities to the telehealth network, bringing
the total to 22 communities. These communities
receive a broad range of services: specialist
consultation services such as dermatology,
psychiatry and internal medicine; rehabilitation
services; regularly scheduled counselling
sessions; family visitation; and continuing
medical education.
Nunavut has many unique needs and
challenges with respect to the health and wellbeing of its residents. Approximately one-fifth of
the Department’s budget is spent on medical
travel. Due to the very low population density in
this vast territory and limited health
infrastructure (equipment and health human
resources), access to a range of hospital and
specialist services often requires that residents
be sent out of the Territory. A new regional
hospital in Iqaluit and new regional health
facilities in Rankin Inlet and Cambridge Bay,
that will be built over the next three years, will
enable Nunavut to build internal capacity and
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Chapter 3 – Nunavut
enhance the range of services that can be
provided within the Territory. There continue to
be high rates of respiratory diseases such as
tuberculosis. Nunavut continues to be
challenged by the acute shortage of nurses,
despite aggressive national and international
recruitment and retention activities. Recruitment
and retention of other health care professionals
such as social workers, physicians and
physiotherapists is also a challenge.
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, importance of traditional foods,
etc.
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 non-profit basis.
The Medical Care Act (NWT, 1988 and as
duplicated for Nunavut by section 29 of the
Nunavut Act, 1999) governs the entitlement to
and payment of benefits for insured medical
services. The Hospital Insurance and Health
and Social Services Administration Act (NWT,
1988 and as duplicated for Nunavut by section
29 of the Nunavut Act, 1999) enables the
establishment of hospital and other health
services.
Through the Dissolution Act (Nunavut, 1999),
the three former Health and Social Services
Boards of Baffin, Kitikmeot and 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 for
the fiscal year 2002-2003.
174
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. In November 2002, the Auditor
General released the audit report for 2000-2001
entitled 2002 Annual Report to the Nunavut
Legislative Assembly.
2.0 Comprehensiveness
2.1
Insured Hospital Services
Insured Hospital Services are provided in
Nunavut under the authority of the Hospital and
Social Services Administration Act and
Regulations, sections 2 to 4. No amendments
were made to legislation or Regulations in
2002-2003.
In 2002-2003, insured hospital services were
delivered in 26 facilities throughout Nunavut,
including a general hospital located in Iqaluit
and 25 community health centres. The Baffin
Regional Hospital in Iqaluit is the only acute
care facility in Nunavut providing a range of inand out-patient hospital services as defined by
the Canada Health Act. Community health
centres provide public health, out-patient
services, emergency room services and some
overnight services (observations). There are
also a limited number of birthing beds at the
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Nunavut
Rankin Inlet Birthing Centre. Public health
services are provided at a Public Health Clinic
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,
audiology and speech therapy services in an
out-patient facility or in an approved hospital;
and
‰
psychiatric and psychology services provided
under an approved hospital program.The
Department of Health and Social Services
makes the determination to add insured
services in its facilities based on the
availability of appropriate resources,
equipment and overall feasibility in
accordance with financial guidelines set by
the Department and with the approval of the
Nunavut Financial Management Board. No
Canada Health Act Annual Report, 2002-2003
new services were added in 2002-2003 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 legislation or Regulations in
2002-2003.
Medical doctors are the only medical
practitioners permitted to deliver insured
physician services in Nunavut. The physician
must be in good standing with a College of
Physicians and Surgeons and be licensed to
practise in Nunavut. The Government of
Nunavut’s Medical Registration Committee
currently manages this process for Nunavut
physicians. There are a total of 14.5 full- time
family physicians in Nunavut (eight in the Baffin
region; 4.5 in the Kivalliq region; 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, 2003, Nunavut had 176
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 2002-2003, no
physicians provided written notice of this
election.
Insured physician services means 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.
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
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Chapter 3 – Nunavut
Cabinet for approval. No additions or deletions
were added in 2002-2003.
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 the purpose of billing the Plan for
the provision of insured dental services. In
2002-2003, three 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.
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 2002-2003.
2.4
Uninsured Hospital, Physician and
Surgical-Dental Services
Services provided for 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
176
‰
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, unless has
prior approval.
The Baffin Regional Hospital charges $2,180.25
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 NonInsured 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 for Inuit and First Nations.
Canada Health Act Annual Report, 2002-2003
Chapter 3 – Nunavut
3.0 Universality
3.1
Eligibility
Eligibility for the Nunavut Health Care Plan is
briefly defined under section 3(1)(2)(3) of the
Medical Care Act. The Department also adheres
to the Inter-Provincial/Territorial Agreement on
Eligibility and Portability as well as internal
guidelines. No amendments were made to the
legislation or Regulations in 2002-2003.
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 firstday 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 nonCanadian 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 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 InterProvincial/Territorial 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, 2002-2003
3.2
Registration Requirements
Registration requirements include a completed
application form and supporting documentation.
A health care card is issued to each resident.
Nunavut will be going to a staggered renewal
process once a new health claims system is put
into place next fiscal year. 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, 2003, 28,039 residents were
registered with the Nunavut Health Care Plan.
Nunavut’s population statistics as published by
Statistics Canada 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 were
adopted by Nunavut in 1999.
4.0 Portability
4.1
Minimum Waiting Period
Consistent with section 3 of the InterProvincial/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
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Chapter 3 – Nunavut
province, decides to take up permanent
residency in Nunavut.
4.2
Coverage During Temporary
Absences In Canada
The Medical Care Act, section 4(2), prescribes
the benefits payable where insured medical
services are provided outside Nunavut but
within Canada. The Hospital Insurance and
Health and Social Services Administration Act,
sections 5(d) and 28(1)(j)(o), provide the
authority for the Minister to enter into
agreements with other jurisdictions to provide
health services to Nunavut residents and the
terms and conditions of payment. No legislative
or regulatory changes were made in 2002-2003
with respect to coverage outside Nunavut.
Students studying outside Nunavut must notify
the Department and provide proof of enrolment
to ensure coverage continues. 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 receipt of 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 InterProvincial/Territorial Agreement on Eligibility and
Portability, as of January 1, 2001.
Nunavut participates in Physician and Hospital
Reciprocal Billing. Agreements are in place with
other provinces and territories (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
Coordinating Committee on Reciprocal Billing. 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
178
hospital and through visiting specialist services
in the Kitikmeot area (Western Arctic).
The Physician Reciprocal Billing Agreements
provide payment of insured physician services
on behalf of eligible Nunavut residents receiving
insured services outside the territory. Payment
is made to the host province at the rates
established by that province.
Out-of-territory hospitals were paid
$22,547,986.26 in the fiscal year 2002-2003.
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 $110 for out-patient care.
No changes were made to these rates in
2002-2003.
In 2002-2003, Nunavut paid a total of $586.75
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, 2002-2003
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 the one acute care hospital facility in
Nunavut. The hospital has 25 beds available for
acute, rehabilitative, palliative and chronic care
services. The hospital has a staff of 101,
including seven physicians, one surgeon and 37
nurses. The facility provides in-patient, outpatient, and 24-hour emergency services. Local
physicians provide emergency services on
rotation. Medical services provided include an
ambulatory care/out-patient clinic, intensive care
services, respiratory services, cardiovascular
care, maternity, palliative care, gastrointestinal
bleeds and hypertension treatment. 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 (Manitoba),
Winnipeg, Edmonton and Yellowknife to provide
insured services to referred patients.
Outside the Baffin Regional Hospital, out-patient
and 24-hour emergency services are provided
by all 25 health centres located in the
communities.
Although nursing and other health professionals
were not at the desired levels of staffing, all
basic services were provided in 2002-2003.
Canada Health Act Annual Report, 2002-2003
Nunavut is seeking to increase resources in all
areas.
The use of telehealth services has been a
significant step in improving access to hospital,
medical and other health and social services in
Nunavut. To date, telehealth facilities are active
in 15 communities with a goal of expanding to
seven more communities in 2003-2004. 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 agreements
with a number of health regions or facilities to
provide medical and visiting specialists and
other visiting health practitioner services. For
services and equipment unavailable in Nunavut,
patients are referred to other jurisdictions. The
telehealth network, linking 15 communities,
allows for the delivery of a broad range of
services: specialist consultation services such
as dermatology, psychiatry and internal
medicine; rehabilitation services; regularly
scheduled counselling sessions; family
visitation; and continuing medical education. In
2002-2003, Nunavut had 176 physicians
registered, of which 170 had an annual license
and six had limited a license (less than one
year).
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
There is one fee-for-service physician residing
in Nunavut. Because fee-for-service physicians
pay the expenses of running a practice in an
isolated community, they are paid a rate 20
179
Chapter 3 – Nunavut
percent greater than the amounts set out in the
schedule (per the Medical Care Act, section 4).
The fees are negotiated between the
Department of Health and Social Services and
the physician, and are based on the NWT
standards. The remaining physicians are on
contract at a per-diem rate or are on salary.
Visiting specialists are paid on a per diem-basis
under the terms of their contracts.
5.5
Payments to Hospitals
Funding for the Baffin Regional Hospital and the
25 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.
Nursing home services are available at the
Iqaluit and Arviat’s Elders Homes. These
facilities provide the highest level of long-term
care in Nunavut; that is, extensive chronic care
services up to the point of acute care (levels 4
and 5) services. Acute care cases are
transferred to the closest hospital.
8.0 Additional Materials
Submitted to Health Canada
2002 Annual Report to the Nunavut Legislative
Assembly
http://www.oag-bvg.gc.ca/domino/reports.nsf/
html/01nunavut_ehtml/$file/02english.pdf
Budget Address 2003-2004
6.0 Recognition Given to Federal
Transfers
Recognition will be given this year when the
Director of Medical Care presents the
2002-2003 annual report to the Minister.
http://www.gov.nu.ca/baeng.pdf
Department of Health and Social Services Main
Estimates 2003-2004
http://www.gov.nu.ca/Nunavut/English/
budget/2003/hss.pdf
Department of Health and Social Services
Capital Estimates 2003-2004
http://www.gov.nu.ca/Nunavut/English/budget/
2003/capital/hss.pdf
7.0 Extended Health 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. Services include
basic housekeeping support, meal preparation
and assistance with daily living.
Department of Health and Social Services
Business Plan 2003-2004
http://www.gov.nu.ca/Nunavut/English/budget/
2003/bp/hss.pdf
Public Accounts 2000-2001
http://www.gov.nu.ca/Nunavut/English/research/g
pa.pdf
Intermediate care is available at St. Theresa’s
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.
180
Canada Health Act Annual Report, 2002-2003
Annex A – Provincial and Territorial Health Care
Insurance Plan Statistics
Introduction
The purpose of this Annex 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 Act.
The Annex contains statistical data on the cost
and utilization of insured hospital, physician and
surgical- dental services for each province and
territory for the five consecutive fiscal years
ending on March 31 of 1998-1999, 1999-2000,
2000-2001, 2001-2002 and 2002-2003.
The information has been provided by provincial
and territorial officials. In order to ensure
consistency in reporting, Health Canada
provided provincial/territorial governments with a
user’s guide outlining what and how to provide
the information. The user’s guide was prepared
in consultation with representatives in each
provincial and territorial government.
Although efforts were made to capture data on a
consistent basis, differences exist in the
reporting of health care programs and services
between provincial and territorial governments.
Therefore, comparisons between jurisdictions
are not made.
Figures presented in the statistical annex are
provided to Health Canada by provincial and
territorial government authorities on a
cooperative basis. Provincial and territorial
governments are responsible for the quality and
completeness of the data they provide. The
Ministère de la Santé et des Services sociaux
du Québec and the Alberta Department of
Health and Wellness have chosen not to
present Health Canada with statistics for this
annex. Numbers appearing in the 2002-2003
column of the Alberta section of this annex were
culled by Health Canada from the narrative
description of Alberta’s health care insurance
plan description in chapter 3.
Canada Health Act Annual Report, 2002-2003
For a discussion of the associated programs on
which the data in these tables are based, please
refer to Chapter 3 – Provincial and Territorial
Health Care Insurance Plans in 2002-2003.
Organization of the Information
Information in the tables on the following pages
is organized into provincial and territorial
sections of this annex and grouped according to
the eight subcategories described below. In
some cases data were not yet available and
estimates were provided. In other cases, the
requested statistics did not apply to the
particular province or territory or were not
available.
Registered Persons
Registered persons are the number of residents
registered with the health care insurance plans
of each province or territory. These estimates
can be assessed with respect to the universality
criterion of the Canada Health Act to assist
Canadians, governments and stakeholders in
reviewing the extent to which residents of
provinces and territories have registered for
coverage or chosen to opt out of their
jurisdiction’s health care insurance plan.
Insured Hospital Services within Own
Province or Territory
Statistics on the provision of insured hospital
services within each jurisdiction to residents of
the jurisdiction and to visitors from other
provinces or territories are provided in fields 2
through 13.
Details include numbers of facilities by type of
care provided; number of beds; number of
separations (i.e. persons released or discharged
from health facilities); average length of stay;
total payments in the province/territory per
category of care; average cost per visit by type
of care; and the number of, and payments to,
private for-profit health care facilities.
181
Annex A – Provincial and Territorial Health Care Insurance Plan Statistics
These statistics are collected and presented to
provide insights and understanding on how each
provincial and territorial health insurance plan
meets the requirements of the accessibility
criterion of the Canada Health Act as it applies
to insured hospital services.
Insured Hospital Services Provided to
Residents in Another Province or Territory
This subsection presents out-of-province or outof-territory insured hospital services that are
paid for by a person’s home jurisdiction when
they travel to other parts of Canada. The
information reported includes the total number
of claims paid for insured hospital services in
other provinces or territories, total payments
made, and the average payment level.
These statistics can assist the federal Minister
of Health in assessing provincial and territorial
compliance with the in-country portability
provisions in section 11(b)(i) of the Canada
Health Act as they apply to insured hospital
services.
Insured Hospital Services Provided Outside
Canada
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. Statistics
reported in this subsection are of the same type
as hospital services provided out-of-province or
out-of-territory.
These statistics can assist Canadians and the
federal Minister of Health assess provincial and
territorial compliance with the out-of-country
portability provisions in section 11(b)(ii) of the
Canada Health Act as they relate to insured
hospital services.
Insured Surgical-Dental Services within Own
Province or Territory
The information in this subsection describes
insured surgical-dental services provided in
each province and territory. This includes the
number of participating professionals (dentists,
dental surgeons, and oral surgeons); the
number of services provided; total payments
made in the fiscal year; and the average
payment per service.
182
These statistics relate principally to the
assessment of a province’s or territory’s
compliance with the accessibility criterion of the
Canada Health Act as it applies to insured
surgical-dental services.
Insured Physician Services within Own
Province or Territory
Statistics in this subsection 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.
Details include the number of physicians
participating in the provincial or territorial health
insurance plan; the number of physicians optedout or not participating in the plan; the number
of insured services provided; the total payments
made to physicians by category of physician
and by category of service; and the average
payment level per insured physician service.
These statistics relate principally to the
assessment of a province’s or territory’s
compliance with the accessibility criterion of the
Canada Health Act as it applies to insured
physician services.
Insured Physician Services provided to
Residents in Another Province or Territory
This subsection reports on physician services
that are paid by a jurisdiction to other provinces
or territories for their visiting residents. Statistics
include the number of services paid, total
payments made, and the average payment level
per service.
These statistics can assist the federal Minister
of Health in assessing provincial and territorial
compliance with the in-country portability
provisions in section 11(b)(i) of the Canada
Health Act as they apply to insured physician
services.
Insured Physician Services Provided Outside
Canada
Physician services provided out-of-country
represent a person’s medical costs incurred
while travelling outside of Canada that are paid
for by their home province or territory. Statistics
reported in this subsection are the same as for
physician services provided out-of-province or
out-of-territory.
Canada Health Act Annual Report, 2002-2003
Annex A – Provincial and Territorial Health Care Insurance Plan Statistics
These statistics can assist Canadians and the
federal Minister of Health assess provincial and
territorial compliance with the out-of-country
portability provisions in section 11(b)(ii) of the
Canada Health Act as they relate to insured
physician services.
Canada Health Act Annual Report, 2002-2003
183
Newfoundland and Labrador
Registered Persons
1998-1999
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
(#)
622,744
1999-2000
618,118 1
2000-2001
2001-2002
616,944 2
565,000 3
2002-2003
560,644 4
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1
Data are as of March 1, 2000.
2
Data are as of April 11, 2001.
3
Data as of April 30, 2002.
4
Data as of April 15, 2003.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
33
0
0
0
0
0
33
33
0
0
0
0
0
33
32
0
0
0
0
0
32
32
0
0
0
0
0
32
32
0
0
0
0
0
32
1,814
0
62
0
0
1,876
1,807
0
57
0
0
1,864
not available
0
not available
0
0
1,643
not available
0
not available
0
0
1,670
not available
0
not available
0
0
1,677
1,814
0
62
0
0
1,876
1,807
0
57
0
0
1,864
not available
0
not available
0
0
1,643
not available
0
not available
0
0
1,670
not available
0
not available
0
0
1,677
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
185
Newfoundland and Labrador
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
5
6
186
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
68,729
0
227
0
0
0
0
0
68,956
66,828
0
272
0
0
0
0
0
67,100
not available
0
not available
0
0
0
0
0
not available
not available
0
not available
0
0
0
0
0
not available
not available
0
not available
0
0
not available
not available
not available
not available
7.50
0.00
not available
0.00
0.00
7.40
0.00
not available
0.00
0.00
not available
0.00
not available
0.00
0.00
not available
0.00
not available
0.00
0.00
not available
0.00
not available
0.00
0.00
457,065,782
0
0
0
0
0
509,018,766
0
0
0
0
0
537,428,824
0
0
0
0
0
619,884,087
0
0
0
0
0
672,874,609 5
0
0
0
0
0
457,065,782
509,018,766
537,428,824
619,884,087
672,874,609 5
690.00
0.00
0.00
0.00
690.00
0.00
0.00
0.00
705.00
0.00
0.00
0.00
725.00
0.00
0.00
0.00
850.00 6
0.00
0.00
0.00
(#)
(# of
days)
($)
($)
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.
New methodology for 2002-2003.
Canada Health Act Annual Report, 2002-2003
Annex A
Newfoundland and Labrador
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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
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
1
0
1
0
1
0
1
0
1
0
1
1
1
1
1
not available
0
not available
0
not available
0
not available
0
not available
0
not available
not available
not available
not available
not available
212,990
0
387,030
0
270,750
0
338,200
0
286,425
0
212,990
387,030
270,750
338,200
286,425
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
187
Newfoundland and Labrador
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
1,826
1,549
1,699
1,681
1,588
28,739
25,546
24,929
26,155
26,464
12,037,091
10,144,354
10,608,368
10,312,515
10,817,595
3,316,482
3,138,582
3,047,375
3,213,978
3,488,186
6,592.00
6,549.00
6,244.00
6,135.00
6,812.00
115.00
123.00
122.00
123.00
132.00
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
188
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
42
73
111
62
61
363
260
287
258
278
503,043
198,072
1,102,540
123,692
269,963
56,614
15,626
36,260
22,567
18,432
4,997.00
2,713.00
9,933.00
1,995.00
4,426.00
156.00
60.00
126.00
87.00
66.00
Canada Health Act Annual Report, 2002-2003
Annex A
Newfoundland and Labrador
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
30
35
35
26
33
10,000
9,000
11,000
10,000
11,000
374,000
354,000
389,000
409,000
419,000
38.34
38.73
35.06
39.82
37.76
2001-2002
2002-2003
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician: 7
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
7
Excludes inactive physicians.
8
Total Salaried and Fee-for-service.
1998-1999
1999-2000
2000-2001
not available
not available
not available
not available
432 8
480 8
not applicable
912 8
437 8
485 8
not applicable
922 8
(#)
448 8
478 8
8
504
500 8
not applicable
not applicable
952 8
978 8
(#)
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
(#)
Canada Health Act Annual Report, 2002-2003
189
Newfoundland and Labrador
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service: 9
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service: 9
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service: 9
a. medical
b. surgical
c. diagnostic
d. other
e. all services
9
190
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2,471,000
2,440,000
not applicable
4,911,000
2,489,000
2,443,000
not applicable
4,932,000
2,340,000
2,318,000
not applicable
4,657,000
2,263,000
2,218,000
not applicable
4,481,000
2,147,000
2,206,000
not applicable
4,353,000
3,107,000
487,000
1,317,000
not applicable
4,911,000
3,104,000
468,000
1,361,000
not applicable
4,932,000
2,878,000
433,000
1,346,000
not applicable
4,657,000
2,728,000
398,000
1,345,000
not applicable
4,481,000
2,607,000
379,000
367,000
not applicable
4,353,000
41,521,000
71,640,000
not applicable
113,161,000
42,429,000
72,780,000
not applicable
115,209,000
43,251,000
73,239,000
not applicable
116,490,000
42,751,000
75,177,000
not applicable
117,928,000
50,961,000
78,157,000
not applicable
129,118,000
not available
not available
not available
not available
113,161,000
72,500
10,923
31,786
not applicable
115,209,000
71,987
10,834
33,670
not applicable
116,490,000
not available
not available
not available
not applicable
117,928,000
not available
not available
not available
not available
not available
16.80
29.36
not applicable
23.04
17.05
29.79
not applicable
23.36
18.49
31.60
not applicable
25.01
18.89
33.90
not applicable
26.32
23.74
35.43
not applicable
29.66
not available
not available
not available
not applicable
23.04
not available
not available
not available
not applicable
23.36
not available
not available
not available
not applicable
25.01
not available
not available
not available
not available
26.30
not available
not available
not available
not available
not available
(#)
(#)
($)
($)
($)
($)
Fee-for-Service.
Canada Health Act Annual Report, 2002-2003
Annex A
Newfoundland and Labrador
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
171,000
161,000
173,000
143,000
143,000
4,241,000
4,327,000
4,562,000
4,082,000
4,231,000
24.77
28.41
26.35
28.56
29.57
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
4,000
4,000
6,000
4,000
3,000
65,000
107,000
424,000
67,000
172,000
17.25
19.61
70.16
16.37
54.30
191
Prince Edward Island
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
130,004
134,006
138,205
140,001
141,031
(#)
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
7
not applicable
not applicable
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
not applicable
not applicable
7
7
not applicable
not applicable
not applicable
not applicable
not applicable
7
470
57
20
19
not applicable
566
470
57
20
19
not applicable
566
470
57
20
19
not applicable
566
479
57
20
19
not applicable
575
474
57
20
19
not applicable
575
470
57
20
19
not applicable
566
470
57
20
19
not applicable
566
470
57
20
19
not applicable
566
479
57
20
19
not applicable
575
474
57
20
19
not applicable
575
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
193
Prince Edward Island
Annex A
Insured Hospital Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
1
194
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
18,644
not available
377
not available
6,250
not available
not available
not applicable
25,271
17,796
not available
360
not available
6,186
not available
not available
not applicable
24,342
18,280
not available
329
not available
not available
267
1,363
not applicable
20,239
16,409
not available
336
not available
not available
274
1,356
not applicable
18,375
16,335
not available 1
387
not available 1
not available 1
not available
1,362
not applicable
18,084
7.90
not available
19.00
not available
not applicable
8.40
not available
18.00
not available
not applicable
8.20
not available
20.00
not available
not applicable
8.10
not available
13.00
4.00
not applicable
7.90
not available 1
13.80
not available
not applicable
101,600,000
not applicable
not applicable
not applicable
not applicable
not applicable
104,000,000
not applicable
not applicable
not applicable
not applicable
not applicable
106,774,200
not applicable
not applicable
not applicable
not applicable
not applicable
109,128,000
900
not applicable
not applicable
not applicable
not applicable
115,697,000
not applicable
not applicable
not applicable
not applicable
not applicable
101,600,000
104,000,000
106,774,200
109,128,900
115,697,000
689.81
not applicable
not applicable
not applicable
695.72
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
(#)
(# of
days)
($)
($)
Regional Health Authorities do not provide this information to the Prince Edward Island Department of Health and Social Services,
therefore data are not available.
Canada Health Act Annual Report, 2002-2003
Annex A
Prince Edward Island
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
2
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not applicable
not applicable
not available
not available
not applicable
not available
not applicable
not applicable
not available
not available
not applicable
not available
not applicable
not applicable
not available
not available
not applicable
not available
not applicable
not applicable
not available
not available
not applicable
not available 2
not applicable
not applicable
not available 2
not available 2
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available 2
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
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
($)
($)
(#)
(#)
($)
Payments to facilities are not separated by in-patient and out-patient services.
Canada Health Act Annual Report, 2002-2003
195
Prince Edward Island
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (In Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (In Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (In Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (In Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (In Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (In Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2,279
1,812
1,903
2,220
2,059
16,457
14,428
14,839
17,572
16,790
12,300,000
10,600,000
10,127,380
9,417,000
11,713,751
2,600,000
2,300,000
2,380,567
2,930,100
2,879,064
5,397.00
5,850.00
5,322.00
4,242.00
5,689.00
158.00
160.00
160.00
167.00
171.00
3
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
3
196
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
27
21
30
26
23
102
106
112
85
152
50,100
53,800
54,180
123,127
79,577
11,700
21,700
43,494
13,702
25,954
1,856.00
2,561.00
1,806.00
4,736.00
3,459.00
115.00
205.00
388.00
161.00
171.00
3
Preliminary data as of November 2003. Figures are subject to change when additional hospital service claims, for 2002-2003, are
received by PEI.
Canada Health Act Annual Report, 2002-2003
Annex A
Prince Edward Island
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2
2
2
2
2
400
176
145
176
312
52,700
37,600
53,100
60,989
88,443
132.00
214.00
366.00
347.00
283.00
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
98
72
not applicable
170
99
74
not applicable
173
101
75
not applicable
176
101
75
not applicable
176
97
92
not applicable
189
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
197
Prince Edward Island
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
4
198
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
869,320
422,483
not applicable
1,291,803
848,816
415,130
not applicable
1,263,946
861,112
409,917
not applicable
1,271,029
816,197
358,600
not applicable
1,174,797
716,597
362,619
not applicable
1,079,216
158,836
146,186
117,461
869,320
1,291,803
154,930
144,947
115,253
848,816
1,263,946
152,796
143,940
113,181
861,112
1,271,029
15,000,000
16,200,000
not applicable
31,200,000
15,700,000
17,100,000
not applicable
32,800,000
15,800,000
17,200,000
not applicable
33,000,000
6,200,000
8,300,000
1,700,000
not applicable
31,200,000
6,600,000
8,800,000
1,700,000
not applicable
32,800,000
6,500,000
8,900,000
1,800,000
15,800,000
33,000,000
17.00
38.00
not applicable
24.00
18.00
41.00
not applicable
26.00
18.00
42.00
not applicable
26.00
20.00
43.00
not applicable
27.00
23.00
45.00
not applicable
31.00
39.00
57.00
15.00
not applicable
24.00
43.00
61.00
15.00
not applicable
26.00
43.00
62.00
15.00
not applicable
26.00
47.00
62.00
16.00
20.00
27.00
51.00
63.00
18.00
23.00
31.00
(#)
(#)
107,683
140,020
110,897
816,197 4
1,174,797
96,152
150,036
116,431
716,597
1,079,216
4
($)
16,588,900
15,559,600
not applicable
32,148,500
16,537,250
16,446,970
not applicable
32,984,220
($)
5,061,000
8,703,600
1,795,000
16,588,900 4
32,148,500
4,892,997
9,509,720
2,044,253
16,537,250
32,984,220
4
($)
($)
Includes general practitioners.
Canada Health Act Annual Report, 2002-2003
Annex A
Prince Edward Island
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (In Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
56,192
56,084
46,832
67,435
48,369
3,090,000
3,080,000
3,370,102
3,871,900
3,778,171
55.00
55.00
72.00
57.00
78.00
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
807
666
728
677
521
25,495
38,274
57,365
33,995
30,076
31.00
57.00
79.00
50.00
58.00
199
Nova Scotia
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
937,587
944,487
947,963
953,385
955,475
(#)
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
35
not applicable
not applicable
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
not applicable
not applicable
35
35
not applicable
not applicable
not applicable
not applicable
not applicable
35
3,221 1
not applicable
not applicable
not applicable
not applicable
3,221
3,117 1
not applicable
not applicable
not applicable
not applicable
3,117
3,089 1
not applicable
not applicable
not applicable
not applicable
3,089
2,982 1
not applicable
not applicable
not applicable
not applicable
2,982
2,938 1
not applicable
not applicable
not applicable
not applicable
2,938
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
(#)
(#)
(#)
Includes rehabilitative care.
Canada Health Act Annual Report, 2002-2003
201
Nova Scotia
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care: 3
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
1999-2000
2000-2001
2001-2002
2002-2003
106,954
not available
846
not available
89,046
1,690
9,675
133
208,344
104,509
not available
778
not available
93,700
2,002
9,607
135
210,731
98,209
not available
792
not available
96,832
2,064
9,038
150
207,085
93,878
not available
827
not available
96,797
2,161
8,893
155
202,711
90,865
not available
855 2
not available
97,559
2,077
8,656
201
200,213
7.93
not applicable
42.00
3.68
125.00
8.29
not applicable
43.30
3.69
159.41
8.61
not applicable
47.20
3.80
147.08
8.50
not applicable
42.90
3.70
111.90
8.27
not applicable
39.07
4.07
76.20
795,946,000
not applicable
not applicable
not applicable
not applicable
not applicable
812,776,800
not applicable
not applicable
not applicable
not applicable
not applicable
877,019,426
not applicable
not applicable
not applicable
not applicable
not applicable
926,797,569
not applicable
not applicable
not applicable
not applicable
not applicable
1,021,934,504
not applicable
not applicable
not applicable
not applicable
not applicable
795,946,000
812,776,800
877,019,426
926,797,569
1,021,934,504
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
(#)
(# of
days)
($)
($)
2
Type 4 level of care.
3
$'s are paid to acute care facilities/DHAs only.
202
1998-1999
Canada Health Act Annual Report, 2002-2003
Annex A
Nova Scotia
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
1
0
1
0
1
0
1
0
1
0
1
1
1
1
1
154
0
120
0
109
0
81
0
83
0
0
0
0
0
0
19,572
0
15,677
0
14,627
0
10,926
0
11,714
0
0
0
0
0
0
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
203
Nova Scotia
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2,395
2,382
2,520
2,050
2,300
29,927
30,086
32,859
30,749
34,425
10,395,116
10,499,281
9,961,995
8,536,691
12,685,659
3,770,060
3,772,315
4,171,365
4,009,667
4,447,816
4,340.34
4,407.75
3,953.17
4,115.45
5,515.50
125.98
125.38
126.94
130.39
129.20
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
204
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
not available
not available
not available
not applicable
not applicable
not applicable
not applicable
not applicable
859,642
1,053,577
735,834
1,000,023
938,092
not applicable
not applicable
not applicable
not applicable
not applicable
not available
not available
not available
not available
not available
not applicable
not applicable
not applicable
not applicable
not applicable
Canada Health Act Annual Report, 2002-2003
Annex A
Nova Scotia
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
54
55
39
35
36
16,909
17,525
6,853
4,497
5,188
1,726,646
1,467,485
998,692
884,506
939,004
102.11
83.74
144.27
196.69
181.00
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
0
1,853
829
1,095
0
1,924
920
1,067
0
1,987
865
1,128
10
2,003
875
1,142
9
2,026
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
205
Nova Scotia
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service: 4
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician: 5
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service: 4,5
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service: 4
a.
b.
c.
d.
e.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
4,334,359
1,794,146
0
6,128,505
4,619,083
1,606,842
0
6,225,925
4,498,232
1,645,535
3,951
6,147,718
4,521,991
1,650,685
2,999
6,175,675
4,563,449
1,677,973
2,512
6,243,934
5,809,644
320,861
1,544,529
0
7,675,034
5,908,054
317,871
1,514,011
0
7,739,936
5,457,153
985,321
1,121,296
291,352
6,147,718
5,462,682
1,009,997
1,124,792
308,326
7,905,797
6,458,299
1,096,509
1,144,383
324,081
9,023,272
91,620,190
118,656,216
0
210,276,406
104,587,110
112,250,617
0
216,837,727
102,332,556
117,891,477
175,890
220,399,923
102,555,964
118,414,434
162,779
221,133,176
113,507,874
127,688,914
165,984
241,362,772
not available
not available
not available
not available
317,320,281
not available
not available
not available
not available
350,091,235
239,036,017
77,328,861
25,385,064
7,287,248
349,037,190
244,049,190
80,867,051
26,262,276
8,015,345
359,193,862
270,161,897
91,426,158
28,530,589
8,210,021
398,328,665
21.14
66.14
0.00
34.31
22.64
69.86
0.00
34.83
22.75
71.64
44.52
35.85
22.68
71.74
54.28
35.81
24.87
76.10
66.08
38.66
not available
not available
not available
not available
41.34
not available
not available
not available
not available
45.23
29.40
68.53
57.21
47.78
35.85
29.18
68.49
58.97
53.58
35.81
41.83
83.38
24.93
25.33
44.14
(#)
(#)
($)
($)
($)
($)
medical
surgical
diagnostic
other
all services
4
Fee- for- service + alternate funded programs.
5
Discrepancies may exist between data presented here and the Nova Scotia Annual Statistical Tables due to methodological
differences.
206
Canada Health Act Annual Report, 2002-2003
Annex A
Nova Scotia
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
180,299
179,833
187,390
not available
not available
4,766,189
5,078,794
5,562,125
not available
not available
26.43
28.24
29.68
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
2,541
2,421
2,748
not available
not available
98,461
109,484
121,780
not available
not available
38.75
45.22
44.32
207
New Brunswick
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
735,510
739,336
738,598
737,299
738,774
(#)
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
31
0
1
0
0
0
32
31
0
1
0
0
0
32
31
0
1
0
0
0
32
31
0
1
0
0
0
32
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
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
3,036
397
20
0
0
3,453
3,036
397
20
0
0
3,453
3,036
397
20
0
0
3,453
3,036
397
20
0
0
3,453
(#)
(#)
(#)
3,049 1
397
20
0
0
4,035
Includes acute non-teritary, oncology tertiary, cardiac surgery tertiary and neurosurgery tertiary beds.
Canada Health Act Annual Report, 2002-2003
209
New Brunswick
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
Nu newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
109,542
2,398
411
0
42,962
307
7,939
0
163,559
108,353
2,281
444
0
46,287
308
7,778
0
165,451
102,465
1,887
465
0
46,345
342
7,455
0
158,959
102,465
1,887
465
0
46,345
342
7,455
0
158,959
98,461 2
not available
not available
not available
not available
not available
not available
not available
not available
6.80
not available
47.30
not available
not available
6.80
not available
41.30
not available
not available
7.10
not available
41.20
not available
not available
7.10
not available
41.20
not available
not available
8.50 2
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
not available
not available
not available
not available
not available
not available
not available
not available
not available
679,000,000 3
722,600,000 3
768,400,000 3
839,100,000 3
893,400,000 3
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
(#)
(# of
days)
($)
($)
2
Includes: acute, rehab, extended, tertiary services (except psych.). Excludes: newborns, stillborns, alcohol and drug, hostel, DVA, and
contract beds. Source: New Brunswick Annual Report 2002-2003.
3
Gross hospital facility expenditures as shown in the New Brunswick Annual Report 2002-2003.
210
Canada Health Act Annual Report, 2002-2003
Annex A
New Brunswick
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
N
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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
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
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 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
not available
not available
not available
not available
not available
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
211
New Brunswick
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
N
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
3,768 pts /
24,915 days
3,900 pts /
25,655 days
4,130 pts /
26,572 days
3,796 pts /
23,342 days
4,168 pts /
23,949 days
36,081
32,796
35,834
36,687
40,145
21,863,730
22,473,974
21,561,907
19,110,500
23,477,103
4,374,860
4,235,429
4,702,219
5,261,500
5,387,946
877.53
876.01
811.45
818.72
1,005.79
121.25
129.14
131.22
143.42
134.21
Insured Hospital Services Provided Outside Canada
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
145 pts /
661 days
212 pts /
1,691 days
166 pts /
1,096 days
148 pts /
1,447days
180 pts /
843 days
395
524
639
1,003
1,000
150,403
487,760
458,759
440,088
420,659
85,443
105,783
180,712
133,360
244,217
24. Average payment for out-of-country, in($)
patient insured hospital services.
227.54
288.44
418.58
304.14
290.71
25. Average payment for out-of-country,
out-patient insured hospital services.
216.31
201.88
282.80
132.96
244.22
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
212
($)
Canada Health Act Annual Report, 2002-2003
Annex A
New Brunswick
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
17
12
16
12
16
790
751
1,004
1,010
1,283
132,577
136,491
189,777
186,944
208,946
167.82
181.75
189.02
185.09
162.86
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
619
709
not available
1,328
629
721
not available
1,350
645
710
not available
1,355
689
799
not available
1,488
675
731
not available
1,406
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
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
213
New Brunswick
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service: 1
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service: 1
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service: 1
a. medical
b. surgical
c. diagnostic
d. other
e. all services
1
Fee-for-service payments only.
2
Radiology only.
3
Includes general practitioners.
214
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
3,692,566
2,551,663
not available
6,244,229
3,721,782
2,612,744
not available
6,334,526
3,668,781
2,590,346
not available
6,259,127
3,611,747
2,523,217
not available
6,134,964
3,731,076
2,624,893
not available
6,355,969
(#)
(#)
729,803
828,626
993,234 2
3,692,566
6,244,229
739,911
852,725
1,020,108 2
3,721,782
6,334,526
728,947
839,980
1,021,419 2
3,668,781
6,259,127
699,991
826,342
996,884 2
3,611,747
6,134,964
749,181
887,993
987,719
3,731,076
6,355,969
2
($)
77,851,628
104,752,866
not available
182,604,494
77,958,130
111,554,173
not available
189,512,303
78,139,070
111,224,207
not available
189,363,277
85,584,720
119,386,452
not available
204,971,172
100,812,443
135,546,463
not available
236,358,906
40,384,442
46,871,179
17,497,245 2
77,851,628 3
182,604,494
41,795,791
48,732,272
21,026,109 2
77,958,130 3
189,512,302
41,068,744
47,840,045
22,315,418 2
78,139,070 3
189,363,277
43,525,046
52,103,502
23,757,904 2
85,584,720 3
204,971,172
50,457,210
60,579,805
24,509,448
100,812,443
236,358,906
21.08
41.05
not available
20.95
42.70
not available
21.30
42.94
not available
23.70
47.32
not available
27.02
51.64
not available
29.24
29.92
30.25
33.41
37.19
55.34
56.56
17.62 2
21.08 3
29.24
56.49
57.15
20.61 2
20.95 3
29.92
56.34
56.95
21.85 2
21.30 3
30.25
62.18
63.05
23.83 2
23.70 3
33.41
67.35
68.22
24.81
27.02
37.19
($)
2
3
($)
($)
2
3
Canada Health Act Annual Report, 2002-2003
Annex A
New Brunswick
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
140,375
137,950
141,014
161,415
178,569
5,684,969
6,050,729
6,280,048
7,721,995
9,302,980
40.37
40.50
43.86
47.84
52.10
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
3,835
4,554
4,202
4,360
5,018
223,066
356,128
362,994
482,915
395,061
50.39
58.17
78.20
110.76
78.73
215
Ontario
Registered Persons
1998-1999
1999-2000
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
2000-2001
2001-2002
2002-2003
11,700,000
11,800,000
12,100,000
(#)
11,300,000
11,400,000
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
157
22
5
not available 1
not available 2
4
not available 3
154
12
4
not available 1
not available 2
3
not available 3
150
12
4
not available 1
not available 2
3
not available 3
139
11
4
not available 1
not available 2
3
not available 3
139
11
4
not available 1
not available 2
3
not available 3
23,872
7,787
1,822
not available 5
not available 5
not available 5
24,254
7,505
1,975
not available 5
not available 5
not available 5
25,008
7,455
2,137
not available 5
not available 5
not available 5
24,233 4
7,389
2,270
not available 5
not available 5
not available 5
24,436 4
6,896
2,349
not available 5
not available 5
not available 5
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
not available 6
(#)
(#)
(#)
1
Ontario does not have facilities in these categories. These types of facilities are privately owned and any insured services provided are
covered by the province.
2
Day surgery only reports cases and the stretchers are not reported whereas acute, chronic and rehabilitative units report beds and have
separations.
3
Total is not available as data on day surgery stretchers/beds is not available.
4
Acute staffed beds include Provincial Psychiatric Hospitals and data are from Daily Census Report. Prior were funded Provincial
Psychiatric Hospital beds.
5
Details for other types of beds are not kept separately, they are included as part of the acute, chronic and rehabilitation beds reporting.
6
There is no central repository for this information.
Canada Health Act Annual Report, 2002-2003
217
Ontario
Annex A
Insured Hospitals Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
2002-2003
(#)
1,131,333
17,165
18,865
not available 9
896,833
not available 9
134,505
not available 9
not available 9
1,007,464
18,943
20,837
not available 9
943,045
not available 9
134,136
not available 9
not available 9
1,004,042
20,236 8
22,937 8
not available 9
983,916
not available 9
130,062
not available 9
not available 9
1,011,283 7
20,432
27,004
not available 9
1,012,618
not available 9
134,475
not available 9
not available 9
1,017,199 7
20,897
29,599
not available 9
not available
not available 9
not available
not available 9
not available 9
6.52
129.10
30.30
2.83
not available 10
6.59
128.87
29.85
2.90
not available 10
6.95
118.13
26.32
2.96
not available 10
7.50
114.93
26.45
2.91
not available 10
7.80
106.87
25.38
not available
not available 10
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
not available 11
(# of
days)
($)
7,100,000,000
7,700,000,000 12 8,700,000,000 12 9,200,000,000
10,300,000,000
($)
691.00
274.00
385.00
not available 10
761.00
287.00
436.00
not available 10
723.63
287.28
503.34
not available 10
836.57
324.16
470.40
not available 10
845.76 13
356.66 13
498.44 13
not available 10
7
Acute separation included Provincial Psychiatric Hospitals.
8
Chronic and Rehabilitation are revised to match internal reporting.
9
Data is not collected by these classifications -e.g. alternative level of care is included with acute separations.
10
Data is not collected under the category of "others".
11
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.
12
Data has been revised to include Provincial Psychiatric Hospitals.
13
Preliminary information.
218
Canada Health Act Annual Report, 2002-2003
Annex A
Ontario
Insured Hospital Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
2002-2003
($)
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 14
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
not available 15
($)
(#)
(#)
($)
14
The reliability of the data is questionable and the results of the calculations are questionable and are not supportable or reportable.
Facilities in Ontario tend to be mixed (acute/chronic, chronic/rehabilitative beds) with only a minority having one type of activity.
Separating by facility type gives a small sample size and significantly understates the amount activity related to chronic and
rehabilitative outpatients. Mergers and amalgamations during this period also contribute variability to the figures particularly when
viewed by main activity.
15
Data is not collected within a single system in the ministry.
Canada Health Act Annual Report, 2002-2003
219
Ontario
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
8,431
9,031
9,540
8,633
9,306
104,398
155,648
161,882
144,831
140,692
32,800,000
41,300,000
39,900,000
36,800,000
48,500,000
13,300,000
18,700,000
22,000,000
18,000,000
16,500,000
3,890.00
4,573.00
4,182.00
4,262.70
5,211.70
127.00
120.00
136.00
124.30
117.30
2001-2002
2002-2003
18,542
23,295
Insured Hospital Services Provided Outside Canada
1998-1999
1999-2000
2000-2001
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24,141
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
16
Included in #20.
17
Included in #22.
18
Included in #24.
220
($)
2002-2003
20,657
20,503
not available 16
not available 16
not available 16
not available 16
not available 16
21,400,000
17,000,000
18,800,000
19,300,000
27,200,000
not available 17
not available 17
not available 17
not available 17
not available 17
886.00
not available 18
823.00
not available 18
918.00
not available 18
1,043.20
not available 18
1,167.40
not available 18
Canada Health Act Annual Report, 2002-2003
Annex A
Ontario
Insured Surgical-Dental Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
2002-2003
350
350
357
327
319
70,658
69,400
71,660
74,000
75,600
7,900,000
8,100,000
8,200,000
8,600,000
9,300,000
111.80
116.71
115.21
116.00
123.02
Insured Physician Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
(#)
10,221
9,994
not available 19
20,215
10,227
10,284
not available 19
20,511
10,281
10,392
not available 19
20,673
10,395
10,520
not available 19
20,915
10,508
10,724
not available 19
21,232
26
196
not available 19
222
25
188
not available 19
213
25
177
not available 19
202
22
165
not available 19
187
17
134
not available 19
151
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
not available 20
(#)
(#)
19
All physicians are categorized as general practitioner or specialist.
20
Ontario has no non-participating physicians, only opted-out physicians who are reported under item #31.
Canada Health Act Annual Report, 2002-2003
221
Ontario
Annex A
Insured Physician Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
21
222
2002-2003
(#)
80,400,000
89,900,000
not available 21
170,300,000
79,600,000
91,400,000
not available 21
171,000,000
79,700,000
93,600,000
not available 21
173,300,000
77,800,000
99,600,000
not available 21
177,400,000
76,800,000
102,300,000
not available 21
179,100,000
84,200,000
21,600,000
64,400,000
not available 21
170,200,000
84,100,000
2,200,000
64,800,000
not available 21
170,900,000
82,900,000
22,300,000
68,100,000
not available 21
173,300,000
81,800,000
22,700,000
72,900,000
not available 21
177,400,000
81,800,000
23,900,000
73,400,000
not available 21
179,100,000
(#)
($)
1,676,900,000
1,725,200,000
1,734,100,000
1,741,400,000
1,733,200,000
2,587,200,000
2,699,200,000
2,824,300,000
2,936,700,000
3,065,100,000
not available 21 not available 21 not available 21 not available 21 not available 21
4,264,100,000
4,424,400,000
4,558,400,000
4,678,100,000
4,798,300,000
($)
2,605,600,000
2,678,600,000
2,699,800,000
2,731,400,000
2,742,800,000
608,500,000
633,800,000
670,800,000
706,800,000
735,000,000
1,050,100,000
1,112,000,000
1,187,800,000
1,239,800,000
1,320,500,000
not available 21 not available 21 not available 21 not available 21 not available 21
4,264,200,000
4,424,400,000
4,558,400,000
4,678,100,000
4,798,300,000
($)
20.86
28.78
not available 21
25.05
21.67
29.53
not available 21
25.87
21.77
30.19
not available 21
26.32
22.40
29.50
not available 21
26.40
22.57
29.96
not available 21
26.79
30.94
28.19
16.30
not available 21
25.05
31.84
28.78
17.15
not available 21
25.87
32.59
30.09
17.45
not available 21
26.32
33.40
31.10
17.00
not available 21
26.40
33.53
30.75
17.99
not available 21
26.79
($)
All physicians are categorized within general practitioner, specialist and within medical, surgical or diagnostic.
Canada Health Act Annual Report, 2002-2003
Annex A
Ontario
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
433,396
455,136
433,463
469,146
497,880
13,300,000
14,000,000
14,300,000
15,500,000
17,700,000
31.00
31.00
33.00
33.00
35.00
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
207,736
184,107
179,679
157,191
200,428
7,000,000
11,600,000
15,500,000
8,200,000
10,200,000
34.00
63.00
86.00
51.90
51.00
223
Manitoba
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st. 1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
1,142,465
1,144,424
1,149,904
1,152,982
1,156,217
2002-2003
(#)
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1998-1999
1999-2000
2000-2001
2001-2002
95
42
not available
not applicable
not applicable
not applicable
99
95
42
not available
not applicable
not applicable
not applicable
99
95
32
not available
not applicable
not applicable
not applicable
98
96
32
not available
not applicable
not applicable
not applicable
99
92
52
not available
not available
not available
not available
97
4,436
402
not available
not available
not available
4,841
4,394
402
not available
not available
not available
4,796
4,406
385
not available
not available
not available
4,791
4,595
385
not available
not available
not available
4,980
not available
not available
not available
not available
not available
5,019 3
4,439
402
not available
not available
not available
4,841
4,394
402
not available
not available
not available
4,796
4,406
385
not available
not available
not available
4,791
4,595
385
not available
not available
not available
4,980
not available
not available
not available
not available
not available
5,019 3
(#)
(#)
(#)
1
The population data is based on records of residents registered with Manitoba Health as at June 1.
2
Includes both chronic care and rehabilitative care.
3
Includes community mental health beds. Community mental health beds are not captured under separations (measure 5) or average
length of stay (measure 6).
Canada Health Act Annual Report, 2002-2003
225
Manitoba
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
2
226
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
136,499
1,757
not available
not available
111,931
not available
14,814
not available
265,001
132,650
1,876
not available
not available
115,136
not available
14,807
not available
264,469
127,903
1,905
not available
not available
116,305
not available
14,403
not available
260,516
124,917
1,780
not available
not available
92,957
not available
14,333
not available
233,987
123,662
1,753
not available
not available
93,885
not available
14,053
not available
233,353
9.49
74.30 2
not available
3.89
not available
9.72
69.04 2
not available
3.47
not available
9.91
78.40 2
not available
3.47
not available
9.10
72.19 2
not available
3.33
not available
8.90
64.40 2
not available
3.37
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
953,834,797
65,153,895
not available
not available
not available
not available
1,046,407,229
70,872,152
not available
not available
not available
not available
1,046,407,229
70,872,152
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
not available
not available
not available
not available
(#)
(# of
days)
($)
($)
Includes both chronic care and rehabilitative care.
Canada Health Act Annual Report, 2002-2003
Annex A
Manitoba
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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
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
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
1
0
not applicable
not applicable
not applicable
not applicable
1
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not available
0
not applicable
not applicable
not applicable
not applicable
not available
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not available
0
not applicable
not applicable
not applicable
not applicable
not available
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
227
Manitoba
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
3,307
2,571
3,037
2,892
2,714
28,007
21,570
29,217
26,479
26,059
11,292,528
8,655,520
12,152,757
11,427,627
12,918,117
3,451,891
2,694,973
4,089,018
3,776,489
3,783,059
3,414.73
3,366.60
4,001.57
3,951.50
4,759.81
123.25
124.94
139.87
142.60
145.17
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
228
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
588
565
567
557
569
5,782
6,053
6,335
6,676
6,025
1,058,815
1,028,127
1,065,302
2,008,580
1,847,910
690,877
905,479
2,435,560
3,267,764
914,251
1,800.71
1,819.69
1,878.84
3,607.40
3,249.89
119.49
149.59
384.46
489.00
151.73
Canada Health Act Annual Report, 2002-2003
Annex A
Manitoba
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
102
105
101
not available
116
2,925
3,318
3,256
3,401
3,455
589,378
590,125
660,870
677,295
714,590
201.50
177.86
202.97
199.15
206.83
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
900
938
not applicable
1,838
915
939
not applicable
1,854
948
not available
not applicable
not available
not available
not available
not applicable
not available
954
1,010
not applicable
1,964
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
229
Manitoba
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
230
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
5,859,568
7,698,155
not applicable
13,557,723
5,931,022
8,147,749
not applicable
14,078,771
6,211,011
8,741,628
not applicable
14,952,639
6,244,197
9,198,787
not applicable
15,442,984
6,161,451
9,779,269
not applicable
15,940,720
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
103,068,422
165,946,999
not applicable
269,015,421
114,868,502
178,359,474
not applicable
293,227,976
132,200,004
199,231,274
not applicable
331,431,278
140,703,474
214,392,377
not applicable
355,095,851
143,846,209
221,948,290
not applicable
365,794,499
not available
not available
not available
not available
376,500,221
not available
not available
not available
not available
416,902,176
not available
not available
not available
not available
467,886,678
not available
not available
not available
not available
496,268,700
not available
not available
not available
not available
521,611,200
17.59
21.56
not applicable
19.84
19.37
21.89
not applicable
20.83
21.28
22.79
not applicable
22.17
22.53
23.31
not applicable
22.99
23.35
22.70
not applicable
22.95
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
(#)
(#)
($)
($)
($)
($)
Canada Health Act Annual Report, 2002-2003
Annex A
Manitoba
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
206,521
183,497
192,272
211,464
212,795
6,121,559
5,568,205
6,148,444
7,381,785
7,691,159
29.640
30.340
31.980
34.900
36.14
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
6,587
7,116
6,763
6,345
5,826
519,928
520,712
500,757
529,029
607,066
78.93
73.17
74.04
83.40
104.20
231
Saskatchewan
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
1,031,933
1,041, 256
1,021,762
1,024,788
1,024,827
(#)
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other 1
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
71
0
1
0
0
0
72
71
0
1
0
0
0
72
68
0
1
0
0
0
69
66
0
1
0
0
0
67
65
0
1
0
0
0
66
3,078
not applicable
142
not applicable
735
3,955
2,944
not applicable
142
not applicable
718
3,804
2,802
not applicable
142
not applicable
670
3,614
2,544
not applicable
142
not applicable
714
3,400
2,544
not applicable
67
not applicable
876 1
3,487
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
(#)
(#)
(#)
"Other" staffed beds include beds used for a variety of other sub-acute purposes. Examples include observation, respite care, palliative
care, convalescent care and long term care. This count includes 66 Department of Veteran's Affairs beds located in the Wascana
Rehabilitation Centre.
Canada Health Act Annual Report, 2002-2003
233
Saskatchewan
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
2
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
143,604
not applicable
1,058
not available
53,890
not available
12,819
3,309
214,680
133,768
not applicable
927
not available
55,426
not available
12,597
4,065
206,783
131,063
not applicable
984
not available
55,526
not available
11,992
4,646
204,211
124,481
not applicable
842
not available
55,269 2
not available
12,248
4,374 3
197,214 4
not available
not applicable
not available
not available
not available
not available
not available
not available
not available
5.80
not applicable
30.50
3.51
15.40
5.60
not applicable
34.70
3.72
15.80
5.70
not applicable
31.90
3.60
15.40
5.7
not applicable
35.0
3.4
15.5 3
not available
not applicable
not available
not available
not available
565,682,800
not applicable
35,437,299
not applicable
not applicable
not applicable
619,538,151
not applicable
36,824,546
not applicable
not applicable
not applicable
680,326,248
not applicable
38,249,010
not applicable
not applicable
not applicable
720,174,393 5
not applicable
39,656,384
not applicable
not applicable
not applicable
not available
not applicable
not available
not applicable
not applicable
not applicable
601,120,099
656,362,697
718,575,258
759,830,777
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
(#)
(# of
days)
($)
($)
Surgical day care (out-patient) cases are defined as cases that involve day procedures that are on the Canadian Institute for Health
Information's 1991 list of operative procedures. The surgical day case count for 2001-2002 is an estimate because two reporting
changes in 2001-2002 made it impossible to obtain counts that are fully comparable to previous years:
(a) ICD-10/CCI (Canadian Classification of Interventions) coding was implemented in some Saskatchewan hospitals. Some
procedures formerly reported under operative codes were reported under CCI codes that translate to non-operative CCP codes.
(b) There were some changes (reductions) in the reporting of procedures that have been moved out of operating rooms to ambulatory
care. The Department will further reassess the method used for counting/tracking day surgery after 2002-2003, when CCI data will be
available for all facilities.
3
"Other" separations and length of stay are for patients treated in psychiatric units in acute care hospitals
4
"Total separations" exclude long term care separations.
5
234
Includes all acute care base funding and special payments, including medical remuneration, specialized services, and tertiary capital
($2M), but does not include funding to inpatient mental health care or substance abuse payments.
Canada Health Act Annual Report, 2002-2003
Annex A
Saskatchewan
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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
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
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
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
235
Saskatchewan
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
4,275
4,917
4,527
4,692
4,422
40,328
43,296
46,199
45,320
50,401
18,311,400
21,235,200
20,208,100
22,037,200
23,447,100
5,180,800
5,622,500
6,046,600
5,836,500
7,144,800
4,283.37
4,318.73
4,463.91
4,696.76
5,302.37
128.47
129.86
130.88
128.78
141.76
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
236
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
244
380
272
252
287
1,576
1,553
1,369
1,172
1,049
1,907,500
1,891,000
1,039,500
1,009,400
1,891,800
400,200
481,600
377,600
375,900
359,400
7,817.62
4,976.32
3,821.69
4,005.56
6,591.64
253.93
310.11
275.82
320.73
342.61
Canada Health Act Annual Report, 2002-2003
Annex A
Saskatchewan
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
113
97
92
94
94
18,500
18,100
19,900
18,900
18,500
1,272,000
1,309,000
1,404,700
1,275,400
1,264,200
68.76
72.32
70.59
67.48
68.34
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
907
595
0
1,502
940
610
0
1,550
1,016
593
0
1,609
937
696
0
1,633
936
700
0
1,636
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
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
237
Saskatchewan
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service: 6
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service: 6
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service: 6
a. medical
b. surgical
c. diagnostic
d. other
e. all services
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
6,742,712
3,127,345
0
9,870,057
6,785,673
3,163,046
0
9,948,719
6,873,539
3,250,953
0
10,124,492
6,760,156
3,700,801
0
10,460,957
6,631,582
3,637,879
0
10,269,461
6,048,849 7
735,770 8
2,345,180 9
740,258 10
9,870,057
6,028,070 7
723,626 8
2,312,606 9
884,417 10
9,948,719
6,071,567 7
787,655 8
2,288,038 9
977,232 10
10,124,492
6,017,477 7
994,321 8
2,262,256 9
1,186,903 10
10,460,957
5,788,055 7
984,405 8
2,179,286 9
1,317,715 10
10,269,461
(#)
(#)
($)
128,784,792
122,465,930
0
251,250,722
133,042,948
125,735,201
0
258,778,149
134,989,267
129,470,569
0
264,459,836
137,541,402
144,566,069
0
282,107,471
139,410,263
151,061,558
0
290,471,821
143,548,623 7
51,255,592 8
40,473,208 9
15,973,299 10
251,250,722
148,848,496 7
50,843,890 8
41,503,336 9
17,582,427 10
258,778,149
151,152,270 7
51,681,286 8
43,216,810 9
18,409,471 10
264,459,837
160,742,594 7
56,027,014 8
44,488,404 9
20,849,458 10
282,107,470
162,032,557 7
58,596,690 8
48,355,683 9
21,486,890 10
290,471,821
($)
($)
19.10
39.16
0.00
25.46
19.61
39.75
0.00
26.01
19.64
39.83
0.00
26.12
20.35
39.06
0.00
26.97
21.02
41.52
0.00
28.29
23.73 7
69.66 8
17.26 9
21.58 10
25.46
24.69 7
70.26 8
17.95 9
19.88 10
26.01
24.90 7
65.61 8
18.89 9
18.84 10
26.12
26.71 7
56.35 8
19.67 9
17.57 10
26.97
27.99 7
59.52 8
22.19 9
16.31 10
28.29
($)
6
Fee-for-service.
7
Includes visits, hospital care, psychotherapy.
8
Includes surgeries, surgical assistance, obstetrics, anaesthesia.
9
Includes x-rays, laboratory services, diagnostics.
10
Includes surcharges, premiums, on-call physician services.
238
Canada Health Act Annual Report, 2002-2003
Annex A
Saskatchewan
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
374,900
392,400
425,800
444,430
458,100
10,897,500
12,237,200
13,767,600
15,520,000
16,948,900
29.07
31.19
32.33
34.92
37.00
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
Canada Health Act Annual Report, 2002-2003
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
not available
not available
not available
658,400
1,186,900
722,400
588,100
1,129,300
not available
not available
not available
not available
not available
239
Alberta
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2,912,925
2,957,045
3,007,582
3,072,384
2002-2003
1
(#)
3,124,487
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
102
104
1
not applicable
not applicable
0
207
102
104
1
not applicable
not applicable
3
210
102
105
1
not applicable
not applicable
3
211
103
106
1
not applicable
not applicable
3
213
100
110
1
not provided
not provided
3
214
6,404
6,179
240
not applicable
not applicable
12,823
6,275
6,179
240
not applicable
not applicable
12,694
6,365
6,430
240
not applicable
not applicable
13,035
6,533
6,701
240
not applicable
not applicable
13,474
not provided
not provided
not provided
not provided
not provided
not provided
9,788
6,114
240
not applicable
not applicable
16,142
9,788
6,114
240
not applicable
not applicable
16,142
9,788
6,164
240
not applicable
not applicable
16,192
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not provided
not provided
not provided
not provided
not provided
not provided
1
(#)
(#)
(#)
These figures are considered preliminary until the release of the Alberta Ministry of Health and Wellness' Alberta Health Care
Insurance Plan Statistical Supplement, 2002-2003.
Canada Health Act Annual Report, 2002-2003
241
Alberta
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
242
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
not available
not available
not available
not available
not available
not available
346,092
not available
not available
not available
not available
not available
not available
not available
not available
346,316
not available
not available
not available
not available
not available
not available
not available
not available
343,099
not available
not available
not available
not available
not available
not available
not available
not available
not available
not provided
not provided
not provided
not provided
not provided
not provided
not provided
not provided
not provided
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 provided
not provided
not provided
not provided
not provided
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 provided
not provided
not provided
not provided
not provided
not provided
not applicable
not applicable
not applicable
not applicable
not provided
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 provided
not provided
not provided
not provided
(#)
(# of
days)
($)
($)
Canada Health Act Annual Report, 2002-2003
Annex A
Alberta
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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 provided
not provided
not provided
not provided
not provided
not provided
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 provided
not provided
not provided
not provided
not available
not available
not available
not available
not available
not available
not available
not available
not provided
not provided
not available
not available
not available
not available
not provided
not available
not available
not available
not available
not available
not available
not available
not available
not provided
not provided
not available
not available
not available
not available
not provided
not available
not available
not available
not available
not available
not available
not available
not available
not provided
not provided
not available
not available
not available
not available
not provided
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
243
Alberta
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
4,714
4,820
4,656
4,205
57,574
59,443
56,408
61,230
13,269,781
13,632,730
14,699,049
12,328,205
6,706,065
6,920,702
5,287,271
7,115,105
not provided
2,814.97
2,828.37
3,157.01
2,931.80
not provided
116.48
116.43
93.73
116.20
not provided
1
72,250 2
not provided
23,707,079 2
Insured Hospital Services Provided Outside Canada
1998-1999
1999-2000
2000-2001
2001-2002
4,005
5,215
4,151
4,457
3,777
5,097
3,945
3,942
356,747
483,648
374,005
416,635
275,687
364,087
298,725
309,119
not provided
24. Average payment for out-of-country, in($)
patient insured hospital services.
89.08
92.74
90.10
93.48
not provided
25. Average payment for out-of-country,
out-patient insured hospital services.
72.99
71.43
75.72
78.42
not provided
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
($)
2002-2003
7,437 2
not provided
546,853 2
1
These figures are considered preliminary until the release of the Alberta Ministry of Health and Wellness' Alberta Health Care
Insurance Plan Statistical Supplement, 2002-2003.
2
Includes both in-patient and out-patient services.
244
1
Canada Health Act Annual Report, 2002-2003
Annex A
Alberta
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
232
250
232
250
234
11,920
14,292
14,708
14,585
not provided
1,853,322
2,092,003
2,116,386
2,167,898
2,394,458
155.48
146.38
143.89
148.64
not provided
1
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2,464
1,978
not applicable
4,442
2,545
2,096
not applicable
4,641
2,659
2,197
not applicable
4,856
2,746
2,333
not applicable
5,079
2,841
2,365
not provided
5,206
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
not provided
not provided
not provided
not provided
1
(#)
(#)
(#)
These figures are considered preliminary until the release of the Alberta Ministry of Health and Wellness' Alberta Health Care
Insurance Plan Statistical Supplement, 2002-2003.
Canada Health Act Annual Report, 2002-2003
245
Alberta
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
1
246
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
15,543,092
10,798,883
0
26,341,975
15,914,666
11,319,078
0
27,233,744
16,132,591
11,710,080
0
27,842,671
16,132,591
11,710,080
0
27,842,671
not provided
not provided
not provided
not provided
19,119,550
1,211,712
5,036,153
0
25,367,415
19,829,029
1,238,043
5,274,903
0
26,341,975
20,328,498
1,316,312
5,588,934
0
27,233,744
20,647,611
1,396,422
5,798,638
0
27,842,671
not provided
not provided
not provided
not provided
not provided
383,842,634
464,270,463
0
848,113,097
410,502,506
493,040,446
0
903,542,952
430,681,658
528,392,197
0
959,073,855
474,076,958
587,092,735
0
1,061,169,693
not provided
not provided
not provided
1,225,626,637
549,507,274
133,916,239
164,689,584
0
848,113,097
586,587,852
140,067,988
176,887,112
0
903,542,952
618,596,110
150,223,933
190,253,812
0
959,073,855
684,971,654
164,427,152
211,770,887
0
1,061,169,693
not provided
not provided
not provided
not provided
not provided
24.70
42.99
0.00
32.20
25.79
43.56
0.00
33.18
26.70
45.12
0.00
34.45
29.39
50.14
0.00
38.11
not provided
not provided
not provided
not provided
28.74
110.52
32.70
0.00
33.43
29.58
113.14
33.53
0.00
34.30
30.43
114.12
34.04
0.00
35.22
33.17
117.75
36.52
0.00
38.11
not provided
not provided
not provided
not provided
not provided
1
(#)
(#)
($)
($)
($)
($)
These figures are considered preliminary until the release of the Alberta Ministry of Health and Wellness' Alberta Health Care
Insurance Plan Statistical Supplement, 2002-2003.
Canada Health Act Annual Report, 2002-2003
Annex A
Alberta
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
359,653
380,635
418,587
493,798
559,503
9,983,110
11,397,620
12,436,188
11,998,825
13,880,981
27.76
29.94
29.71
24.30
24.81
1
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
1
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
25,192
21,989
20,891
22,928
21,289
862,852
871,292
907,010
1,043,997
976,232
34.25
39.62
43.42
45.53
45.86
1
These figures are considered preliminary until the release of the Alberta Ministry of Health and Wellness' Alberta Health Care
Insurance Plan Statistical Supplement, 2002-2003.
Canada Health Act Annual Report, 2002-2003
247
British Columbia
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
3,924,490
3,943,991
4,022,789
4, 076,892
4,106,488
(#)
Insured Hospital Services Within Own Province or Territory
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed: 1
a. acute care
b. chronic care 2
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
94
17
3
25
not applicable
0
139
94
17
3
25
not applicable
0
139
94
18
3
25
not applicable
0
140
94
18
3
25
not applicable
0
140
92
18
3
25
not applicable
0
138
7,352
7,364
160
not applicable
362
15,238
7,688
7,247
156
not applicable
not applicable
15,091
7,646
7,261
162
not applicable
not applicable
15,069
7,321
7,830
163
not applicable
not applicable
15,314
7,093
7,421
150
not applicable
not available
14,664
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
(#)
(#)
(#)
For items 1-10: All data is preliminary for 2002-2003. Data has been restated for all years to reflect changes in data sources. Historical
and current data may differ from report to report because of changes in data sources, definitions and methodology from year to year.
1
Neither approved nor staffed bed counts are available for 2002-2003. Data provided reflects 'average occupied beds', calculated as
total days of care / 365.25 days, rounded up to the nearest whole number.
All years have been restated to reflect the new methodology.
Note that surgical day care cases do not generate a day count; they are, therefore, excluded from bed calculations.
Newborns, stillbirths, and non-residents are included; out-of-province care to BC residents is excluded.
2
For all years, the bed count for chronic care facilities is calculated as the sum of total days of care
provided in each facility in the year / 365 days. 100% occupancy is assumed. See note 4 for the
definition of facilities.
Canada Health Act Annual Report, 2002-2003
249
British Columbia
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care: 3,4,5,8
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care: 6,7,8,9
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care: 10
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
392,319
4,608
1,256
not applicable
258,648
not applicable
42,169
2,287
701,287
391,817
4,884
1,261
not applicable
284,895
not applicable
41,698
not applicable
724,555
378,822
4,700
1,421
not applicable
289,900
not applicable
40,204
not applicable
715,047
353,117
4,890
1,495
not applicable
293,346
not applicable
39,669
not applicable
692,517
340,635
4,955
1,408
not applicable
302,370
not applicable
39,696
not applicable
689,064
6.60
604.00
46.47
2.75
57.70
6.90
598.00
45.00
2.70
not applicable
7.10
586.00
41.50
3.00
not applicable
7.20
618.00
39.76
3.02
not applicable
7.30
633.60
38.90
3.00
not applicable
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
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
not available
not available
not available
not available
not available
(#)
(# of
days)
($)
($)
For items 1-10: All data is preliminary for 2002-2003. Data has been restated for all years to reflect changes in data sources. Historical and current
data may differ from report to report because of changes in data sources, definitions and methodology from year to year.
3
For items 5a, 5c to 5i, newborns and stillbirths are included, as are non-residents. Out-of-province care to BC residents are excluded.
4
For item 5b, data was formerly reported through the Discharge Abstract Database (DAD), but this was discontinued in 2001-2002. All years have
been restated from the Continuing Care Data Warehouse for extended care facilities that formerly reported through the DAD. The definition of
'separation' is the same as that used for acute care.
5
For 1998-1999, item 5h, discharge planning unit (DPU) cases were classified as 'other'. DPU was replaced by Alternative Level of Care (ALC) only in
1999-2000 and for all subsequent years. ALC cases are already counted in acute separations, part 5a, for all years.
6
For item 6, all categories, cases are assigned to year by separation date, so average length of stay calculations may include days from previous years.
7
For item 6a, the calculation of acute average length of stay is now based on total days in the facility, including ALC for all years. For 1998-1999 only,
DPU is shown separately under 6e ('other'). This results in a slightly shorter acute average length of stay for that year. (See note 5) If DPU is included
in the calculation of acute average length of stay, the value for 1998-1999 would be 6.9.
8
For items 5c and 6c data has been restated for all years. Changes from earlier reports reflect updates, definition changes, and restatements from
CIHI.
9
For 1998-1999, item 6e, the value presented is for DPU only. See notes 5 and 7.
10
Payments to Health Authorities for the provision of the full range of regionally delivered services are as follows: $4.4 billion in 1999-2000, $5.1 billion in
2000-2001, $5.4 billion in 2001-2002, and $6.1 billion in 2002-2003.
250
Canada Health Act Annual Report, 2002-2003
Annex A
British Columbia
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care: 11
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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
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
not available
not available
1
not available
1
not available
1
not available
1
not available
not available
1
1
1
1
not available
not available
810
not available
634
not available
689
not available
612
not available
not available
810
634
689
612
not available
not available
558,000
not available
348,700
not available
353,100
not available
358,600
not available
not available
558,000
348,700
353,100
358,600
($)
($)
(#)
(#)
($)
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
For items 1-10: All data is preliminary for 2002-2003. Data has been restated for all years to reflect changes in data sources.
Historical and current data may differ from report to report because of changes in data sources, definitions and methodology from year
to year.
11
There are approximately 50 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.
Canada Health Act Annual Report, 2002-2003
251
British Columbia
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
7,994
7,231
8,113
8,113
7,618
73,807
70,070
83,765
80,732
83,152
35,830,522
34,477,406
35,882,521
40,898,996
40,195,515
9,075,191
9,585,916
9,149,496
10,604,141
11,223,254
4,482.00
4,768.00
4,422.84
5,041.17
5,276.39
123.00
137.00
109.23
131.35
134.97
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
252
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
2,793
2,494
2,097
1,964
1,795
435
324
720
637
949
3,492,437
5,375,289
6,463,676
9,246,228
2,294,341
100,863
65,137
134,789
119,928
543,969
1,250.00
2,155.00
3,082.34
4,707.86
1,278.18
232.00
201.00
187.21
188.27
573.20
Canada Health Act Annual Report, 2002-2003
Annex A
British Columbia
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
283
272
283
275
249
50,899
54,638
55,643
43,505
36,680
5,455,250
5,893,820
6,321,864
5,401,691
5,400,000
107.18
107.87
113.61
124.16
147.22
Insured Physician Services Within Own Province or Territory
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
4,276
3,225
0
7,501
4,277
3,268
0
7,545
4,359
3,297
0
7,656
4,430
3,380
0
7,810
4,471
3,421
0
7,892
4
13
0
17
4
10
0
14
3
5
0
8
3
3
0
6
3
3
0
6
1
0
0
1
1
0
0
1
1
0
0
1
1
0
0
1
1
0
0
1
(#)
(#)
(#)
Canada Health Act Annual Report, 2002-2003
253
British Columbia
Annex A
Insured Physician Services Within Own Province or Territory
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a.
b.
c.
d.
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
254
1999-2000
2000-2001
2001-2002
2002-2003
21,891,611
29,872,189
not applicable
51,763,800
22,942,977
32,791,108
not applicable
55,734,085
23,037,717
34,565,990
not applicable
57,603,707
22,786,171
36,207,479
not applicable
58,993,650
23,099,256
38,541,400
not applicable
61,640,656
24,012,366
4,163,434
23,588,000
not applicable
51,763,800
25,129,877
4,431,716
26,172,492
not applicable
55,734,085
25,201,483
4,417,069
27,985,155
not applicable
57,603,707
24,994,070
4,317,461
29,682,119
not applicable
58,993,650
25,423,944
4,393,613
31,823,099
not applicable
61,640,656
629,435,878
848,273,150
not applicable
1,477,709,028
658,975,986
933,134,583
not applicable
1,592,110,569
665,989,273
969,589,022
not applicable
1,635,578,295
720,481,512
1,076,308,991
not applicable
1,796,790,503
749,814,981
1,153,801,097
not applicable
1,903,616,078
879,483,221
229,199,294
369,026,513
not applicable
1,477,709,028
928,286,068
250,524,151
413,300,350
not applicable
1,592,110,569
942,736,513
252,828,480
440,013,302
not applicable
1,635,578,295
1,025,573,356
279,700,734
491,516,413
not applicable
1,796,790,503
1,068,072,122
296,852,610
538,691,346
not applicable
1,903,616,078
28.75
28.40
not applicable
28.55
28.72
28.46
not applicable
28.57
28.91
28.05
not applicable
28.39
31.62
29.73
not applicable
30.46
32.46
29.94
not applicable
30.88
36.63
55.05
15.64
not applicable
28.55
36.94
56.53
15.79
not applicable
28.57
37.41
57.24
15.72
not applicable
28.39
41.03
64.78
16.56
not applicable
30.46
42.01
67.56
16.93
not applicable
30.88
(#)
(#)
($)
general practitioners
specialists
other
total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
1998-1999
($)
($)
($)
Canada Health Act Annual Report, 2002-2003
Annex A
British Columbia
Insured Physician Services Provided to Residents in Another Province or Territory 12
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
680,230
552,056
579,550
541,922
492,996
19,841,176
16,979,901
18,547,284
18,842,752
22,425,511
29.17
30.76
32.00
34.77
45.49
Insured Physician Services Provided Outside Canada 13
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
80,717
77,424
77,968
71,871
61,768
3,346,453
3,485,618
3,281,561
3,009,750
2,671,752
41.46
45.02
42.09
41.88
43.25
12
Numbers for items 39-41 have been restated for all years, due to a change in the calculation method.
13
Numbers for items 42-44 have been restated for all years, due to a change in the calculation method. Figures for 2002-2003 are
preliminary, and will be revised upwards in next year's report. Out of country claims are frequently submitted after the end of the fiscal
year, and processing takes time. In addition, there was a significant backlog of unpaid claims at the end of 2002-2003.
Canada Health Act Annual Report, 2002-2003
255
Yukon
Registered Persons
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
31,925
31,255
31,133
31,036
30,534
2001-2002
2002-2003
(#)
Insured Hospital Services Within Own Province or Territory
1998-1999
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1999-2000
2000-2001
(#)
2
0
0
0
0
13 1
15
2
0
0
0
0
13 1
15
2
0
0
0
0
13 1
15
2
0
0
0
0
13 1
15
2
0
0
0
0
13 1
15
59
not applicable
not applicable
not applicable
92
68
61
not applicable
not applicable
not applicable
92
70
61
not applicable
not applicable
not applicable
92
70
61
not applicable
not applicable
not applicable
92
70
61
not applicable
not applicable
not applicable
92
70
59
not applicable
not applicable
not applicable
92
68
61
not applicable
not applicable
not applicable
92
70
61
not applicable
not applicable
not applicable
92
70
61
not applicable
not applicable
not applicable
92
70
61
not applicable
not applicable
not applicable
92
70
(#)
(#)
1
Includes 12 health centres and one satellite health station.
2
Day surgery beds.
Canada Health Act Annual Report, 2002-2003
257
Yukon
Annex A
Insured Hospitals Services Within Own Province or Territory
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
258
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
3,117
not applicable
not applicable
not applicable
1,606
0
392
0
5,115
2,967
not applicable
not applicable
not applicable
1,624
0
374
0
4,965
3,021
not applicable
not applicable
not applicable
1,619
0
363
0
5,003
2,986
not applicable
not applicable
not applicable
1,542
0
340
0
4,868
3,044
not applicable
not applicable
not applicable
1,686
0
316
0
5,046
4.50
not applicable
not applicable
2.90
not applicable
4.70
not applicable
not applicable
3.00
not applicable
4.70
not applicable
not applicable
3.10
not applicable
4.70
not applicable
not applicable
3.00
not applicable
4.50
not applicable
not applicable
2.90
not applicable
19,023,617
not applicable
not applicable
not applicable
0
4,796,107 1
19,587,158
not applicable
not applicable
not applicable
0
5,502,144 1
20,350,026
not applicable
not applicable
not applicable
0
5,483,948 1
21,920,937
not applicable
not applicable
not applicable
0
5,997,920 1
22,515,448
not applicable
not applicable
not applicable
0
6,133,453 1
23,819,724
25,089,302
25,833,974
27,918,907
28,648,901
694.50
not applicable
not applicable
not applicable
694.50
not applicable
not applicable
not applicable
694.50
not applicable
not applicable
not applicable
732.50
not applicable
not applicable
not applicable
837.50
not applicable
not applicable
not applicable
(#)
(# of
days)
($)
($)
Canada Health Act Annual Report, 2002-2003
Annex A
Yukon
Insured Hospital Services Within Own Province or Territory
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
110.00
not applicable
not applicable
not applicable
400.00
not applicable
110.00
not applicable
not applicable
not applicable
400.00
not applicable
110.00
not applicable
not applicable
not applicable
400.00
not applicable
110.00
not applicable
not applicable
not applicable
400.00
not applicable
110.00
not applicable
not applicable
not applicable
400.00
not applicable
349.71
not applicable
not applicable
not applicable
337.15
not applicable
not applicable
not applicable
335.46
not applicable
not applicable
not applicable
356.23
not applicable
not applicable
not applicable
359.56
not applicable
not applicable
not applicable
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
($)
($)
(#)
(#)
($)
Canada Health Act Annual Report, 2002-2003
259
Yukon
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
769
735
719
663
666
6,637
7,025
6,760
6,547
7,241
4,196,661
4,683,562
4,218,846
4,299,055
5,861,530
826,425
920,769
861,375
945,804
1,037,692
5,457.30
6,372.20
5,867.66
6,484.25
8,801.10
124.52
131.07
127.43
144.47
143.31
Insured Hospital Services Provided Outside Canada
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
260
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
13
11
9
15
9
53
67
54
40
26
45,440
22,125
27,520
50,599
9,339
7,354
7,080
8,368
4,431
2,451
3,495.39
2,011.37
3,057.78
3,373.27
1,037.67
138.76
105.68
154.97
110.78
94.27
Canada Health Act Annual Report, 2002-2003
Annex A
Yukon
Insured Surgical-Dental Services Within Own Province or Territory
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
12
9
11
11
8
297
214
222
214
150
64,397
59,458
50,876
51,078
37,342
217.19
277.84
229.17
238.69
248.95
Insured Physician Services Within Own Province or Territory 3
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
3
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
40
4
0
44
41
5
0
46
43
6
0
49
49
5
0
54
53
6
0
59
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 only resident family physicians and specialists.
Canada Health Act Annual Report, 2002-2003
261
Yukon
Annex A
Insured Physician Services Within Own Province or Territory 4
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
4
262
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
151,743
14,170
0
165,913
153,542
11,704
0
165,246
164,497
14,789
0
179,286
160,932
11,881
0
172,813
186,479
11,040
0
197,519
120,830
23,110
21,972
0
165,913
123,333
22,092
19,822
0
165,247
131,685
25,670
18,978
0
176,333
131,004
26,653
15,156
0
172,813
154,591
26,388
16,540
0
197,519
5,058,606
1,321,577
0
6,380,183
5,248,704
1,189,271
0
6,437,975
5,803,619
1,263,380
0
7,066,999
5,692,583
1,143,968
0
6,836,551
6,740,552
971,283
0
7,711,835
5,026,530
1,005,170
348,483
0
6,380,183
5,144,453
978,628
314,893
0
6,437,975
5,729,729
1,028,529
308,741
0
7,066,999
5,550,975
1,057,467
228,109
0
6,836,551
6,386,109
1,029,697
296,029
0
7,711,835
33.34
93.27
0.00
38.45
34.18
101.61
0.00
38.96
35.28
85.43
0.00
39.42
35.38
96.29
0.00
39.56
36.15
87.98
0.00
39.04
41.60
43.50
15.86
0.00
38.46
41.71
44.30
15.89
0.00
38.96
43.51
40.07
16.27
0.00
40.08
42.38
39.68
15.05
0.00
39.56
41.31
39.02
17.90
0.00
39.04
(#)
(#)
($)
($)
($)
($)
Measures 33 to 38 do not include services and costs provided by Alternative Payment physicians.
Canada Health Act Annual Report, 2002-2003
Annex A
Yukon
Insured Physician Services Provided to Residents in Another Province or Territory
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
29,834
31,020
36,828
32,461
34,853 5
1,207,371
1,404,195
1,642,495
1,601,642
1,799,019 5
40.47
45.27
44.60
49.34
51.62 5
Insured Physician Services Provided Outside Canada
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
5
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
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
Includes BC & Alberta only.
Canada Health Act Annual Report, 2002-2003
263
Yukon
Annex A
Insured Physician Services Within Own Province or Territory,
Visiting Specialists, Locum Doctors and Member Reimbursements
45. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. all physicians
46. Number of insured physician services
provided, by category of service:
a. medical services
b. surgical services
c. diagnostic services
d. all insured physician services
47. Total payment to (fee-for-service)
physicians for insured services by
category of physicians:
a. general practitioners
b. specialists
c. all physicians
48. Total payment to physicians for
insured services, by category of
service:
a. medical services
b. surgical services
c. diagnostic services
d. all insured physician services
49. Average payment for insured (fee-forservice) physicians services by
category of physicians:
a. general practitioners
b. specialists
c. all physicians
50. Average payment for insured
physician services by category of
service:
a.
b.
c.
d.
264
medical services
surgical services
diagnostic services
all insured physician services
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
30,391
10,443
40,834
27,757
11,332
39,089
32,986
7,009
39,995
18,663
11,323
29,986
21,896
12,830
34,726
33,007
4,483
3,344
40,834
31,609
5,141
2,339
39,089
31,099
6,121
2,775
39,995
23,431
4,888
1,667
29,986
25,402
7,510
1,814
34,726
994,636
681,869
1,676,505
907,848
727,972
1,635,820
1,156,197
303,424
1,459,621
699,718
885,944
1,585,662
788,293
1,192,364
1,980,657
1,477,892
121,755
76,857
1,676,504
1,436,115
132,349
67,356
1,635,820
1,133,717
260,188
65,716
1,459,621
1,224,899
285,503
75,261
1,585,663
1,392,766
481,940
105,951
1,980,657
32.73
65.29
41.06
32.71
64.24
41.85
35.05
43.29
36.50
37.50
78.25
52.88
36.00
92.94
57.04
44.78
27.16
22.98
41.06
45.43
25.74
28.80
41.85
36.46
42.51
23.68
36.50
52.28
58.41
45.15
52.88
54.82
64.17
58.41
57.04
(#)
(#)
($)
($)
($)
($)
Canada Health Act Annual Report, 2002-2003
Northwest Territories
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
Registered Persons
1998-1999
1999-2000
2000-2001
41,000
41,673
2001-2002
(#)
42,886 1
2002-2003
40,399 1
Insured Hospital Services Within Own Province or Territory
1998-1999
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1999-2000
2000-2001
2001-2002
2002-2003
4 Hospitals 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
28 4
32
4 Hospitals 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
28 4
32
4 Hospitals 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
28 4
32
4 Hospitals 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
28 4
32
not available
not available
not available
not available
not available
212
not available
not available
not available
not available
not available
220
not available
not available
not available
not available
not available
173
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
212
not available
not available
not available
not available
not available
220
not available
not available
not available
not available
not available
173
not available
not available
not available
not available
not available
not available
2
(#)
(#)
(#)
1
2001-02 figure is as of September 18, 2002, and the 2002-03 figure is as of September 2, 2003.
2
Hospital data for 2002-2003 is incomplete at time of publication.
3
Northwest Territories does not have facilities that provide these services as their primary type of care. Instead, the 4 hospital acute care
facilities provide long term care, extended care, day surgery, out-patient services, diagnostic services and rehabilitative care.
4
Includes Health Centres and Public Health Units. Figures for measures 3 through 25 do not include Health Centre and Public Health Unit
activity.
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
Canada Health Act Annual Report, 2002-2003
265
Northwest Territories
Annex A
Insured Hospitals Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
2002-2003
2
(#)
not available
not available
7,955
not available
2,772
not available
472
59,634
70,833
not available
not available
7,217
not available
2,445
not available
725
65,405
75,792
not available
not available
6,984
not available
2,254
not available
533
67,562
77,333
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
not available
15.20
2.89
4.65
not available
not available
11.10
3.01
4.36
not available
not available
26.57
2.97
4.01
not available
not available
not available
not available
not available
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
not applicable 3
36,215,847 3
40,282,046 3
44,268,039 3
48,451,358 3
(# of
days)
($)
($)
not available
not available
1,443.67
1,346.70
not available
not available
1,761.67
1,472.54
not available
not available
1,904.15
1,681.33
not available
not available
not available
not available
2
Hospital data for 2002-2003 is incomplete at time of publication.
3
Northwest Territories does not have facilities that provide these services as their primary type of care. Instead, the 4 hospital acute care
facilities provide long term care, extended care, day surgery, out-patient services, diagnostic services and rehabilitative care.
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
266
Canada Health Act Annual Report, 2002-2003
Annex A
Northwest Territories
Insured Hospital Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
2
2002-2003
2
($)
not available
not available
107.33
not available
390.43
106.52
not available
not available
118.91
not available
433.19
117.64
not available
not available
131.82
not available
409.67
129.80
not available
not available
not available
not available
not available
not available
not available
not available
148.50
557.18
not available
not available
175.44
568.95
not available
not available
232.98
606.13
not available
not available
not available
not available
0
0
0
0
0
0
0
0
0
0
0
0
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
not applicable
($)
(#)
(#)
($)
Hospital data for 2002-2003 is incomplete at time of publication.
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
Canada Health Act Annual Report, 2002-2003
267
Northwest Territories
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1,076
952
991
1,040
7,828
8,105
8,366
8,663
7,414,480
6,741,844
7,432,531
9,716,439
1,200,552
1,775,206
1,838,847
2,280,191
6,890.78
7,081.77
7,500.03
9,342.73
153.37
219.03
219.80
263.21
2001-2002
2002-2003
Insured Hospital Services Provided Outside Canada
1998-1999
1999-2000
2000-2001
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
24. Average payment for out-of-country, in($)
patient insured hospital services.
25. Average payment for out-of-country,
out-patient insured hospital services.
($)
2002-2003
6
5
3
1
12
16
15
12
10,606
3,744
13,771
1,595
2,363
2,205
2,851
2,775
1,767.63
748.87
4,590.49
1,595.00
196.91
137.84
190.06
231.28
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
268
Canada Health Act Annual Report, 2002-2003
Annex A
Northwest Territories
Insured Surgical-Dental Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
2002-2003
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
Insured Physician Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
(#)
35 5
18 5
106 6
159 7
29 5
18 5
151 6
198 7
24 5
13 5
175 6
212 7
37 5
16 5
156 6
209 7
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
(#)
(#)
5
Southam Medical Database, Canadian Institute for Health Information. 2002/03 numbers are estimates from NWT Department of Health
and Social Services.
6
This is an estimate of the number of locum physicians. For measures 33 through 38, locum physicians are captured
within the general practitioners and specialists categories.
7
Estimate based on total active physicians for each fiscal year.
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
Canada Health Act Annual Report, 2002-2003
269
Northwest Territories
Annex A
Insured Physician Services Within Own Province or Territory
1998-1999
1999-2000
2000-2001
2001-2002
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
2002-2003
(#)
142,395
9,495
not available
151,890
82,242
5,471
not available
87,713
32,473
5,622
not available
38,095
18,615
5,511
not available
24,126
not available
not available
not available
not available
213,665
not available
not available
not available
not available
200,198
not available
not available
not available
not available
199,744
not available
not available
not available
not available
194,622
5,589,151
650,639
not available
6,239,790
3,357,266
599,167
not available
3,956,433
1,226,780
616,393
not available
1,843,173
824,617
616,650
not available
1,441,267
not available
not available
not available
not available
12,334,580
not available
not available
not available
not available
17,037,488
not available
not available
not available
not available
20,032,822
not available
not available
not available
not available
19,865,194
39.3
68.5
not available
41.08
40.82
109.52
not available
45.11
37.78
109.64
not available
48.38
44.30
111.89
not available
59.74
not available
not available
not available
not available
57.7
not available
not available
not available
not available
85.10
not available
not available
not available
not available
100.29
not available
not available
not available
not available
102.07
(#)
($)
($)
($)
($)
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
270
Canada Health Act Annual Report, 2002-2003
Annex A
Northwest Territories
Insured Physician Services Provided to Residents in Another Province or Territory
1998-1999
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1999-2000
2000-2001
2001-2002
2002-2003
44,476
40,091
42,351
42,974
2,340,523
2,779,834
2,149,607
2,623,129
52.62
69.34
50.76
61.04
Insured Physician Services Provided Outside Canada
1998-1999
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
1999-2000
2000-2001
2001-2002
2002-2003
212
186
98
91
18,197
18,166
9,393
5,871
85.83
97.67
95.85
64.51
Statistics for 1998-1999 are not provided as effective April 1, 1999, Nunavut Territory was formed from part of the Northwest Territories.
Canada Health Act Annual Report, 2002-2003
271
Nunavut
Registered Persons
1998-1999
1. Total number of persons registered
under the health care insurance plan
as of March 31st.
1999-2000
2000-2001
2001-2002
2002-2003
not available
26,829
28,630
29,478
(#)
Insured Hospital Services Within Own Province or Territory
1998-1999
2. Number of facilities providing insured
hospital services (excluding psychiatric
hospitals and nursing homes), by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total facilities
3. Number of staffed beds in all facilities
providing insured hospital services, by
type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total staffed beds
4. Approved bed complement for all
facilities providing insured hospital
services, by type of bed:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. other
f. total approved bed complement
1
1999-2000
2000-2001
2001-2002
2002-2003
1
not available
not available
not available
not available
25 1
not available
1
not available
not available
not available
not available
25 1
not available
1
not available
not available
not available
not available
25 1
not available
1
not available
not available
not available
not available
25 1
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
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
(#)
(#)
(#)
Health Centres.
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
Canada Health Act Annual Report, 2002-2003
273
Nunavut
Annex A
Insured Hospitals Services Within Own Province or Territory
1998-1999
5. Number of separations from all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. alternative level of care
g. newborns
h. other
i. total separations
6. Average length of in-patient stay in all
facilities providing insured hospital
services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. newborns
e. other
7. Payments to facilities providing
insured hospital services, by the
facility's primary type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
g. total payments to facilities
providing insured hospital services
8. Average in-patient per diem cost for
all facilities providing in-patient insured
hospital services, by type of care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
1999-2000
2000-2001
2001-2002
2002-2003
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
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
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
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
(#)
(# of
days)
($)
($)
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
274
Canada Health Act Annual Report, 2002-2003
Annex A
Nunavut
Insured Hospital Services Within Own Province or Territory
1998-1999
9. Average out-patient cost per visit for
all facilities providing out-patient
insured hospital services, by type
of care:
a. acute care
b. chronic care
c. rehabilitative care
d. out-patient diagnostic care
e. surgical day care (out-patient)
f. other
10. Average (in-patient and out-patient)
cost per visit for all facilities providing
insured hospital services, by type of
care:
a. acute care
b. chronic care
c. rehabilitative care
d. other
11. Number of private for-profit health
care facilities providing insured
hospital services, by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total private for-profit health care
facilities
12. Number of insured hospital services
provided at private for-profit health
care facilities, by the facility's primary
type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total insured hospital services
provided at private for-profit health
care facilities
13. Total payments to private for-profit
health care facilities providing insured
hospital services by the facility's
primary type of care:
a. private surgical facilities
b. private diagnostic imaging facilities
c. Total payments to private for-profit
health care facilities
1999-2000
2000-2001
2001-2002
2002-2003
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
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
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
($)
($)
(#)
(#)
($)
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
Canada Health Act Annual Report, 2002-2003
275
Nunavut
Annex A
Insured Hospital Services Provided to Residents in Another Province or Territory
1998-1999
14. Total number of claims paid for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
(#)
15. Total number of claims paid for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
(#)
16. Total payments for out-ofprovince/territory, in-patient, insured
hospital services (in Canada).
($)
17. Total payments for out-ofprovince/territory, out-patient, insured
hospital services (in Canada).
($)
18. Average payment for out-ofprovince/territory, in-patient insured
hospital services (in Canada).
($)
19. Average payment for out-ofprovince/territory, out-patient insured
hospital services (in Canada).
($)
1999-2000
2000-2001
2001-2002
2002-2003
1,842
1,549
1,782
2,524
9,656
8,682
9,155
10,677
8,546,013
7,612,791
7,681,154
18,640,982
1,470,018
1,352,594
1,525,710
1,740,038
4,639.00
4,915.00
4,310.41
7,385.49
152.00
156.00
166.65
162.00
Insured Hospital Services Provided Outside Canada
1998-1999
1999-2000
2000-2001
2001-2002
2002-2003
14
0
0
0
5
1
53
3
12,010
0
0
0
1,130
110
128,398
982
24. Average payment for out-of-country, in($)
patient insured hospital services.
857.00
0.00
0.00
0.00
25. Average payment for out-of-country,
out-patient insured hospital services.
226.00
110.00
2,422.60
327.28
20. Total number of claims paid for out-ofcountry, in-patient, insured hospital
services.
(#)
21. Total number of claims paid for out-ofcountry, out-patient, insured hospital
services.
(#)
22. Total payments for out-of-country, inpatient, insured hospital services.
($)
23. Total payments for out-of-country, outpatient, insured hospital services.
($)
($)
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
276
Canada Health Act Annual Report, 2002-2003
Annex A
Nunavut
Insured Surgical-Dental Services Within Own Province or Territory
1998-1999
26. Number of dentists participating in the
health insurance plan.
(#)
27. Number of insured surgical-dental
services provided by participating
dentists.
(#)
28. Total payments to dentists for insured
surgical-dental services.
($)
29. Average payment per service for
insured surgical-dental services.
($)
1999-2000
2000-2001
2001-2002
2002-2003
27
21
not available
not available
0
not available
not available
not available
0
not available
not available
not available
0.0
not available
not available
not available
Insured Physician Services Within Own Province or Territory
1998-1999
30. Number of physicians participating in
the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
31. Number of physicians opted-out of the
health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
32. Number of physicians not participating
in the health insurance plan, by type of
physician:
a. general practitioners
b. specialists
c. other
d. total
1999-2000
2000-2001
2001-2002
2002-2003
85
79
0
164
59
55
0
114
81
67
0
148
106
80
0
186
not available
not available
not available
not available
0
0
0
0
0
0
0
0
0
0
0
0
not available
not available
not available
not available
0
0
0
0
0
0
0
0
0
0
0
0
(#)
(#)
(#)
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
Canada Health Act Annual Report, 2002-2003
277
Nunavut
Annex A
Insured Physician Services Within Own Province or Territory
1998-1999
33. Number of insured physician services
provided, by type of physician
(fee-for-service):
a. general practitioners
b. specialists
c. other
d. total
34. Number of insured physician services
provided, by category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
35. Total payments to (fee-for-service)
physicians for insured physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. total
36. Total payments to physicians for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. total
37. Average payment per service for
insured (fee-for-service) physician
services, by type of physician:
a. general practitioners
b. specialists
c. other
d. all physicians
38. Average payment per service for
insured physician services, by
category of service:
a. medical
b. surgical
c. diagnostic
d. other
e. all services
1999-2000
2000-2001
2001-2002
2002-2003
not available
not available
not available
not available
61,074
29,485
0
0
39,035
19,733
0
58,768
44,876
20,656
0
65,532
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
2,323,234
1,146,522
3,469,756
2,494,221
1,229,811
0
3,724,032
1,943,399
1,042,366
0
2,985,765
2,137,218
1,199,648
0
3,336,866
not available
not available
not available
not available
not available
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not avialable
not available
not available
not available
not available
40.83
41.00
0.00
40.92
49.79
52.82
0.00
50.81
47.62
58.08
0.00
50.92
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
(#)
(#)
($)
($)
($)
($)
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
278
Canada Health Act Annual Report, 2002-2003
Annex A
Nunavut
Insured Physician Services Provided to Residents in Another Province or Territory
1998-1999
39. Number of services paid for out-ofprovince/territory, insured physician
services (in Canada).
(#)
40. Total payments for out-ofprovince/territory insured physician
services (in Canada).
($)
41. Average payment per service for outof-province/territory insured physician
services (in Canada).
($)
1999-2000
2000-2001
2001-2002
2002-2003
not available
55,389
39,438
43,064
not available
3,232,940
2,335,998
2,674,445
not available
58.00
59.23
62.10
Insured Physician Services Provided Outside Canada
1998-1999
42. Number of services paid for out-ofcountry, insured physician services.
(#)
43. Total payments for out-of-country
insured physician services.
($)
44. Average payment per service for outof-country insured physician services.
($)
1999-2000
2000-2001
2001-2002
2002-2003
0
0
12
1
0
0
14,835
8
0.0
0.00
1,236.25
7.61
Statistics for 1998-1999 are not provided as Nunavut was formed April 1, 1999.
Canada Health Act Annual Report, 2002-2003
279
Annex C – 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.
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.
Canada Health Act Annual Report, 2002-2003
305
Annex C – Policy Interpretation Letters
[Following is the text of the letter sent on June 18, 1985 to all provincial and territorial Ministers
of Health by the Honourable Jake Epp, Federal Minister of Health and Welfare. (Note: Minister
Epp sent the French equivalent of this letter to Quebec on July 15, 1985.) ]
June 18, 1985
OTTAWA, K1A 0K9
Sent to all Ministers of Health [except the Minister for Quebec, who received an equivalent letter in
French on July 15, 1985]
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.
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Public Administration
This criterion is generally accepted. The intent is that the provincial health care insurance plans be
administered by a public authority, accountable to the provincial government for decision-making on
benefit levels and services, and whose records and accounts are publicly audited.
Comprehensiveness
The intent of the Canada Health Act is neither to expand nor contract the range of insured services
covered under previous federal legislation. The range of insured services encompasses medically
necessary hospital care, physician services and surgical-dental services which require a hospital for their
proper performance. Hospital plans are expected to cover in-patient and out-patient hospital services
associated with the provision of acute, rehabilitative and chronic care. As regards physician services, the
range of insured services generally encompasses medically required services rendered by licensed
medical practitioners as well as surgical-dental procedures that require a hospital for proper
performance. Services rendered by other health care practitioners, except those required to provide
necessary hospital services, are not subject to the Act’s criteria.
Within these broad parameters, provinces, along with medical professionals, have the prerogative and
responsibility for interpreting what physician services are medically necessary. As well, provinces
determine which hospitals and hospital services are required to provide acute, rehabilitative or chronic
care.
Universality
The intent of the Canada Health Act is to ensure that all bona-fide residents of all provinces be entitled to
coverage and to the benefits under one of the twelve provincial/territorial health care insurance plans.
However, eligible residents do have the option not to participate under a provincial plan should they elect
to do so.
The Agreement on Eligibility and Portability provides some helpful guidelines with respect to the
determination of residency status and arrangements for obtaining and maintaining coverage. Its
provisions are compatible with the Canada Health Act.
I want to say a few words about premiums. Unquestionably, provinces have the right to levy taxes and
the Canada Health Act does not infringe upon that right. A premium scheme per se is not precluded by
the Act, provided that the provincial health care insurance plan is operated and administered in a manner
that does not deny coverage or preclude access to necessary hospital and physician services to bonafide residents of a province. Administrative arrangements should be such that residents are not
precluded from or do not forego coverage by reason of an inability to pay premiums.
I am acutely aware of problems faced by some provinces in regard to tourists and visitors who may
require health services while travelling in Canada. I will be undertaking a review of the current practices
and procedures with my Cabinet colleagues, the Minister of External Affairs, and the Minister of
Employment and Immigration, to ensure all reasonable means are taken to inform prospective visitors to
Canada of the need to protect themselves with adequate health insurance coverage before entering the
country.
In summary, I believe all of us as Ministers of Health are committed to the objective of ensuring that all
duly qualified residents of a province obtain and retain entitlement to insured health services on uniform
terms and conditions.
Portability
The intent of the portability provisions of the Canada Health Act is to provide insured persons continuing
protection under their provincial health care insurance plan when they are temporarily absent from their
province of residence or when moving from province to province. While temporarily in another province
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of Canada, bona-fide residents should not be subject to out-of-pocket costs or charges for necessary
hospital and physician services. Providers should be assured of reasonable levels of payment in respect
of the cost of those services.
Insofar as insured services received while outside of Canada are concerned, the intent is to assure
reasonable indemnification in respect of the cost of necessary emergency hospital or physician services
or for referred services not available in a province or in neighbouring provinces. Generally speaking,
payment formulae tied to what would have been paid for similar services in a province would be
acceptable for purposes of the Canada Health Act.
In my discussions with provincial/territorial Ministers, I detected a desire to achieve these portability
objectives and to minimize the difficulties that Canadians may encounter when moving or travelling about
in Canada. In order that Canadians may maintain their health insurance coverage and obtain benefits or
services without undue impediment, I believe that all provincial/territorial Health Ministers are interested
in seeing these services provided more efficiently and economically.
Significant progress has been made over the past few years by way of reciprocal arrangements which
contribute to the achievement of the in-Canada portability objectives of the Canada Health Act. These
arrangements do not interfere with the rights and prerogatives of provinces to determine and provide the
coverage for services rendered in another province. Likewise, they do not deter provinces from
exercising reasonable controls through prior approval mechanisms for elective procedures. I recognize
that work remains to be done respecting inter-provincial payment arrangements to achieve this objective,
especially as it pertains to physician services.
I appreciate that all difficulties cannot be resolved overnight and that provincial plans will require
sufficient time to meet the objective of ensuring no direct charges to patients for necessary hospital and
physician services provided in other provinces.
For necessary services provided out-of-Canada, I am confident that we can establish acceptable
standards of indemnification for essential physician and hospital services. The legislation does not define
a particular formula and I would be pleased to have your views.
In order that our efforts can progress in a co-ordinated manner, I would propose that the FederalProvincial 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
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Annex C – Policy Interpretation Letters
Canada Health Act to their respective health care insurance plans. At the same time, I believe that all
provincial/ territorial Health Ministers understand and respect my accountability to the Parliament of
Canada, including an annual report on the operation of provincial health care insurance plans with
regard to these fundamental criteria.
Conditions
This leads me to the conditions related to the recognition of federal contributions and to the provision of
information, both of which may be specified in regulations. In these matters, I will be guided by the
following principles:
1. to make as few regulations as possible and only if absolutely necessary;
2. to rely on the goodwill of Ministers to afford appropriate recognition of Canada’s role and
contribution and to provide necessary information voluntarily for purposes of administering the
Act and reporting to Parliament;
3. to employ consultation processes and mutually beneficial information exchanges as the
preferred ways and means of implementing and administering the Canada Health Act;
4. to use existing means of exchanging information of mutual benefit to all our governments.
Regarding recognition by provincial/territorial governments of federal health contributions, I am satisfied
that we can easily agree on appropriate recognition, in the normal course of events. The best form of
recognition in my view is the demonstration to the public that as Ministers of Health we are working
together in the interests of the taxpayer and patient.
In regard to information, I remain committed to maintaining and improving national data systems on a
collaborative and co-operative basis. These systems serve many purposes and provide governments, as
well as other agencies, organizations, and the general public, with essential data about our health care
system and 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.
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I want to emphasize that where a provincial plan does authorize user charges, the entire scheme must
be consistent with the intent of the reasonable accessibility criterion as set forth [in this letter].
Regulations
Aside from the recognition and information regulations referred to above, the Act provides for regulations
concerning hospital services exclusions and regulations defining extended health care services.
As you know, the Act provides that there must be consultation and agreement of each and every
province with respect to such regulations. My consultations with you have brought to light few concerns
with the attached draft set of Exclusions from Hospital Services Regulations.
Likewise, I did not sense concerns with proposals for regulations defining Extended Health Care
Services. These help provide greater clarity for provinces to interpret and administer current plans and
programs. They do not alter significantly or substantially those that have been in force for eight years
under Part VI of the Federal Post-Secondary Education and Health Contributions Act (1977). It may well
be, however, as we begin to examine the future challenges to health care that we should re-examine
these definitions.
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
Minister of Health
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Annex C – 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 twotier 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
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Annex C – Policy Interpretation Letters
provincial plan pays the physician fee for a medically necessary service delivered at a clinic, it must also
pay for the related hospital services provided or face deductions for user charges.
I recognize that this interpretation will necessitate some changes in provinces where clinics currently
charge facility fees for medically necessary services. As I do not wish to cause undue hardship to those
provinces, I will commence enforcement of this interpretation as of October 15, 1995. This will allow the
provinces the time to put into place the necessary legislative or regulatory framework. As of October 15,
1995, I will proceed to deduct from transfer payments any amounts charged for facility fees in respect of
medically necessary services, as mandated by section 20 of the Canada Health Act. I believe this
provides a reasonable transition period, given that all provinces have been aware of my concerns with
respect to private clinics for some time, and given the promising headway already made by the
Federal/Provincial/Territorial Advisory Committee on Health Services, which has been working for some
time now on the issue of private clinics.
I want to make it clear that my intent is not to preclude the use of clinics to provide medically necessary
services. I realize that in many situations they are a cost-effective way to deliver services, often in a
technologically advanced manner. However, it is my intention to ensure that medically necessary
services are provided on uniform terms and conditions, wherever they are offered. The principles of the
Canada Health Act are supple enough to accommodate the evolution of medical science and of health
care delivery. This evolution must not lead, however, to a two-tier system of health care.
I indicated earlier in this letter that, while user charges for medically necessary services are my most
immediate concern, I am also concerned about the more general issues raised by the proliferation of
private clinics. In particular, I am concerned about their potential to restrict access by Canadian residents
to medically necessary services by eroding our publicly funded system. These concerns were reflected in
the policy statement which resulted from the Halifax meeting. Ministers of Health present, with the
exception of the Alberta Minister, agreed to:
take whatever steps are required to regulate the development of private clinics in Canada, and to
maintain a high quality, publicly funded medicare system.
Private clinics raise several concerns for the federal government, concerns which provinces share.
These relate to:
-
weakened public support for the tax funded and publicly administered system;
-
the diminished ability of governments to control costs once they have shifted from the public to the
private sector;
-
the possibility, supported by the experience of other jurisdictions, that private facilities will
concentrate on easy procedures, leaving public facilities to handle more complicated, costly cases;
and
-
the ability of private facilities to offer financial incentives to health care providers that could draw
them away from the public system - resources may also be devoted to features which attract
consumers, without in any way contributing to the quality of care.
The only way to deal effectively with these concerns is to regulate the operation of private clinics.
I now call on Ministers in provinces which have not already done so to introduce regulatory frameworks
to govern the operation of private clinics. I would emphasize that, while my immediate concern is the
elimination of user charges, it is equally important that these regulatory frameworks be put in place to
ensure reasonable access to medically necessary services and to support the viability of the publicly
funded and administered system in the future. I do not feel the implementation of such frameworks
should be long delayed.
I welcome any questions you may have with respect to my position on private clinics and facility fees. My
officials are willing to meet with yours at any time to discuss these matters. I believe that our officials
need to focus their attention, in the coming weeks, on the broader concerns about private clinics referred
to above.
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As I mentioned at the beginning of this letter, divergent interpretations of the Canada Health Act apply to
a number of other practices. It is always my preference that matters of interpretation of the Act be
resolved by finding a Federal/Provincial/Territorial consensus consistent with its fundamental principles. I
have therefore encouraged F/P/T consultations in all cases where there are disagreements. In situations
such as out-of-province or out-of-country coverage, I remain committed to following through on these
consultative processes as long as they continue to promise a satisfactory conclusion in a reasonable
time.
In closing, I would like to quote Mr. Justice Emmett M. Hall. In 1980, he reminded us:
“we, as a society, are aware that the trauma of illness, the pain of surgery, the slow decline to death,
are burdens enough for the human being to bear without the added burden of medical or hospital bills
penalizing the patient at the moment of vulnerability.”
I trust that, mindful of these words, we will continue to work together to ensure the survival, and renewal,
of what is perhaps our finest social project.
As the issues addressed in this letter are of great concern to Canadians, I intend to make this letter
publicly available once all provincial Health Ministers have received it.
Yours sincerely,
Diane Marleau
Minister of Health
Canada Health Act Annual Report, 2002-2003
315
Annex D – Dispute Avoidance and Resolution
Process under the Canada Health Act
In April 2002, the Honourable A. Anne McLellan outlined in a letter to her provincial and territorial
counterparts a Canada Health Act Dispute Avoidance and Resolution process, which was agreed to by
provinces and territories, except Quebec. The process meets federal and provincial/territorial interests of
avoiding disputes related to the interpretation of the principles of the Canada Health Act, and when this
is not possible, resolving disputes in a fair, transparent and timely manner.
The process includes the dispute avoidance activities of government-to-government information
exchange; discussions and clarification of issues, as they arise; active participation of governments in ad
hoc federal/provincial/ territorial committees on Canada Health Act issues; and Canada Health Act
advance assessments, upon request.
Where dispute avoidance activities prove unsuccessful, dispute resolution activities may be initiated,
beginning with government-to-government fact-finding and negotiations. If these are unsuccessful, either
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.
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.
Canada Health Act Annual Report, 2002-2003
317
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-togovernment 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.
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.
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Annex D – Dispute Avoidance and Resolution Process
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.
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.
‰
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.
Canada Health Act Annual Report, 2002-2003
321
Annex E – Evolution of Federal Health Care
Transfers
Federal support for provincial health care goes back to the late 1940s with the creation of the National
Health Grants. These grants were considered to be essential building blocks of a national health care
system. While the grants were mainly used to build up the Canadian hospital infrastructure, they also
served to support initiatives in areas such as professional training, public health research, tuberculosis
control and cancer control. By the mid 1960s, the grants available to the provinces totalled more than
$60 million annually.
In the mid 1950s in response to public pressures, the federal government agreed to provide financial
assistance to provinces to help them put in place health insurance programs. In January 1956, the
federal government placed concrete proposals before the provinces to inaugurate a phased health
insurance program, with priority to hospital insurance and diagnostic services. Discussions on these
proposals led to the adoption of the Hospital Insurance and Diagnostic Services Act in 1957. The
implementation of the Hospital Insurance and Diagnostic Services (HIDS) program started in July 1958,
by which time the five provinces of Newfoundland, Saskatchewan, Alberta, British Columbia and
Manitoba (starting July) were operating hospital insurance plans. By 1961, all provinces and territories
were participating in the program.
The second phase of the federal intervention in support of provincial and territorial health insurance
programs came as a result of the recommendations of the Royal Commission on Health Services (Hall
Commission) created in 1961. In its final report (1964), the Commission recommended the establishment
of a new program that would ensure that all Canadians have access to necessary medical care.
The Medical Care Act was introduced in Parliament in early December 1966 and received Royal Assent
on December 21, 1966. The implementation of the Medical Care program started on July 1, 1968 and by
1972 all provinces and territories were participating in the program.
Originally, the federal government’s method of contributing to provincial and territorial hospital insurance
programs was based on the cost to provinces and territories of providing insured hospital services.
Under the Hospital Insurance and Diagnostic Services Act (1957), the federal government reimbursed
the provinces and territories for approximately 50 percent of the costs of hospital insurance. Under the
Medical Care Act (passed in 1966, came into effect in 1968), the federal contribution in support of
medical care was 50 percent of the average national per capita costs of the insured services, multiplied
by the number of insured persons in each province and territory.
Established Programs Financing (EPF)
On April 1, 1977, federal cost sharing in support of health care services was replaced by block funding
with the passage of the Federal-Provincial Fiscal Arrangements and Established Programs Financing
Act, 1977, known also as the EPF Act. Under the EPF Act, federal contributions to the provinces for the
three “established” programs—Hospital Insurance, Medical Care and Post-Secondary Education—were
no longer tied to provincial expenditures on the basis of cost-sharing formulas. Rather, federal
contributions in the base year of 1975-1976 were escalated by the rate of growth of the Gross National
Product (GNP). This “block-funded” system of payments was no longer open-ended, and for most of EPF
history payments were tied to economic and population growth under various formulae.
Under EPF, cash and tax transfers were provided to the provinces and territories in support of health and
post-secondary education. Except for the first few years, the EPF (cash plus tax transfers) was
distributed among provinces and territories on an equal per capita basis.
Canada Health Act Annual Report, 2002-2003
323
Annex E – Evolution of Federal Health Care Transfers
Tax transfers were calculated based on the value of income tax points transferred by the federal
government to the provinces and territories in 1977—13.5 personal income tax points and one corporate
income tax point.
EPF cash funds were transferred monthly to each province and territory. Starting in 1984-1985, these
transfers were subject to provincial/territorial health insurance plans satisfying the criteria and conditions
set out in the Canada Health Act.
In 1995-1996, the last year of EPF, provinces and territories received $22.0 billion total EPF entitlements
(cash and tax), 71.2 percent of which was intended for health care and the rest for post-secondary education.
Canada Health and Social Transfer (CHST)
In the 1995 Budget, the federal government announced the Canada Health and Social Transfer, which
replaced the EPF and the Canada Assistance Plan (CAP), the federal provincial cost-sharing plan for
social services.
When the CHST came into effect on April 1, 1996, provinces and territories received the same share of
the CHST that they had received under the Canada Assistance Plan (CAP), and health and postsecondary education funding made under Established Programs Financing. The provincial and territorial
distribution that existed under the previous programs was carried over into the CHST, but has been
gradually adjusted to now reflect each province and territory’s share of the Canadian population.
The CHST has continued to provide support through both cash and tax transfers for health and other
social programs delivered by the provinces and territories.
The CHST is a single block fund, consisting of both cash and tax transfers to the provincial and territorial
governments in support of health care, post-secondary education, social assistance and social services.
Building on the September 2000 First Ministers’ Accord, the 5-year funding framework was extended in
the 2003 Federal Budget to fiscal year 2007-2008.
For fiscal year 2002-2003, CHST payments amounted to $35.3 billion in the form of tax point transfers
and cash contributions (Source: Finance Canada, September 2003, http://www.fin.gc.ca).
February 2003 First Ministers’ Accord
Federal transfers in support of provincial and territorial health care were restructured with the February
2003 Health Care Renewal Accord and the subsequent 2003 Budget. The CHST is augmented by the
5-year $16 billion Health Reform Fund (HRF) beginning in 2003-2004. Two new transfers, the Canada
Health Transfer (CHT) and Canada Social Transfer (CST) will be established by March 31, 2004 from a
split in the CHST (CHT 62 percent: CST 38 percent). Following progress on the primary health care, home
care and catastrophic drug reforms, the Health Reform Fund will be folded into the CHT in 2008-2009.
Making CHST Payments
The Department of Finance has been responsible for making CHST payments to the provinces and
territories since April 1, 1996. However, the Minister of Health continues to be responsible for
determining the amounts of any deductions or withholdings pursuant to the Canada Health Act, including
those for extra-billing and user charges, and for communicating these amounts to the Department of
Finance in advance of the payment dates. The Department of Finance then makes the actual deductions
from the twice-monthly CHST payments to the provinces and territories.
Further information of federal fiscal programs and arrangements are available from the
Department of Finance (http://www.fin.gc.ca).
324
Canada Health Act Annual Report, 2002-2003
Annex E – Evolution of Federal Health Care Transfers
History of Federal Transfers Related to Health Care
1957 The Hospital Insurance and Diagnostic Services Act is passed unanimously in both the House of Commons
and the Senate, establishing a cost-shared program providing universal insurance coverage and access to
hospital services to all residents of participating provinces. By 1961, all provinces and territories have joined
this program.
1966 The Canada Assistance Plan (CAP) is introduced, enabling the federal government to pay for, among other
things, half the cost of certain health services required by needy persons but not funded though the Hospital
Insurance and Diagnostic Insurance Act.
1968 The federal Medical Care Act is enacted, which establishes a conditional cost-sharing program which
empowers the federal Health Minister to make financial contributions to those provinces and territories which
operate medical care insurance plans meeting minimum criteria. By 1972, all provinces and territories are
participating in this program.
1977 The Federal-Provincial-Territorial Fiscal Arrangements and Established Programs Financing Act (EPF Act) is
passed. The Extended Health Care Services Program is established and provides for equal per capita
funding.
1982 The EPF Act is renewed. The funding formula is amended so that the national per capita combined transfers
are equal.
1984 The Canada Health Act (CHA) is passed, amalgamating the provisions of the Hospital Insurance and
Diagnostic Services Act and the Medical Care Act. The Act also includes the extended health care services
provisions, which had previously been included under EPF. The Canada Health Act strengthens the criteria
that provinces/territories must meet in order to qualify for full federal funding under the EPF Act.
The EPF Act is re-named Federal-Provincial Fiscal Arrangements and Federal Post-Secondary Education
and Health Contributions Act, 1977.
1995 The federal budget announces that EPF and CAP will be replaced by the Canada Health and Social Transfer
(CHST) block fund beginning April 1, 1996. CHST entitlements are set at $26.9 billion for 1996-1997 and
$25.1 billion for 1997-1998. CHST entitlements for 1996-1997 are to be allocated among provinces and
territories in the same proportion as combined EPF and CAP entitlements for 1995-1996.
1996 The federal budget announces a five-year CHST funding arrangement (1998-1999 to 2002-2003) and
provides a cash floor transfer to provinces and territories of $11 billion per year.
1998 The Federal-Provincial-Territorial Fiscal Arrangements and Federal Post-Secondary Education and Health
Contributions Act is amended to put in place a $12.5 billion CHST cash floor, beginning in 1997-1998 and
extending to 2002-2003.
1999 The federal government announces in their budget increases in provincial and territorial CHST cash
entitlements of $11.5 billion over five years . The $11.5 billion is provided to address fiscal pressures in the
health care sector.
2000 The February Budget announced increased CHST funding of $2.5 billion to help provinces and territories
fund post-secondary education and health care. This brings CHST cash to $15.5 billion for each of the years
from 2000-2001 to 2003-2004.
Following the First Ministers Meeting of September 11, 2000, the Prime Minister announces an increase in
health funding through the CHST of more than $21 billion dollars in cash entitlements over five years. The
new money addresses concerns raised by provincial and territorial governments that additional funds are
needed to deal with immediate fiscal pressures in the health, post-secondary education and social services /
social assistance sectors.
A $1B Medical Equipment Fund is established to enable provinces and territories to immediately purchase
and install medical equipment for diagnostic services and treatment. The Fund is allocated on an equal per
capita basis.
2003 Federal transfers in support of provincial and territorial health care were restructured with the February 2003
Health Care Renewal Accord and the subsequent 2003 Budget. The CHST is augmented by the 5-year
$16 billion Health Reform Fund beginning in 2003-2004. Two new transfers, the Canada Health Transfer
(CHT) and Canada Social Transfer (CST) will be established by March 31, 2004 from a split in the CHST
(CHT 62 percent: CST 38 percent).
Canada Health Act Annual Report, 2002-2003
325
Annex F –
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 different definition or interpretation.
Term
Description
Accessibility
The accessibility criterion of the Canada Health Act (section 12) requires that
health care insurance plans of provinces and territories provide:
‰
insured health care services on uniform terms and conditions, on a basis that
does not impede or preclude reasonable access to these services by insured
persons, either directly or indirectly;
‰
payment for insured health services according to a system of payment
authorized by the law of the province or territory;
‰
reasonable compensation for all insured health care services rendered by
physicians and dentists; and
‰
payment to hospitals to cover the cost of insured health care services.
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 Bed
An acute care bed is a bed in a health care facility which has been designated
for the treatment or care of an in-patient with an acute disease or health
condition.
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.
Canada Health Act
(CHA)
The Canada Health Act received Royal Assent on April 17, 1984, with the
unanimous support of the House of Commons and the Senate. The Act, which
replaced the Hospital Insurance and Diagnostic Services Act (1957) and the
Medical Care Act (1968), sets out the national standards that the provincial and
territorial health insurance plans must meet in order to receive the full federal
cash contribution under the Canada Health and Social Transfer (CHST).
Canada Health Act Annual Report, 2002-2003
327
Annex F – Glossary
Term
Description
Canada Health and
Social Transfer
(CHST)
The Canada Health and Social Transfer is the largest federal transfer to
provinces and territories, providing support of health care, post-secondary
education, social assistance and social services. The CHST came into effect on
April 1, 1996, replacing the Canada Assistance Plan (CAP), which cost-shared
provincial and territorial social assistance and social service programs, and
Established Programs Financing (EPF), which provided funding to support
health care and post-secondary education.
As was the case under EPF, the CHST is composed of a tax transfer and a
cash transfer. The tax transfer component goes back to 1977 when, under EPF,
the federal government agreed with provincial and territorial governments to
reduce its personal and corporate income tax rates in all provinces while they
increased their tax bases by an equivalent amount. As a result, revenue that
would have flowed to the federal government began to flow directly to provincial
and territorial governments.
The CHST gives provinces and territories the flexibility to allocate payments
among social programs according to their priorities, while upholding the
principles of the Canada Health Act and the condition that there be no period of
minimum residency with respect to social assistance.
Chronic Care
Chronic care is care required by a person who is chronically ill or has a
functional disability (physical or mental) whose acute phase of illness is over,
whose vital processes may or may not be stable and who requires a range of
services and medical management that can only be provided by a hospital.
Chronic Care Bed
A chronic care bed is a bed designated for ongoing in-patient, long-term medical
services.
Chronic Care Facility
A chronic care facility is a health care facility that provides ongoing, long-term,
in-patient medical services. Chronic care facilities do not include nursing homes.
Comprehensiveness
A criterion of the Canada Health Act (section 9), which states that the health
insurance plans of the provinces and territories must insure all insured health
services (hospital, physician, surgical-dental) and, where provided by law in a
province or territory, services rendered by other health care practitioners.
Consultation Process
Under Section 14(2) of the Canada Health Act, the Minister of Health must
consult with a province or territory with respect to a potential breach of the five
criteria and two conditions of the Act, before discretionary penalties can be
levied for that province or territory.
Convention Refugee
A Convention refugee is a person who meets the definition of refugee in the
1951 United Nations Convention Relating to the Status of Refugees. In general,
it is someone who has left his or her home country and has a well-founded fear
of persecution based on race, religion, nationality, political opinion, or
membership in a particular social group and is unable or, by reason of his or her
fear, unwilling to seek the protection of the home country. In Canada, the
Immigration and Refugee Board, Convention Refugee Determination Division,
decides who is a Convention Refugee.
328
Canada Health Act Annual Report, 2002-2003
Annex F – Glossary
Term
Description
Coordinating
Committee for
Reciprocal Billing
(CCRB)
Please see "Interprovincial Health Insurance Agreements Coordinating
Committee."
Day Surgery Bed
A day surgery bed is a bed in a health care facility designated for short-term
(less than 24 hours) surgical services.
Diagnostic Imaging
A procedure that detects or determines the presence of various diseases and/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.
Diagnostic Physician
Service
For purposes of reporting on the Canada Health Act, a diagnostic physician
service is any medically required service rendered by a medical practitioner that
detects or determines the presence of diseases or conditions.
Discretionary
Penalties
Discretionary penalties are outlined in sections 14 to 17 of the Canada Health
Act. Under these provisions, the federal minister of health may authorize that a
reduction in federal payments to a province or territory under the Canada Health
and Social Transfer (CHST) be made when a breach of any of the five criteria
or two conditions of the Canada Health Act have been identified and could not
otherwise be resolved through consultations between the respective levels of
government. The amount of any deduction is based on the gravity of the
default.
Dispute Avoidance
and Resolution
(DAR)
In April 2002, provincial and territorial governments accepted a Canada Health
Act dispute avoidance and resolution (DAR) process that would apply to the
interpretation of the principles of the Canada Health Act as outlined by the
Honourable A. Anne McLellan, federal Minister of Health, in a letter to the
Honourable Gary Mar, Alberta Minister of Health and Wellness. The Canada
Health Act dispute avoidance and resolution process commits governments to
continue to actively participate in ad-hoc federal, provincial and territorial
committees on Canada Health Act issues and undertake government-togovernment information exchange, discussions and clarification on issues as
they arise. Health Canada will also continue to provide advance assessments
on provincial and territorial measures and direction, when requested. Please
see Annex D of the Canada Health Act Annual Report, 2002-2003 for a more
detailed description of the DAR process.
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.
Canada Health Act Annual Report, 2002-2003
329
Annex F – Glossary
Term
Description
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
Canada Health Act. 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 Canada
Health Act. The letter has been reproduced for reference purposes in Annex C
of the Canada Health Act Annual Report, 2002-2003.
Established
Programs Financing
(EPF)
Introduced in 1977, the Federal-Provincial Fiscal Arrangements and Established
Programs Financing Act, also known as the EPF Act, replaced previous federal
cost-sharing programs for insured hospital, medical and post-secondary
transfers to provinces and territories.
The EPF transfer was a block fund which increased annually on the basis of
economic and population growth. Under the EPF, cash and tax transfers were
provided to provinces and territories in support of health and post-secondary
education. Tax transfers consisted of income tax points transferred by the
federal government to provincial and territorial governments in 1977.
In 1995-1996, the last year of EPF, provinces and territories received $22.0
billion in EPF entitlement (cash plus tax), 71.2 percent of which was intended for
health care and the rest for post-secondary education.
The EPF transfer was replaced in 1996 by the Canada Health and Social
Transfer.
Extended Health
Care Services
Section 2 of the Canada Health Act defines extended health care services as
nursing home intermediate care service; adult residential care service; home
care service; and ambulatory health care service.
Extra-billing
Section 2 of the Canada Health Act defines extra-billing as 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 insurance plan of a province or territory.
Extra-billing and User
Charges Information
Regulations
The only regulations in force under the Canada Health Act are the Extra-billing
and User Charges Information Regulations, which require provincial and
territorial governments to provide to the federal Minister of Health, prior to the
beginning of a fiscal year, estimates of extra-billing and user charges that are
permitted to exist under their health care insurance plans so that appropriate
deductions to federal transfers can be levied. Provincial and territorial
governments are also required under these Regulations to provide financial
statements showing the amounts of extra-billing and user charges actually
charged in a fiscal year so that reconciliations with previously estimated
deductions can be applied. A copy of these regulations is provided in Annex B of
the Canada Health Act Annual Report, 2002-2003.
330
Canada Health Act Annual Report, 2002-2003
Annex F – Glossary
Term
Description
Family-based
Registration
A method for registering or enrolling persons under a health care insurance plan
whereby insured persons are registered as family units.
Federal Policy on
Private Clinics
(Marleau Letter)
On January 6, 1995, federal Minister of Health Diane Marleau wrote to each of
her provincial and territorial counterparts, providing them with the federal policy
position and legal interpretation that the definition of "hospital" as set out in the
Canada Health Act includes any facility providing acute, rehabilitative or chronic
care and includes those health care facilities known as "clinics." She informed
them that after October 15, 1995, it was her intention to interpret facility fees
charged to patients in such facilities or clinics as user fees. Any province or
territory not in compliance with the federal policy on private clinics faced
mandatory penalties under the Canada Health Act calculated from October 15,
1995. These penalties take the form of deductions from monthly cash transfer
payments under the Canada Health and Social Transfer. The Marleau Letter is
included in Annex C of the Canada Health Act Annual Report, 2002-2003.
Fee-for-service
This is a method of payment for physicians 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, dental 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 Care
Insurance Plan
The Canada Health Act (section 2) defines a health care insurance plan as a
plan or plans established by the law of a province or territory to provide for
insured health services as defined under this same Act. (Please refer to
definition of insured health services in this glossary.)
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 5 applications for claims to the HISF since 1986;
however, none of these have qualified under the terms and conditions for
reimbursement.
Canada Health Act Annual Report, 2002-2003
331
Annex F – Glossary
Term
Description
Hospital
Section 2 of the Canada Health Act defines a hospital as any facility or portion
thereof that provides hospital care, including acute, rehabilitative or chronic care,
but does not include a hospital or institution primarily for the mentally
disordered, or a facility or portion thereof that provides nursing home
intermediate care service or adult residential care service, or comparable
services for children.
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-ofprovince or out-of-territory claims for hospital in- and out-patient services from
either jurisdiction. Under such an agreement, insured hospital services are
payable at the approved rates of the host province or territory or as otherwise
agreed upon by the parties involved or by the Interprovincial Health Insurance
Agreements Coordinating Committee (IHIACC).
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.
Insured Health
Services
Under Section 2 of the Canada Health Act, 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 Hospital
Services
Under Section 2 of the Canada Health Act and the Federal Policy on Private
Clinics, insured hospital services include any of the following services provided
to in-patients or out-patients at a hospital or clinic if the services are medically
necessary for the purpose of maintaining health, preventing disease or
diagnosing or treating an injury, illness or disability, namely:
332
‰
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
or clinic;
‰
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 from the hospital or
clinic.
Canada Health Act Annual Report, 2002-2003
Annex F – Glossary
Term
Description
Insured Person
An insured person is interpreted under the Canada Health Act as a resident of a
province or territory other than
‰ a member of the Canadian Forces,
‰
a member of the Royal Canadian Mounted Police who is appointed to rank
therein,
‰
a person serving a term of imprisonment in a penitentiary as defined in the
Penitentiary Act, or
‰
a resident of the province or territory who has not completed such minimum
period of residence or waiting period, not exceeding three months, as may
be required by the province or territory for eligibility for or entitlement to
insured health services.
Insured Physician
Service
Please see "Physician Services."
Insured SurgicalDental Service
Please see "Surgical-Dental Services."
Interprovincial Health
Insurance
Agreements
Coordinating
Committee (IHIACC)
The Interprovincial Health Insurance Agreements Coordinating Committee,
comprised of federal, provincial and territorial health department officials, was
established in 1991 as the Coordinating Committee for Reciprocal Billing
(CCRB), with the mandate to identify and resolve administrative issues related
to interprovincial/territorial billing arrangements for medical (physician) and
hospital services. The general intent of the provincial/territorial reciprocal billing
agreements is to ensure that eligible Canadians have access to medically
necessary health services when referred for these services outside their
province or territory, when travelling or during educational leave or temporary
employment. In 2002, the Committee changed its name to the Interprovincial
Health Insurance Agreements Coordinating Committee to better reflect that the
Committee's scope also extends to eligibility for health insurance coverage as
well as interprovincial/territorial billing issues.
Mandatory Penalties
Provinces that allow extra-billing and user charges are subject to mandatory
dollar-for-dollar deductions from federal transfer payments. Mandatory penalties
are outlined in sections 20 to 21 of the Canada Health Act. Under these
provisions, the federal minister of health may authorize that a reduction in
federal payments to a province or territory under the Canada Health and Social
Transfer (CHST) be made when a breach any of the extra-billing and user
charges provisions of the Canada Health Act has been identified and could not
otherwise be resolved through consultations between the respective levels of
government.
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
primarily 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 public health
insurance 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.
Canada Health Act Annual Report, 2002-2003
333
Annex F – Glossary
Term
Description
Medical Practitioner
Section 2 of the Canada Health Act defines a medical practitioner as a person
lawfully entitled to practise medicine in the place in which the practice is carried
on by that person.
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-ofprovince/territory claims for medical services provided by a licenced physician to
residents of the other jurisdiction. Where a reciprocal billing agreement exists,
an insured medical service is payable at the approved rate of the host province
or territory.
Non-Participating
Physician
This is a physician operating completely outside provincial or territorial health
insurance plans. Neither the physician nor the patient is eligible for any cost
coverage for services rendered or received from the provincial or territorial
health insurance plans. A non-participating physician may therefore establish his
or her own fees, which are paid directly by the patient.
Opted-out Physician
These are physicians who operate outside the provincial or territorial health
insurance plans, and who bill their patients directly at provincial or territorial fee
schedule rates. The provincial or territorial plans reimburse patients of opted-out
physicians for charges up to, but not more than the amount paid by the plan
under fee schedule agreement.
Out-patient
This is a patient admitted to a hospital, clinic or other health care facility for
treatment that does not require an overnight stay.
Out-patient
Diagnostic Care
Out-patient diagnostic care includes health care services in a health care facility
for procedures that do not require an overnight stay and that detect and/or
determine various diseases or health conditions.
Out-patient Surgical
Facility
This is a health care facility providing short-term (day only) surgical services.
Participating
Physician/Dentist
These are licensed physicians or dentists who are enrolled in provincial or
territorial health insurance plans.
Physician Services
Section 2 of the Canada Health Act defines physician services as any medically
required services rendered by medical practitioners.
Portability
This criterion of the Canada Health Act (section 11) requires that provincial and
territorial health insurance plans not impose any minimum period of residence,
or waiting period in excess of three months before residents become eligible for
insured health services. In addition, the plans must cover and pay for insured
services provided to insured persons while they are temporarily outside the
province and during any period of residence, or waiting period imposed by the
health care insurance plan of another province or territory.
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 pays out dividends or profits to
its owners, shareholders, operators or members.
334
Canada Health Act Annual Report, 2002-2003
Annex F – Glossary
Term
Description
Private (not-for-profit)
Health Care Facility
This is a privately owned health care facility that is 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.
Provision of
Information Condition
The Canada Health Act (section 13 (a)) requires that provincial and territorial
governments provide information to the federal minister of health as may be
reasonably required, in relation to insured health care services and extended
health care services, for the purposes of administering the Act.
Public Administration
Criterion
The public administration criterion set out in section 8 of the Canada Health Act
requires that each provincial and territorial health care insurance plan be
administered and operated on a non-profit basis by a public authority that is
responsible to the provincial or territorial government, and whose accounts and
financial transactions are publicly audited.
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.
Recognition
Condition
The Canada Health Act (section 13(b)) requires that provincial and territorial
governments give recognition to the Canada Health and Social Transfer (CHST)
in any public documents, advertisements or promotional material relating to
insured health care services and extended health services in the province or
territory.
Refugee Claimant
A refugee claimant is a person of non-Canadian nationality who has arrived in
Canada and has applied for refugee protection status in Canada under the
Immigration and Refugee Protection Act. If a refugee claimant receives a final
determination from the Immigration and Refugee Board that he or she meets
the definition of refugee in the 1951 United Nations Convention Relating to the
Status of Refugees, then he or she may apply for permanent residence status in
Canada.
Rehabilitative Bed
This is a bed designated for in-patient, rehabilitative treatment services in a
hospital setting (e.g., rehabilitative treatment for spinal or head injuries).
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).
Resident
Section 2 of the Canada Health Act defines a resident as a person lawfully
entitled to be or to remain in Canada who resides and is ordinarily present in
the province or territory, but does not include a tourist, a transient or a visitor to
the province or territory.
Canada Health Act Annual Report, 2002-2003
335
Annex F – Glossary
Term
Description
Separations
This is the total number of in- and out-patients released from a health facility
following discharge, transfer, day surgery or death. Separations include
newborns.
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.
Staffed Beds
This is the number of beds for which a health care facility has staff to provide
health services.
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.
Surgical Day Care
Surgical day care includes health care services involving medical operative
procedures delivered in a health care facility which do not require an overnight
stay in the facility for post-operative recovery or observation.
Surgical-Dental
Services
Section 2 of the Canada Health Act defines surgical-dental services as 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.
Surgical Physician
Service
For purposes of reporting on the Canada Health Act, a surgical physician
service is any medically required surgery rendered by a medical practitioner.
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.
336
Canada Health Act Annual Report, 2002-2003
Annex F – Glossary
Term
Description
Universality
This criterion of the Canada Health Act (section 10) requires that each provincial
or territorial health care insurance plan entitle one hundred per cent of the
insured persons of the province or territory to the insured health services
provided for by the plan on uniform terms and conditions.
User Charge
Section 2 of the Canada Health Act defines a user charge as any charge for an
insured health service that is authorized or permitted by a provincial or territorial
health care insurance plan that is not payable, directly or indirectly, by a
provincial or territorial health care insurance plan, but does not include any
charge imposed by extra-billing. Please refer as well to the definition for extrabilling.
Visits
Visits refers to the number of times an individual or group of individuals seeks
treatment at a health care facility. It is possible for an individual to visit a health
care facility more than once in one calendar day.
Canada Health Act Annual Report, 2002-2003
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