CANADA HEALTH ACT ANNUAL REPORT 2010–2011 CANADA HEALTH ACT s s e n e iv s n e h re p m o C n io at tr is in ANNUAL REPORT 2010–2011 dm A lic ub P y ilit sib es cc A y ilit tab Por ity rsal nive U s enes nsiv rehe omp C tion inistra lic Adm Pub lic Administration iversality Portability Accessibility Pub Un siveness prehen Com n ratio inist dm lic A Pub HEALTH CANADA IS THE FEDERAL DEPARTMENT RESPONSIBLE FOR HELPING THE PEOPLE OF CANADA MAINTAIN AND IMPROVE THEIR HEALTH. HEALTH CANADA IS COMMITTED TO IMPROVING THE LIVES OF ALL OF CANADA’S PEOPLE AND TO MAKING THIS COUNTRY’S POPULATION AMONG THE HEALTHIEST IN THE WORLD AS MEASURED BY LONGEVITY, LIFESTYLE AND EFFECTIVE USE OF THE PUBLIC HEALTH CARE SYSTEM. Published by authority of the Minister of Health. Canada Health Act — Annual Report 2010–2011 is available on Internet at the following address: http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/index-eng.php Également disponible en français sous le titre: Loi canadienne sur la santé – Rapport Annuel 2010-2011 This publication can be made available on request on diskette, large print, audio-cassette and braille. For further information or to obtain additional copies, please contact: Health Canada Address Locator 0900C2 Ottawa, Ontario K1A 0K9 Telephone: (613) 957-2991 Toll free: 1-866-225-0709 Fax: (613) 941-5366 © Majesty the Queen in Right of Canada, represented by the Minister of Health of Canada, 2011 All rights reserved. No part of this information (publication or product) may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, or stored in a retrieval system, without prior written permission of the Minister of Public Works and Government Services Canada, Ottawa, Ontario K1A 0S5 or [email protected] HC Pub: 110152 Cat.: H1-4/2011E ISSN: 0842-3202 CKNOWLEDGEMENTSAcknowledgements Health Canada would like to acknowledge the work and effort that went into producing this Annual Report. It is through the dedication and timely commitment of the following departments of health and their staff that we are able to bring you this report on the administration and operation of the Canada Health Act: Newfoundland and Labrador Department of Health and Community Services Prince Edward Island Department of Health and Wellness Nova Scotia Department of Health and Wellness New Brunswick Department of Health Quebec Department of Health and Social Services Ontario Ministry of Health and Long-Term Care Manitoba Health Saskatchewan Health Alberta Health and Wellness British Columbia Ministry of Health Yukon Department of Health and Social Services Northwest Territories Department of Health and Social Services Nunavut Department of Health and Social Services We also greatly appreciate the extensive work effort that was put into this report by our production team: the desktop publishing unit, the translators, editors and concordance experts, and staff of Health Canada at headquarters and in the regional offices. CANADA HEALTH Act — ANNUAL REPORT 2010–2011 i ii CANADA HEALTH Act — ANNUAL REPORT 2010–2011 TABle OF ContentS Acknowledgements_________________________________________________________________________________________ i Introduction ______________________________________________________________________________________________ 1 Chapter 1 — Canada Health Act Overview ____________________________________________________________________ 3 Chapter 2 — Administration and Compliance _________________________________________________________________ 9 Chapter 3 — Provincial and Territorial Health Care Insurance Plans in 2010–2011 ______________________________ 15 Newfoundland and Labrador __________________________________________________________________ 17 Prince Edward Island _________________________________________________________________________ 27 Nova Scotia __________________________________________________________________________________ 35 New Brunswick _______________________________________________________________________________ 45 Quebec ______________________________________________________________________________________ 55 Ontario ______________________________________________________________________________________ 61 Manitoba ____________________________________________________________________________________ 73 Saskatchewan ________________________________________________________________________________ 85 Alberta ______________________________________________________________________________________ 95 British Columbia _____________________________________________________________________________ 103 Yukon ______________________________________________________________________________________ 117 Northwest Territories ________________________________________________________________________ 127 Nunavut ____________________________________________________________________________________ 135 Annex A — Canada Health Act and Extra-Billing and User Charges Information Regulations __________________ 143 Annex B — Policy Interpretation Letters __________________________________________________________________ 165 Annex C — Dispute Avoidance and Resolution Process under the Canada Health Act __________________________ 175 Provincial and Territorial Departments of Health Contact Information __________________________ inside back cover CANADA HEALTH Act — ANNUAL REPORT 2010–2011 iii iv CANADA HEALTH Act — ANNUAL REPORT 2010–2011 INTRODUCTION The roles and responsibilities for Canada’s health care system are shared between the federal and provincial/ territorial governments. The provincial and territorial governments have primary jurisdiction in the adminis- tration and delivery of health care services. This includes setting their own priorities, administering their health care budgets and managing their own resources. The INTRodUctioN federal government, under the Canada Health Act, sets out the criteria and conditions that must be satisfied by the provincial and territorial health insurance plans for provinces and territories to qualify for their full share of the cash contribution available to them under the federal Canada has a predominantly publicly financed and Canada Health Transfer. administered health care system. The Canadian health insurance system is achieved through 13 interlocking On an annual basis, the federal Minister of Health is provincial and territorial health insurance plans, and is required to report to Parliament on the administra- designed to ensure that all eligible residents of Canadian tion and operation of the Canada Health Act, as set provinces and territories have reasonable access to out in section 23 of the Act. The vehicle for so doing medically necessary hospital and physician services is the Canada Health Act Annual Report. While the on a prepaid basis, without charges related to the pro- principal and intended audience for the report is vision of insured health services. Parliamentarians, it is a public document that offers a comprehensive report on insured health services The Canadian health insurance system evolved in each of the provinces and territories. The annual into its present form over more than five decades. report is structured to address the mandated report- Saskatchewan was the first province to establish uni- ing requirements of the Act; as such, its scope does not versal, public hospital insurance in 1947 and, ten years extend to commenting on the status of the Canadian later, the Government of Canada passed the Hospital health care system as a whole. Insurance and Diagnostic Services Act (1957) to share in the cost of these services with the provinces and ter- Provincial and territorial health care insurance plans ritories. By 1961, all the provinces and territories had generally respect the criteria and conditions of the public insurance plans that provided universal access Canada Health Act. However, when instances of to hospital services. Saskatchewan again pioneered by possible non-compliance with the Act arise, Health providing insurance for physician services, beginning in Canada’s approach to the administration of the Act 1962. The Government of Canada enacted the Medical emphasizes transparency, consultation and dialogue Care Act in 1966 to cost share the provision of insured with provincial and territorial health care ministries. physician services with the provinces and territories. The application of financial penalties through deduc- By 1972, all provincial and territorial plans had been tions under the Canada Health Transfer is considered extended to include physician services. only as a last resort when all other options to resolve an issue collaboratively have been exhausted. Pursuant In 1979, at the request of the federal government, to the commitment made by premiers under the 1999 Justice Emmett Hall undertook a review of the state Social Union Framework Agreement, federal, provincial of health services in Canada. In his report, he affirmed and territorial governments (except Quebec) agreed that health care services in Canada ranked among the through an exchange of letters, in April 2002, to a best in the world, but warned that extra-billing by doc- Canada Health Act Dispute Avoidance and Resolution tors and user fees levied by hospitals were creating a (DAR) process. The DAR process was formalized in the two-tiered system that threatened the universal acces- First Ministers’ 2004 Accord. Although the DAR pro- sibility of care. This report, and the national debate it cess includes dispute resolution