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.