CANADA HEALTH ACT

CANADA HEALTH ACT

Public Administration Accessibility Universality

Comprehensiveness

ANNUAL 2014 REPORT 2015

Portability

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 2014?2015 is available on Internet at the following address:

?galement disponible en fran?ais sous le titre: Loi canadienne sur la sant? ? Rapport Annuel 2014-2015

This publication can be made available on request on diskette, large print, audio-cassette and braille.

For further information or to obtain additional copies, please contact: Health Canada Address Locator 0900C2 Ottawa, Ontario K1A 0K9 Telephone: (613) 957-2991 Toll free: 1-866-225-0709 Fax: (613) 941-5366

? Her Majesty the Queen in Right of Canada, represented by the Minister of Health of Canada, 2015

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 copyright@pwgsc.gc.ca

HC Pub: 150140

Cat.: H1-4E-PDF ISBN:1497-9144

ACKNOWLEDGEMENTS

Health Canada would like to acknowledge the work and effort that went into producing this Annual Report. It is through the dedication and timely commitment of the following departments of health and their staff that we are able to bring you this report on the administration and operation of the Canada Health Act:

Newfoundland and Labrador Department of Health and Community Services Prince Edward Island Department of Health and Wellness Nova Scotia Department of Health and Wellness New Brunswick Department of Health Quebec Ministry of Health and Social Services Ontario Ministry of Health and Long-Term Care Manitoba Health, Healthy Living and Seniors Saskatchewan Health Alberta Health British Columbia Ministry of Health Yukon Health and Social Services Northwest Territories Department of Health and Social Services Nunavut Department of Health We also greatly appreciate the extensive work effort that was put into this report by our production team: the desktop publishing company, the translators, editors and concordance experts, printers and staff of Health Canada at headquarters and in the regional offices.

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TABLE OF CONTENTS

Acknowledgements___________________________________________________________________________________________ i Introduction_________________________________________________________________________________________________1 Chapter 1 -- Canada Health Act Overview_________________________________________________________________________3 Chapter 2 -- Administration and Compliance______________________________________________________________________11 Chapter 3 -- Provincial and Territorial Health Care Insurance Plans in 2013?2014________________________________________19

Newfoundland and Labrador________________________________________________________________________21 Prince Edward Island______________________________________________________________________________31 Nova Scotia______________________________________________________________________________________39 New Brunswick___________________________________________________________________________________49 Quebec_________________________________________________________________________________________ 59 Ontario_________________________________________________________________________________________63 Manitoba________________________________________________________________________________________75 Saskatchewan_____________________________________________________________________________________85 Alberta__________________________________________________________________________________________95 British Columbia_________________________________________________________________________________103 Yukon__________________________________________________________________________________________115 Northwest Territories____________________________________________________________________________ 125 Nunavut________________________________________________________________________________________133 Annex A -- Canada Health Act and Extra-Billing and User Charges Information Regulations____________________________141 Annex B -- Policy Interpretation Letters________________________________________________________________________163 Annex C -- Dispute Avoidance and Resolution Process under the Canada Health Act___________________________________171 Contact Information for Provincial and Territorial Departments of Health__________________________________inside back cover

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INTRODUCTION

Canada has a predominantly publicly financed and administered health care system. The Canadian health insurance system is achieved through 13 interlocking provincial and territorial health insurance plans, and is designed to ensure that all eligible residents of Canadian provinces and territories have reasonable access to medically necessary hospital and physician services on a prepaid basis, without charges related to the provision of insured health services.

The Canadian health insurance system evolved into its present form over more than six decades. Saskatchewan was the first province to establish universal, public hospital insurance in 1947 and, ten years later, the Government of Canada passed the Hospital Insurance and Diagnostic Services Act (1957), to share in the cost of these services with the provinces and territories. By 1961, all the provinces and territories had public insurance plans that provided universal access to hospital services. Saskatchewan again pioneered by providing insurance for physician services, beginning in 1962. The Government of Canada enacted the Medical Care Act in 1966 to cost-share the provision of insured physician services with the provinces and territories. By 1972, all provincial and territorial plans had been extended to include physician services.

In 1979, at the request of the federal government, Justice Emmett Hall undertook a review of the state of health services in Canada. In his report, he affirmed that health care services in Canada ranked among the best in the world, but warned that extra-billing by doctors and user charges levied by hospitals were creating a two-tiered system that threatened the universal accessibility of care. This report, and the national debate it generated, led to the enactment of the Canada Health Act in 1984.

The Canada Health Act is Canada's federal health insurance legislation and defines the national principles that govern the Canadian health insurance system, namely, public administration, comprehensiveness, universality, portability and accessibility. These principles reflect the underlying Canadian values of equity and solidarity.

The roles and responsibilities for Canada's health care system are shared between the federal, provincial and territorial governments. The provincial and territorial governments have

primary jurisdiction in the administration and delivery of health care services. This includes setting their own priorities, administering their health care budgets and managing their own resources. The federal government, under the Canada Health Act, sets out the criteria and conditions that must be satisfied by the provincial and territorial health insurance plans for provinces and territories to qualify for their full share of the cash contribution available to them under the federal Canada Health Transfer.

On an annual basis, the federal Minister of Health is required to report to Parliament on the administration and operation of the Canada Health Act, as set out in section 23 of the Act. The vehicle for so doing is the Canada Health Act Annual Report. While the principal and intended audience for the annual report is Parliamentarians, it is a public document that offers a comprehensive description of insured health services in each of the provinces and territories. The annual report is structured to address the mandated reporting requirements of the Act; as such, its scope does not extend to commenting on the status of the Canadian health care system as a whole.

Provincial and territorial health care insurance plans generally respect the criteria and conditions of the Canada Health Act and many exceed the requirements of the Act. However, when instances of possible non-compliance with the Act arise, Health Canada's approach to the administration of the Act emphasizes transparency, consultation and dialogue with provincial and territorial health care ministries. The application of financial penalties through deductions under the Canada Health Transfer is considered only as a last resort when all other options to resolve an issue collaboratively have been exhausted. Pursuant to the commitment made by premiers under the 1999 Social Union Framework Agreement, federal, provincial and territorial governments (except Quebec) agreed through an exchange of letters, in April 2002, to a Canada Health Act Dispute Avoidance and Resolution (DAR) process. The DAR process was formalized in the First Ministers' 2004 Accord. Although the DAR process includes dispute resolution provisions, the federal Minister of Health retains the final authority to interpret and enforce the Canada Health Act.

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