Canada Health Act

Administration

In administering the Canada Health Act (CHA), the federal Minister of Health is assisted by Health Canada policy, communications and information officers located in Ottawa and in the six regional offices of the Department, and by lawyers with the Department of Justice.

Health Canada takes its responsibilities under the CHA seriously, working 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.

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 fulfil 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 non-compliance 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;
• disseminating information on the CHA and on publicly funded health care insurance programs in Canada;
• responding to information requests and correspondence relating to the CHA by preparing responses to inquiries 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;
• conducting issue analysis and policy research in order to provide policy advice, and
• collaborating with provincial and territorial health department representatives on the recommendations to the Minister concerning the interpretation of the CHA; and Interprovincial Health Insurance Agreements Coordinating Committee.

Interprovincial Health Insurance Agreements Coordinating Committee (IHIACC)

The Canada Health Act Division chairs the Interprovincial Health Insurance Agreements Coordinating Committee and provides a secretariat for the Committee. The Committee was formed in 1991 to address issues affecting the interprovincial billing of hospital and medical services as well as issues related to registration and eligibility for health insurance coverage. It oversees the application of interprovincial health insurance agreements in accordance with the CHA.

The within-Canada 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 interprovincial/territorial and signing them is not a requirement of the CHA.

In 2004-2005, IHIACC updated its high cost procedure (e.g. organ transplants) rates to reflect current costs.

Compliance

Provinces and territories must comply with the CHA criteria and conditions in order to receive the full amount of the Canada Health Transfer (CHT) cash contribution (previous to April 1, 2004, the cash contribution was payable under the Canada Health and Social Transfer).

Health Canada's approach to resolving possible CHA compliance issues emphasizes transparency, consultation and dialogue with provincial and territorial health ministry officials. In most instances, issues are successfully resolved through consultation and discussion based on a thorough examination of the facts. Deductions have only been applied when all options to resolve the issue have been exhausted. To date, most disputes and issues related to administering and interpreting the CHA have been addressed and resolved without resorting to deductions.

Health Canada officials routinely liaise with provincial and territorial health ministry representatives and health insurance plan administrators to help resolve common problems experienced by Canadians related to eligibility for health insurance coverage and portability of health services within and outside Canada.

The Canada Health Act Division and regional office staff monitor the operations of provincial and territorial health care insurance plans in order to provide advice to the Minister on possible non-compliance with the CHA. Sources for this information include: provincial and territorial government officials and publications; media reports; and correspondence received from the public and other non-government organizations. Staff in the Compliance and Interpretation Unit, Canada Health Act Division, assess issues of concern and complaints on a case-by-case basis. The assessment process involves compiling all facts and information related to the issue and taking appropriate action. Verifying the facts with provincial and territorial health officials may reveal issues that are not directly related to the 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 then ask the jurisdiction in question to investigate the matter and report back. Division staff, then discuss the issue and its possible resolution with provincial officials. Only if the issue is not resolved to the satisfaction of the Division after following the aforementioned steps, is it brought to the attention of the federal Minister of Health.

Compliance Issues

No new CHA compliance issues arose during 2004-2005. With respect to compliance issues noted in previous years, other than specific developments noted below, bilateral communications on these issues are ongoing.

This information is factual as of March 31, 2005. Unless otherwise indicated, bilateral communications on these issues are ongoing. Consult previous Canada Health Act Annual Reports for further details on issues pre-dating April 2004. In addition, Health Canada continues to review, monitor and assess the impact and implications of a number of other health issues.

Patient charges for magnetic resonance imaging (MRI) and computed tomography (CT) scans

There are private clinics in British Columbia, Alberta, Quebec and Nova Scotia that provide MRI and CT services on a private basis. In these provinces, MRI and CT scans are covered under the provincial health care insurance plan only when the service is performed in an approved hospital. Under the CHA, MRI and CT services are considered to be insured health services when they are medically necessary for maintaining health, preventing disease or diagnosing or treating an injury, illness or disability and are provided in a hospital or a facility providing hospital care.

Health Canada met with provincial officials in January and February 2005 to clarify the federal position and to reiterate the commitment of the federal government to work collaboratively to address the issue.

Patient charges by specialty referral centres and for self-referrals to physician specialists

Since 2002, two specialist referral clinics in British Columbia have been offering expedited consultations with physician specialists for a fee for individuals who choose to bypass their family physicians to seek specialized treatment. Under the CHA, charges over and above the rate paid by a provincial health insurance plan to insured persons for medically necessary hospital and physician services constitute extra-billing. In December 2004, Health Canada officials restated this position to British Columbia. Further bilateral consultations are required on this issue.

Patient charges for insured health services in private surgical clinics

Health Canada has been engaged in bilateral discussions with British Columbia on patient charges for insured health services in private surgical clinics since June 2000, and has continued to press British Columbia to improve its capacity to audit and investigate charges at these facilities so that insured persons are not charged for insured health services. A deduction of $72,464 was made to British Columbia's March 2005 CHT payment in respect of extra-billing and user charges, as reported by the province for 2002-2003. In March 2005, Health Canada wrote to the British Columbia government to request a meeting to discuss B.C.'s methods for reporting the extent of extra-billing and user charges levied at private surgical facilities in the province.

Following media reports in March 2000, the Régie de l'assurance maladie du Québec (RAMQ) launched an investigation into claims that a Quebec private clinic was charging patients up to $400 for the use of operating rooms to perform medical procedures for which physicians billed the RAMQ. Health Canada communicated the CHA concerns about insured persons being charged for insured health services to the Quebec Department of Health and Social Services. Health Canada and Quebec officials met to discuss this issue in February 2005, at which time Quebec reiterated that information pertaining to RAMQ investigations are confidential. They added that there had been no recent patient complaints, but were unable to confirm that the situation had been resolved.

Patient charges for medical/surgical supplies

Health Canada received correspondence from Manitoba Health in February 2005 about the ongoing patient charges for medical/surgical supplies and the issue of "tray fees". The issue continues to be the subject of ongoing discussion between Health Canada and Manitoba Health.

Canada Health Transfer Deductions in 2004-2005

Deductions were taken from the March 2005 Canada Health Transfer (CHT) payments to three provinces as a result of charges to patients that occurred during 2002-2003. A deduction of $72,464 was made to British Columbia on the basis of charges reported by the province for extra-billing and patient charges at surgical clinics. A deduction of $1,100 was made to Newfoundland and Labrador as a result of patient charges for an MRI in a hospital, and a deduction of $5,463 was made to Nova Scotia as a reconciliation for deductions that had already been made to Nova Scotia for patient charges at a private clinic.