Evaluation of Military Health Care

Assistant Deputy Minister (Review Services)
Authorities, Responsibilities and Accountabilities
B/W Comd
Base/Wing Commander
Canadian Armed Forces
Chief Dental Officer
Canadian Forces Health Information System
CF H Svcs Gp
Canadian Forces Health Services Group
CF Mil Pers Instr
Canadian Forces Military Personnel Instructions
Chief of Military Personnel
Commanding Officer
Defence Administrative Orders and Directives
D Med Pol
Directorate of Medical Policy
Department of National Defence
Federal Health Claims Processing Service
Fiscal Year
Health and Lifestyle Information Survey
Health Services Group
Medical Employment Limitation
Military Personnel Command
Office of Collateral Interest
Office of Primary Interest
Program Alignment Architecture
Patient Experience Questionnaire
Performance Information Profile
Queen’s Regulations and Orders
Road to Mental Readiness
Surgeon General
Canada’s defence policy: Strong, Secure, Engaged

Overall Assessment

  • Military Health Care fulfills an ongoing need and aligns with government roles and priorities
  • Structural and functional gaps, including lack of formal authorities, may affect the delivery of health services
  • CAF members are satisfied with their health care
  • Overall cost effectiveness of Military Health Care cannot be assessed, but some good practices have been introduced
Table 1. Summary of Key Findings and Recommendations. This table provides a consolidation of report findings and recommendations.
Key Findings Recommendations
1. Regular Force CAF members need access to health services. -
2. Military Health Care is aligned with federal roles and responsibilities. -
3. The objectives of Military Health Care are aligned with departmental priorities. -
4. The Surgeon General and the Chief Dental Officer lack the proper authorities to deliver their required responsibilities as the heads of the medical and dental professional branches in the CAF and DND. Efforts have been underway to rectify this for some time.

1. Formally establish the authorities, responsibilities and accountabilities of the Surgeon General and the Chief Dental Officer.

OPI: Commander, Military Personnel Command
OCI: CF H Svcs Gp

5. CF H Svcs Gp has some mechanisms in place to ensure safety and quality of service, but more could be done to sustain efforts and monitor service effectiveness. -
6. Health-related policy documents and directives for the CAF are not comprehensive and up to date.

2. Finalize the complete set of policies, directives and instructions on MELs. Examine all other policy areas to identify other urgent policy creation/revision needs, and develop a plan for the timely completion of these.

OPI: CF H Svcs Gp

7. A formalized performance measurement system is not fully operational.

3. Develop and implement a performance measurement framework for the CAF health system, including the finalization of the Total Health Care Performance Information Profile (PIP), compiling performance indicators from across all program activities.

OPI: Commander, Military Personnel Command

4. Dedicate human and other resources to performance measurement. Once the PIP is finalized, identify challenges to data availability and develop a plan to address any gaps.

OPI: CF H Svcs Gp

8. Overall, CAF members, their COs and B/W Comds are satisfied with health care and advice received. -
9. Wait times, likely caused by personnel shortages, are a concern to some in the CAF.

5. Prepare a report to CMP showing progress towards meeting targets for all occupations for which shortages exist. For occupations where sufficient progress is not being made, the report should describe how the recruitment and retention strategy will be adjusted to correct this.

OPI: CF H Svcs Gp

10. Communication between units and CF H Svcs Gp personnel, such as through MELs, could be improved. See Recommendation 2
Efficiency and Economy
11. Military health care expenditures have increased slightly, both in dollar terms and relative to total DND expenditures, over the evaluation period. -
12. There is insufficient evidence to conclude on the cost efficiency of CAF health services, due to financial coding issues and lack of a satisfactory benchmark for comparison. CF H Svcs Gp has successfully implemented some cost-saving measures, but there may be some inefficiencies in payments to civilian health care providers. -
Table 1 Details - Summary of Key Findings and Recommendations
Table 2. Military Health Care expenditures, total DND/CAF expenditures, and Regular Force CAF members, FY 2010/11 to FY 2016/17. This table displays the expenditures related to PAA element 4.1.8 Military Health Care, expenditures for total DND/CAF, and total number of Regular Force CAF members, for FYs 2010/11 to 2016/17.
- FY 2010/11 FY 2011/12 FY 2012/13 FY 2013/14 FY 2014/15 FY 2015/16 FY 2016/17
Military Health Care Spending ($M) 693 711 708.5 698.6 694.7 694.4 721.5
Total DND/CAF Spending ($M) 20,298 20,219 19,978 18,764 18,454 18,666 18,606
Regular Force CAF Members 68,251 68,760 67,686 67,139 66,130 65,879 66,096
Table 2 Details - Military Health Care expenditures
Table 3. List of stakeholders. This table lists some of the key external stakeholders for Military Health Care.
- Stakeholders
Other government departments

Veterans Affairs Canada

Health Canada, Public Health Agency of Canada

Statistics Canada

Public Works and Government Services Canada

Other organizations in Canada

Provincial health care systems

Private medical/dental clinics

Medical and dental associations

Accreditation Canada

Commission on Dental Accreditation Canada

Canadian and Provincial/Territorial medical and dental associations

Provincial/Territorial regulatory authorities (medical, dental, pharm, nursing, etc. for licensure of our personnel)

Canadian College of Health Leaders


North Atlantic Treaty Organization

Other Allied Nations

Table 3 Details - List of Stakeholders
ADM(RS) Recommendation
ADM(RS) Recommendation
ADM(RS) Recommendation
ADM(RS) Recommendation

2.2.2 Extent to which In-Garrison Care and Advice Meet the Needs of the CAF

Key Finding 8: Overall, CAF members, their COs and B/W Comds are satisfied with health care and advice received.

Surveys of commanding officers (COs) and base/wing commanders (B/W Comds), and of CAF members more broadly, show that the majority are satisfied with the health care and advice they receive from CF H Svcs Gp. Patients – the beneficiaries of the health services – appear to have greater satisfaction than health care providers. 

CAF satisfaction with health services was assessed through three surveys – two implemented by CF H Svcs Gp, and one carried out for this evaluation. The Health and Lifestyle Information Survey (HLIS) is a quadrennial survey of the CAF, carried out by Directorate Force Health Protection within CF H Svcs Gp, which focuses on health status with some questions on health care utilization. The most recent such survey was conducted in FY 2013/14. The second CF H Svcs Gp survey is the Patient Experience Questionnaire (PEQ), administered in FY 2017/18 to patients visiting a CAF medical or dental unit. To get perspectives from those in positions of command, a survey of B/W Comds and COs was carried out as part of this evaluation. Details on the methodology for this survey are described in Annex B.

Overall, the surveys show the majority of respondents are satisfied with the medical, dental, and mental health care provided by CF H Svcs Gp. As shown in the chart below, B/W Comds and COs are mostly satisfied with health care delivery in their units. Both the HLIS and the PEQ report that in excess of 80 percent of respondents were satisfied with the health services they received overall.Footnote 41  The lower ratings for mental health seen in the survey of B/W Comds and COs were not observed in the surveys of the CAF population.

Figure 1
Figure 1. Satisfaction with operating hours, wait times, and effectiveness of health care. This figure shows the percentage of B/W Comds and COs surveyed who agreed or strongly agreed with the following statements: 1) operating hours are appropriate; 2) wait times are acceptable; and 3) services are effective in improving health/readiness.
Figure 1 Details - Satisfaction with operating hours, wait times, and effectiveness of health care
ADM(RS) Recommendation
ADM(RS) Recommendation
Figure 2
Figure 2. CAF health care expenditures, dollar value and percentage of total departmental expenditures, FY 2010/11 to 2016/17. This figure displays expenditures on Military Health Care (PAA sub-sub-program 4.1.8) in both dollar terms and as a percentage of total departmental spending from FY 2010/11 to 2016/17.
Figure 2 Details - CAF health care expenditures, dollar value and percentage of total departmental expenditures, FY 2010/2011 to 2016/2017

ADM(RS) Recommendation

ADM(RS) Recommendation

ADM(RS) Recommendation

ADM(RS) Recommendation

ADM(RS) Recommendation

Table B-1. Evaluation Limitations and Mitigation Strategies. List of the limitations of the evaluation and the corresponding mitigation strategy.
Limitation Mitigation Strategy
The possibility that the interviewees would provide biased information and only positive stories about their Program. A comparison was made between interviewees and other people from the same organization or group, and information from other sources, such as documents and files.
Lack of performance measurement information The evaluation consulted multiple sources of quantitative and qualitative information to determine the performance of the program. However, performance measurement data was limited for this program. Data obtained was supplemented by primary data collection carried out by DGE.
Older data collection Because of delays in the evaluation, some of the data collection, such as interviews, were carried out two years prior to report publication. Every attempt was made to ensure all evidence presented in this report is current.
Table B-1 Details - Evaluation Limitations and Mitigation Strategies
Figure C-1
Figure C-1. Logic Model for the Military Health Care Program. This shows the relationship between the program’s main activities, outputs and expected outcomes.
Figure C-1 Details - Logic Model for Evaluation of Military Health Care 
Table D-1. Evaluation Matrix. This table lists the Evaluation Question and Indicators, and links them to the finding within the report.
Evaluation Issues/Questions Indicators Finding Number
1.1 To what extent is there a continuing need for CAF Health Services? 1.1.1 Existing CAF operational requirements and DAOD that require medical, dental and health services 1
1.2 To what extent is there a federal role and responsibility for the delivery of CAF Health Services? 1.2.1 Existing Acts and legislations which outline the Federal Role and Responsibilities 2
1.3 To what extent are CAF Health Services aligned with governmental and departmental priorities? 1.3.1 Evidence of alignment with priorities from the Minister of Defence’s statements, mandate letter, and SSE 3
1.3.2 Evidence of alignment with priorities from DND Departmental Plan and Departmental Results Report 3
2.1 Does CFHS have the appropriate authorities and governance to achieve their mandate? 2.1.1 Extent that the SG and CDO have the required regulatory authorities within the CAF and DND to conduct their core roles 4
2.1.2 Extent that the governance structure allows CFHS to achieve its objectives 5
2.1.3 The health policies and directives have been developed and are up to date and communicated 6
2.1.4 Extent that CF H Svcs Gp has an appropriate performance measurement system in place 7
2.2 To what extent is in-garrison care meeting the needs of the CAF? 2.2.1 CAF members are satisfied with the in-garrison care they receive 8, 9
2.2.2 Commanders are satisfied with the in-garrison care provided to their units 8, 9
2.2.3 Commanders are satisfied with the advice they receive from health services personnel 8, 10
2.2.4 CF H Svcs Gp monitors the in-garrison care provided to the CAF 5, 7
3.1 To what extent is the CF H Svcs Gp providing military health care in a cost-efficient manner? 3.1.1 Best practices which can impact efficiency are implemented 12
3.1.2 Extent CF H Svcs Gp has the required tools to achieve its objectives 5, 7
3.1.3 Extent that CF Health Services is cost efficient 11, 12
Table D-1 Details - Evaluation Matrix  

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