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
- 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
|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
|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
|Military Health Care Spending ($M)
|Total DND/CAF Spending ($M)
|Regular Force CAF Members
Table 2 Details - Military Health Care expenditures
|Other government departments
Veterans Affairs Canada
Health Canada, Public Health Agency of Canada
Public Works and Government Services Canada
|Other organizations in Canada
Provincial health care systems
Private medical/dental clinics
Medical and dental associations
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
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 Details - Satisfaction with operating hours, wait times, and effectiveness of health care
Figure 2 Details - CAF health care expenditures, dollar value and percentage of total departmental expenditures, FY 2010/2011 to 2016/2017
|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 Details - Logic Model for Evaluation of Military Health Care
|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
|1.2 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
|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
|1.3.2 Evidence of alignment with priorities from DND Departmental Plan and Departmental Results Report
|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
|2.1.2 Extent that the governance structure allows CFHS to achieve its objectives
|2.1.3 The health policies and directives have been developed and are up to date and communicated
|2.1.4 Extent that CF H Svcs Gp has an appropriate performance measurement system in place
|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
|2.2.2 Commanders are satisfied with the in-garrison care provided to their units
|2.2.3 Commanders are satisfied with the advice they receive from health services personnel
|2.2.4 CF H Svcs Gp monitors the in-garrison care provided to the CAF
|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
|3.1.2 Extent CF H Svcs Gp has the required tools to achieve its objectives
|3.1.3 Extent that CF Health Services is cost efficient
Table D-1 Details - Evaluation Matrix
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