Interim Guidance for the Delivery of Health Care to Reserve Force Personnel

Document Status: Current

Document Type: Instruction

Document Number: 4090-02

Original Source: 6610-2 (D H Svcs Del) 16 Jul 09

Approval: Surgeon General

Subject Matter Expert: SSO Primary Care Services

OPI:  D MED Pol

Effective Date: 16 Jul 09

Last Reviewed: 31 May 10

Background

Application

1. This Instruction applies to all CF personnel, Department of National Defence (DND) Public Servants, contractors and sub-contractors who provide health services to CF members.

General

2. In recent years the Canadian Forces (CF) has depended more and more on the Reserve Force for both domestic and international operations. Without the Reserve Force the CF would have a difficult time meeting the demands of the Canada First Defence policy and more specifically operations such as the mission in Afghanistan.

3. The health of the Primary Reserves is fundamental to their success and the success of the CF. A sound policy on the delivery of health care to Class B Reservists not only allows for a fit fighting force, but also allows us to better serve the health needs of the Reserve population and provide better advice to the commanders of these units.

4. QR&O Chapter 34, the founding document from which entitlement to care in the CF is derived, is currently under review.

Direction and Guidance

5. Until the QR&Os have been amended and a formal policy written, this document will serve as guidance for the delivery of health care to Class B Reservists. This Instruction is not intended to address the Periodic Health Assessment or immunization policy for Class A Reservist.

Key Principles

6.The following key principles shall be used to guide decisions on entitlement to health care for Reserve Force personnel:

a. There must, first and foremost, be an overall culture of looking after our uniformed force and having the benefit of the doubt go to the member.

b. We must always ensure we are meeting the emergent and urgent health care needs of the member.

c. Chronic Care needs for members on Short term contract (<180 days) are best looked after by their civilian care providers.

d. The level of care we deliver must be based on clinical need and may include diagnostic workup and treatment if deemed necessary by the clinical staff.

e. We must use every patient encounter to better educate our Reserve Force members with respect to their entitlements to care.

f. We must partner with our civilian health care system to better support our Reserve Force personnel throughout their careers.

Guidance for Care Delivery

7. The following shall be used to guide decisions on the delivery of health care to Reserve Force personnel:

a. All members of the Primary Reserve Force that present to a clinic should, as a minimum, be evaluated to ensure their immediate health care needs are met.

b. Class A Reservists

i. If the injury or illness is related to duty or training, the care will be delivered by the CFHS until it can be safely transferred to the member’s primary care physician. Spectrum of Care benefits related to the injury or illness above and beyond the provincial health care coverage will continue to be covered by DND.

ii.If the injury or illness is not related to service or is a chronic medical condition the member will be advised of this and told to follow-up with their civilian primary care physician.

c. Class B Reservists

i. If the member is on a Class B period of service of longer than 180 days, they will continue to receive the same health care benefits as a Regular Force member.

ii. If a member is on a Class B period of service of less than or equal to 180 days, but can prove they have signed consecutive periods of Class B service that have either resulted in, or will result in, 181 or more consecutive days of service, they will be given the same health care benefits as a Regular Force member.

iii. If the member is on a short term Class B period of service of 180 days or less and their injury or illness is related to duty or training, health care will be delivered by the CFHS until it can be safely transferred to the member’s primary care physician. Spectrum of Care benefits related to the injury or illness above and beyond the provincial or territorial health care coverage will continue to be covered by DND.

iv. If the member is on a short term Class B period of service of 180 days or less and the injury or illness is not related to service, their emergent and/or urgent health care needs will provided by the CFHS and the member will be told to follow-up with their civilian primary care physician.

v. If the member is on a short term Class B period of service of 180 days or less, entitlements such as eye glasses, hearing aids, orthotics, CPAP machines, etc, will not be provided by DND. The conditions that such items are used for are typically chronic conditions that existed prior to their engagement on the contract and will exist after the contract ends. It is more appropriate for these chronic care items to be provided through the provincial or territorial health care system or, when required, by the member themselves.

vi. If a member is on a Class B period of service longer than 180 days and this period of Class B service is interrupted by a Class C period of service, the member will continue to receive the same health care benefits as a Regular Force member through both the Class B and Class C periods of service.

d. Class C Reservist. Reserve Force personnel Class C periods of service will be treated as Regular Force Members.

e. Above all else, if in doubt, give the benefit of the doubt to member.

Guidance for Management

8. It is recognized that implementation of the guidance above will increase care delivery costs. Unfortunately our appreciation for just how much cost will increase is very limited. Clinic Managers are therefore required to capture the cost of more open access to urgent and emergent care as best they can at the local level and identify the associated funding pressures in their quarterly returns. Clinic Managers must also closely monitor the workload increase that the provision of such care will generate and report those instances where its provision is compromising the clinic’s ability to provide care to those with full entitlement. Clinic Managers and Base Surgeons must proactively focus on educating their local populations with respect to Reserve Force entitlements to health care. This must include education of the Reserve Force members, the Reserve Force chain of command and the members of the clinic’s care delivery team.

Conclusion

9. The Primary Reserve is an import aspect of the CF Total Force concept and a key contributor to our success in both Domestic and International Operations. The members of the Primary Reserve have made a commitment to their country and deserve the support of the CF and the CFHS. We must be sure that appropriate care providers, whether civilian or military, are looking after these members and in some instances this may involve a combination of the two health care systems. First and foremost, we must always rely on a premise of caring for members in uniform and always give them the benefit of the doubt. Far better to resolve any individual case of uncertain entitlement to care after the fact, than to deny care to any individual when they are in need of care.