About the CAF spectrum of care
The Constitution Act places responsibility upon the Federal Government for providing medical care to members of the Canadian Armed Forces (CAF). This is because the Canada Health Act and the provincial health insurance acts exclude members of the CAF from the list of "insured persons" for the purpose of provincial health care coverage. Therefore, the CAF provides its members with comprehensive health care comparable to that guaranteed to all Canadian citizens under the Canada Health Act.
The Canada Health Act of 1 April 1984, which applies to all Canadians, states that: "....the primary objective of Canadian health care policy is to protect and restore the physical and mental well-being of the residents of Canada and to facilitate reasonable access to health services without financial or other barriers." the Act further states that insured person means: "....a resident of the province other than a member of the Canadian Forces."
On behalf of the Department of National Defence (DND) and CAF, Commanders are responsible to ensure that the health services requirements of CAF members and eligible persons are met. The Commander CF Health Services Group will develop and maintain an organizational structure to assist CAF health care personnel and enable Commanders, within the chain of Command, to fulfill their responsibilities for the provision of health care to entitled members..
Definitions
National Provider Network (NPN). A national network of civilian medical care providers (individuals or facilities) registered to assist in the delivery of in-garrison medical care to eligible persons when CF Health Services resources are not available.
Senior Medical Authority (SMA). The SMA is the Senior Medical Authority on each CAF Base/Wing, who is responsible for the management of in-garrison medical services provided to the military population in their designated area of responsibility.
Certified Civilian Health Practitioner: A civilian who is registered, licensed or certified to provide health services within the province in which care is provided; and
Certified Military Health Practitioner: A military health care provider, who is registered, licensed or certified to provide health services within a province of Canada.
Contracted Plan Administrator (CPA). The CPA is the civilian agency that has been contracted to administer the NPN. The CPA assists the SMA in ensuring health services are available to all eligible persons.
Clinical Specialist: Physician, surgeon or dentist, who has specialized training in medicine or dentistry exceeding the level of training acquired by a general practitioner or dentist.
Health Care Provider (HCP). A military, public service or contracted clinician (physician, physician assistant, nurse practitioner) who usually sees the patient.
Components of the CAF Spectrum of Care
The spectrum of care consists of six parts:
- Comprehensive Medical Care;
- Supplemental Health Care;
- Occupational Health Care;
- Preventive Medicine;
- Health Promotion; and
- Comprehensive Dental Care.
Management of the Spectrum of Care – Spectrum of Care Committee
The Canadian Forces Spectrum of Care Committee (CAF SoCC) was formed in 2002 to bring discipline decision support to the health benefits and services provided to Canadian Armed Forces members, ensuring care comparable to provincial health care plans. The Canadian Armed Forces Spectrum of Care (CAF SoC) emphasizes evidence-based medicine/dentistry and ensures benefits are essential for maintaining health and operational readiness to enhance the quadruple aim of health of the population; enhancement of patient care; resource stewardship; and operational readiness.
Governed by senior CAF leadership since 2007, the committee's membership reflects the CAF's responsibility to provide comprehensive health care to all members while optimizing medical and dental fitness for operational duty. The Committee considers significant changes to the type or cost of CAF health care benefits that merit enterprise-wide consideration. Recommendations are forwarded to the Chief Military Personnel (CMP) for approval, with broader issues potentially considered by the Chief of Defence Staff (CDS) and/or other senior CAF governing bodies.
Purpose of the Spectrum of Care Committee
The CAF SoCC is the senior advisory forum established to assist CMP in the exercise of their functional authority for the administration of Health and Wellness services. The Committee provides senior leadership review and recommendations with respect to the health care benefits that should be included in the CAF SoC and, therefore, the benefits to be provided at public expense to CAF members and other eligible persons. The SoCC utilizes established SoC guiding principles during its deliberations.
Spectrum of Care Guiding Principles
The following guiding principles are exactly that, guiding principles rather than a binary set of yes or no criteria against which a treatment, service or item is approved or not. These guiding principles are not utilized in isolation but instead guide the evaluation of any spectrum of care request taking into consideration the unique and specific nature of the health requirements of the CAF member, for whom the treatment, service or item is requested. In addition to the five guiding principles below, there is a requirement to consider the limitations on the Right to specific care based on the need to balance limited resources. This has been challenged in court and upheld by the SCC. (Auton, Supreme Court of Canada 2004). For further information, see "Medical care services" and "Dental care services" and "Exclusions and limitations for health services".
While all guiding principles are considered in the evaluation of any request, the first three principles are considered essential criteria while the final two principles are considered important but not essential.
Guiding Principles:
1. The treatment, service, or item adheres to the scientific principle of evidence-based medicine /dentistry.
- This principle ensures that public funds are expended only on treatments, services, and items that are proven to be effective, consistent with the government’s mandate of financial stewardship and value-based healthcare. The treatments, services or items must also demonstrate more than a placebo effect. It mitigates procedures or remedies that have not been thoroughly investigated and scientifically proven.
2. The treatment, service or item is necessary for the purpose of maintaining health and mental well-being or preventing disease, diagnosing or treating an injury, illness or disability.
- The term “necessary” implies that without the treatment, service, or item, a disease or injury could occur, will persist or worsen and have a significant negative impact on health. The inclusion of “preventing disease” recognizes the importance of health promotion and protection and permits the inclusion of these activities and programs within the Spectrum of Care.
- Needs vs wants. What are the consequences to health if the treatment, service or item is not provided? What is a public responsibility and what is an individual’s responsibility? A treatment, service or item determined to be a “need” may be covered at public expense whereas a “want”, falling outside what can be deemed a “need” will be at the expense of the individual seeking it.
- When considering whether or not a treatment, service or item is necessary to maintain mental well-being, it is important to have a clear idea of the extent to which the mental well-being of an individual is the responsibility of the CAF to fund (How much of mental well-being is a health issue and how much is a quality of life issue?).
3. The treatment, service, or item is not for purely experimental, research or cosmetic purposes.
- This principle is largely self-explanatory. While CAF members may be permitted to participate in clinical trials or undergo procedures for cosmetic purposes, members remain responsible for any associated costs.
- Must have a clear functional benefit.
- A treatment may be considered cosmetic in certain circumstances and a medical/dental treatment in others. For example, cosmetic plastic surgery vs reconstructive plastic surgery or different types of malocclusions when considering orthodontics.
4. The treatment, service, or item sustains or restores a serving member to an operationally effective and deployable member of the CAF.
- This principle sets the CAF apart from the provincial health care plans. It recognizes that an acceptable level of health and functionality in the CAF is higher than that of non-military Canadians and that the CAF is accepting responsibility to provide health care to restore or sustain a member to that higher level.
- This principle has led to the inclusion of some items in the CAF Spectrum of Care that are not commonly funded by provinces but are supported by arguments of operational imperative.
5. The treatment, service, or item is funded by at least one provincial/territorial health care plan or federal agency.
- The CAF Spectrum of Care aims to be, overall, equivalent to what is provided publicly to other Canadians.
- While the CAF is not beholden to provide identical services to those provided by the provinces, it is important that our members are neither unfairly advantaged nor disadvantaged by virtue of their status as a CAF member.
- The funding of a treatment, service or item is funded by a single province/territory does not inherently mean that the item will be included in the CAF Spectrum of Care.
- Likewise, a comparison to coverage provided by other federal agencies may provide useful information for consideration but must be considered in the context of the CAF population and the other guiding principles.