Results at a Glance – Health Canada's First Nations and Inuit Supplementary Health Benefits (Non-Insured Health Benefits) Program

Introduction

  • The Non-Insured Health Benefits (NIHB) Program is administered by Health Canada's First Nations and Inuit Health Branch, with support from regional offices.
  • The Program provides coverage for specified, medically necessary, health-related goods and services beyond those offered by provinces and territories.  Benefit areas include:
    • Prescription and over-the-counter drugs (pharmacy);
    • Medical transportation (MT);
    • Dental care;
    • Medical supplies and equipment (MS&E);
    • Vision care; and,
    • Short-term crisis intervention mental health counselling (STCIMHC).
  • The Program is a ‘payer of last resort' (i.e., when clients are eligible for coverage under other plans, claims must be submitted to these plans first) for eligible First Nations and Inuit clients who are not covered through:
    • social programs;
    • private insurance plans; or,
    • provincial or territorial health insurance.
  • This evaluation assessed the Program's relevance and performance from April 2009 to March 2015.

Background

  • The Program has been administered by Health Canada since 1945.
  • The Program's expenditures were $5.8 billion from 2009 to 2015, and grew by an average of 4% annually.
  • The Program processes a large number of claims each year (e.g., over 17 million paid claims in 2014-2015).
  • The Program was last evaluated in 2009-2010.

What the evaluation found

  • The Program provides needed supplemental health benefits to a large number of First Nations and Inuit clients and contributes to their improved health status.
  • Challenges in the Coordination of Benefits (COB) with other plans, due in part to lack of clarity on the role of the Program as a ‘payer of last resort', impact service delivery.
  • The Program is being utilized by clients but there remain challenges related to awareness (STCIMHC), knowledge of benefit coverage (vision care), and accessibility (MT approvals, escorts).
  • The Program has implemented processes and systems to monitor expenditures on a monthly and quarterly basis for most benefit areas.  The Program is developing and implementing a five-year forecasting model.
  • Benefit policy and Program development are evidence-based.
  • Client and provider compliance are effectively monitored via audits for pharmacy, MS&E and dental benefits.  Improvements are being implemented in other areas.
  • Collaboration with partners has improved.
  • While the Program collects a significant amount of administrative data, enhancements are possible.

Recommendations and responses

  • Review and streamline NIHB Program COB procedures and practices with other publicly and privately funded supplementary health benefit plans to ensure clarity, minimize delays and facilitate client access to benefits.

    Management agrees (with conditions) to review and streamline COB procedures for coordination with a focus on privately funded supplementary health benefit plans.   

  • Consider conducting a strategic analysis, in specific geographic areas, to support the enhancement of local health services to improve access to care and to progressively reduce MT benefit expenditures where feasible.

    Management agrees to conduct analyses to identify opportunities for enhancement of local health services to improve access to care. 

  • Consider greater standardization of administrative data collection for MT, vision care and STCIMHC benefits across regions to improve monitoring and demonstration of Program-level outcomes, such as access (e.g., utilization rates, approvals, denials, appeals).

    Management agrees and received funding through Budget 2017 to undertake procurement of new IT/claims processing systems in each of these benefit areas, which will serve to increase standardization of NIHB administrative data collection nationally.

About this evaluation

This evaluation was approved by Health Canada's Deputy Minister in October 2017.  Data collection methods included: literature and document reviews, analysis of administrative and financial data, benchmarking analysis, individual benefit assessment sessions, comparative analysis by benefit, key informant interviews, and a survey for Inuit residing in Nunavut and Inuvialuit.

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