Non-Insured Health Benefits Program - 2012/2013 Annual Report Summary

The 2012/2013 Non-Insured Health Benefits (NIHB) Program Annual Report, now in its 19th edition, provides national and regional data on the Program's eligible client population, expenditures, and benefit utilization. The Annual Report also provides an update on NIHB's efforts in the area of client safety.

Client Population:

  • The total number of eligible clients as of March 31, 2013 was 926,044, an increase of 3.3% from March 2012.
  • Over the last ten years, the NIHB client population has grown at an average annual rate of 2.4%.
  • As of March 31, 2013, a total of 26,142 newly registered First Nation clients had become eligible to receive benefits as a result of the creation of the new Qalipu Mi'kmaq First Nations band and to new clients joining the Program through Bill C-3.
  • The Ontario region had the largest eligible population, representing 21.3% of the national total, followed by the Manitoba region at 15.6% and the Saskatchewan region at 15.3%.
  • From March 2012 to March 2013, the Atlantic region had the highest percentage change in total eligible clients with a 6.5% increase. This is mainly attributed to the registration of an additional 2,437 new Qalipu Mi'kmaq First Nations clients.
  • Of the 926,044 total eligible clients at the end of the 2012/13 fiscal year, 883,133 (95.4%) were First Nations clients while 42,911 (4.6%) were Inuit clients.

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Expenditures:

  • In 2012/13, total NIHB expenditures were $1,104.6 million, up 2.8% or $30.3 million from 2011/12 to 2012/13. This growth is lower than the 4.5% annual growth increase recorded in 2011/12.
  • Of the $1,104.6 million, NIHB Pharmacy costs (including medical supplies and equipment) represented the largest proportion at $462.7 million (41.9%), followed by NIHB Medical Transportation costs at $351.4 million (31.8%) and NIHB Dental costs at $222.7 million (20.2%).
  • The highest net growth in expenditures over fiscal year 2011/12 was in medical transportation benefits at $18.1 million, followed by dental benefits which increased by $ 3.6 million.
  • NIHB Pharmacy benefit expenditures had the lowest growth rate in 2012/13 at 0.7%. This increase is the lowest annual growth rate recorded for pharmacy benefits over the past 20 years. This lower growth can be attributed to provincial pricing policies that have resulted in reduced costs for generic drugs, and from the introduction of new generic drugs throughout the year (e.g., Lipitor, Crestor).
  • NIHB Dental benefit expenditures recorded the second lowest growth rate at 1.7% in 2012/13. The lower than anticipated increase can be attributed, in part, to a backlog in processing of predetermination claims as a result of centralization of services.
  • The Manitoba region accounted for the highest proportion of total expenditures at $228.3 million, or 20.7% of the national total, followed by the Ontario region at $186.5 million (16.9%) and the Saskatchewan region at $163.4 million (14.8%). In comparison, the lowest expenditures were in the Yukon ($10.7 million) and the Northwest Territories ($27.8 million). These totals represented 1.0% and 2.5% respectively of the national total.
  • The Atlantic Region experienced the highest expenditure growth rate over the last fiscal year at 16.7%. This increase in expenditures can be attributed to the registration of 23,856 Qalipu Mi'kmaq First Nations clients who became eligible to receive benefits through the NIHB Program in September 2011.

Utilization:

  • In 2012/13, the national utilization rate was 62% for NIHB Pharmacy benefits paid through the Health Information and Claims Processing Services (HICPS) system. This slightly lower rate over the last two fiscal years is a result of new Bill C-3 and Qalipu Mi'kmaq First Nations clients registering with the NIHB Program throughout the fiscal year and therefore not claiming benefits for the entire fiscal year.
  • Pharmacy utilization rates vary across the regions.  In 2012/13, regional rates ranged from a low of 46% in Nunavut to 70% in Saskatchewan. The national utilization rate for dental benefits paid through HICPS, in 2012/13, was 36%, constant with the previous fiscal year.
  • National NIHB Dental utilization rates have remained relatively stable over the past five years. The highest dental utilization rate was in the Quebec region (44%) and the lowest rate was in the Manitoba region (31%). The highest utilization rate increase was in the Atlantic region, from 28% in 2011/12 to 34% in 2012/13. Over the two year period between 2011/12 and 2012/13, 449,422 distinct clients received NIHB Dental benefits resulting in an overall 49% utilization rate over this period.
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