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3.0 Relevance

3.1 Continued Need for the Program

The recipient population of the Program ranges in age from 19 to 100 years. The health care needs of Veterans vary from minor, easily treatable conditions to complex multiple conditions. The war service recipient segment of the population has an average age of 88 years. These recipients are experiencing deteriorating health and end of life issues. Their needs include: home support; hearing and mobility aids; nursing services; prescription drugs; as well as other benefits and services provided through the Program.

The other population segment, CAF recipients, has an average age of 58 years. Recent studies about the health of CAF Veterans suggest that VAC’s programs and services need to be capable of assisting those with complex states of health.Footnote4 This complexity is demonstrated by the number and variety of physical, mental and social conditions reported by those receiving benefits from VAC. In addition, CAF Veterans released from the military between 1998 and 2007 who receive VAC benefits more often reported below average health-related quality of life than the general population.Footnote5 This is not surprising because Veterans (both war service and CAF) with chronic health problems and disabilities seek health benefit assistance from VAC.

While the two recipient groups are often portrayed as separate and distinct, there is a segment of CAF recipients (9%) that has a similar age profile (those aged 70-79) as war service recipients and an additional 22% of CAF recipients are also approaching this age profile. With age being an indicator of health status, these CAF recipients’ needs would be similar to those of the war service recipients in the same age group.

Figure 1 – Age Distribution of Recipients as of March 31, 2012
Age War Service Canadian Forces
Less than 29 0 1,952
30 - 39 0 6,242
40 - 49 0 16,382
50 - 59 0 14,271
60 - 69 0 11,669
70 - 79 1,267 15,685
80 - 89 34,211 5,956
90+ 20,709 308

Source: VAC Quarterly Fact Sheet. March 2012.

The availability of private/public health care insurance constitutes a key difference between the two groups. The majority of CAF Veterans reported having health care coverage for: medications (86%), dental (69%), and vision care (66%).Footnote6 Health insurance was reported to be less available in the past to war service recipients. As a result, VAC provided more access to war service recipients through B-line coverage.

The Program responds to the needs of the majority of recipients who have eligibility. Based on a file review, 90% of recipients with identified needs were receiving benefits and services to meet those needs. For 9%, the provision of benefits and services had been requested and action was in progress, or there was limited file information available to arrive at a conclusion. Less than 1% of recipients appeared to have needs that were not being addressed.

Determining eligibility can be challenging for staff and confusing for recipients. This is due to complex eligibility criteria based on service, income, need, etc. Individual expectations regarding access to benefits and services does not always correspond to actual eligibility criteria (also see section 4.1).

The Program is evolving to meet the changing needs of recipients. Between 2008 and 2012 a review of benefits and services resulted in numerous updates to program offerings. Over the past five years, the Department’s Research Directorate led several initiativesFootnote7 resulting in valuable evidence and data that informs the Department on Veterans’ health issues. To ensure the Program remains responsive to the current and future needs of eligible Veterans, VAC should continue to review the effectiveness of new types of treatments (see section 4.2 for additional information on program forecasts).

3.2 Alignment with Government Priorities and Responsibilities

The Program is aligned with the priorities of the Government of Canada as stated in the June 2011 Speech from the Throne, "to continue to recognize and support all Veterans", and, "… to respect provincial jurisdiction and working with the provinces to ensure that the health care system is sustainable and that there is accountability for results."

The Program aligns with the Government of Canada outcome area of "healthy Canadians"Footnote8, as program participants are provided with access to health care benefits aimed at meeting their health care needs.

The Program respects provincial jurisdiction in accordance with the Canada Health Act, by providing financial support to eligible Veterans under the mandate and responsibility of VAC. Eligible Veterans are entitled to the benefits indicated in the Veterans Health Care Regulations or in the Canadian Forces Members and Veterans Re-establishment and Compensation Act.

The Program is a key component to achieving VAC’s mandate by contributing to the Veteran's "care, treatment and re-establishment in civil life".Footnote9

Program Comparison with Other Countries

The evaluation team examined the programs across a number of other countries. A more detailed analysis of the health care benefit programs of the governments of Australia and the United States was conducted as these countries have more elements of comparability. All three countries provide various levels of financial support for health care benefits and services. A common eligibility criterion is injury during active service. Also, restrictions are applied to benefits and services based on eligibility. Though there are several comparable factors, each country has a different health care system, therefore the delivery of services and benefits to Veterans is unique to each country.

Potential Overlap with Other Canadian Programs

Most extended health benefits provided to Canadians fall within the domain of private insurers and, to a lesser extent, the provinces. These benefits are not covered by the Canada Health Act. Each province offers a varying suite of extended benefit programs. The level of service offered and the eligibility criteria differ from province to province with most programs income-tested, age-related, and demographically defined. As a result, some overlap of some services exists among provincial, community, and the Program. The potential for overlap is further compounded because VAC does not consistently monitor recipients’ access to other health care coverage including private/public insurance. The result of having both jurisdictions providing health care coverage, some provinces, on learning that a resident is a Veteran, may refer them to VAC regardless of the Veteran’s eligibility for services from VAC.

The potential for overlap is managed in the following ways:

  • If the health need resulted from the Veteran’s service-related injuries, his/her care is the responsibility of the federal government through VAC.
  • If the health need is not associated with the Veteran’s service-related injury, the Veteran is advised to first use provincial coverage or private insurance.

These processes have provided mixed results. In some situations, VAC pays for services that should have been covered by the provinces, and some provinces pay for services that should have been covered by VAC. This finding is supported by other departmental reports. The Department is working to determine the extent of this issue and have it resolved through a combination of short- and long-term measures.

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