The Health Care Benefits Program, commonly referred to as the Treatment Benefits Program, provides eligible Veterans and other qualified individuals with financial support to access health care benefits to meet their identified needs. Support is provided under the authority of the Veterans Health Care Regulations, Part One. Veterans Affairs Canada (VAC)’s Program InventoryFootnote 1 identifies the Health Care Benefits Program under Core Responsibility 1: Benefits, Services and Support.
The Treatment Benefits Program (herein referred to as the Program) established during World War II is one of the Department’s flagship programs. It is generally seen as stable, with continual updates to benefits/services offered and some changes to program delivery in recent years. There have been no recent changes to the program design structure and the majority of program decision making and transactions are straightforward, with efficient reimbursement to providers/program recipients. Although the 2017 VAC National Veteran Survey does not have a question relating to the prioritization of VAC programs based on need, recipients highly ranked their understanding of the Program benefits and services available (77%), number of service providers available (91%), and that the Program meets their health care needs (84%).
1.1 Program Overview
The Program is complex with fourteen separate Programs of Choice (POCs). These groupings of benefits together contain hundreds of individual benefits and services to meet a variety of eligible health care needs. A brief overview of the benefits and services provided through each of the POCs is included in Appendix A.
As of March 31, 2017, there were just under 80,000 Veterans accessing the ProgramFootnote 2. The overall number of Program recipients has been declining each year since 2005-06. This decline is the result of a mortality rate that is higher for war service Veterans than the rate of Canadian Armed Forces (CAF) Veterans joining the program. However the rate of decline slowed in 2015–16, as more CAF are coming to Veterans Affairs Canada (VAC). VAC is now forecasting slight increases in Treatment Benefit recipients for the next five years.Footnote 3
Program expenditures totalled $308 million in 2016–17. Three POCs account for approximately 80% of program expenditures: Prescription Drugs (POC 10), Related Health Services (POC 12) (for example: occupational therapy, physiotherapy, massage therapy) and Audio Services (POC 3). These same three POCs are also the most frequently used benefits/services by Veterans. Table 1 details the number of program recipients, benefit authorizationsFootnote 4, transactionsFootnote 5 and expenditures by POC for the fiscal year 2016–17.
| POC | Program Recipients | Total Benefit AuthorizationsFootnote 6 | Total Benefit TransactionsFootnote 7 | Total ExpendituresFootnote 8 |
|---|---|---|---|---|
| 1 | 6,957 | 13,584 | 30,235 | $1,731,000 |
| 2 | 5,108 | 66,420 | 605,463 | $1,365,000Footnote 9 |
| 3 | 39,816 | 116,939 | 304,628 | $45,012,000 |
| 4 | 13,738 | Not available | 122,770 | $11,397,000 |
| 5 | 1,535 | 3,336 | 15,086 | $10,795,000 |
| 6 | 2,024 | 3,835 | 19,927 | $3,101,000 |
| 7 | 8,652 | 32,922 | 80,355 | $5,091,000 |
| 8 | 15,714 | 66,556 | 103,010 | $7,560,000 |
| 9 | 1,401 | 2,593 | 10,510 | $2,012,000 |
| 10 | 46,081 | Not available | 4,673,960 | $135,038,000Footnote 10 |
| 11 | 3,692 | 4,655 | 7,686 | $3,666,000 |
| 12 | 29,127 | 270,180 | 695,846 | $59,097,000 |
| 13 | 13,362 | 76,788 | 144,395 | $20,844,000 |
| 14 | 7,658 | 15,666 | 23,802 | $3,619,000 |
| 79,964Footnote 11 | 673,474 | 6,837,673 | $308,033,000Footnote 12 |
Note: supplementary coverage for Health Related Travel (described in Appendix A) accounted for another $18 million in program expenditures in 2016-17.
1.2 Program Eligibility
The Program does not have a separate application process. Eligibility is based on receipt of other VAC programs/services. Veterans and other qualified individuals may qualify to receive financial support for treatment benefits if they are in receipt of services or supports of the following VAC programs:
- Disability Benefits;
- Veterans Independence Program;
- Long Term Care Program; and/or
- War Veterans Allowance.
Benefits and services under the Program are provided to eligible recipients in two situations:
- For the treatment of service related disabilities; and/or
- As supplementary coverage when the required benefits or services are not provided under provincial health programs.
Additionally, participants of the Rehabilitation Program may qualify for financial support for treatment benefits related to their rehabilitation plan.
1.3 Program Delivery
VAC provides funding for recipients to receive benefits and services from health care providers. The Program is administered by VAC field staff in over thirty VAC area offices across the country and by a third-party health claims processor. Benefits and services are administered through the Federal Health Care Processing System (FHCPS) using VAC policies, processes, and rules established in individual benefit gridsFootnote 13. Oversight of the Program is provided by VAC’s Head Office Service Delivery and Program Management Division. The delivery of the Program is also supported by other divisions within VAC, including the following:
- Health Professionals;
- Field Operations;
- Policy and Research;
- Contract Administration;
- Central Operations;
- Finance; and
- Service Delivery Advisory Team (SDAT)Footnote 14.
At the time of the evaluation, the Program’s Performance Information Profile continued to be updated. The program objective and logic model had received minimal updates since the last evaluation in 2013. The logic model can be found in Appendix B.