GroupNews – October 2020
Eckler’s GroupNews monthly newsletter provides commentary on the issues affecting Canadian group benefit plans.
In this edition:
- Quebec proposes amendments to increase flexibility of parental insurance benefits
- Manitoba amendments provide nurses with additional authority to prescribe drugs
- Manitoba Bill 2 amends Optometry Act to expand options for practice of optometry
- Prince Edward Island pharmacists receive additional power to prescribe in certain situations
- New data on implantable medical devices in Canada
- Long-term care in Canada during the pandemic
Benefit plan management
Quebec proposes amendments to increase flexibility of parental insurance benefits
The Quebec government has introduced Bill 51, An Act mainly to improve the flexibility of the parental insurance plan in order to promote family-work balance
(Bill 51). Bill 51 is intended to offer greater flexibility for Quebec residents using parental leaves in the province.
Bill 51 extends the periods during which maternity, paternity, parental and adoption benefits may be paid, including:
- Extending the payment of maternity benefits up to the 20th week after the week of delivery, up from
18 weeks; - Providing up to an additional five weeks of exclusive parental benefits to each parent on the birth of more than one child as a result of a single pregnancy; and
- Changing the number of weeks available to the parents of an adopted child from a total of 37 weeks shared between parents, to five exclusive weeks for each parent and an additional 32 weeks of shareable benefits.
Additionally, in the event of a child’s death, parents will be granted extra time before parental benefits end.
Impact: Extending parental benefit leaves will require plan sponsors to review human resources policies and benefit programs to ensure that they remain compliant with legislative requirements.
Legal and legislative news
Manitoba amendments provide nurses with additional authority to prescribe drugs
Manitoba has released Regulation 93/2020 (Regulation). Subject to certain restrictions, the Regulation will allow a nurse who holds a valid certificate of practice and is registered under The Regulated Health Professions Act to prescribe a drug or vaccine relating to travel health, reproductive health, sexually transmitted infections and blood-borne pathogens or diabetes health without the notation “(authorized prescriber)” on their certificate of practice.
Impact: Allowing registered nurses to provide prescriptions could result in patients receiving prescriptions in a timelier manner, which might in turn reduce visits to doctors’ offices and reduce wait and recovery times.
Legal and legislative news
Manitoba Bill 2 amends the Optometry Act to expand options for practice of optometry
The Manitoba government has released Bill 2: The Budget Implementation and Tax Statutes Amendment Act, 2020 (Bill 2) amending the Optometry Act to enable the practice of optometry to be carried on by a registered optometrist through a professional corporation.
The amendment repeals the definition of optometrist and adds definitions that allow professional corporations to hold permits authorizing them to carry on the practice of optometry in the province during the period specified in the permit.
A professional corporation established in the province may carry on the practice of optometry under the corporation’s name or as a member of a general partnership of professional corporations. However, the professional corporation may practise only through members who are authorized to practise optometry in the province.
Impact: Allowing optometrists to carry on practice as members of a professional corporation will offer more choice for Manitobans. Professional corporations may allow optometrists to pool resources to provide more services at one location and offer shorter wait times for procedures.
Legal and legislative news
Prince Edward Island pharmacists receive additional power to prescribe in certain situations
The government of Prince Edward Island has amended the Regulated Health Professions Act to make it easier for pharmacists to prescribe medications in certain situations. The amendment to the Pharmacist and Pharmacy Technician Regulations removes the requirement for pharmacists to assess a patient in person before prescribing a drug or vaccine. The amendment also adds uncomplicated cystitis (urinary tract infection) to the list of minor ailments for which a pharmacist may provide a prescription.
Impact: Allowing pharmacists to prescribe medication or vaccines without requiring an in-person consultation will allow patients to receive prescriptions in a timelier manner and may allow individuals currently isolated due to the COVID-19 pandemic the ability to obtain prescriptions by alternative methods. It could reduce wait times, and potentially lessen the need for doctor’s visits if patients can receive prescriptions without an in-person visit.
Research
New data on implantable medical devices in Canada
The Canadian Institute for Health Information (CIHI) released data on implantable medical devices (IMD) in Canada. The data focuses on 12 high volume, and high-cost medical device procedures provided in hospitals across the country.
With a wide range of applications, IMD are surgically or medically inserted into and remain in the human body to help improve and prolong lives. The data released from CIHI focuses on IMD procedures such as cataract lens insertions, knee replacements, hip replacements, ear tube procedures and cardiovascular IMD procedures (coronary stent, pacemaker and defibrillator).
Key findings include:
- In 2018–2019 there was a total of 706,952 hospitalizations and day surgeries in Canada were associated with the 12 high-volume, high-cost IMDs. Cataract lens insertion was the most common, with 413,202 procedures, while knee and hip replacements were the second and third most frequently performed procedures (75,220 and 61,645, respectively). Coronary stent was the fourth most frequently performed procedure.
- Seniors account for a higher proportion of IMD procedures with half of patients aged 65 and older. Given the growing population of Canadians over the age of 65, it is expected that the demand for these procedures will also increase. Ear tube procedures were more commonly performed in children, with half of the procedures performed in children younger than three years old.
- More than half of the procedures for cataract lens insertion and for knee, hip and shoulder replacements were performed on women, while more males underwent cardiovascular-related procedures as well as procedures related to ear tubes, and spinal fusion and fixation hardware.
- The estimated total hospital cost of the 12 IMD procedures was $3.7 billion for 2018–2019. Despite having lower volumes of IMD procedures, higher costs were incurred from inpatient hospitalizations ($2.8 billion) compared with day surgeries ($872 million).
Impact: As the expected demand for implantable medical devices increases, it is important for plan sponsors and plan members to ensure that their benefit plans reflect an increasing need. As employees work longer – and potentially past the normal retirement date – time off and benefit payments for IMD procedures may become an important factor in benefit planning.
Actuaries’ corner
Long-term care in Canada during the pandemic
This is an update to the Actuaries’ corner from December 2019, in which we highlighted a paper released by the National Institute on Ageing (NIA) at Ryerson University on the future costs of long-term care (LTC) in Canada.
The COVID-19 pandemic has shed new light on the systemic vulnerabilities of the LTC services offered in Canada. Bonnie-Jeanne MacDonald, director of financial security research at the NIA and resident scholar at Eckler, presented the provinces’ LTC response to the pandemic at the recent Canadian Annual Conference of the International Foundation of Employee Benefit Plans.
Every province and territory acted differently at different points in time to LTC facilities but essentially all:
- Stopped all non-essential visits from family and friends;
- Prevented staff from working in multiple settings; and
- Required all staff and visitors to be masked.
As the second wave of COVID-19 infections is hitting the country, the NIA highlights two priorities for the management of LTC. First, the policies should work to reintegrate families and friends back into the LTC settings for the benefit of their loved ones. In a step in the right direction, many provinces and territories have reviewed their admission and discharge policies to allow for greater flexibility. Secondly, a conversation must be started to evaluate how the future provision of LTC in Canada should be approached.
The 2019 NIA report had already emphasized the future cost of LTC in Canada, with annual costs expected to grow from $22 billion to $71 billion (in 2019 dollars) over 30 years. In addition, significant care is provided to seniors by unpaid family caregivers – and if this were instead paid publicly, it would add an extra
$27 billion by 2050.
Impact: In a COVID-19 environment, it is more important than ever for governments, plan sponsors and individuals to work together to develop sustainable solutions to counter the heavy financial burden that will be imposed by Canada’s ageing population. Increasing healthcare costs – and the resulting accounting liabilities for retiree benefits – will continue to be an issue for plan sponsors in a post-COVID world. Plan sponsors who still want to offer some level of retiree coverage may want to rethink their benefit offerings to support their ageing population while controlling their financial risk exposure. Various stakeholders should continue to discuss approaches to encourage additional savings towards retirement needs, be it through existing vehicles or new ones targeted at healthcare or LTC needs.
This publication has been prepared by the GroupNews editorial board for general information and does not constitute professional advice. The information contained herein is based on currently available sources and analysis. The data used may be from third-party sources that Eckler has not independently verified, validated, or audited. They make no representations or warranties with respect to the accuracy of the information, nor whether it is suitable for the purposes to which it is put by users. The information is not intended to be taken as advice with respect to any individual situation and cannot be relied upon as such.
Current editorial board members are: Andrew Tsoi-A-Sue, Ellen Whelan, Charlene Milton, Philippe Laplante, and Nick Gubbay.