Nova Scotia’s healthcare system should be familiar to its residents, although you might not know how all of the pieces fit together. Some changes have been made to the system in recent years, but it’s not something to be intimidated by. Despite the recent changes, Nova Scotia’s healthcare system isn’t too complicated and this guide will help you better understand how it works, and how it’s funded.
- Canada Health Act and Canada Health Transfer
- How Nova Scotia’s Healthcare System is Funded
- The Nova Scotia Department of Health and Wellness (DHW)
- The Nova Scotia Health Authority (NSHA)
- The Izaak Walton Killam Health Centre (IWK)
- Nova Scotia’s Health Insurance Programs
- Nova Scotia Pharmacare Programs
- How Efficient is Nova Scotia’s Healthcare System?
Canada Health Act and Canada Health Transfer
To begin, it’s important to understand the legislature that Nova Scotia must follow when creating its healthcare system. It all starts with the Canada Health Act (CHA) and Canada Health Transfer (CHT).
The Canada Health Act is Canada’s federal legislation for publicly funded health care. The CHA aims to ensure that all eligible residents of Canada have reasonable access to healthcare services, regardless of geography or economic status. The Act sets out the primary objective of Canadian health care policy, which is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”
The Canada Health Transfer represents the transfer of financial funds to provide long-term support for healthcare services in each province and territory. As such, the Canada Health Act has established criteria and conditions that provinces and territories must follow in order to receive the federal cash contribution from the Canada Health Transfer.
How Nova Scotia’s Healthcare System is Funded
Before Nova Scotia receives funds from the Canada Health Transfer, the federal government first needs to collect these funds from a variety of different sources. The federal government’s budget comes from:
- Non-resident income Tax ($7.8 billion)
- Personal income tax ($153.6 billion)
- Employment insurance premiums ($21.1 billion)
- Corporate income tax ($47.8 billion)
- Other revenues ($29.4 billion)
- Other taxes & duties ($53.8 billion).
From these taxes and revenues received by the Canadian government, $38.6 billion is given to the healthcare sector via the Canada Health Transfer. This $38.6 billion is then divided between all of Canada’s provinces and territories.
For the 2018-2019 fiscal year, Nova Scotia received $999 million from the Canada Health Transfer. Nova Scotia then takes this $999 million and divides it amongst the most relevant divisions and branches to deliver health related services throughout the province.
To make it simple, funding for Nova Scotia’s healthcare system is as follows:
The Nova Scotia Department of Health and Wellness (DHW)
The Nova Scotia Department of Health and Wellness (DSW) is the government body responsible for allocating the $999 million transfer from the federal government. They do this by dividing the funds between the most relevant divisions and branches, including:
- Nova Scotia Health Authority (NSHA)
- IWK Health Centre
- Nova Scotia’s Health Insurance Programs (MSI & Hospital Insurance Program)
- Pharmacare Programs
These four programs – through the strategic direction of the DHW – provide a number of different services including primary care, community programs, hospital visits and stays, drug benefits and coverage, and more. The DHW is responsible for providing guidance and policy direction to these programs, while also holding them accountable for service delivery.
The DHW oversees a wide range of Nova Scotia’s health initiatives, programs, and services. These include:
- 8-1-1: access to non-emergency health information and services.
- Addictions: includes a range of services provided to Nova Scotians through Addiction Service offices.
- Continuing Care: includes services that are provided outside of the hospital and in the homes of Nova Scotians (e.g. home care services in Halifax).
- E-health: the information technology systems that help support healthcare delivery to Nova Scotians.
- Emergency Health Services: the delivery, development, implementation, monitoring, and evaluation of emergency care, including ambulances and LifeFlight.
- Family Physicians: the directory listing for physicians within the province looking to take new patients.
- Health Card: Nova Scotia’s health insurance program that covers medically required hospital, medical, dental, and optometric services.
- Health Services Emergency Management: the mitigation, prevention, response, and recovery to emergency health events.
- Infection Prevention and Control: the coordination, integration, and consistent infection prevention and control practices across health care providers and organizations.
- Mental Health Services: includes mental health programs and services administered by the Nova Scotia Health Authority and IWK Health Centre.
- Pharmacare: Nova Scotia’s public drug plans that help with the cost of prescribed drugs and medical devices.
- Physical Activity, Sport and Recreation: the improvement of health outcomes by raising funds for physical activity, sport, and recreation programs.
- Primary Health Care: the coordination of doctor visits, ongoing supports, follow-up visits for patients and families.
- Protection for Persons in Care Act: an extra safeguard for patients and residents receiving care in Nova Scotia, this Act requires health care administrators and service providers to report all instances of abuse.
- Public Health: includes communicable disease prevention and control; environmental health; healthy communities; healthy development; and population health assessment and surveillance.
- Quality & Patient Safety: a branch of the DHW that is responsible for driving health system improvement.
- Wait Times: a website that provides information on Nova Scotia’s wait times for publicly funded tests, treatments, and services across the province.
- Thrive: a province-wide plan to help prevent obesity and chronic diseases by encouraging physical activity and healthy eating.
Most of these service and programs are provided directly by the Nova Scotia Health Authority, the IWK Centre, the Medical Service Insurance Program, and Pharmacare Programs, all of which receive policy direction from the DHW and the Nova Scotia government.
The Nova Scotia Health Authority (NSHA)
In 2015, the government of Nova Scotia restructured its healthcare system to combine the nine district health authorities into the new Nova Scotia Health Authority (NSHA). The Nova Scotia Health Authority is responsible for allocating healthcare services to Nova Scotian communities, and partners with the IWK Health Centre to plan and deliver primary care, community health, and acute care.
The NSHAs specific responsibilities involve:
- Governing, managing, and providing health services in Nova Scotia.
- Implementing the strategic direction set by the Nova Scotia Department of Health & Wellness.
- Engaging with the local communities and health boards to deliver and improve upon the province’s health care.
The Nova Scotia Health Authority provides health programs and services to Nova Scotians through a team of healthcare professionals that operate hospitals, health care centres, and community-based programs across the province. The NSHA is currently the largest employer in the province with more than 23,000 employees, 2,500 physicians, and 7,000 volunteers that provide care at more than 45 facilities throughout the province.
Some of the programs and services that the Nova Scotia Health Authority provides include:
- Rehabilitation service: includes physiotherapy, social work, acquired brain injury (ABI) programs, and more.
- Mental health: includes outreach programs, child and adolescent outpatient clinical services, community mental health services, crisis response services, and more.
- Palliative care: includes end-of-life care, occupational and physiotherapy, social work, bereavement support, etc.
- Pathology & laboratory services: includes blood collection clinics, water testing, and specimen drop off services.
- Primary health care: includes influenza vaccinations, family practices, walk-in clinics, etc.
- Cancer care: includes cancer patient navigation programs, cancer diagnosing and imaging, cancer prevention programs, patient and family comfort rooms, and more.
- Continuing Care services: includes home care services (nursing, personal support, etc.), long-term care, respite care and support, and adult day programs.
- Addiction services: includes addiction clinics, community mental health and addiction clinics, first nation services, gambling services, and more.
To see the entire list of services and programs the Nova Scotia Health Authority provides, please visit their Services Directory page.
The Izaak Walton Killam Health Centre (IWK)
The IWK Health Centre is a hospital in Halifax that provides care to individuals from Nova Scotia, New Brunswick, and Prince Edward Island.
The IWK Health Centre provides various different types of services, held under 5 umbrellas: Women’s & Newborn Health, Research, Children’s Health, Mental Health & Addictions, and Primary Health.
1. Women’s & Newborn Health
The Women’s & Newborn Health umbrella of the IWK Health Centre provides the following services:
- Women’s health: includes breast health; Early Pregnancy Complications Clinic (EPCC); Enhanced Recovery After Surgery (ERAS); fetal assessment and treatment centre; birth unit; adult surgery inpatient unit; gynecology day surgery; and more
- Newborn health: includes family medicine; Neonatal Intensive Care Unit (NICU); newborn screening; perinatal follow-ups; prenatal screening and diagnosis; prenatal special care unit; infant feeding resources and education; and more
The IWK Health Centre conducts research into disorders and diseases affecting women, children, youth, and families, and is home to many leading research centres, including:
- Autism Research Centre
- Biomedical Translational Imaging Centre
- Canadian Centre for Vaccinology
- Centre for Genomics Enhanced Medicine
- Centre for Pediatric Pain Research
- Centre for Research in Family Health
- Centre for Therapeutic Technology
- Maritime Intestinal Research Alliance (MIRA)
- MicroResearch International
3. Children’s Health
The IWK Health Centre aims to improve children’s health in Nova Scotia by providing a variety of health related services. Some of these services include:
- Early Intensive Behavioural Intervention (EIBI) Program
- Gastroenterology, Nutrition & Pediatric Health Psychology Team
- Nephrology (Kidney Disease)
- Pediatric Endocrinology and Diabetes Unit
- Medical, Surgical and Neurosciences Unit (MSNU)
4. Mental Health & Addictions
The Mental Health & Addictions program is one of three clinical programs at the IWK Health Centre. This program treats children and youth up to the age of 19. For residents over 19 years of age, the centre works with the individual to transition them into the adult program/services.
The Mental Health & Addictions program provides services in schools, community clinics, residential settings, and inpatient environments. The program also consults family practice physicians and community partners to enhance the care that they provide to Nova Scotia’s local communities.
5. Primary Health
The IWK Health Centre provides leadership in strengthening Nova Scotia’s primary health care (e.g. availability of family doctors) to women, children, youth, and families.
From the IWK Health Centre Primary Health webpage:
“Emphasis is placed on understanding the health status of the population and the needs of the communities we serve. We actively build relationships with the community – learning and gaining an understanding from communities of what they need from the IWK and how the IWK can provide support. Support is provided by working with others within the IWK and from community organizations to ensure seamless care across the health care system.”
The initiatives that fall within the Primary Health umbrella of the IWK Health Centre include Bilingual Services, Community Health Teams, Diversity and Inclusion, Healthy Habits & Healthy Families, prideHealth, and the You’re In Charge program.
Nova Scotia’s Health Insurance Programs
- Standard level accommodations and meals in hospitals
- Hospital visits and stays including in-hospital physiotherapy, nursing, and care
- Doctor visits
- Medically necessary dental and optometric services (e.g. surgical removal of impacted teeth)
- Laboratory and other diagnostic services (e.g. X-rays, MRIs, CAT scans, etc.)
- Routine dental for children under the age of 14
- Oral and facial surgeries when medically necessary and done in a hospital
- One eye examination every two years for people under the age of 10 or over the age of 64
- There may be coverage for prosthetics (e.g. artificial limbs) via the program. See the Rehabilitation & Supportive Care Services web page for more information.
The following services are not covered by Nova Scotia’s Health Insurance Programs:
- Ambulance services, with the exception of transportation between medical facilities (e.g. hospitals)
- Prescription medications; however, there are prescription drug programs available under Pharmacare
- Paramedical services, including massage therapists, osteopaths, naturopaths, chiropractors, etc.
- Cosmetic surgery
- Medical devices and equipment such as wheelchairs and crutches; however, coverage is provided for eligible Pharmacare recipients
Residents of Nova Scotia are covered for medical expenses under the Medical Services Insurance Programs, administered by Medavie Blue Cross on behalf of the Nova Scotia Department of Health and Wellness. Although Medavie Blue Cross is a contracted insurance service provider, the service costs are covered by the province. This means that residents of Nova Scotia do not pay any premiums for these programs. The Department of Health and Wellness also directly administers the province’s Hospital Insurance Program which covers hospital related costs.
Your Nova Scotia Health Card provides coverage for Nova Scotia’s Health Insurance Programs. It contains the information needed by hospitals and physicians when visiting a hospital or doctor’s office, and needs to be present for all visits.
Nova Scotia Pharmacare Programs
Nova Scotia Pharmacare is a public drug plan that helps residents with the costs of prescribed drugs and medical devices (e.g. hearing aids). The Nova Scotia Formulary details which drugs and supplies are listed under the following Pharmacare sub-programs:
- Nova Scotia Seniors’ Pharmacare Program: a provincial drug insurance plan that helps Nova Scotians over the age of 65 that don’t otherwise have prescription drug coverage. This program helps cover the cost of prescription drugs and medical devices.
- Family Pharmacare Program: a program designed to help families who have no drug coverage, or if the cost of the prescription drugs have become a financial burden.
- Diabetes Assistance Program: a government-run program that offers care and education across 38 full-time Diabetes Centres to Nova Scotians with diabetes.
- Drug Assistance for Cancer Patients: an insurance plan designed to help Nova Scotians with the cost of cancer-related drugs and supplies.
- Community Services Pharmacare Programs: a benefits program that provides prescription drug coverage to:
How Efficient is Nova Scotia’s Healthcare System?
Now that you’ve read about how healthcare in Nova Scotia works and how it’s funded, it’s time to answer the question: how efficient is Nova Scotia’s healthcare system? We can do this by looking at a number of different healthcare attributes, and comparing the scores for each attribute against the Canadian average.
There are a number of factors that contribute to the efficiency and effectiveness of Nova Scotia’s healthcare system, and this chart only includes a sample. For more insight into the factors that contribute to the success of Nova Scotia’s healthcare system, please read the Your Health System report for Nova Scotia by the Canadian Institute for Health Information.
Hopefully, Nova Scotia’s healthcare system isn’t all that difficult to understand. Although its structure varies quite significantly from that of other provinces, the evolution of Nova Scotia’s healthcare system has resulted in a very efficient and effective structure. To see how health care systems are structured differently in other provinces, check out our guide Healthcare in Ontario: How Does it Work and How is it Funded?