September 2007 What’s Annual Notes on Provincial Health Care Changes Annual Notes on Provincial Health
Health care security is extremely important to Canadians. Changes in provincial health
Care Changes
care coverage affect the lives of Canadians and, potentially, employer benefit plans.
British Columbia
Consistent with the September Forums of the past number of years, this issue of ForumAlberta Saskatchewan
focuses on significant and practical changes in the Canadian health care system that have
Manitoba Ontario Quebec British Columbia New Brunswick
On July 3, 2007, the Ministry of Health announced that patients who experience severe
Nova Scotia Prince Edward Island
breathing conditions such as chronic bronchitis and emphysema will benefit from
Newfoundland and
PharmaCare coverage for the medication tiotropium, also known as Spiriva. PharmaCare
Labrador
estimates that initially 6,000 patients may receive coverage for tiotropium at a total cost
Yukon Continued Improvements
On May 29, 2007, the Health Minister launched the Primary Health Care Charter
Insert
which outlines a new vision for primary care in British Columbia. The Charter sets the
Investment
direction and establishes seven health priorities that are supported by a number of high-
Consulting Insights
impact projects to transform the primary health care system in BC. The seven priorities
Implementation of Portable Alpha Strategies
• improved access to primary health care;
Aon Survey on the
• increased access to primary maternity care;
Performance of Institutional Pooled
• increased chronic disease prevention;
• enhanced management of chronic diseases;• improved coordination and management of co-morbidities;• improved care for the frail elderly; and• enhanced end-of-life care.
All of the priorities are supported by projects that have common themes of assisting physicians in redesigning their practices to improve care and see more patients, building networks of interdisciplinary care for individuals living with chronic
Aon Consulting • Forum • September 2007
conditions, as well as working with patients as
and part of the 10-year immunization strategy to
partners, and not merely passive recipients of care.
minimize the risk of vaccine-preventable diseases. The strategic directions outlined in the strategy
In May 2007, the Ministry of Employment and
Income Assistance announced that the province had provided the Alliance for Equality of Blind
Canadians with a $355,000 one-time grant to
help visually impaired British Columbians cover
the cost of moderate, low-technology visual aids.
• strengthen parental education and counselling;
The program started mid-July. To be eligible,
people must be residents of BC, over 18 years of
• strengthen provider training and education;
age, and have severe vision loss that eyeglasses
• strengthen public education and awareness; and
• strengthen research and evaluation. Alberta New regulations under the Health Professions Saskatchewan Act which allow pharmacists to prescribe drugs
As of July 1, 2007, a new Seniors’ Drug Plan for
came into effect on April 1, 2007. As a result,
Saskatchewan residents 65 years of age and older
pharmacists will soon be able to prescribe some
came into effect. It ensures that seniors will pay
drug treatments, continue prescriptions made
no more than $15 per prescription for drugs in
by other health practitioners, and administer
the Saskatchewan Formulary. Seniors are now
injectable drug treatments, such as vaccines.
automatically covered under the Seniors’ Drug
Pharmacists who wish to be able to prescribe
Plan the month they turn age 65; no application
medications will have to complete appropriate
is required. Low-income seniors receiving the
training approved by the Alberta College of
Guaranteed Income Supplement, Saskatchewan
Pharmacists. Upon completion, pharmacists
Income Plan or Special Support coverage who
will be able to prescribe for conditions within
were paying less than $15 per prescription prior
limits that will be established by the College.
to July 1, 2007 will continue to do so. Patients
This will help to ensure that pharmacists will
with palliative care coverage and those covered by
only prescribe for those conditions that they are
certain Saskatchewan Aids to Independent Living
competent to assess. Although the regulations
programs continue to receive Saskatchewan
came into force April 1, 2007, training is
expected to take some time and will begin in
Saskatchewan children with diabetes have
access to free insulin pumps as of July 1, 2007.
In February 2007, Alberta Health and Wellness
Saskatchewan Health provides insulin pumps and
the necessary supplies to diabetic children who
distribute $8 million to the province’s nine health
require these devices to adequately stabilize their
regions over two years from a new Innovation
blood sugar levels. Under the children’s insulin
in Immunization Fund in an effort to increase
pump program, eligible children 17 years of age
immunization rates. The new fund is a method of
and under who meet program criteria receive
increasing accessibility to immunization services
insulin pumps and insulin pump supplies.
Aon Consulting • Forum • September 2007
Manitoba
The Transparent Drug System for Patients Act, 2006
(Bill 102) came into force in stages, specifically on
October 1, 2006 and April 1, 2007. Of particular
gives Manitobans the option of paying their
importance to plan sponsors is the allowance of
Pharmacare deductible in monthly instalments.
Off Formulary Interchangeability (OFI) that was
The instalment program is intended to help
implemented on April 1st of this year. Previously,
persons with high drug costs by reducing
a generic drug was required to be listed on the
financial hardships caused by high lump-sum
Ontario Drug Benefit formulary prior to it
drug costs. To be eligible for the Manitoba
being designated as interchangeable, and hence,
deductible instalment program, an individual
substituted in place of a more expensive brand
equivalent. This change is expected to result in increased savings for plan sponsors.
• be enrolled with the Manitoba Pharmacare
Another change to the drug system resulting
• have eligible Manitoba Pharmacare drug costs
from this legislation reflects the public plan’s
over a 30-day period that are equal to or above
intention to reimburse pharmacists for professional
services. These cognitive services encompass
• have reached or exceeded their benefit limit
disease/medication management and counselling,
for drug coverage they receive through another
and demonstrate the province’s commitment to
recognizing the important role pharmacists play
• pre-authorize withdrawals from their bank
in primary care. On July 17, 2007, the Ontario
account by Manitoba Hydro for the cost of the
deductible instalment and their hydro bill.
program. Under this program, people who are being treated with three or more drugs for chronic
The Manitoba Pharmacare Program covers 100%
conditions are allowed to consult with their
of drug costs once the income-based deductible
pharmacist for up to 30 minutes once per year
to review the medications they are taking. The program is free of charge to all Ontarians, not just
Ontario Drug Benefit Program recipients. As this
On August 2, 2007, the Ministry of Health and
is a government-sponsored benefit, the associated
costs will not be passed through to private
Papilloma Virus (HPV) Immunization Program.
Beginning in the fall, the three-dose HPV vaccine will be offered to about 84,000 young women
in Grade eight. HPV is a common sexually transmitted virus and causes cervical cancer
Due to the adoption of Bill 130, revisions have been
and genital warts. The school-based vaccination
made to the Act respecting prescription drug insurance
program will be administered by public health
that clarify the fact that individuals covered by
nurses. The vaccination will be voluntary. The
a private group benefits plan must provide drug
initiative represents an investment of $117 million
insurance for their children and spouse, unless they
over three years. The funding is being provided
are already covered under another plan. In addition,
through a recent federal budget initiative.
effective as of January 1, 2007, employers who
Aon Consulting • Forum • September 2007
sponsor prescription drug coverage under
would be investing up to $4.2 million to
such coverage from an eligible employee’s
purchase and deliver publicly-funded flu
remuneration, unless the employee provides
vaccines to infants, seniors and others at
high risk of complications from influenza.
Nova Scotia
Insurance Plan increased as indicated in
On & After Increase July , 2007 July , 2007
premium increased by 6%, or an additional $24, bringing the annual cost to $424
Monthly Deductible
from $400. Seniors are required to pay a
Monthly Co-insurance
co-payment of 33% for each prescription to a maximum of $30 per prescription, up
Maximum Monthly Contribution* Maximum Annual
annual cap was increased by 6%, or $22, to
* Different calculations are used for persons age 65 and over
Since April 1, 2007, patients who rely on
who are in receipt of the Guaranteed Income Supplement.
** Individuals age 65 and over who are in receipt of the
maximum Guaranteed Income Supplement do not pay the
Specifically, such patients now have access to a monthly supply of portable oxygen.
New Brunswick
and Wellness announced that the publicly
active daily living. Eligible home oxygen
be expanded this year to Grade 12 students
clients are provided with up to 10 tanks
part or all of the cost of the 10 tanks of
the client’s need, income and family size.
health care workers will be for one year, and will target those born in 1970 or later
became available to Nova Scotians facing
an incurable illness. An increase in the
Aon Consulting • Forum • September 2007
allow palliative care patients to remain
serious illnesses. It began to be offered to
all Grade 9 students across the province in
of home-care services per month, for a total of 600 hours in the last three months
Newfoundland and Labrador
entitlement will allow patients to access
signed a four-year agreement to give both
parties a simplified structure with fair and
support, and respite support for families.
reasonable reimbursement, and clear policies
There are no fees for enhanced palliative
receive a professional fee (where applicable, based on the program component) of
contraceptives, and a 33 1/3% mark up for
diabetes supplies and insulin. Under the
pharmacists will receive a professional fee
drugs, oral contraceptives, and diabetes
2008 to March 2011, the professional fee
suffering from chronic pain receive equal
access to quality, evidence-informed care. It also aims to ensure that all
In April 2007, major enhancements to the
health professionals receive appropriate
to make drugs more affordable for residents
encompasses five key areas, specifically,
self management, primary care education,
secondary services, and tertiary services.
whose drug costs are consuming an unreasonable share of their income.
Prince Edward Island
individual families will have their annual
family income. Those with net incomes up
to, but not including, $40,000 will pay a
maximum of 5% of their net income; those
authorization for coverage of the Alzheimer’s
with net incomes of $40,000 to under $75,000
earning $75,000 to under $150,000 will pay a maximum of 10%. The government will pay
As of January 2007, Health and Social Services announced that the chickenpox vaccine will be
The government’s Low Income Drug Program
available for all Yukon infants when they reach
(LIDP) provides drug coverage for families
with children with annual household incomes up to $30,000, to couples earning up to
Continued Improvements
$21,000, and to singles earning up to $19,000
Again this year, each province and territory has
reported improvements in health care delivery
ranging from 20% to 70% of total drug costs.
and access. Updates from the various ministries
of health report measurable reductions in
persons receiving benefits under either the
health care wait times, improvements in access
LIDP or the Senior Citizen’s Drug Subsidy
to health care, and concerted efforts to increase
Program whose co-payment amount for their
the number of doctors and nurses. These results
drugs exceeds 5% of their income will receive
indicate that health care security is being taken
further benefits than is currently the case.
seriously in all Canadian jurisdictions. About Forum This issue of Forumwas published by Aon Consulting, a member of Aon Consulting Worldwide.
For information about Forum:
National Research Department, Aon Consulting Inc. • 145 Wellington Street West • Suite 500 • Toronto, Ontario • M5J 1H8 E-mail: [email protected]
Service national de recherche, Groupe-conseil Aon • 700 De La Gauchetière Street West • Suite 1900 • Montreal, Quebec • H3B 0A7 E-mail: [email protected]
For information about Aon Consulting: 1.877.292.2714 or http://www.aon.ca
Our Offices in Canada British Columbia Manitoba Saskatchewan Nova Scotia Publication Mail Agreement Number: 002770 Ce bulletin est également publié en français. Return Undeliverable Canadian Addresses to Circulation Department: ISSN 1480-4484 Wellington Street West • Suite 00 • Toronto, Ontario • MJ H8
Aon Consulting • Forum • September 2007
I n s i g h t s I n t o R e s u l t s - o r i e n t e d H u m a n R e s o u r c e s S o l u t i o n s
Investment Consulting Insights Aon Consulting Implementation of Portable Alpha Strategies
A basic introduction to portable alpha strategies was
Possible Alpha Sources: Possible Beta Sources:
provided in the September 2006 Forum. This year, the implementation of these strategies is explored. What is a “Portable Alpha” Strategy?
The traditional portable alpha strategy consists of two parts:
a) Assets are allocated to an index investment, either
directly or through the use of derivatives. The return
on the index investment is referred to as “beta.”
b) Investment in an “alpha” source, which represents
the excess return earned by a manager over an index.
For example, a long position in an actively managed
fund and a short position in the index underlying the
Pension plans implement portable alpha strategies in
Implementation Considerations
order to separate asset mix decisions from the selection of
When performing due diligence on portable alpha funds, plan
sponsors should pay attention to the following issues:
Implementation Issues
• the selection of the beta and alpha sources, since these
products vary significantly in risk and return expectations;
In order to “port” alpha from one asset class or manager
• the manager’s track record of implementing these strategies
to another, a pension plan has to make use of complex
derivatives contracts (e.g., swaps or futures). Use of these
• the correlation of the product with existing managers and
contracts requires time-consuming and costly legal reviews,
ongoing cash flow management and rebalancing, and
• the currency risk and currency hedging strategies within
counterparty credit risk analyses. Therefore, for all but the
very largest Canadian pension plans, direct implementation
• the risk management built into the investment process;
of portable alpha strategies is not practical.
• the reliability and consistency of alpha sources: diversified
A growing number of fund managers are introducing
packaged portable alpha solutions. These products
are more expensive and less flexible than direct
• the fees (e.g., hedge fund products have high fees and
implementation, but simplify pension fund accounting,
liquidity, and performance measurement, and limit
Portable alpha strategies are becoming increasingly popular
the plan sponsor’s liability to the value of the initial
with pension plans. However, plan sponsors should pay
investment. Common packaged products include the
particular attention to the implementation issues before
deciding to invest in these strategies.
Aon Consulting • Investment Consulting Insights • September 2007
Aon Survey on the Performance of Institutional Pooled Funds
We are pleased to present the results of the
by over 100 Canadian pension fund managers.
Aon quarterly survey on the performance of
The following table illustrates the performance
institutional pooled funds. The survey covers more
of the funds by asset class for various periods
than 350 pooled funds which are actively managed
Aon Pooled Fund Universe Average annual returns () (2) for the periods ending June 0, 2007 Balanced funds Canadian bonds SC Universe Canadian equities S&P/TSX Composite S&P/TSX Composite Capped US equities (CAN $) S&P 00 International equities (CAN $) MSCI-EAFE
Source: The results present the combined pooled fund returns from the surveys conducted by Aon and Principia for Pooled Funds of
(1) With the exception of the three-month and one-year periods for which returns have not been annualized. (2) Returns before management fees.
Aon Consulting • Investment Consulting Insights • March 2006
Aon Consulting • Investment Consulting Insights • September 2007
FEVER: A FRIEND OR FOE ? When a child has a fever, it’s usually an indication that he has some kind of infection. The fever can often seem dramatic without actually being serious; the height of fever is not an indication of the severity of the illness, and wide swings in temperature don’t necessarily indicate either a worsening or an improvement in your child’s illness. It’s natural for
PESTICIDES AND BREAST CANCER: PREVENTION IS CRUCIAL Northwest Coalition for Alternatives to Pesticides This report is published by the Northwest Coalition for Alternatives to Pesticides. NCAPis a nonprofit, five-state regional organization that promotes sustainable resource manage-ment, prevention of pest problems, use of alternatives to pesticides, and the right to be freefrom pesticide
September 2007
I n s i g h t s I n t o R e s u l t s - o r i e n t e d H u m a n R e s o u r c e s S o l u t i o n s
Investment Consulting Insights