Non-Insured Health Benefits program: First Nations and Inuit Health Branch: Annual report 2022 to 2023

Introduction

The Non-Insured Health Benefits (NIHB) program provides registered First Nations and recognized Inuit with coverage for a range of medically necessary health benefits including prescription drugs and over-the-counter (OTC) medications, dental and vision care, medical supplies and equipment, mental health counselling, and transportation to access medically required health services that are not available on reserve or in the community of residence. This report covers the 2022 to 2023 fiscal year. A fiscal year runs from April 1 to March 31. During 2022 to 2023, NIHB provided access to benefits coverage for 936,006 eligible clients.

In line with Canada's commitments under the United Nations Declaration of the Rights of Indigenous Peoples and the Truth and Reconciliation Commission's Calls to Action, Indigenous Services Canada (ISC) works with Indigenous organizations including the Assembly of First Nations and the Inuit Tapiriit Kanatami, to advance shared priorities focused on improving health outcomes for First Nations and Inuit.

Now in its twenty-ninth edition, the 2022 to 2023 NIHB Annual Report provides national and regional data on the NIHB program client population, expenditures, benefit types and benefit utilization. This Report is published in accordance with the NIHB program's performance management responsibilities and is intended for the following target audiences:

• First Nations and Inuit organizations and governments at community, regional and national levels
• Regional and Headquarters managers and staff of Indigenous Services Canada and
• Others in government and in non-government organizations with an interest in the provision of health services to First Nations and Inuit communities.

Eligible client population by region: March 2023

Ontario had the largest proportion of the eligible population, representing 24.4% of the national total, followed by Manitoba and Saskatchewan at 17.7% each.

Note that population values are based on region of band registration, which is not necessarily the client's current region of residence. The majority of British Columbia clients previously covered by the NIHB program are now covered by the B.C. First Nations Health Authority (FNHA) and are not represented in this chart. The remaining NIHB clients in B.C. are Inuit clients, or clients associated with B.C. bands, but residing in other provinces and territories of Canada, where they are covered under the NIHB program.

Source: SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 2.1 Eligible client population by region

This image is a map of Canada with the following population values:

• Atlantic has 69,589
• Quebec has 83,279
• Ontario has 228,734
• Manitoba has 165,855
• Saskatchewan has 165,347
• Alberta has 131,796
• British Columbia has 17,897
• Yukon has 7,852
• Northwest Territories have 28,233
• Nunavut has 37,418
• Total eligible population is 936,006

Eligible population by client type and region: March 2022 and March 2023

Of the 936,006 total eligible clients at the end of the 2022 to 2023 fiscal year, 884,102 (94.5%) were First Nations clients while 51,904 (5.5%) were Inuit clients. The number of First Nations clients increased by 2.2% and the number of Inuit clients increased by 1.3%

From March 2022 to March 2023, Quebec had the highest percentage change in total eligible clients with a 4.5% increase, followed by Saskatchewan and Ontario with increases of 2.4% and 2.2% respectively.

Eligible client population over time: March 2014 to March 2023

Over the past 10 years, the total number of eligible clients in the SVS has increased by 15.7%, from 808,686 in March 2014 to 936,006 in March 2023.

Source: SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 2.2: Eligible client population, March 2014 to March 2023

This image visually describes NIHB eligible population growth over ten years as follows:

• 2014 was 808,686
• 2015 was 824,033
• 2016 was 839,129
• 2017 was 853,088
• 2018 was 867,749
• 2019 was 873,312
• 2020 was 887,518
• 2021 was 898,839
• 2022 was 915,895
• 2023 was 936,006

Over the past five years, the NIHB program's total number of eligible clients increased by 7.2% from 873,312 in March 2019 to 936,006 in March 2023. Quebec had the largest increase in eligible clients over this period, with a growth rate of 14.3%. The Atlantic region and Ontario followed with growth rates of 8.9% and 7.8% respectively.

Annual population growth, Canadian population and eligible client population: 2014 to 2023

From 2014 to 2023, the Canadian population increased by 10.8% while the NIHB eligible First Nations and Inuit client population increased by 15.7%.

The lower than average NIHB program client population growth rate in 2014 can be attributed to the transfer of responsibility for First Nations clients living in British Columbia to the First Nations Health Authority (FNHA).

Source: SVS and Statistics Canada Catalogue No. 91-002-XWE, Quarterly Demographic Statistics, adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 2.3: Annual population growth, Canadian population and eligible client population

This image is a line graph that visually describes annual population growth for the NIHB eligible population and for the Canadian population.

Year	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
NIHB client Population	808,686	824,033	839,129	853,088	867,749	873,312	887,518	898,839	915,895	936,006
Growth rate	-12.7%	1.9%	1.8%	1.7%	1.7%	0.6%	1.6%	1.3%	1.9%	2.2%
Canadian population	35,152,370	35,535,348	35,832,513	36,264,604	36,708,083	37,058,856	37,589,262	38,007,166	38,226,498	38,929,902
Growth rate	1.2%	1.1%	0.8%	1.2%	1.2%	1.0%	1.4%	1.1%	0.6%	1.8%

Eligible client population by age group, gender and region: March 2023

The NIHB program recognizes the importance of representative data for our gender diverse client population. As of 2020, clients can choose Male, Female or Another Gender as a gender identifier when applying for or updating their registration with Indigenous Services Canada, which is captured in population and benefit utilization data. As the total number of clients who have chosen Another Gender to-date is low, these data have been suppressed in certain provincial/territorial population totals, in keeping with government practices for safe-guarding the privacy of individuals. All clients are included in National totals.

Of the 936,006 NIHB eligible clients on the SVS as of March 31, 2023 49.2% were male (460,653), 50.8% were female (475,234) and a small percentage of clients selected another gender (119).

The average age of the eligible client population was 35 years of age. By region, this average ranged from a low of 29 years of age in Nunavut to a high of 42 years of age in British Columbia.

The average age of the male and female eligible client population was 34 years and 36 years respectively. The average age for males ranged from a low of 28 years in Nunavut to a high of 40 years in British Columbia. The average age for females varied from a low of 29 years in Nunavut to a high of 44 years in British Columbia.

Population analysis by age group: March 2023

The overall NIHB client population is relatively young compared to the general Canadian population. The share of the NIHB client population under 20 years of age was 28.6% compared to 21.1% for the Canadian population. Nearly two-thirds (61.5%) of eligible clients are under the age of 40, compared to 48.6% for the Canadian population. The average age of NIHB clients is 35 compared to 42 years of age for the Canadian population.

Source: SVS and Statistics Canada CANSIM table 051-0001, Population by Age and Sex Group, adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 2.4: Proportion of Canadian population and of the NIHB client population by age group

This image is a bar graph that visually describes the proportion of the Canadian population and the NIHB eligible population by age group, as follows:

• the percentage of the Canadian population aged 0 to 9 is 10.1%
• the percentage of the NIHB population aged 0 to 9 is 10.9%
• the percentage of the Canadian population aged 10 to 19 is 10.9%
• the percentage of the NIHB population aged 10 to 19 is 17.8%
• the percentage of the Canadian population aged 20 to 29 is 13.4%
• the percentage of the NIHB population aged 20 to 29 is 17.2%
• the percentage of the Canadian population aged 30 to 39 is 14.1%
• the percentage of the NIHB population aged 30 to 39 is 15.7%
• the percentage of the Canadian population aged 40 to 49 is 12.8%
• the percentage of the NIHB population aged 40 to 49 is 12.0%
• the percentage of the Canadian population aged 50 to 59 is 13.0%
• the percentage of the NIHB population aged 50 to 59 is 11.4%
• the percentage of the Canadian population aged 60 and over is 25.6%
• the percentage of the NIHB population aged 60 and over is 15.1%

A comparison of March 2019 to March 2023 eligible client population shows an aging population. The client population 40 and above, as a proportional share of the overall client population, increased from 36.3% in 2019 to 38.5% in 2023. The senior population, defined as clients 65 years of age and over, has been slowly increasing as a proportion of the total NIHB client population. In 2014, seniors represented 7.0% of the overall NIHB population. Most recently in 2023, seniors accounted for 10.3%.

Source: SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 2.5: Proportion of eligible NIHB client population by age group

This image is a bar graph that visually describes the proportion of First Nations population and of Inuit population by age group as follows:

• the proportion of the First Nations and Inuit population aged 0 to 9 was 13.9% in March 2019 and 10.9% in March 2023
• the proportion of the First Nations and Inuit population aged 10 to 19 was 17.7% in March 2019 and 17.8% in March 2023
• the proportion of the First Nations and Inuit population aged 20 to 29 was 17.8% in March 2019 and 17.2% in March 2023
• the proportion of the First Nations and Inuit population aged 30 to 39 was 14.3% in March 2019 and 15.7% in March 2023
• the proportion of the First Nations and Inuit population aged 40 to 49 was 12.1% in March 2019 and 12.0% in March 2023
• the proportion of the First Nations and Inuit population aged 50 to 59 was 11.4% in March 2019 and 11.4% in March 2023
• the proportion of the First Nations and Inuit population aged 60 and over was 12.8% in March 2019 and 15.1% in March 2023

Factors influencing NIHB program sustainability: 2022 to 2023

Cost and service pressures on the Canadian health system have been linked to factors such as an aging population and the increased demand for and utilization of health goods, particularly pharmaceuticals, and services. In addition to these factors, NIHB program expenditures are driven by the number of eligible clients and their medical needs. A significant proportion of NIHB clients live in small and remote communities, and require medical transportation to access health services that are not available locally.

Factors influencing NIHB program expenditures

NIHB expenditures by benefit ($ millions): 2022 to 2023

In 2022 to 2023, total NIHB program benefit expenditures were $1,891.7 million. This represents an increase of 11.6% over NIHB expenditures of $1,695.3 million in 2021 to 2022. Medical transportation costs represented the largest proportion of expenditures at 37.6% ($710.6 million), followed by pharmacy benefit costs at 32.7% ($617.8 million) and dental benefit costs at 17.6% ($332.8 million).

NIHB medical transportation, pharmacy and dental benefit expenditures accounted for 87.8% of all NIHB expenditures in 2022 to 2023.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 3.1: NIHB expenditures by benefit ($ millions)

This image is a pie chart visually describing NIHB expenditures in millions and proportion of total by benefit area for fiscal year 2022 to 2023, as follows.

• total expenditure for medical transportation is $710.6 and proportion of total expenditures is 37.6%
• total expenditure for pharmacy is $617.8 and proportion of total expenditures is 32.7%
• total expenditure for dental is $332.8 and proportion of total expenditures is 17.6%
• total expenditure for medical supplies and equipment is $65.7 and proportion of total expenditures is 3.5%
• total expenditure for mental health counselling is $98.9 and proportion of total expenditures is 5.2%
• total expenditure for vision care is $49.5 and proportion of total expenditures is 2.6%
• total expenditure for other is $16.5 and proportion of total expenditures is 0.9%

Not reflected in the $1,891.7 million in NIHB expenditures are approximately $57.3 million in administration costs. More detail is provided in Section 11.

NIHB expenditures and growth by benefit: 2022 to 2023

NIHB program benefit expenditures increased by 11.6%, or $196.4 million from fiscal year 2021 to 2022. The highest net increase in expenditures were in the NIHB medical transportation and pharmacy benefits at $108.4 and $41.5 million respectively. Factors affecting benefit expenditure growth are discussed in subsequent sections of this report.

Expenditures in the "other" category are related to program oversight, including supplementary funding for the FNHA for additional clients who became eligible after the transfer of responsibilities due to changes in federal legislation, as well as contribution agreements to support engagement with Indigenous partner organizations.

NIHB expenditures by benefit and region (thousands of dollars): 2022 to 2023

Manitoba accounted for the highest proportion of total expenditures at $451.8 million, or 23.9% of the national total, followed by Ontario at $365.1 million (19.3%), and Saskatchewan at $363.3 million (19.2%). By comparison, the lowest expenditures were in the Atlantic region at $92.5 million (4.9%).

Headquarters expenditures by benefit type represent costs paid for claims processing services. Headquarters expenditures in the other category are comprised of operational expenditures associated with NIHB program oversight and policy development. This includes arrangements with the FNHA to provide funding for additional clients who became eligible following the transfer of responsibilities in 2013, due to changes in federal legislation, as well as contribution agreements with Indigenous partner organizations, such as the Assembly of First Nations and Inuit Tapiriit Kanatami, and regional Indigenous organizations. Headquarters expenditures account for 1.6% ($30.3 million) of total NIHB expenditures, and do not include the $57.3 million in administration (HQ) costs outlined in Section 11.

NIHB annual expenditures ($ Millions) and percentage change

In 2022 to 2023, NIHB program expenditures totalled $1,891.7 million, an increase of 11.6% from $1,695.1 million in 2021 to 2022. Since 2013 to 2014, total expenditures have grown by 84.3%. The annualized rate of growth over this period was 5.8%. There has been wide variation in growth rates between 2013 to 2014 and 2022 to 2023, from a low of -7.1% in 2013 to 2014 to a high of 13.7 % in 2021 to 2022.

Fluctuations in NIHB expenditures growth rates are impacted by a number of factors, as set out in figure 3.1. Changes in the eligible client population have a direct impact on growth. Notable examples include the transfer of responsibility for First Nations clients residing in B.C. to the FNHA in 2013 to 2014, the creation of the Qalipu Mi'kmaq band in 2011, and an increase in eligible clients as a result of amendments to the Indian Act. The coronavirus (COVID-19) outbreak and provincial/territorial public health restrictions on the provision of in-person services in fiscal year 2020 to 2021, along with larger than typical utilization of NIHB benefits in fiscal 2021 to 2022 once restrictions were ended, impacted growth in those years.

If expenditures for FNHA eligible clients are excluded from 2012 to 2013 and 2013 to 2014 total NIHB expenditures, then the growth rate for 2013 to 2014 would have been 2.8%.

Source: FIRMS and FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 3.2 NIHB annual expenditures ($ Millions) and percentage change

This image is a bar graph which visually describes NIHB annual expenditures in millions and annual percentage change by fiscal year, as follows:

• 2013 to 2014 is $1,026 and -7.1%
• 2014 to 2015 is $1,031 and 0.5%
• 2015 to 2016 is $1,101 and 6.7%
• 2016 to 2017 is $1,207 and 9.7%
• 2017 to 2018 is $1,309 and 8.4%
• 2018 to 2019 is $1,391 and 6.2%
• 2019 to 2020 is $1,519 and 9.3%
• 2020 to 2021 is $1,491 and -1.9%
• 2021 to 2022 is $1,695 and 13.7%
• 2022 to 2023 is $1,892 and 11.6%

NIHB annual expenditures by benefit (thousands of dollars)

In the 10 year period ending 2022 to 2023, expenditures for NIHB mental health services and medical transportation benefits have grown more than other benefit areas. NIHB mental health expenditures had the highest percentage growth at 598.5%, from $14.2 million in 2013 to 2014 to $98.9 million in 2022 to 2023. NIHB medical transportation had the highest expenditure growth from $352.0 million in 2013 to 2014 to $710.6 million in 2022 to 2023, a change of 101.9%.

Over the same period, NIHB medical supplies and equipment (MS&E) expenditures increased by 114.1% and NIHB dental expenditures increased by 60.6%.

Per capita NIHB expenditures by region: 2022 to 2023

Expenditures per capita are total NIHB expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

The national per capita expenditures for all benefits in 2022 to 2023 were $1,989. Manitoba had the highest per capita cost at $2,724. The Northern region followed with a per capita cost of $2,473. The higher than average per capita cost for these regions is partly attributable to high medical transportation costs due to the large number of First Nations and Inuit clients living in remote or fly-in only northern communities. By contrast, the Atlantic region had the lowest per capita cost of $1,329, due to the comparatively low medical transportation expenditures in the region.

Source: FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 3.3: Per capita NIHB expenditures by region

This bar graph visually describes NIHB annual expenditures in millions by fiscal year and by region. Per capita expenditures:

• for Atlantic are $1,329
• for Quebec are $1,537
• for Ontario are $1,596
• for Manitoba are $2,724
• for Saskatchewan are $2,197
• for Alberta are $2,062 and
• for the North are $2,473
• national per capita expenditures are $1,989

Distribution of NIHB pharmacy expenditures ($ Millions): 2022 to 2023

The NIHB pharmacy benefit is comprised of multiple components. Prescription drugs paid through the Health Information and Claims Processing Services (HICPS) system was the largest piece, accounting for $485.9 million or 78.7% of all NIHB pharmacy expenditures, followed by over-the-counter (OTC) and controlled access (CAD) drugs (HICPS) which totalled $105.0 million or 17.0%.

Regional Drugs, at $1.9 million or 0.3% of pharmacy benefit costs, refers to prescription drugs and OTC medications paid through Indigenous Services Canada regional offices.

Contribution agreements, which accounted for $13.0 million or 2.1% of total pharmacy benefit costs, are used to fund the provision of pharmacy benefits through agreements such as those with the Mohawk Council of Akwesasne in Ontario and the Bigstone Cree Nation in Alberta.

HICPS contract costs related to claims processing through the HICPS system totalled $11.9 million or 1.9% in 2022 to 2023.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 4.1: Distribution of NIHB pharmacy expenditures ($ Millions)

This image is a pie chart which visually describes NIHB pharmacy expenditures in millions and proportion of total expenditures by component type:

• prescription drugs (HICPS) are $485.98 and 78.7%
• OTC/CAD drugs (HICPS) are $105.0 and 17.0%
• HICPS contract costs are $11.9 and 1.9%
• contribution agreements are $13.0 and 2.1%
• regional drugs are $1.9 and 0.3%
• total expenditures $617.8

Total NIHB pharmacy expenditures by type and region (thousands of dollars): 2022 to 2023

Prescription drug costs paid through the HICPS system represented the largest component of total NIHB Pharmacy costs accounting for $485.9 million or 78.7%. The Saskatchewan region had the largest proportion of these costs at 21.0%, followed by Manitoba at 19.8% and Ontario at 18.9%.

The next highest component was over-the-counter (OTC) and controlled access drug (CAD) costs at $105.0 million or 17.0%. The regions of Manitoba (22.7%), Saskatchewan (21.9%) and Alberta (16.9%) had the largest proportions of these costs in 2022 to 2023.

Annual NIHB pharmacy expenditures

NIHB pharmacy expenditures increased by 7.2% during fiscal year 2022 to 2023. Over the past five years, growth in pharmacy expenditures has ranged from a high of 8.3% in 2019 to 2020 to a low of 1.0% in 2018 to 2019.

The five year annualized growth rate for NIHB pharmacy expenditures is 5.5%. The introduction of lower cost generic drugs as they become available on the market have kept pharmacy benefit growth moderate. As well, NIHB has negotiated Product Listing Agreements (PLA) with drug manufacturers to allow for the coverage of certain medications at a reduced price through the use of rebates. On March 31, 2023, NIHB had over 300 PLA in effect.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 4.2: Annual NIHB pharmacy expenditures and percentage change

This image is a bar graph which visually describes NIHB annual pharmacy expenditures in millions and percentage change by fiscal year, as follows:

• 2018 to 2019 expenditures are $471.6 million and growth is 1.0%
• 2019 to 2020 expenditures are $510.7 million and growth is 8.3%
• 2020 to 2021 expenditures are $550.9 million and growth is 7.9%
• 2021 to 2022 expenditures are $576.3 million and growth is 4.6%
• 2022 to 2023 expenditures are $617.8 million and growth is 7.2%

Per capita NIHB pharmacy expenditures by region: 2022 to 2023

Expenditures per capita are total NIHB pharmacy expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

In 2022 to 2023, the national per capita expenditure for NIHB Pharmacy benefits was $647. This was an increase of 4.7% from the $618 recorded in 2021 to 2022.

Quebec had the highest per capita NIHB Pharmacy expenditures at $778, followed by Saskatchewan at $766.

The Northern region had the lowest per capita expenditures at $455 followed by Ontario at $498. Relatively low per capita expenditures in the North are attributed to lower than average utilization rates and also a younger population utilizing lower cost medications.

Source: FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 4.3: Per capita NIHB pharmacy expenditure by region

This image is a bar graph which visually describes NIHB pharmacy expenditures per capita by region, as follows:

• Atlantic is $658
• Quebec is $778
• Ontario is $498
• Manitoba is $725
• Saskatchewan is $766
• Alberta is $732
• North is $455 and
• National is $647

NIHB pharmacy utilization rates by region

Utilization rates represent the number of clients who received at least one pharmacy benefit paid through the HICPS system in the fiscal year, as a proportion of the total number of eligible clients. In 2022 to 2023, the national utilization rate was 60% for NIHB Pharmacy benefits paid through the HICPS system.

The rates understate the actual level of utilization as the data do not include pharmacy services provided through contribution agreements and benefits provided through community health facilities. For example, the HICPS system does not capture any data on services used by the Bigstone Cree Nation client population in Alberta and the Akwesasne client population in Ontario. If these populations were removed, the utilization rate for pharmacy benefits in Alberta would have been 68.0% and for Ontario the utilization rate for pharmacy benefits would have been 53.1% in 2022 to 2023. If both the Bigstone and Akwesasne client populations were removed from the overall NIHB population, the national utilization rate for pharmacy benefits would have been 61.2%.

NIHB pharmacy claimants by age group, gender and region: 2022 to 2023

Of the 936,006 clients eligible to receive benefits under the NIHB program, a total of 559,355 claimants received at least one pharmacy item paid through the Health Information and Claims Processing Services (HICPS) system in 2022 to 2023. Of this total, 317,683 were female (57%) and 241,672 were male (43%). This compares to the total eligible population where 51% were female and 49% were male.

The average age of pharmacy claimants was 38 years. The average age for female and male claimants was 38 and 37 years of age, respectively.

Distribution of eligible NIHB population, pharmacy expenditures and pharmacy incidence by age group: 2022 to 2023

In 2022 to 2023, 3.5% of all clients were in the 0 to 4 age group, but this group accounted for only 0.5% of all pharmacy claims made and only 0.7% of total pharmacy expenditures. In contrast, 10.3% of all eligible clients were in the 65+ age group, but accounted for 25.2% of all pharmacy claims submitted and 17.8% of total pharmacy expenditures.

During 2022 to 2023, the average claimant aged 65 or more submitted 91 claims compared to 71 claims for their counterpart in the 60 to 64 age group and 6 claims for the average claimant in the 0 to 4 age group.

Source: HICPS, FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 4.4: Distribution of eligible NIHB population, pharmacy expenditures and pharmacy incidence by age group

This image is a bar graph which visually describes percentage of NIHB annual pharmacy expenditures and incidence by age group, as follows:

Age	Eligible clients	Expenditures	Incidence
0-4	3.5%	0.7%	0.5%
5-9	7.4%	1.4%	1.0%
10-14	8.9%	1.9%	1.2%
15-19	8.9%	3.1%	2.0%
20-24	8.4%	4.1%	2.7%
25-29	8.7%	6.5%	5.1%
30-34	8.5%	8.2%	7.2%
35-39	7.2%	8.2%	7.8%
40-44	6.3%	8.5%	8.0%
45-49	5.7%	8.7%	8.6%
50-54	5.8%	10.0%	9.7%
55-59	5.6%	10.7%	10.6%
60-64	4.8%	10.1%	10.4%
65+	10.3%	17.8%	25.2%
Total	100.0%	100.0%	100.0%

An examination of pharmacy benefit cost per NIHB claimant indicates that these expenditures vary according to age. For example, in 2022 to 2023 the average cost per child aged 0 to 9 years was $234. The cost increased steadily for every age group, with claimants aged 35-39 having an average cost of $1,148, comparable to the total average claimant cost of $1,056. Claimants aged 60-64 years had the highest cost per claimant with an average of $1,854 for all pharmacy claims received throughout the fiscal year.

NIHB Top ten therapeutic classes by number of claimants: 2022 to 2023

Table 4.5 ranks the top ten therapeutic classes of prescription drugs according to number of claimants. In 2022 to 2023, Penicillins had the highest number of distinct claimants at 160,840. Antidepressants ranked second in number of claimants with 121,413 followed by Proton Pump Inhibitors with 111,091 claimants.

NIHB OTC (including CAD) drug claims incidence by therapeutic class: 2022 to 2023

Table 4.6 looks at the number of claims by therapeutic classification for over-the-counter (OTC) drugs.

Vitamins accounted for the largest number of OTC drug claims in 2022 to 2023 at 1.5 million paid claims, or 32.7% of all OTC claims. Central nervous systems agents had the next highest share of OTC claims at 1.0 million (22.1%) followed by gastrointestinal drugs at 365,751 claims (8.0%).

Distribution of NIHB MS&E expenditures ($ Millions): 2022 to 2023

The NIHB MS&E benefit is comprised of multiple components. The cost of medical equipment paid through the HICPS system was the largest component, accounting for $44.6 million or 68.5% of all NIHB MS&E expenditures, followed by medical supplies paid through HICPS which totalled $19.2 million or 29.5%.

Contribution agreements, which accounted for $0.3 million or 0.5% of total MS&E benefit costs, are used to fund the provision of benefits through agreements such as those with the Mohawk Council of Akwesasne in Ontario and the Bigstone Cree Nation in Alberta.

Regional MS&E, which refers to MS&E items paid through Indigenous Services Canada regional offices, accounted for $0.5 million or 0.8%.

HICPS contract costs related to claims processing through the HICPS system totalled $0.5 million or 0.7% of MS&E expenditures in 2022 to 2023.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 5.1: Distribution of NIHB MS&E expenditures ($ Millions)

This image is a pie chart which visually describes NIHB medical supplies and equipment expenditures in millions and proportion of total expenditures by component type:

• medical supplies (HICPS) are $19.2 and 29.5%
• medical equipment (HICPS) are $44.6 and 68.5%
• contract costs are $0.5 and 0.7%
• contribution agreements are $0.3 and 0.5%
• MS&E (regional) are $0.5 and 0.8%
• total expenditures $65.7

Total NIHB MS&E expenditures by type and region (thousands of dollars): 2022 to 2023

Medical equipment costs paid through the HICPS system represented the largest component of total NIHB MS&E costs accounting for $44.6 million or 68.5%. Saskatchewan had the largest proportion of these costs at 23.8%, followed by Manitoba at 22.2% and Alberta at 19.8%.

The next highest component was medical supplies costs at $19.2 million or 29.5%. Saskatchewan (24.4%), Alberta (19.0%) and Manitoba (18.3%) had the largest proportions of these costs in 2022 to 2023.

All other MS&E expenditures, including contribution agreement costs, account for only 2.0% of total MS&E expenditure.

Annual NIHB MS&E expenditures

NIHB MS&E expenditures increased by 17.3% during fiscal year 2022 to 2023. The coronavirus (COVID-19) outbreak and provincial/territorial public health restrictions on the provision of in-person services in fiscal year 2020 to 2021, along with larger than typical utilization of the benefit in fiscal 2021 to 2022 once restrictions were ended, impacted growth in the past two years. Over the past five years, growth in MS&E expenditures has ranged from a high of 17.3% in 2021 to 2022 to a low of -3.2% in 2020 to 2021.

The five year annualized growth rate for NIHB MS&E expenditures is 8.5%.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 5.2: Annual NIHB MS&E expenditures

This is a bar graph which visually describes NIHB annual pharmacy expenditures in millions and percentage change by fiscal year, as follows:

• 2018 to 2019 are $46.5 and 15.7%
• 2019 to 2020 are $53.2 and 14.5%
• 2020 to 2021 are $51.5 and -3.2%
• 2021 to 2022 are $60.4 and 17.3%
• 2022 to 2023 are $65.7 and 8.6%

Per capita NIHB MS&E expenditures by region: 2022 to 2023

Expenditures per capita are total NIHB MS&E expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

In 2022 to 2023, the national per capita expenditure for NIHB MS&E benefits was $70. This was an increase of 6.2% from the $66 recorded in 2021 to 2022.

Alberta had the highest per capita NIHB MS&E expenditures at $95, followed by Saskatchewan and Manitoba at $93 and $84.

Quebec had the lowest per capita MS&E expenditures at $38 followed by Ontario at $44. Relatively low per capita expenditures in Quebec and Ontario are attributed to provincial programs which provide financial assistance for the provision of certain medical equipment items to all residents.

Source: FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 5.3: Per capita NIHB MS&E expenditures by region

This image is a bar graph which visually describes NIHB MS&E expenditures per capita by region, as follows:

• Atlantic has $69
• Quebec has $38
• Ontario has $44
• Manitoba has $84
• Saskatchewan has $93
• Alberta has $95
• North has $75 and
• National has $70

NIHB MS&E utilization rates by region

Utilization rates are the number of clients who received at least one MS&E benefit paid through the HICPS system in the fiscal year, as a proportion of the total number of eligible clients.

In 2022 to 2023, the national utilization rate was 8.3% for NIHB MS&E benefits paid through the HICPS system.

The rates understate the actual level of utilization as the data do not include MS&E services provided through contribution agreements and benefits provided through community health facilities.

NIHB MS&E claimants by age group, gender and region: 2022 to 2023

Of the 936,006 clients eligible to receive benefits under the NIHB program, a total of 77,818 claimants, representing 8.3% of the NIHB client population, received at least one MS&E item paid through the Health Information and Claims Processing Services (HICPS) system in 2022 to 2023. Of this total, 45,166 were female (58%) and 32,652 were male (42%). This compares to the total eligible population where 51% were female and 49% were male.

The average age of MS&E claimants was 50 years. The average age for female and male claimants was 51 and 49 years of age, respectively.

Distribution of eligible NIHB population, MS&E expenditures and MS&E incidence by age group: 2022 to 2023

In 2022 to 2023, 3.5% of all clients were in the 0 to 4 age group, but this group accounted for only 1.6% of all MS&E claims made and only 1.9% of total MS&E expenditures. In contrast, 10.3% of all eligible clients were in the 65+ age group, but they accounted for 36.3 % of all MS&E claims submitted and 35.7% of total MS&E expenditures.

The average MS&E claimant submitted 5 claims in 2022 to 2023, a rate that is relatively consistent over all age groups.

Source: HICPS, FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 5.4: Distribution of eligible NIHB population, MS&E expenditures and MS&E incidence by age group

This image visually describes NIHB annual MS&E expenditures and incidence by age group, as follows:

Age	Eligible Clients	Expenditures	Incidence
0-4	3.5%	1.9%	1.6%
5-9	7.4%	3.5%	3.1%
10-14	8.9%	2.9%	2.7%
15-19	8.9%	2.9%	2.7%
20-24	8.4%	2.4%	2.6%
25-29	8.7%	2.8%	3.1%
30-34	8.5%	3.5%	4.1%
35-39	7.2%	4.1%	4.2%
40-44	6.3%	4.4%	4.6%
45-49	5.7%	6.2%	6.2%
50-54	5.8%	8.5%	8.2%
55-59	5.6%	10.2%	10.1%
60-64	4.8%	10.9%	10.8%
65+	10.3%	35.7%	36.3%
Total	100.0%	100.0%	100.0%

NIHB medical supplies expenditures by category: 2022 to 2023

In 2022 to 2023, medical surgical supplies such as incontinence items accounted for 79.0% of all medical supply expenditures, an increase from the 74.3% recorded in 2021 to 2022. Self-care supplies, such as enteral feeding bags, represented 5.8% of all medical supply expenditures, followed by audiology supplies, such as hearing aid batteries at 4.9%.

Source: HICPS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 5.5: NIHB medical supplies expenditures by category

This bar graph visually describes percentage of NIHB medical equipment expenditures by category, as follows:

• medical surgical supplies is 79.0%
• self-care supplies is 5.8%
• audiology supplies is 4.9%
• prosthetic supplies is 4.0%
• oxygen supplies is 2.9%
• respiratory supplies is 1.6%
• all others is 1.8%

NIHB medical equipment expenditures by category: 2022 to 2023

In 2022 to 2023, mobility equipment such as wheelchairs accounted for 20.2% of all medical equipment expenditures, a decrease from the 21.7% recorded in 2021 to 2022. Audiology equipment, such as hearing aids, represented 19.8% of all medical equipment expenditures, followed by respiratory equipment such as CPAP machines at 10.8%.

Source: HICPS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 5.6: NIHB medical supplies expenditures by category

This bar graph visually describes percentage of NIHB medical equipment expenditures by category, as follows:

• mobility equipment is 20.2%
• audiology equipment is 19.8%
• self-care equipment is 10.8%
• respiratory equipment is 10.5%
• oxygen equipment is 8.7%
• orthotics equipment is 8.1%
• all others is 16.0%

Distribution of NIHB dental expenditures ($ millions): 2022 to 2023

NIHB dental expenditures are comprised of multiple distinct components. Fee-for-service dental costs paid through the HICPS system represented the largest expenditure portion, accounting for $304.9 million or 91.6% of all NIHB dental costs.

The next highest component was contribution agreements, which accounted for $15.5 million or 4.7% of total dental expenditures. Contribution agreements are used to fund the provision of dental benefits through agreements such as those with the Mohawk Council of Akwesasne in Ontario and the Bigstone Cree Nation in Alberta.

Expenditures for contract dentists providing services to clients in remote communities totalled $8.7 million or 2.6% of total costs.

HICPS contract costs related to claims processing through the HICPS system totalled $3.7 million or 1.1% in 2022 to 2023.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 6.1: Distribution of NIHB dental expenditures ($ millions)

This image is a pie chart which visually describes NIHB dental expenditures in millions by component type.

• expenditures for fee-for-service (HICPS) are $304.9 and 91.6%
• contract dentists is $8.7 and 2.6%
• HICPS contract costs is $3.7 and 1.1%
• contribution agreements is $15.5 and 4.7%
• total dental expenditures are $332.8

Total NIHB dental expenditures by type and region (thousands of dollars): 2022 to 2023

Of the $332.8 million in NIHB dental expenditures in 2022 to 2023, Saskatchewan (21.2%), Ontario (20.2%) and Alberta (19.6%) had the largest overall proportion. Saskatchewan had the highest total dental expenditures at $70.5 million and the Atlantic region had the lowest total dental expenditures at $12.6 million.

Annual NIHB dental expenditures

NIHB dental expenditures increased by 10.1% during fiscal year 2022 to 2023. The coronavirus (COVID-19) outbreak and provincial/territorial public health restrictions on the provision of in-person services in fiscal year 2020 to 2021, along with larger than typical utilization of the benefit in fiscal 2021 to 2022 once restrictions were ended, significantly impacted growth in those two years.

Over the last five years, annual growth rates for NIHB dental expenditures have ranged from a high of 27.9% in 2021 to 2022 to a low of negative 16.5% in 2020 to 2021.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 6.2: NIHB Dental expenditures and annual percentage change

This image is a bar graph which visually describes NIHB dental expenditures in millions and annual percentage change by fiscal year, as follows:

• 2018 to 2019 is $269.0 and 8.0%
• 2019 to 2020 is $282.9 and 5.2%
• 2020 to 2021 is $236.3 and -16.5%
• 2021 to 2022 is $302.2 and 27.9%
• 2022 to 2023 is $332.8 and 10.1%

NIHB dental expenditures by region

Per capita NIHB dental expenditures by region: 2022 to 2023

Expenditures per capita are total NIHB dental expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

In 2022 to 2023, national per capita NIHB dental expenditures were $352, an increase of 7.7% from $327 in 2021 to 2022.

Alberta had the highest per capita dental expenditures at $495, followed by Saskatchewan at $426 and the Northern region at $413. The Atlantic region had the lowest per capita dental expenditures at $182 per eligible client.

Per capita values reflect NIHB dental expenditures only, and do not include additional dental services that may be provided to First Nations and Inuit populations through other Indigenous Services Canada programs or through transfers and other arrangements.

Source: FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 6.3: Per capita NIHB dental expenditures by region

This image is a bar graph which visually describes NIHB dental expenditures per capita by region, as follows:

• Atlantic is $182
• Quebec is $245
• Ontario is $293
• Manitoba is $363
• Saskatchewan is $426
• Alberta is $495
• North is $413
• National is $352

NIHB dental utilization rates by region

Utilization rates reflect the number of clients who, during the fiscal year, received at least one dental service paid through the HICPS system as a proportion of the total number of eligible clients.

In 2022 to 2023, the national utilization rate for dental benefits paid through the HICPS system was 35%. National NIHB dental utilization rates in 2020 to 2021 were impacted by provincial/territorial public health restrictions on the provision of in-person services due to the coronavirus (COVID-19) outbreak.

Dental utilization rates vary across the regions with the highest dental utilization rates found in Alberta and Quebec at 41% and 39% respectively. The lowest dental utilization rate was in Yukon (31%). Please note that the dental utilization rates understate the actual level of access, as these data do not include contract dental services provided in some regions or dental services provided through contribution agreements. For example, HICPS data does not capture any services utilized by the Bigstone Cree Nation. If this client population was removed from the Alberta Region's population, the utilization rate for dental benefits for Alberta would have been 44% in 2022 to 2023. The same scenario would apply for the Ontario Region. If the Akwesasne client population in Ontario were to be removed, the utilization rate for dental benefits in Ontario would have been 34%. The utilization rate also does not reflect services received through Indigenous Services Canada programs such as Community Oral Health Services which include dental therapy services and the Children's Oral Health Initiative (COHI).

Over the two year period between 2021 to 2022 and 2022 to 2023, 442,128 distinct clients received NIHB dental services through HICPS, resulting in an overall 47% utilization rate over this period.

NIHB dental claimants by age group, gender and region: 2022 to 2023

Of the 936,006 clients eligible to receive dental benefits through the NIHB program, 330,494 claimants (35%) received at least one dental procedure paid through the HICPS system in 2022 to 2023.

Of this total, 186,231 were female (56%) and 144,263 were male (44%), compared to the total eligible NIHB population where 51% were female and 49% were male.

The average age of dental claimants was 33 years, indicating clients tend to access dental services at a slightly younger age compared to pharmacy services (37 years of age). The average age for female and male claimants was 34 and 32 years of age respectively.

Approximately 33% of all dental claimants were under 20 years of age. 36% of male claimants were in this age group compared to 30% of female claimants. Approximately 8% of all claimants were seniors aged 65 and over in 2022 to 2023.

NIHB fee-for-service dental expenditures by service category: 2022 to 2023

In 2022 to 2023, expenditures for restorative services (crowns, fillings, etc.) were the highest of all dental service categories at $131.1 million. Diagnostic services (examinations, radiographs, etc.) at $35.8 million and preventive services (scaling, sealants, etc.) at $33.0 million were the next highest service categories. Rounding out the top 5 were oral surgery (extractions, etc.) at $32.0 million and endodontic services (root canal treatments, etc.) at $21.6 million.

In 2022 to 2023, the three highest dental procedures by expenditure were composite restorations ($111.2 million), scaling ($24.9 million) and extractions ($22.6 million).

Distribution of eligible NIHB population, dental expenditures and incidence by age group: 2022 to 2023

The ratio of incidence to expenditures is relatively consistent across most age groupings; however, there are notable exceptions. For children aged 5 to 14, a larger number of low-cost procedures, such as fillings, are provided, so this group accounts for 21.7% of claims, but only 16.5% of expenditures.

Source: HICPS and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 6.4: Distribution of eligible NIHB population, dental expenditures and incidence by age group

This image visually describes distribution percentage of NIHB dental clients, incidence and expenditures by age group, as follows:

Age	Eligible Clients	Expenditures	Incidence
0-4	3.5%	3.4%	3.5%
5-9	7.4%	7.2%	9.9%
10-14	8.9%	9.3%	11.8%
15-19	8.9%	11.9%	11.2%
20-24	8.4%	9.6%	8.6%
25-29	8.7%	9.4%	8.7%
30-34	8.5%	8.5%	8.1%
35-39	7.2%	7.0%	6.6%
40-44	6.3%	5.9%	5.7%
45-49	5.7%	5.4%	5.2%
50-54	5.8%	5.6%	5.3%
55-59	5.6%	5.2%	4.9%
60-64	4.8%	4.5%	4.1%
65+	10.3%	7.1%	6.3%
Total	100.0%	100.0%	100.0%

Distribution of NIHB medical transportation expenditures ($ Millions): 2022 to 2023

In 2022 to 2023, NIHB medical transportation expenditures totalled $710.6 million.

Contribution agreements for the management of medical transportation benefits by First Nations communities, territorial governments and other organizations represented the largest component, accounting for $316.5 million, or 44.5% of total benefit expenditures.

Of benefit expenditures managed by the NIHB program, living expenses at $98.2 million (13.8%), scheduled flights at $97.4 million (13.7%) and air ambulance at $92.8 million (13.1%) were the largest expenditures, accounting for a combined total of over 40%.

Rounding out medical transportation expenditures are costs for land ambulance at $61.4 million (8.6%), land and water transportation at $33.6 million (4.7%) and chartered flights at $10.7 million (1.5%).

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 7.1: Distribution of NIHB medical transportation expenditures ($ Millions)

This image is a pie chart which visually describes NIHB medical transportation expenditures and percentage by type, as follows: Expenditures for scheduled flights are $97.4 million and 13.7%, living expenses are $98.2 million and 13.8%, air ambulances are $92.8 million and 13.1%, land ambulances are $61.4 million and 8.6%, land and water transportation are $33.6 million and 4.7%, chartered flights are $10.7 million and 1.5% and contribution agreements are $316.5 million and 44.5% for a total of $710.6 million.

Annual NIHB medical transportation expenditures

NIHB medical transportation expenditures increased by 18.0% in 2022 to 2023 compared to the previous year. The coronavirus (COVID-19) outbreak and provincial/territorial public health restrictions on the provision of in-person services in fiscal year 2020 to 2021, along with larger than typical utilization of the medical transportation benefit in fiscal 2021 to 2022 once restrictions were ended, impacted growth in those two years. Over the past five years, overall medical transportation costs have grown by 43.5% from $495.0 million in 2018 to 2019 to $710.6 million in 2022 to 2023.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 7.2: Annual NIHB medical transportation expenditures

This image is a bar graph which visually describes NIHB medical transportation expenditures and percentage growth by year, as follows:

• 2018 to 2019 expenditures are $495.0 and percentage change 7.7%
• 2019 to 2020 are $537.2 and 8.5%
• 2020 to 2021 are $525.7 and -2.1%
• 2021 to 2022 are $602.2 and 14.6%
• 2021 to 2022 are $710.6 and 18.0%

On a regional basis, the highest 5 year growth rate was in Saskatchewan where expenditures grew by 52.5% from $75.3 million in 2018 to 2019 to $114.9 million in 2022 to 2023. This was followed by Manitoba with an increase of 48.5% from $157.0 million in 2018 to 2019 to $233.1 million in 2022 to 2023.

Manitoba had the highest total medical transportation expenditures at $233.1 million in 2022 to 2023, followed by Ontario at $140.3 million and Saskatchewan at $114.9 million.

NIHB medical transportation expenditures by type and region (thousands of dollars): 2022 to 2023

In 2022 to 2023 Manitoba had the highest overall NIHB medical transportation expenditures at $233.1 million, primarily as a result of air transportation, which totalled $131.5 million. High medical transportation costs in the region reflect in part the large number of First Nations clients living in remote or fly-in only northern communities.

Ontario had the second highest medical transportation expenditures total in 2022 to 2023 at $140.3 million. Saskatchewan and the Northern region followed at $114.8 million and $103.9 million, respectively.

Per capita NIHB medical transportation expenditures by region: 2022 to 2023

Expenditures per capita are total NIHB medical transportation expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

In 2022 to 2023, the national per capita expenditure for NIHB medical transportation benefits was $759, an increase of 15.5% from the $658 recorded in 2021 to 2022.

The Northern region had the highest per capita expenditure in medical transportation at $1,414, followed by Manitoba at $1,406. These expenditures reflect the large number of First Nations and Inuit clients living in remote or fly-in communities that need to urban centres to access health services.

In contrast, the Atlantic region had the lowest per capita expenditure at $252. Compared to other regions, this lower per capita cost is reflective of the geography of the region, which allows easier access to health services with less need for air travel.

Source: SVS and FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 7.3: Per capita NIHB medical transportation expenditures by region

This bar graph visually describes NIHB per capita medical transportation expenditures by region, as follows:

• Atlantic at $252
• Quebec at $347
• Ontario at $614
• Manitoba at $1,406
• Saskatchewan at $695
• Alberta at $546
• North at $1,414
• National at $759

Distribution of NIHB vision care expenditures ($ millions): 2022 to 2023

NIHB vision care expenditures are comprised of several distinct components. Fee-for-service vision care costs paid through HICPS system represented the largest expenditure portion, accounting for $44.9 million or 90.7% of all NIHB vision care costs.

The next highest component was contribution agreements, which accounted for $4.3 million or 8.8% of total vision care costs. Contribution agreements are used to fund First Nations or Inuit communities and organizations and/or Territorial Governments directly for the provision of vision care benefits.

HICPS contract costs related to claims processing through the HICPS system totalled $238 thousand or 0.5% in 2022 to 2023.

Regional vision care, at $49,600 or 0.1% of vision care benefit costs, refers to vision care claims paid through Indigenous Services Canada regional offices.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 8.1: Distribution of NIHB vision care expenditures ($ Millions)

This image is a pie chart which visually describes NIHB vision care expenditures and proportion of total expenditure by component type as follows: vision care (HICPS) at $44.9 million and 90.7%, vision care (regional) at $50 thousand and 0.1%, HICPS contract costs at $238 thousand and 0.5%, and contribution agreements at $4.3 million and 8.8%

NIHB vision care expenditures and growth by region (thousands of dollars): 2022 to 2023

NIHB vision care expenditures totalled $49.5 million in 2022 to 2023, an increase of 3.5% from the previous year.

Saskatchewan had the highest vision care costs at $10.6 million, or 22.1% of total vision care expenditure, followed by Alberta at $9.4 million (19.7%) and Ontario at $8.1 million (17.0%). Headquarters expenditures are costs related to claims processing through the HICPS system.

Annual NIHB vision care expenditures and percentage change

NIHB vision care expenditures increased by 3.5% during fiscal year 2022 to 2023. Over the past five years, growth in vision care expenditures has ranged from a high of 26.1% in 2019 to 2020 to a low of -13.9% in 2020 to 2021.

The five year annualized growth rate for NIHB vision care expenditures is 6.3%.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 8.2: Annual NIHB vision care expenditures

This image is a bar graph which visually describes NIHB vision care expenditures by year in millions and percentage change, as follows:

• 2018 to 2019 is $36.5 million and 8.6%
• 2019 to 2020 is $46.0 million and 26.1%
• 2020 to 2021 is $39.6 million and -13.9%
• 2021 to 2022 is $47.8 million and 20.8%
• 2022 to 2023 is $49.5 million and 3.5%

On a regional basis, the highest growth rate over this five year period was in Quebec where expenditures grew by 113.9% from $1.9 million in 2018 to 2019 to $4.1 million in 2022 to 2023. Manitoba had largest net increase in expenditures over this period, where costs grew by $3.0 million.

Per capita NIHB vision care expenditures by region: 2022 to 2023

Expenditures per capita are total NIHB vision care expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

In 2022 to 2023, the national per capita expenditure in NIHB vision care benefits was $53, an increase of 1.3% from the $52 recorded in 2021 to 2022.

Alberta had the highest per capita expenditure at $72, followed by Saskatchewan and the North at $64. The lowest per capita NIHB vision care benefit expenditure was in Ontario at $38.

Source: SVS and FST adapted by Program Analytics and Risk Mitigation

Text alternative for Figure 8.3: Per capita NIHB vision care expenditures by region

This image visually describes NIHB per capita vision care expenditures by region, as follows:

• Atlantic $60
• Quebec $49
• Ontario $38
• Manitoba $46
• Saskatchewan $64
• Alberta $72
• North $64
• National $53

NIHB vision care claimants by age group, gender and region: 2022 to 2023

Of the 936,006 clients eligible to receive benefits under the NIHB program, a total of 160,904 claimants, representing 17.2% of the NIHB client population, had at least one vision care claim paid through the Health Information and Claims Processing Services (HICPS) system in 2022 to 2023. Of this total, 97,247 were female (60.4%) and 63,657 were male (39.6%). This compares to the total eligible population where 51% were female and 49% were male.

The average age of vision care claimants was 36 years. The average age for female and male claimants was 37 and 36 years of age, respectively.