Province Needs to Resolve Barriers to Out-of-Province Care: AG
For release September 15 – Nova Scotia needs to create an alternative pathway for specialized out-of-province medical claims when local care isn’t an option, the Auditor General says in a new report.
“Patients without a Nova Scotian specialist face an unclear and difficult pathway to access required medical care outside the province,” Auditor General Kim Adair says in a new report released today.
“The duplication of review efforts by the Department and the Program Administrator has slowed response times and is not cost effective.”
Under the Canada Health Act, provinces and territories in Canada must ensure that all eligible residents have access to medically necessary insured health services. When these services are not available in a patient’s home province, there are options to seek treatment elsewhere.
In Nova Scotia, the out-of-province claims program is vital for ensuring access to medical care for diagnoses like eye cancer, lymphedema, gender dysphoria and for patients who are candidates for lung transplants.
In the more than four years between January 1, 2022 and March 31, 2026, the program received 1,669 application requests, with more than 90% approved at a total cost of $44.5 million. Of the 125 denials, 47 led to appeals, resulting in 13 reversals. Two of the denied applications faced further challenge when they were escalated to the Supreme Court of Nova Scotia.
The 2024 judicial review and subsequent decision found two individuals had been unfairly rejected in their requests for coverage.
Following the decision, Premier Tim Houston requested our Office review the program’s human-centred approach, its application and intake processes, and the specific circumstances surrounding the judicial review.
The new audit reveals that the Department did not have a human-centred approach to review applications as program communication was originally meant only for medical staff, not patients.
And while the Department did evolve its process to reflect the changes highlighted in the judicial review decision, the modifications did not resolve the barriers to accessing care. As a result, individuals without in-province specialists still face an unclear and difficult route to access care.
The audit makes eight recommendations to the Department, including the creation of an alternative pathway within the out-of-province medical claims program for patients with no Nova Scotia specialist.
In addition, the Auditor General recommends the Department formally update the out-of-province medical claims policies to clearly define and embed a human-centred approach in the review, decision-making, and communication processes.
“This will allow patients to navigate the process more seamlessly,” the Auditor General said.
The Department has agreed to all the recommendations and indicates one has already been completed, with the majority set to be implemented by September 2027.