Non-Insured Health Benefits program: First Nations and Inuit Health Branch: Annual report 2023 to 2024

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Section 1: Overview
Section 2: Client population
Section 3: NIHB program benefit expenditures
Section 4: NIHB pharmacy expenditure and utilization data
Section 5: NIHB medical supplies and equipment (MS&E) expenditure and utilization data
Section 6: NIHB dental expenditures and utilization data
Section 7: NIHB medical transportation expenditures and utilization data
Section 8: NIHB vision care benefits and utilization data
Section 9: NIHB mental health counselling expenditure and utilization data
Section 10: 10-year regional expenditure trends
Section 11: NIHB program administration
Section 12: NIHB policy and program initiatives
Section 13: Technical notes

Section 1: Overview

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 2023 to 2024 fiscal year. A fiscal year runs from April 1 to March 31. During 2023 to 2024, NIHB provided access to benefits coverage for 959,207 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 30th edition, the 2023 to 2024 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
Others in government and in non-government organizations with an interest in the provision of health services to First Nations and Inuit communities

Section 2: Client population

To be an eligible client of the NIHB program, an individual must be a resident of Canada and 1 of the following:

a First Nations person who is registered under the Indian Act
an Inuk recognized by an Inuit Land Claim organization
a child less than 24 months old whose parent is a registered First Nations person or a recognized Inuk

As of March 31, 2024, 959,207 First Nations and Inuit clients were eligible to receive benefits under the NIHB program, an increase of 2.5% from March 2023.

First Nations and Inuit population data are drawn from the Status Verification System (SVS), which is operated by the NIHB program. SVS data on First Nations clients are based on information provided by Indigenous Services Canada. SVS data on Inuit clients are based on information provided by the Governments of the Northwest Territories and Nunavut, and Inuit organizations including the Inuvialuit Regional Corporation, Nunavut Tunngavik Incorporated and the Makivik Corporation.

Amendments to the Indian Act have meant that more individuals can claim or restore their status as registered Indians. The Gender Equity in Indian Registration Act, which came into force on January 31, 2011, and An Act to amend the Indian Act in response to the Superior Court of Quebec decision in Descheneaux c. Canada, which came into force December 12, 2017, aim to eliminate known sex-based inequities in registration. Additional amendments came into force on August 15, 2019 which eliminated the 1951 cut-off provision of the Indian Act in order to extend entitlement to grandchildren born or adopted prior to September 4, 1951. Because of this, many people became entitled to be registered as an Indian under the Indian Act. Once registered, these individuals are eligible to receive benefits through the NIHB program.

The creation of the Qalipu Mi'kmaq First Nations band was announced on September 26, 2011 as a result of a settlement agreement negotiated between the Government of Canada and the Federation of Newfoundland Indians (FNI). Through the formation of this band, members of the Qalipu Mi'kmaq became recognized under the Indian Act and eligible for registration.

The British Columbia Tripartite Framework Agreement on First Nation Health Governance was signed by Canada, the First Nations Health Council (FNHC) and the British Columbia Ministry of Health on October 13, 2011. Consistent with the commitments set out in the Framework agreement, between July 2, 2013 and October 1, 2013 the First Nations Health Authority (FNHA) assumed responsibility for the design, management, delivery and/or funding of the delivery of health services to First Nations residing in British Columbia. Since then, First Nations individuals residing in BC have received their health benefits through the FNHA's Health Benefits Program, which replaced the NIHB program in BC.

Eligible client population by region: March 2024

Ontario had the largest proportion of the eligible population, representing 24.3% of the national total, followed by Manitoba and Saskatchewan at 17.8 and 17.7% respectively.

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 British Columbia First Nations Health Authority (FNHA) and are not represented in this chart. The remaining NIHB clients in British Columbia are Inuit clients, or clients associated with British Columbia bands but residing in other provinces and territories of Canada, where they are covered under the NIHB program.

**Figure 2.1 Eligible client population by region**

Eligible population by client type and region: March 2023 and March 2024

Of the 959,207 total eligible clients at the end of the 2023 to 2024 fiscal year, 905,990 (94.5%) were First Nations clients while 53,217 (5.5%) were Inuit clients. The number of First Nations clients increased by 2.5% and the number of Inuit clients increased by 2.5%

From March 2023 to March 2024, British Columbia had the highest percentage change in total eligible clients with a 4.0% increase, followed by Quebec and Nunavut with increases of 3.8% and 3.0% respectively.

Table 2.1: Eligible population by client type and region
Region	First Nations		Inuit		Total		% Change
Region	March 2023	March 2024	March 2023	March 2024	March 2023	March 2024	2023 to 2024
Atlantic	69,137	70,308	452	464	69,589	70,772	1.7%
Quebec	81,267	84,372	2,012	2,057	83,279	86,429	3.8%
Ontario	227,807	232,165	927	975	228,734	233,140	1.9%
Manitoba	165,608	170,074	247	262	165,855	170,336	2.7%
Saskatchewan	165,246	169,728	101	104	165,347	169,832	2.7%
Alberta	131,004	134,339	792	829	131,796	135,168	2.6%
British Columbia	17,474	18,179	423	433	17,897	18,612	4.0%
Yukon	7,704	7,775	148	157	7,852	7,932	1.0%
Northwest Territories	18,849	19,050	9,384	9,402	28,233	28,452	0.8%
Nunavut	0	0	37,418	38,534	37,418	38,534	3.0%
National	884,102	905,990	51,904	53,217	936,006	959,207	2.5%
Source: SVS adapted by Program Analytics and Risk Mitigation

Eligible client population over time: March 2015 to March 2024

Over the past 10 years, the total number of eligible clients in the SVS has increased by 16.4%, from 824,033 in March 2015 to 959,207 in March 2024.

**Chart 2.1: Eligible client population, March 2014 to March 2023**

Over the past 5 years, the NIHB program's total number of eligible clients increased by 8.1% from 887,518 in March 2020 to 959,207 in March 2024. Quebec had the largest increase in eligible clients over this period, with a growth rate of 16.3%. British Columbia and the Atlantic region followed with growth rates of 12.4% and 8.3% respectively.

Table 2.2: Eligible client population by region, March 2020 to March 2024
Region	March 2020	March 2021	March 2022	March 2023	March 2024
Atlantic	65,335	66,782	68,277	69,589	70,772
Quebec	74,346	76,085	79,715	83,279	86,429
Ontario	215,751	218,784	223,709	228,734	233,140
Manitoba	159,862	160,954	162,588	165,855	170,336
Saskatchewan	157,162	158,785	161,518	165,347	169,832
Alberta	127,098	128,230	129,657	131,796	135,168
British Columbia	16,561	17,019	17,622	17,897	18,612
Yukon	7,673	7,742	7,801	7,852	7,932
Northwest Territories	27,816	27,847	27,956	28,233	28,452
Nunavut	35,914	36,611	37,026	37,418	38,534
Total	887,518	898,839	915,895	936,006	959,207
annual % change	1.6%	1.3%	1.9%	2.2%	2.5%
Source: SVS adapted by Program Analytics and Risk Mitigation

Annual population growth, Canadian population and eligible client population: 2015 to 2024

Over the previous 10 years, the NIHB eligible client population has grown faster than the Canadian population. From 2015 to 2024, the Canadian population increased by 12.8% while the NIHB eligible First Nations and Inuit client population increased by 16.4%.

**Chart 2.2: Annual population growth, Canadian population and eligible client population**

Year	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
NIHB client population	824,033	839,129	853,088	867,749	873,312	887,518	898,839	915,895	936,006	959,207
Growth rate	1.9%	1.8%	1.7%	1.7%	0.6%	1.6%	1.3%	1.9%	2.2%	2.5%
Canadian population	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	40,097,761
Growth rate	1.1%	0.8%	1.2%	1.2%	1.0%	1.4%	1.1%	0.6%	1.8%	3.0%

Eligible client population by age group, gender and region: March 2024

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. Given that the population of individuals choosing Another Gender is small, data aggregation to a 2-category gender variable is sometimes necessary to protect the confidentiality of responses provided, in keeping with government practices for safeguarding the privacy of individuals. In these cases, individuals in the category "Another Gender" are randomly distributed into the other two gender categories and are denoted by the "＋" symbol.

"Male＋" includes men (and/or boys), as well as some non-binary persons.
"Female＋" includes women (and/or girls), as well as some non-binary persons.

Of the 959,207 NIHB eligible clients on the SVS as of March 31, 2024, 49.2% were male (472,365), 50.8% were female (486,842), and a small percentage of clients were another gender (186).

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

The average age of the male and female eligible client population was 34 and 36 years, respectively. The average age for males ranged from a low of 28 in Nunavut to a high of 40 in British Columbia. The average age for females varied from a low of 29 in Nunavut to a high of 44 in British Columbia. The average age for clients choosing Another Gender was 22 years.

Table 2.3: Eligible client population by age group, gender and region

Source: SVS adapted by Program Analytics and Risk Mitigation

Table 2.3.1: Atlantic region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	1,177	1,978	2,404	2,761	2,689	2,804	2,843	2,503	2,303	2,214	2,397	2,256	1,990	4,468	34,787
Female+	1,046	1,886	2,474	2,577	2,539	2,762	2,782	2,428	2,425	2,204	2,385	2,516	2,272	5,689	35,985
Total	2,223	3,864	4,878	5,338	5,228	5,566	5,625	4,931	4,728	4,418	4,782	4,772	4,262	10,157	70,772
Average age: 39 (Male+: 38, Female+: 40)

Table 2.3.2: Quebec region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	1,187	2,583	3,194	3,465	3,305	3,485	3,666	3,005	2,882	2,534	2,529	2,500	2,463	5,390	44,241
Female+	1,051	2,423	3,050	3,279	3,163	3,347	3,526	3,121	2,765	2,603	2,676	2,854	2,777	7,606	42,188
Total	2,238	5,006	6,244	6,744	6,468	6,832	7,192	6,126	5,647	5,137	5,205	5,354	5,240	12,996	86,429
Average age: 39 (Male+: 36, Female+: 42)

Table 2.3.3: Ontario region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	2,798	6,419	8,404	9,215	9,237	9,737	9,781	8,600	7,462	7,023	7,104	6,997	6,559	14,258	113,594
Female+	2,658	6,025	8,154	8,760	8,897	9,482	9,698	8,363	7,851	7,218	7,394	7,551	7,492	20,003	119,546
Total	5,456	12,444	16,558	17,975	18,134	19,219	19,479	16,963	15,313	14,241	14,498	14,548	14,051	34,261	233,140
Average age: 39 (Male+: 38, Female+: 40)

Table 2.3.4: Manitoba region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	3,189	7,457	8,790	8,855	7,890	7,750	7,506	6,102	5,105	4,525	4,407	4,142	3,370	5,745	84,833
Female+	3,028	7,006	8,409	8,680	7,535	7,477	7,520	5,979	4,978	4,564	4,757	4,353	3,710	7,507	85,503
Total	6,217	14,463	17,199	17,535	15,425	15,227	15,026	12,081	10,083	9,089	9,164	8,495	7,080	13,252	170,336
Average age: 33 (Male+: 32, Female+: 34)

Table 2.3.5: Saskatchewan region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	3,847	7,132	8,580	8,801	7,968	7,589	7,826	6,480	5,250	4,518	4,278	3,848	3,044	4,791	83,952
Female+	3,783	6,871	8,319	8,681	7,828	7,647	7,626	6,411	5,197	4,628	4,549	4,214	3,539	6,587	85,880
Total	7,630	14,003	16,899	17,482	15,796	15,236	15,452	12,891	10,447	9,146	8,827	8,062	6,583	11,378	169,832
Average age: 32 (Male+: 31, Female+: 33)

Table 2.3.6: Alberta region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	3,308	5,782	7,082	6,970	6,376	6,225	5,989	4,963	4,011	3,532	3,167	2,963	2,399	4,126	66,893
Female+	3,052	5,585	6,654	6,891	6,051	5,870	5,779	4,921	4,334	3,615	3,528	3,207	2,875	5,913	68,275
Total	6,360	11,367	13,736	13,861	12,427	12,095	11,768	9,884	8,345	7,147	6,695	6,170	5,274	10,039	135,168
Average age: 32 (Male+: 31, Female+: 33)

Table 2.3.7: British Columbia region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	113	310	414	532	688	813	833	853	779	634	649	559	537	1,104	8,818
Female+	120	284	437	549	670	763	810	785	762	703	671	726	662	1,852	9,794
Total	233	594	851	1,081	1,358	1,576	1,643	1,638	1,541	1,337	1,320	1,285	1,199	2,956	18,612
Average age: 42 (Male+: 40, Female+: 44)

Table 2.3.8: Yukon region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	103	184	262	273	301	314	334	305	280	255	277	310	300	449	3,947
Female+	101	204	222	246	272	305	333	289	276	219	248	281	324	665	3,985
Total	204	388	484	519	573	619	667	594	556	474	525	591	624	1,114	7,932
Average age: 40 (Male+: 39, Female+: 41)

Table 2.3.9: Northwest Territories region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	433	869	1,027	1,084	975	1,238	1,442	1,188	1,011	825	933	884	703	1,402	14,014
Female+	368	813	956	1,015	1,051	1,171	1,429	1,201	1,009	876	925	961	842	1,821	14,438
Total	801	1,682	1,983	2,099	2,026	2,409	2,871	2,389	2,020	1,701	1,858	1,845	1,545	3,223	28,452
Average age: 38 (Male+: 37, Female+: 39)

Table 2.3.10: Nunavut region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	1,785	2,140	2,101	1,979	1,808	1,574	1,549	1,300	1,029	867	827	774	587	1,019	19,339
Female+	1,755	2,062	2,070	1,918	1,689	1,535	1,494	1,292	1,068	881	850	831	620	1,130	19,195
Total	3,540	4,202	4,171	3,897	3,497	3,109	3,043	2,592	2,097	1,748	1,677	1,605	1,207	2,149	38,534
Average age: 29 (Male+: 28, Female+: 29)

Table 2.3.11: Total of all regions
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	17,940	34,854	42,258	43,935	41,237	41,529	41,769	35,299	30,112	26,927	26,568	25,233	21,952	42,752	472,365
Female+	16,962	33,159	40,745	42,596	39,695	40,359	40,997	34,790	30,665	27,511	27,983	27,494	25,113	58,773	486,842
Total	34,902	68,013	83,003	86,531	80,932	81,888	82,766	70,089	60,777	54,438	54,551	52,727	47,065	101,525	959,207
Average age: 35 (Male+: 34, Female+: 36)

Population analysis by age group: March 2024

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 28.4% compared to 21.0% for the Canadian population. Nearly two-thirds (61.3%) of eligible clients are under the age of 40, compared to 49.2% for the Canadian population. The average age of NIHB clients is 35 compared to 42 years of age for the Canadian population.

**Chart 2.3: Proportion of Canadian population and of the NIHB client population by age group**

A comparison of March 2020 to March 2024 eligible client population shows an aging population. The client population 40 and above, as a proportional share of the overall client population, increased from 36.8% in 2020 to 38.7% in 2024. 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 2015, seniors represented 7.5% of the overall NIHB population. Most recently, in 2024, seniors accounted for 10.6%.

**Chart 2.4: Proportion of eligible NIHB client population by age group**

Section 3: NIHB program benefit expenditures

Factors influencing NIHB program sustainability: 2023 to 2024

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.

The following factors influence NIHB program sustainability:

Client base

Changing demographics, including population growth, an aging population, and uncertainty about the registration of new or existing clients
Health status, including disease burden and prevalence of chronic and infectious diseases
Geographic distribution of client population and accessibility of health services

Market forces

Introduction of newer high-cost therapies and procedures
Provincial/Territorial health insurance decisions and care staff shortages
Insurance industry dynamics
Shift from hospital treatments (insured) to non-insured coverage
Economic factors which cause increases in the price of fuel, food/meals and accommodations
Changes in health professional fees and scope of practice

Evidence

Prescribing and treatment decisions of regulated health professionals
Advancements in medical research/evidence, treatments and health technologies
Preventive intervention versus restorative dental treatments
Input received from First Nations and Inuit partners

NIHB expenditures by benefit ($ millions): 2023 to 2024

In 2023 to 2024, total NIHB program benefit expenditures were $2,098.2 million. This represents an increase of 10.9% over NIHB expenditures of $1,891.7 million in 2022 to 2023. Medical transportation costs represented the largest proportion of expenditures at 37.6% ($789.6 million), followed by pharmacy benefit costs at 30.9% ($648.6 million) and dental benefit costs at 18.1% ($379.9 million).

NIHB medical transportation, pharmacy and dental benefit expenditures accounted for 86.7% of all NIHB expenditures in 2023 to 2024.

**Chart 3.1: NIHB expenditures by benefit ($ millions)**

Not reflected in the $2,098.2 million in NIHB expenditures are approximately $68.8 million in administration costs. More detail is provided in Section 11.

NIHB expenditures and growth by benefit: 2023 to 2024

NIHB program benefit expenditures increased by 10.9%, or $206.4 million from fiscal year 2022 to 2023. The highest net increase in expenditures were in the NIHB medical transportation and dental benefits at $79.0 and $50.8 million, respectively. Factors affecting benefit expenditure growth are discussed in subsequent sections of this report.

Table 3.1: NIHB expenditures and growth by benefit
Benefit	Total Expenditures (Thousands of dollars) 2022-2023	Total Expenditures (Thousands of dollars) 2023-2024	% Change From 2022-2023
Medical transportation	$710,614	$789,621	11.1%
Pharmacy	$605,837	$648,600	7.1%
MS&E	$65,181	$75,131	15.3%
Dental	$329,123	$379,940	15.4%
Vision care	$49,246	$52,038	5.7%
Mental health counselling	$98,585	$117,425	19.1%
Other	$33,157	$35,462	7.0%
Total expenditures	$1,891,743	$2,098,218	10.9%
Source: FST adapted by Program Analytics and Risk Mitigation Division

Expenditures in the "other" category are related to:

program oversight including contract costs related to claims processing through the Health Information and Claims Processing Services (HICPS) system
supplementary funding for the FNHA for additional clients who became eligible after the transfer of responsibilities due to changes in federal legislation
contribution agreements to support engagement with Indigenous partner organizations
NIHB navigators

NIHB expenditures by benefit and region (Thousands of dollars): 2023 to 2024

Manitoba accounted for the highest proportion of total expenditures at $503.1 million, or 24.0% of the national total, followed by Ontario at $414.8 million (19.8%), and Saskatchewan at $393.3 million (18.7%). By comparison, the lowest expenditures were in the Atlantic region at $102.3 million (4.9%).

Headquarters expenditures represent costs paid for claims processing services, as well as 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 1.4% ($29.1 million) of total NIHB expenditures and do not include the $68.8 million in administration (HQ) costs outlined in Section 11.

Table 3.2: NIHB expenditures by benefit and region
Region	Medical Transportation	Pharmacy	MS&E	Dental	Vision Care	Mental Health Counselling	Other	Total
Atlantic	$18,294	$49,470	$5,473	$14,425	$3,986	$7,788	$2,844	$102,281
Quebec	$28,596	$70,023	$3,828	$23,367	$4,113	$7,404	$700	$138,032
Ontario	$166,036	$119,964	$12,071	$78,995	$9,732	$27,432	$567	$414,797
Manitoba	$261,374	$128,221	$15,661	$68,952	$8,605	$20,003	$255	$503,072
Saskatchewan	$115,915	$137,470	$17,587	$78,046	$11,243	$31,869	$1,186	$393,315
Alberta	$69,508	$102,556	$13,614	$74,484	$9,355	$18,216	$360	$288,092
North	$129,898	$35,869	$6,898	$38,600	$5,004	$4,711	$490	$221,469
Headquarters	$0	$0	$0	$0	$0	$0	$29,060	$29,060
Total	$789,621	$648,600	$75,131	$379,940	$52,038	$117,425	$35,462	$2,098,218
Source: FST adapted by Program Analytics and Risk Mitigation

NIHB annual expenditures ($ Millions) and percentage change

In 2023 to 2024, NIHB program expenditures totalled $2,098.2 million, an increase of 10.9% from $1,891.7 million in 2022 to 2023. Since 2014 to 2015, total expenditures have grown by 103.4%. The annualized rate of growth over this period was 7.4%. There has been wide variation in growth rates between 2014 to 2015 and 2023 to 2024, from a low of -1.9% in 2020 to 2021 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 British Columbia to the FNHA in 2013 to 2014 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.

**Chart 3.2: NIHB annual expenditures ($ Millions) and percentage change**

NIHB annual expenditures by benefit (Thousands of dollars)

In the 10-year period ending 2023 to 2024, expenditures for NIHB mental health services have grown faster than other benefit areas. NIHB mental health expenditures had the highest percentage growth at 667.8%, from $15.3 million in 2014 to 2015 to $117.4 million in 2023 to 2024. NIHB medical transportation had the highest increase in expenditures from $358.0 million in 2014 to 2015 to $789.6 million in 2023 to 2024, a change of 120.6%.

Over the same period, NIHB medical supplies and equipment (MS&E) expenditures increased by 157.0% and NIHB dental expenditures increased by 91.0%.

Table 3.3: NIHB annual expenditures by benefit (Thousands of dollars)
Benefit	2014-2015	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024
Medical transportation	$357,955	$375,921	$417,035	$459,505	$495,034	$537,179	$525,719	$602,208	$710,614	$789,621
Pharmacy	$376,463	$409,227	$441,186	$467,094	$471,641	$510,691	$536,680	$566,082	$605,837	$648,600
MS&E	$29,233	$30,657	$37,031	$40,167	$46,481	$53,222	$50,932	$60,050	$65,181	$75,131
Dental	$198,942	$214,189	$232,954	$246,222	$264,015	$277,547	$233,224	$299,075	$329,123	$379,940
Vision care	$29,697	$30,016	$32,370	$33,578	$36,467	$45,968	$39,594	$47,609	$49,246	$52,038
Mental health counselling	$15,294	$16,191	$21,728	$33,066	$42,656	$55,126	$73,652	$93,686	$98,585	$117,425
Other	$23,134	$24,311	$25,172	$29,609	$34,270	$39,751	$30,814	$26,586	$33,157	$35,462
Total	$1,030,718	$1,100,512	$1,207,458	$1,309,240	$1,390,563	$1,519,483	$1,490,615	$1,695,295	$1,891,743	$2,098,218
Annual % change	0.4%	6.8%	9.7%	8.4%	6.2%	9.3%	-1.9%	13.7%	11.6%	10.9%
Source: FIRMS and FST adapted by Program Analytics and Risk Mitigation

Per capita NIHB expenditures by region: 2023 to 2024

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.

National per capita expenditures for all benefits in 2023 to 2024 were $2,157. The Northern region had the highest per capita cost at $2,956. Manitoba followed with a per capita cost of $2,953. 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 $1,445, due to the comparatively low medical transportation expenditures in the region.

**Chart 3.3: Per capita NIHB expenditures by region**

Section 4: NIHB pharmacy expenditure and utilization data

The NIHB program covers a comprehensive range of prescription drugs and over-the-counter medications listed on the NIHB Drug Benefit List (DBL). Pharmacy benefits are evidence based and eligible prescription and over-the-counter medications are covered in accordance with program policies

In 2023 to 2024, the NIHB program paid for pharmacy claims made by 583,416 First Nations and Inuit clients. The total spent for these claims was $648.6 million or 30.9% of total NIHB expenditures. Of all the NIHB program benefits, the pharmacy benefit accounts for the second largest share of expenditures and is the benefit most utilized by clients.

Distribution of NIHB pharmacy expenditures ($ Millions): 2023 to 2024

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 $510.1 million or 78.6% of all NIHB pharmacy expenditures, followed by over-the-counter (OTC) and controlled access (CAD) drugs (HICPS) which totalled $122.7 million or 18.9%.

Regional Drugs, at $2.2 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 $13.6 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.

**Chart 4.1: Distribution of NIHB pharmacy expenditures ($ Millions)**

Total NIHB pharmacy expenditures by type and region (Thousands of dollars): 2023 to 2024

Prescription drug costs paid through the HICPS system represented the largest component of total NIHB Pharmacy costs accounting for $510.1 million or 78.6%. The Saskatchewan region had the largest proportion of these costs at 21.2%, followed by Manitoba at 19.8% and Ontario at 18.5%.

The next highest component was over-the-counter (OTC) and controlled access drug (CAD) costs at $122.7 million or 18.9%. The regions of Manitoba (23.0%), Saskatchewan (21.4%) and Alberta (17.1%) had the largest proportions of these costs in 2023 to 2024.

Table 4.1: Total NIHB pharmacy expenditures by type and region (Thousands of dollars)
Region	Operating			Total Operating Costs	Total Contribution Costs	Total Costs
Region	Prescription Drugs	OTC/CAD Drugs	Drugs Regional	Total Operating Costs	Total Contribution Costs	Total Costs
Atlantic	$40,207	$9,263	$0	$49,470	$0	$49,470
Quebec	$57,656	$12,367	$0	$70,023	$0	$70,023
Ontario	$95,160	$19,184	$0	$114,344	$5,620	$119,964
Manitoba	$100,015	$28,205	$0	$128,221	$0	$128,221
Saskatchewan	$109,540	$26,286	$1,570	$137,395	$75	$137,470
Alberta	$73,731	$20,951	$0	$94,682	$7,873	$102,556
North	$29,391	$5,786	$653	$35,829	$39	$35,869
Total	$510,055	$122,715	$2,222	$634,993	$13,607	$648,600
Source: FST adapted by Program Analytics and Risk Mitigation

Annual NIHB pharmacy expenditures

NIHB pharmacy expenditures increased by 7.1% during fiscal year 2023 to 2024. Over the past 5 years, growth in pharmacy expenditures has ranged from a high of 8.3% in 2019 to 2020 to a low of 5.1% in 2020 to 2021.

The 5 year annualized growth rate for NIHB pharmacy expenditures is 4.9%. The introduction of lower cost generic drugs as they become available on the market has 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, 2024, NIHB had almost 350 PLA in effect.

**Chart 4.2: Annual NIHB pharmacy expenditures and percentage change**

Table 4.2: NIHB pharmacy expenditures (Thousands of dollars) by region
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	$35,365	$37,323	$40,657	$45,819	$49,470
Quebec	$50,747	$53,282	$58,827	$64,799	$70,023
Ontario	$97,437	$105,300	$112,069	$113,842	$119,964
Manitoba	$100,059	$106,851	$112,353	$120,207	$128,221
Saskatchewan	$115,074	$116,188	$120,000	$126,676	$137,470
Alberta	$83,526	$84,920	$86,680	$96,511	$102,556
North	$28,337	$29,479	$31,499	$33,457	$35,869
Total	$510,691	$536,681	$566,082	$605,837	$648,600
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Per capita NIHB pharmacy expenditures by region: 2023 to 2024

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 2023 to 2024, the national per capita expenditure for NIHB Pharmacy benefits was $676. This was an increase of 4.5% from the $647 recorded in 2022 to 2023.

Quebec had the highest per capita NIHB Pharmacy expenditures at $810, followed by Saskatchewan at $809.

The Northern region had the lowest per capita expenditures at $479 followed by Ontario at $515. 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.

**Chart 4.3 Per capita NIHB pharmacy expenditure by region**

NIHB pharmacy utilization rates by region

Utilization rates represent the number of clients who received at least 1 pharmacy benefit paid through the HICPS system in the fiscal year, as a proportion of the total number of eligible clients. In 2023 to 2024, the national utilization rate was 61% 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 71.1% and for Ontario, the utilization rate for pharmacy benefits would have been 54.1% in 2023 to 2024. 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 62.3%.

Table 4.3: NIHB pharmacy utilization rates by region
Region	Pharmacy Utilization
Region	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024
Atlantic	63%	60%	61%	63%	64%
Quebec	62%	58%	59%	61%	63%
Ontario	52%	48%	49%	50%	51%
Manitoba	68%	62%	65%	67%	67%
Saskatchewan	70%	63%	65%	68%	68%
Alberta	67%	60%	61%	64%	66%
North	53%	50%	50%	52%	53%
National	61%	57%	58%	60%	61%
Source: HICPS and SVS adapted by Program Analytics and Risk Mitigation

NIHB pharmacy claimants by age group, gender and region: 2023 to 2024

Of the 959,207 clients eligible to receive benefits under the NIHB program, a total of 583,416 claimants received at least 1 pharmacy item paid through the Health Information and Claims Processing Services (HICPS) system in 2023 to 2024. Of this total, 330,824 were female (57%) and 252,592 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 37. The average age for female and male claimants was 38 and 37, respectively.

Table 4.4: NIHB pharmacy claimants by age group, gender and region

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

Table 4.4.1: Atlantic region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	640	1,162	1,152	1,209	1,206	1,353	1,418	1,295	1,300	1,284	1,514	1,550	1,398	3,105	19,586
Female+	568	1,112	1,274	1,777	1,899	2,168	2,107	1,759	1,755	1,625	1,811	1,910	1,771	4,054	25,590
Total	1,208	2,274	2,426	2,986	3,105	3,521	3,525	3,054	3,055	2,909	3,325	3,460	3,169	7,159	45,176
Average age: 41 (Male+: 41, Female+: 41)

Table 4.4.2: Quebec region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	682	1,462	1,585	1,608	1,470	1,577	1,739	1,548	1,526	1,469	1,586	1,646	1,725	3,683	23,306
Female+	626	1,516	1,742	2,228	2,317	2,445	2,560	2,243	1,968	1,864	1,967	2,122	2,123	5,189	30,910
Total	1,308	2,978	3,327	3,836	3,787	4,022	4,299	3,791	3,494	3,333	3,553	3,768	3,848	8,872	54,216
Average age: 40 (Male+: 40, Female+: 41)

Table 4.4.3: Ontario region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	879	2,254	2,585	2,994	3,012	3,880	4,290	3,996	3,668	3,630	3,881	4,016	3,986	7,464	50,535
Female+	853	2,219	2,726	4,302	4,966	6,110	6,234	5,381	5,053	4,665	4,824	5,144	5,051	10,926	68,454
Total	1,732	4,473	5,311	7,296	7,978	9,990	10,524	9,377	8,721	8,295	8,705	9,160	9,037	18,390	118,989
Average age: 42 (Male+: 42, Female+: 43)

Table 4.4.4: Manitoba region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	1,940	4,380	4,627	4,428	3,852	4,124	4,228	3,662	3,334	3,126	3,122	3,059	2,639	4,029	50,550
Female+	1,800	4,520	4,732	5,899	5,651	5,949	6,013	4,782	4,089	3,792	3,983	3,622	3,171	5,560	63,563
Total	3,740	8,900	9,359	10,327	9,503	10,073	10,241	8,444	7,423	6,918	7,105	6,681	5,810	9,589	114,113
Average age: 35 (Male+: 34, Female+: 35)

Table 4.4.5: Saskatchewan region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	2,210	4,525	4,634	4,502	3,943	4,042	4,485	3,991	3,355	3,031	3,068	2,882	2,312	3,675	50,655
Female+	2,170	4,573	4,963	5,993	6,070	6,237	6,205	5,390	4,254	3,831	3,786	3,555	3,054	5,160	65,241
Total	4,380	9,098	9,597	10,495	10,013	10,279	10,690	9,381	7,609	6,862	6,854	6,437	5,366	8,835	115,896
Average age: 34 (Male+: 33, Female+: 35)

Table 4.4.6: Alberta region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	3,456	3,702	3,464	3,097	3,266	3,387	2,940	2,551	2,313	2,129	2,064	1,701	2,809	2,637	39,516
Female+	3,496	3,748	4,429	4,369	4,430	4,423	3,747	3,308	2,803	2,755	2,484	2,268	4,158	3,921	50,339
Total	6,952	7,450	7,893	7,466	7,696	7,810	6,687	5,859	5,116	4,884	4,548	3,969	6,967	6,558	89,855
Average age: 33 (Male+: 32, Female+: 34)

Table 4.4.7: North region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	946	1,204	1,126	1,104	1,029	1,118	1,244	1,162	1,068	1,004	1,151	1,183	1,045	1,900	16,284
Female+	877	1,224	1,137	1,720	2,036	2,077	2,193	1,928	1,642	1,431	1,484	1,524	1,378	2,636	23,287
Total	1,823	2,428	2,263	2,824	3,065	3,195	3,437	3,090	2,710	2,435	2,635	2,707	2,423	4,536	39,571
Average age: 38 (Male+: 37, Female+: 38)

Table 4.4.8: Total for all regions
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	10,780	18,791	19,296	19,077	17,927	19,664	20,559	18,405	16,743	15,831	16,564	16,192	16,070	26,693	252,592
Female+	10,413	19,002	21,135	26,522	27,642	29,732	29,408	25,110	21,869	20,214	20,595	20,459	20,924	37,799	330,824
Total	21,193	37,793	40,431	45,599	45,569	49,396	49,967	43,515	38,612	36,045	37,159	36,651	36,994	64,492	583,416
Average age: 37 (Male+: 37, Female+: 38)

Distribution of eligible NIHB population, pharmacy expenditures and pharmacy incidence by age group: 2023 to 2024

In 2023 to 2024, 3.6% of all clients were in the 0 to 4 age group, but this group accounted for only 0.6% of all pharmacy claims made and only 0.8% of total pharmacy expenditures. In contrast, 10.6% of all eligible clients were in the 65+ age group, but accounted for 25.1% of all pharmacy claims submitted and 17.1% of total pharmacy expenditures.

During 2023 to 2024, the average claimant aged 65 or more submitted 92 claims compared to 74 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.

**Chart 4.4: Distribution of eligible NIHB population, pharmacy expenditures and pharmacy incidence by age group**

Age	Eligible clients	Expenditures	Incidence
0-4	3.6%	0.8%	0.6%
5-9	7.1%	1.6%	1.0%
10-14	8.7%	2.0%	1.3%
15-19	9.0%	3.2%	2.1%
20-24	8.4%	4.3%	3.0%
25-29	8.5%	6.4%	4.9%
30-34	8.6%	8.2%	7.0%
35-39	7.3%	8.5%	7.6%
40-44	6.3%	8.7%	8.0%
45-49	5.7%	8.9%	8.4%
50-54	5.7%	9.7%	9.4%
55-59	5.5%	9.9%	10.0%
60-64	4.9%	10.7%	11.6%
65+	10.6%	17.1%	25.1%
Total	100.0%	100.0%	100.0%

Pharmacy benefit cost per NIHB claimant expenditures vary according to age. For example, in 2023 to 2024 the average cost per child aged 0 to 9 years was $263. The cost increased steadily for every age group, with claimants aged 30-34 having an average cost of $1,047, comparable to the total average claimant cost of $1,088. Claimants aged 60-64 years had the highest cost per claimant with an average of $1,829 for all pharmacy claims received throughout the fiscal year.

NIHB Top ten therapeutic classes by number of claimants: 2023 to 2024

Table 4.5 ranks the top ten therapeutic classes of prescription drugs according to number of claimants. In 2023 to 2024, Penicillins had the highest number of distinct claimants, at 170,086. Antidepressants ranked second in number of claimants, with 126,254 followed by Proton Pump Inhibitors with 114,743 claimants.

Table 4.5: NIHB top ten therapeutic classes by number of claimants
Therapeutic Classification	Claimants	% Change from 2022 to 2023	Examples of product in the therapeutic class
Penicillins	170,086	5.7%	Amoxil (Amoxicillin)
Antidepressants	126,254	4.0%	Effexor (Venlafaxine)
Proton Pump Inhibitors	114,743	3.3%	Losec (Omeprazole)
Non-Steroidal Anti-Inflammatory Drugs (NSAID)	108,260	3.2%	Voltaren (Diclofenac)
Beta-Adrenergic Agonists	96,097	1.0%	Ventolin (Salbutamol)
Opioid Agonists	90,621	0.1%	Statex (Morphine Sulphate)
HMG-COA Reductase Inhibitors (Statins)	87,305	6.0%	Lipitor (Atorvastatin)
Adrenals	81,763	3.6%	Flovent (Fluticasone Propionate)
Cephalosporins	77,245	9.7%	Keflex (Cephalexin)
Angiotensin-Converting Enzyme Inhibitors	73,071	2.2%	Altace (Ramipril)
Source: HICPS adapted by Program Analytics and Risk Mitigation

NIHB OTC (including CAD) drug claims incidence by therapeutic class: 2023 to 2024

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 2023 to 2024 at 1.7 million paid claims, or 33.5% of all OTC claims. Central nervous systems agents had the next highest share of OTC claims at 1.1 million (21.5%) followed by gastrointestinal drugs at 390,494 claims (7.8%).

Table 4.6: NIHB OTC (including CAD) drug claims incidence by therapeutic class
Category	Claims	% Change from 2022 to 2023	Examples
Vitamins	1,668,858	11.1%	Vitamin D (Cholecalciferol)
Central Nervous System Agents	1,069,512	5.4%	Tylenol (Acetaminophen)
Gastrointestinal Drugs	390,494	6.8%	Senokot (Sennosides)
Blood Formation and Coagulation	381,400	11.2%	Iron (Ferrous Gluconate)
Diabetic Devices	313,134	10.7%	Lancets
Skin & Mucous Membrane Agents	224,648	18.5%	Nix (Permethrin)
Hormone & Synthetic Substitutes	213,155	-0.9%	Lantus (Insulin Glargine)
Antihistamines	142,853	7.7%	Reactine (Cetirizine)
Diagnostic Agents	120,547	-7.0%	Blood Glucose Test Strips
Electrolytic/Caloric/Water Balance	120,333	40.4%	Pedialyte (oral electrolyte solution)
Source: HICPS adapted by Program Analytics and Risk Mitigation

Section 5: NIHB medical supplies and equipment (MS&E) expenditure and utilization data

A range of medical supplies and equipment (MS&E) items are covered by the NIHB program. Items covered through the MS&E benefit are intended to address NIHB clients' medical needs in relation to basic activities of daily living (ADL) such as eating, bathing, dressing, toileting and transferring, and include:

Audiology supplies and equipment
Limb and body orthotics supplies and equipment
Footwear supplies and equipment
Oxygen supplies and equipment
Pressure devices supplies and equipment
Prosthetics supplies and equipment
Respiratory supplies and equipment
Self-care supplies and equipment
Low vision supplies and equipment
Mobility supplies and equipment
Communication supplies and equipment
Medical surgical supplies and equipment

MS&E benefits are evidence-based and covered in accordance with program policies. Most items must be approved in advance by the NIHB regional office before they are distributed by an NIHB provider.

Prior to the 2020 to 2021 NIHB Annual Report, expenditure and utilization data for the MS&E benefit were combined with pharmacy benefits in reporting.

In 2023 to 2024, the NIHB program paid for MS&E claims made by a total of 81,504 First Nations and Inuit clients. The total spent for these claims was $75.1 million or 3.6% of total NIHB expenditures.

Distribution of NIHB MS&E expenditures ($ Millions): 2023 to 2024

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 $51.4 million or 68.4% of all NIHB MS&E expenditures, followed by medical supplies paid through HICPS which totalled $22.2 million or 29.6%.

Contribution agreements, which accounted for $0.8 million or 1.1% 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 $0.7 million or 0.9%.

**Chart 5.1: Distribution of NIHB MS&E expenditures ($ Millions)**

Total NIHB MS&E expenditures by type and region (Thousands of dollars): 2023 to 2024

Medical equipment costs paid through the HICPS system represented the largest component of total NIHB MS&E expenditures at $51.4 million or 68.4% of MS&E expenditures. Saskatchewan had the largest proportion of these costs at 23.3%, followed by Manitoba at 21.6% and Alberta at 18.9%.

The next highest component was medical supplies costs at $22.2 million or 29.6%. Saskatchewan (25.2%), Manitoba (18.1%) and Alberta (17.5%) had the largest proportions of these costs in 2023 to 2024.

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

Table 5.1: Total NIHB MS&E expenditures by type and region (Thousands of dollars)
Region	Operating			Total Operating Costs	Total Contribution Costs	Total Costs
Region	Medical Supplies	Medical Equipment	MS&E Regional	Total Operating Costs	Total Contribution Costs	Total Costs
Atlantic	$1,357	$4,113	$3	$5,473	$0	$5,473
Quebec	$1,252	$2,576	$0	$3,828	$0	$3,828
Ontario	$3,978	$7,463	$51	$11,492	$578	$12,071
Manitoba	$4,013	$11,125	$523	$15,661	$0	$15,661
Saskatchewan	$5,596	$11,959	$32	$17,587	$0	$17,587
Alberta	$3,896	$9,713	$4	$13,614	$0	$13,614
North	$2,135	$4,454	$42	$6,632	$267	$6,898
Total	$22,227	$51,403	$656	$74,286	$845	$75,131
Source: FST adapted by Program Analytics and Risk Mitigation

Annual NIHB MS&E expenditures

NIHB MS&E expenditures increased by 15.3% during fiscal year 2023 to 2024. Over the past 5 years, growth in MS&E expenditures has ranged from a high of 17.9% in 2021 to 2022 to a low of -4.3% in 2020 to 2021.

The 5 year annualized growth rate for NIHB MS&E expenditures is 10.1%.

**Chart 5.2: Annual NIHB MS&E expenditures**

Table 5.2: Annual MS&E expenditures by region (Thousands of dollars)
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	$4,359	$4,177	$4,508	$4,785	$5,473
Quebec	$2,564	$2,379	$2,855	$3,149	$3,828
Ontario	$7,322	$7,297	$8,701	$10,045	$12,071
Manitoba	$11,966	$11,146	$13,330	$13,870	$15,661
Saskatchewan	$11,889	$11,908	$13,352	$15,310	$17,587
Alberta	$10,250	$9,647	$11,658	$12,503	$13,614
North	$4,884	$4,024	$5,647	$5,520	$6,898
Total	$53,222	$50,933	$60,050	$65,181	$75,131
Source: FST adapted by Program Analytics and Risk Mitigation

Per capita NIHB MS&E expenditures by region: 2023 to 2024

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 2023 to 2024, the national per capita expenditure for NIHB MS&E benefits was $78. This was an increase of 12.5% from the $70 recorded in 2022 to 2023.

Saskatchewan had the highest per capita NIHB MS&E expenditures at $104, followed by Alberta at $101.

Quebec had the lowest per capita MS&E expenditures at $44 followed by Ontario at $52. 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.

**Chart 5.3: Per capita NIHB MS&E expenditures by region**

NIHB MS&E utilization rates by region

Utilization rates are the number of clients who received at least 1 MS&E benefit paid through the HICPS system in the fiscal year, as a proportion of the total number of eligible clients.

In 2023 to 2024, the national utilization rate for NIHB MS&E benefits paid through the HICPS system was 8%.

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.

Table 5.3: NIHB MS&E utilization rates by region
Region	MS&E Utilization
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	10%	10%	12%	10%	10%
Quebec	7%	7%	9%	7%	7%
Ontario	5%	5%	7%	6%	6%
Manitoba	11%	12%	14%	11%	11%
Saskatchewan	10%	10%	13%	10%	11%
Alberta	8%	8%	10%	8%	8%
North	5%	8%	11%	8%	8%
National	8%	8%	11%	8%	8%
Source: HICPS and SVS adapted by Program Analytics and Risk Mitigation

NIHB MS&E claimants by age group, gender and region: 2023 to 2024

Of the 959,207 clients eligible to receive benefits under the NIHB program, a total of 81,504 claimants, representing 8.5% of the NIHB client population, received at least 1 MS&E item paid through the Health Information and Claims Processing Services (HICPS) system in 2023 to 2024. Of this total, 47,104 were female (58%) and 34,400 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. The average age for female and male claimants was 51 and 49, respectively.

Table 5.4: NIHB MS&E claimants by age group, gender and region

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

Table 5.4.1: Atlantic region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	49	106	97	91	61	99	130	149	157	207	266	299	338	995	3,044
Female+	22	71	79	78	104	176	202	194	217	277	342	448	423	1,387	4,020
Total	71	177	176	169	165	275	332	343	374	484	608	747	761	2,382	7,064
Average age: 53 (Male+: 52, Female+: 54)

Table 5.4.2: Quebec region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	15	66	115	99	64	85	124	153	143	216	236	278	330	948	2,872
Female+	12	54	70	87	102	138	162	156	161	222	281	321	376	1,447	3,589
Total	27	120	185	186	166	223	286	309	304	438	517	599	706	2,395	6,461
Average age: 54 (Male+: 53, Female+: 56)

Table 5.4.3: Ontario region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	50	156	156	147	121	177	228	275	314	377	484	590	679	2,063	5,817
Female+	34	107	119	192	228	320	356	343	411	457	661	763	927	3,099	8,017
Total	84	263	275	339	349	497	584	618	725	834	1,145	1,353	1,606	5,162	13,834
Average age: 55 (Male+: 54, Female+: 56)

Table 5.4.4: Manitoba region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	148	384	354	365	288	412	483	469	555	580	676	816	832	1,776	8,138
Female+	103	277	324	423	551	630	740	713	669	779	1,032	1,063	1,047	2,570	10,921
Total	251	661	678	788	839	1,042	1,223	1,182	1,224	1,359	1,708	1,879	1,879	4,346	19,059
Average age: 48 (Male+: 47, Female+: 48)

Table 5.4.5: Saskatchewan region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	154	296	350	380	311	371	523	510	514	521	591	656	663	1,502	7,342
Female+	116	193	290	482	667	818	854	733	603	715	850	928	981	2,316	10,546
Total	270	489	640	862	978	1,189	1,377	1,243	1,117	1,236	1,441	1,584	1,644	3,818	17,888
Average age: 46 (Male+: 45, Female+: 47)

Table 5.4.6: Alberta region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	65	114	161	169	147	216	277	322	301	357	375	430	402	1,087	4,423
Female+	38	100	126	179	295	365	402	401	410	404	532	612	613	1,833	6,310
Total	103	214	287	348	442	581	679	723	711	761	907	1,042	1,015	2,920	10,733
Average age: 50 (Male+: 48, Female+: 51)

Table 5.4.7: North region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	63	130	127	94	67	81	99	109	136	153	213	257	276	748	2,553
Female+	46	96	106	96	145	162	200	169	212	200	271	344	337	1,042	3,426
Total	109	226	233	190	212	243	299	278	348	353	484	601	613	1,790	5,979
Average age: 50 (Male+: 49, Female+: 51)

Table 5.4.8: Total for all regions
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	548	1,258	1,363	1,354	1,062	1,450	1,875	2,009	2,135	2,432	2,855	3,358	3,534	9,167	34,400
Female+	373	902	1,118	1,548	2,099	2,612	2,930	2,725	2,706	3,075	3,991	4,514	4,733	13,778	47,104
Total	921	2,160	2,481	2,902	3,161	4,062	4,805	4,734	4,841	5,507	6,846	7,872	8,267	22,945	81,504
Average age: 50 (Male+: 49, Female+: 51)

Distribution of eligible NIHB population, MS&E expenditures and MS&E incidence by age group: 2023 to 2024

In 2023 to 2024, 3.6% of all clients were in the 0 to 4 age group, but this group accounted for only 1.7% of all MS&E claims made and only 2.2% of total MS&E expenditures. In contrast, 10.6% of all eligible clients were in the 65+ age group, but they accounted for 35.7 % of all MS&E claims submitted and 35.8% of total MS&E expenditures.

The average MS&E claimant submitted 5 claims in 2023 to 2024, a rate that is relatively consistent over all age groups.

**Chart 5.4: Distribution of eligible NIHB population, MS&E expenditures and MS&E incidence by age group**

Age	Eligible clients	Expenditures	Incidence
0-4	3.6%	2.2%	1.7%
5-9	7.1%	3.9%	3.2%
10-14	8.7%	3.1%	2.6%
15-19	9.0%	2.9%	2.6%
20-24	8.4%	2.4%	2.6%
25-29	8.5%	2.8%	3.3%
30-34	8.6%	3.5%	4.3%
35-39	7.3%	4.2%	4.4%
40-44	6.3%	4.8%	4.8%
45-49	5.7%	6.1%	6.2%
50-54	5.7%	7.7%	7.9%
55-59	5.5%	9.5%	9.8%
60-64	4.9%	11.3%	10.8%
65+	10.6%	35.8%	35.7%
Total	100.0%	100.0%	100.0%

NIHB medical supplies expenditures by category: 2023 to 2024

In 2023 to 2024, medical surgical supplies such as incontinence items accounted for 78.5% of all medical supply expenditures, a decrease from the 79.0% recorded in 2022 to 2023. Self-care supplies, such as enteral feeding bags, represented 6.5% of all medical supply expenditures, followed by prosthetic supplies, such as prosthetic liners at 4.4%.

**Chart 5.5: NIHB medical supplies expenditures by category**

NIHB medical equipment expenditures by category: 2023 to 2024

In 2023 to 2024, mobility equipment such as wheelchairs accounted for 21.7% of all medical equipment expenditures, a decrease from the 22.7% recorded in 2022 to 2023. Audiology equipment, such as hearing aids, represented 21.0% of all medical equipment expenditures, followed by respiratory equipment such as CPAP machines at 13.5%.

**Chart 5.6: NIHB medical equipment expenditures by category**

Section 6: NIHB dental expenditure and utilization data

The NIHB program covers a broad range of dental services, including:

diagnostic services such as examinations and radiographs
preventive services such as scaling, polishing, fluorides and sealants
restorative services such as fillings and crowns
endodontic services such as root canal treatments
periodontal services such as deep scaling
removable prosthodontic services such as partial or complete dentures
oral surgery services such as extractions
services such as braces
adjunctive services such as general anesthesia and sedation.

Dental benefits are covered in accordance with program policies as set out in the NIHB Dental Benefits Guide.

In 2023 to 2024, a total of 344,898 First Nations and Inuit clients accessed dental benefits through the NIHB program, based on claims paid through the HICPS system. The total expenditure for dental benefits was $379.9 million or 18.1% of total NIHB expenditures. The dental benefit accounts for the third largest program expenditure.

Some dental services require predetermination prior to the initiation of treatment. Predetermination is a review that determines if the proposed dental service is covered under the program's guidelines and criteria, as described in the guide. This review is undertaken by the Dental Predetermination Centre (DPC).

Distribution of NIHB dental expenditures ($ millions): 2023 to 2024

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 $354.8 million or 93.4% of all NIHB dental costs.

The next highest component was contribution agreements, which accounted for $15.7 million or 4.1% 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 $9.4 million or 2.5% of total costs.

**Chart 6.1: Distribution of NIHB dental expenditures ($ millions)**

Total NIHB dental expenditures by type and region (Thousands of dollars): 2023 to 2024

Of the $379.9 million in NIHB dental expenditures in 2023 to 2024, Ontario (20.8%), Saskatchewan (20.5%) and Alberta (19.6%) had the largest overall proportion. Ontario had the highest total dental expenditures at $79.0 million and the Atlantic region had the lowest total dental expenditures at $14.4 million.

Table 6.1: Total NIHB dental expenditures by type and region (Thousands of dollars)
Region	Operating		Total operating costs	Total contribution costs	Total costs
Region	Fee-for-service	Contract dentists	Total operating costs	Total contribution costs	Total costs
Atlantic	$14,425	$0	$14,425	$0	$14,425
Quebec	$23,367	$0	$23,367	$0	$23,367
Ontario	$69,211	$2,647	$71,858	$7,138	$78,995
Manitoba	$61,687	$6,403	$68,090	$862	$68,952
Saskatchewan	$73,740	$0	$73,740	$4,306	$78,046
Alberta	$71,275	$4	$71,279	$3,205	$74,484
North	$38,027	$340	$38,367	$233	$38,600
Total	$354,804	$9,393	$364,197	$15,743	$379,940
Source: FST adapted by Program Analytics and Risk Mitigation

Annual NIHB dental expenditures

NIHB dental expenditures increased by 15.4% during fiscal year 2023 to 2024. Over the last 5 years, annual growth rates for NIHB dental expenditures have ranged from a high of 28.2% in 2021 to 2022 to a low of -16.0% in 2020 to 2021.

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 2 years.

The 5 year annualized growth rate for NIHB dental expenditures is 7.6%.

**Chart 6.2: NIHB dental expenditures and annual percentage change**

NIHB dental expenditures by region

Table 6.2: NIHB dental expenditures by region (Thousands of dollars)
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	$11,545	$9,455	$11,801	$12,638	$14,425
Quebec	$18,733	$14,934	$19,092	$20,427	$23,367
Ontario	$55,386	$49,251	$59,326	$67,128	$78,995
Manitoba	$52,622	$49,414	$57,381	$60,247	$68,952
Saskatchewan	$57,639	$47,507	$63,408	$70,480	$78,046
Alberta	$54,993	$47,799	$58,790	$65,240	$74,484
North	$26,546	$20,703	$26,830	$30,332	$38,600
Total	$277,547	$233,224	$299,075	$329,123	$379,940
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Per capita NIHB dental expenditures by region: 2023 to 2024

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 2023 to 2024, national per capita NIHB dental expenditures were $396, an increase of 12.6% from $352 in 2022 to 2023.

Alberta had the highest per capita dental expenditures at $551, followed by the Northern region at $515. The Atlantic region had the lowest per capita dental expenditures at $204 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.

**Chart 6.3: Per capita NIHB dental expenditures by region**

NIHB dental utilization rates by region

Utilization rates reflect the number of clients who, during the fiscal year, received at least 1 dental service paid through the HICPS system as a proportion of the total number of eligible clients.

In 2023 to 2024, the national utilization rate for dental benefits paid through the HICPS system was 36%. 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.

The rates understate the actual level of utilization as the data do not include dental services provided through contribution agreements and benefits provided through community health facilities or other Indigenous Services Canada programs such as Community Oral Health Services which include dental therapy services and the Children's Oral Health Initiative (COHI). 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 dental benefits in Alberta would have been 44.4% and for Ontario the utilization rate for dental benefits would have been 34.8% in 2023 to 2024. If both the Bigstone and Akwesasne client populations were removed from the overall NIHB population, the national utilization rate for dental benefits would have been 37%.

Over the 2 year period between 2022 to 2023 and 2023 to 2024, 460,143 distinct clients received NIHB dental services through HICPS, resulting in an overall 48% utilization rate over this time.

Table 6.3: NIHB dental utilization rates by region
Region	Dental utilization					NIHB dental utilization last two years 2022 to 2024
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024	NIHB dental utilization last two years 2022 to 2024
Atlantic	36%	30%	35%	35%	36%	46%
Quebec	42%	34%	38%	39%	39%	50%
Ontario	32%	26%	30%	32%	33%	42%
Manitoba	37%	27%	32%	33%	34%	46%
Saskatchewan	38%	32%	37%	38%	38%	53%
Alberta	42%	36%	40%	41%	42%	55%
North	38%	29%	33%	35%	35%	50%
National	37%	30%	34%	35%	36%	48%
Source: HICPS and SVS adapted by Program Analytics and Risk Mitigation

NIHB dental claimants by age group, gender and region: 2023 to 2024

Of the 959,207 clients eligible to receive dental benefits through the NIHB program, 344,898 claimants (36%) received at least 1 dental procedure paid through the HICPS system in 2023 to 2024.

Of this total, 194.189 were female (56%) and 150,709 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, 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 35 and 32, respectively.

Approximately 33% of all dental claimants were under 20. 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 2023 to 2024.

Table 6.4: NIHB dental claimants by age group, gender and region

Source: HICPS adapted by Program Analytics and Risk Mitigation

Table 6.4.1: Atlantic region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	108	539	790	1,149	905	881	898	756	746	708	780	779	698	1,413	11,150
Female+	122	606	908	1,249	1,087	1,282	1,215	982	997	880	1,030	1,090	1,017	2,039	14,504
Total	230	1,145	1,698	2,398	1,992	2,163	2,113	1,738	1,743	1,588	1,810	1,869	1,715	3,452	25,654
Average age: 40 (Male+: 39, Female+: 41)

Table 6.4.2: Quebec region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	178	1,131	1,584	1,421	1,045	1,111	1,174	999	928	869	944	974	941	1,722	15,021
Female+	189	1,186	1,613	1,560	1,329	1,481	1,526	1,339	1,217	1,184	1,216	1,275	1,195	2,467	18,777
Total	367	2,317	3,197	2,981	2,374	2,592	2,700	2,338	2,145	2,053	2,160	2,249	2,136	4,189	33,798
Average age: 38 (Male+: 37, Female+: 39)

Table 6.4.3: Ontario region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	706	2,982	3,566	3,277	2,586	2,711	2,555	2,148	1,813	1,780	1,833	1,876	1,891	3,492	33,216
Female+	717	2,879	3,635	3,601	3,334	3,594	3,476	2,919	2,716	2,451	2,615	2,788	2,841	5,704	43,270
Total	1,423	5,861	7,201	6,878	5,920	6,305	6,031	5,067	4,529	4,231	4,448	4,664	4,732	9,196	76,486
Average age: 37 (Male+: 35, Female+: 38)

Table 6.4.4: Manitoba region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	832	2,847	3,199	2,979	2,067	2,116	2,026	1,572	1,315	1,257	1,224	1,214	1,005	1,308	24,961
Female+	856	2,944	3,458	3,619	2,838	2,879	2,886	2,298	1,869	1,701	1,745	1,558	1,401	2,109	32,161
Total	1,688	5,791	6,657	6,598	4,905	4,995	4,912	3,870	3,184	2,958	2,969	2,772	2,406	3,417	57,122
Average age: 31 (Male+: 30, Female+: 32)

Table 6.4.5: Saskatchewan region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	1,059	3,226	3,759	3,360	2,359	2,224	2,317	1,998	1,605	1,471	1,366	1,256	1,010	1,260	28,270
Female+	1,148	3,240	4,027	3,960	3,289	3,501	3,365	2,799	2,239	1,960	1,894	1,748	1,397	2,001	36,568
Total	2,207	6,466	7,786	7,320	5,648	5,725	5,682	4,797	3,844	3,431	3,260	3,004	2,407	3,261	64,838
Average age: 31 (Male+: 29, Female+: 32)

Table 6.4.6: Alberta region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	1,038	3,137	3,760	3,125	2,090	1,925	1,867	1,575	1,308	1,190	1,037	1,058	764	1,121	24,995
Female+	1,059	3,210	3,761	3,566	2,625	2,616	2,631	2,207	1,877	1,643	1,560	1,381	1,238	1,799	31,173
Total	2,097	6,347	7,521	6,691	4,715	4,541	4,498	3,782	3,185	2,833	2,597	2,439	2,002	2,920	56,168
Average age: 30 (Male+: 28, Female+: 31)

Table 6.4.7: North region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	720	1,310	1,242	1,191	986	927	902	787	666	594	540	539	444	646	11,494
Female+	692	1,313	1,529	1,564	1,457	1,402	1,379	1,225	947	826	791	735	673	1,005	15,538
Total	1,412	2,623	2,771	2,755	2,443	2,329	2,281	2,012	1,613	1,420	1,331	1,274	1,117	1,651	27,032
Average age: 31 (Male+: 30, Female+: 32)

Table 6.4.8: Total for all regions
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	4,656	15,301	18,058	16,661	12,174	12,031	11,872	9,968	8,502	7,966	7,834	7,779	6,841	11,066	150,709
Female+	4,811	15,500	19,105	19,294	16,117	16,960	16,684	13,947	12,032	10,792	10,999	10,749	9,876	17,323	194,189
Total	9,467	30,801	37,163	35,955	28,291	28,991	28,556	23,915	20,534	18,758	18,833	18,528	16,717	28,389	344,898
Average age: 33 (Male+: 32, Female+: 35)

NIHB fee-for-service dental expenditures by service category: 2023 to 2024

In 2023 to 2024, expenditures for restorative services (crowns, fillings, etc.) were the highest of all dental service categories at $161.3 million. Diagnostic services (examinations, radiographs, etc.) at $41.7 million and preventive services (scaling, sealants, etc.) at $38.5 million were the next highest service categories. Rounding out the top 5 were oral surgery (extractions, etc.) at $37.2 million and endodontic services (root canal treatments, etc.) at $28.3 million.

Table 6.5: NIHB fee-for-service top 5 dental service categories ($ Millions)
Dental Sub-Benefit	2022 to 2023	2023 to 2024	% Change from 2022 to 2023
Restorative Services	$131.1	$161.3	23.0%
Diagnostic Services	$35.8	$41.7	16.3%
Preventive Services	$33.0	$38.5	16.6%
Oral Surgery Services	$32.0	$37.2	16.3%
Endodontic Services	$21.6	$28.3	30.8%
Source: HICPS adapted by Program Analytics and Risk Mitigation

In 2023 to 2024, the 3 highest dental procedures by expenditure were composite restorations ($138.4 million), scaling ($27.9 million) and extractions ($26.6 million).

Table 6.6: NIHB fee-for-service top 5 dental procedures ($ Millions)
Dental Procedure	2022 to 2023	2023 to 2024	% Change from 2022 to 2023
Composite Restorations	$111.2	$138.4	24.5%
Scaling	$24.9	$27.9	12.2%
Extractions	$22.6	$26.6	17.9%
Root Canal Therapy	$19.7	$26.1	32.6%
Intraoral Radiographs	$13.4	$15.8	18.3%
Source: HICPS adapted by Program Analytics and Risk Mitigation

Distribution of eligible NIHB population, dental expenditures and incidence by age group: 2023 to 2024

The ratio of incidence to expenditures is relatively consistent across most age groupings, with the exception of children aged 5 to 14, where a larger number of low-cost procedures, such as fillings, are provided. This group accounts for 21.8% of claims but only 16.9% of expenditures.

**Chart 6.4: Distribution of eligible NIHB population, dental expenditures and incidence by age group**

Section 7: NIHB Medical transportation expenditure and utilization data

In 2023 to 2024, Non-Insured Health Benefits Medical Transportation expenditures were $789.6 million or 37.6% of total NIHB expenditures. The medical transportation benefit is the largest program expenditure.

NIHB medical transportation benefits are intended to assist eligible clients to access medically necessary health services that are not available on reserve or in their community of residence.

Medical transportation benefits are managed by Indigenous Services Canada regional offices, or by First Nations or Inuit Health Authorities, organizations or territorial governments who manage the benefit through contribution agreements.

Medical transportation benefits include:

ground travel (private vehicle, commercial taxi, fee-for-service driver and vehicle, band vehicle, bus, train, snowmobile taxi, and ground ambulance)
air travel (scheduled flights; chartered flights; helicopter; and air ambulance)
water travel (motorized boat; boat taxi; and ferry)
living expenses (meals and accommodations)
transportation costs for health professionals to provide services to isolated communities

Medical transportation benefits may be provided for clients to access the following types of medically required health services:

medical services insured by provincial/territorial health plans (e.g., appointments with physicians, diagnostic tests, hospital care)
publicly funded alcohol, solvent, drug abuse and detox treatments
traditional healers
eligible benefits and services covered by the NIHB program

Medical transportation benefits may also be provided for a medical escort, such as a nurse, or a non-medical escort, such as a family member or caregiver, to travel with a client who needs assistance or to accompany pregnant clients who require transportation outside their community to deliver their babies.

In addition to client travel, medical transportation expenditures also include costs associated with transporting healthcare professionals to under-serviced and/or remote and isolated communities to facilitate access to medically necessary services.

Distribution of NIHB medical transportation expenditures ($ Millions): 2023 to 2024

In 2023 to 2024, NIHB medical transportation expenditures totalled $789.6 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 $345.2 million, or 43.7% of total benefit expenditures.

Of benefit expenditures managed by the NIHB program, scheduled flights at $119.8 million (15.2%), accommodations and meals at $109.0 million (13.8%), and air ambulance at $105.8 million (13.4%) were the largest expenditures, accounting for a combined total of over 40%.

Rounding out medical transportation expenditures are costs for land ambulance at $64.8 million (8.2%), land and water transportation at $34.6 million (4.4%) and chartered flights at $10.6 million (1.3%).

**Chart 7.1: Distribution of NIHB medical transportation expenditures ($ Millions)**

Annual NIHB medical transportation expenditures

NIHB medical transportation expenditures increased by 11.1% in 2023 to 2024 compared to the previous year. Over the past 5 years, overall medical transportation costs have grown by 47.0% from $537.2 million in 2019 to 2020 to $789.6 million in 2023 to 2024.

On a regional basis, the highest 5 year growth rate was in the North where expenditures grew by 69.6% from $76.6 million in 2019 to 2020 to $129.9 million in 2023 to 2024. This was followed by Ontario with an increase of 55.7% from $106.6 million in 2019 to 2020 to $166.0 million in 2023 to 2024.

Manitoba had the highest total medical transportation expenditures at $261.4 million in 2023 to 2024, followed by Ontario at $166.0 million and Saskatchewan at $115.9 million.

Table 7.1: NIHB Medical transportation expenditures by region (Thousands of dollars)
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	$13,910	$13,263	$15,776	$17,512	$18,294
Quebec	$25,729	$25,379	$26,775	$28,921	$28,596
Ontario	$106,638	$90,646	$114,814	$140,343	$166,036
Manitoba	$168,686	$155,790	$184,200	$233,140	$261,374
Saskatchewan	$83,947	$84,951	$103,152	$114,863	$115,915
Alberta	$61,669	$59,492	$67,206	$71,908	$69,508
North	$76,601	$96,194	$90,286	$103,926	$129,898
Total	$537,179	$525,715	$602,208	$710,614	$789,621
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

NIHB medical transportation expenditures by type and region (Thousands of dollars): 2023 to 2024

In 2023 to 2024 Manitoba had the highest overall NIHB medical transportation expenditures at $261.4 million, primarily as a result of air transportation, which totalled $154.6 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 2023 to 2024 at $166.3 million. The Northern region followed at $129.9 million.

Table 7.2: NIHB medical transportation expenditures by type and region (Thousands of dollars)
Type	Atlantic	Quebec	Ontario	Manitoba	Saskatchewan	Alberta	North	Total
Scheduled Flights	$2,755	$265	$52,371	$57,602	$3,619	$1,034	$2,128	$119,774
Air Ambulance	$50	$16	$86	$91,022	$8,797	$3,094	$2,696	$105,760
Chartered Flights	$0	$7	$1,179	$5,998	$1,998	$1,372	$0	$10,555
Land Ambulance	$516	$234	$1,110	$11,668	$35,757	$15,496	$3	$64,784
Land & Water	$1,318	$239	$6,578	$4,684	$17,600	$2,889	$1,273	$34,581
Accommodations & Meals	$1,977	$105	$42,750	$42,067	$11,268	$7,524	$3,290	$108,981
Total operating	$6,615	$867	$104,074	$213,040	$79,040	$31,409	$9,390	$444,436
Total contributions	$11,679	$27,729	$61,962	$48,334	$36,875	$38,099	$120,507	$345,186
Total	$18,294	$28,596	$166,036	$261,374	$115,915	$69,508	$129,898	$789,621
% Change from 2022-2023	4.5%	-1.1%	18.3%	12.1%	0.9%	-3.3%	25.0%	11.1%
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Per capita NIHB medical transportation expenditures by region: 2023 to 2024

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 2023 to 2024, the national per capita expenditure for NIHB medical transportation benefits was $823, an increase of 8.4% from the $759 recorded in 2022 to 2023.

The Northern region had the highest per capita expenditure in medical transportation at $1,734, an increase of 22.6% over 2022 to 2023. Manitoba followed at $1,534, a 9.2% increase over the previous fiscal year. These expenditures reflect the large number of First Nations and Inuit clients living in remote or fly-in communities who need to travel to urban centres to access health services.

In contrast, the Atlantic region had the lowest per capita expenditure at $258. 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.

**Chart 7.3: Per capita NIHB medical transportation expenditures by region**

Section 8: NIHB vision care benefits and utilization data

The NIHB program provides coverage for vision care benefits as set out in the NIHB Guide to Vision Care Benefits, including:

eye examinations when they are not insured by the province or territory
corrective eyewear (glasses, contact lenses) when prescribed by a vision care professional
eyeglass repairs

Some items such as ocular prosthesis and low vision aids are covered by NIHB as medical supplies and equipment benefits.

In 2023 to 2024, a total of 170,747 First Nations and Inuit clients accessed vision care benefits through the NIHB program, based on claims paid through the HICPS system. The total expenditure for vision care benefits was $52.0 million or 2.5% of total NIHB expenditures.

Distribution of NIHB vision care expenditures ($ millions): 2023 to 2024

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 $47.3 million or 90.9% of all NIHB vision care costs.

The next highest component was contribution agreements, which accounted for $4.7 million or 9.1% 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.

Regional vision care, at $33,400 or 0.1% of vision care benefit costs, refers to vision care claims paid through Indigenous Services Canada regional offices.

**Chart 8.1: Distribution of NIHB vision care expenditures ($ Millions)**

NIHB vision care expenditures and growth by region (Thousands of dollars): 2023 to 2024

NIHB vision care expenditures totalled $52.0 million in 2023 to 2024, an increase of 5.7% from the previous year.

Saskatchewan had the highest vision care costs at $11.2 million, or 21.6% of total vision care expenditure, followed by Ontario at $9.7 million (18.7%) and Alberta at $9.4 million (18.0%).

Table 8.1: NIHB vision care expenditures and growth by region (Thousands of dollars)
Region	Operating		Total Operating Costs	Total Contribution Costs	Total Costs
Region	Fee for Service	Regional	Total Operating Costs	Total Contribution Costs	Total Costs
Atlantic	$3,985	$0.7	$3,986	$0	$3,986
Quebec	$4,113	$0.0	$4,113	$0	$4,113
Ontario	$9,107	$0.0	$9,107	$625	$9,732
Manitoba	$8,039	$0.0	$8,039	$566	$8,605
Saskatchewan	$11,243	$0.0	$11,243	$0	$11,243
Alberta	$7,879	$0.0	$7,879	$1,475	$9,355
North	$2,925	$32.6	$2,958	$2,046	$5,004
Total	$47,292	$33.4	$47,325	$4,712	$52,038
Source: FST adapted by Program Analytics and Risk Mitigation

Annual NIHB vision care expenditures and percentage change

NIHB vision care expenditures increased by 5.7% during fiscal year 2023 to 2024. Over the past 5 years, growth in vision care expenditures has ranged from a high of 26.1% in 2019 to 2020 to a low of -14.4% in 2020 to 2021.

The 5 year annualized growth rate for NIHB vision care expenditures is 7.4%.

**Chart 8.2: Annual NIHB vision care expenditures**

On a regional basis, the highest growth rate over this 5 year period was in Quebec where expenditures grew by 50.4% from $2.7 million in 2019 to 2020 to $4.1 million in 2023 to 2024. Ontario had largest net increase in expenditures over this period, where costs grew by $1.9 million.

Table 8.2: NIHB vision care expenditures (Thousands of dollars) by region
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	$4,150	$3,436	$4,158	$4,149	$3,986
Quebec	$2,736	$2,814	$3,938	$4,081	$4,113
Ontario	$7,860	$7,346	$8,113	$8,633	$9,732
Manitoba	$6,935	$6,042	$7,334	$7,669	$8,605
Saskatchewan	$9,844	$8,493	$10,581	$10,585	$11,243
Alberta	$10,514	$8,030	$9,405	$9,446	$9,355
North	$3,929	$3,206	$4,081	$4,683	$5,004
Total	$45,968	$39,367	$47,609	$49,246	$52,038
Source: FST adapted by Program Analytics and Risk Mitigation

Per capita NIHB vision care expenditures by region: 2023 to 2024

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 2023 to 2024, the national per capita expenditure in NIHB vision care benefits was $54, an increase of 1.3% from the $53 recorded in 2022 to 2023. This figure is misleading, due to the small number of clients submitting claims for vision care services. National per claimant expenditure, that is the expenditure per client who received NIHB coverage for vision care in 2023 to 2024 was $305.

Alberta had the highest per capita expenditure at $69, followed by the North at $67 and Saskatchewan at $66. The lowest per capita NIHB vision care benefit expenditure was in Ontario at $42.

**Chart 8.3: Per capita NIHB vision care expenditures by region**

NIHB vision care claimants by age group, gender and region: 2023 to 2024

Of the 959,207 clients eligible to receive benefits under the NIHB program, a total of 170,747 claimants, representing 17.8% of the NIHB client population, had at least 1 vision care claim paid through the Health Information and Claims Processing Services (HICPS) system in 2023 to 2024. Of this total, 103,159 were female (60.4%) and 67,588 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 37. The average age for female and male claimants was 37 and 36, respectively.

Table 8.3: NIHB vision care claimants by age group, gender and region

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

Table 8.3.1: Atlantic region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	68	420	587	541	376	382	403	310	300	365	466	457	405	949	6,029
Female+	74	476	706	727	661	652	641	549	560	553	624	675	621	1,456	8,975
Total	142	896	1,293	1,268	1,037	1,034	1,044	859	860	918	1,090	1,132	1,026	2,405	15,004
Average age: 40 (Male+: 40, Female+: 41)

Table 8.3.2: Quebec region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	24	282	407	473	361	343	347	331	333	373	408	400	460	735	5,277
Female+	17	301	575	701	629	649	666	583	550	661	576	645	619	1,090	8,262
Total	41	583	982	1,174	990	992	1,013	914	883	1,034	984	1,045	1,079	1,825	13,539
Average age: 41 (Male+: 41, Female+: 41)

Table 8.3.3: Ontario region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	47	717	1,257	1,269	1,014	931	995	841	799	965	950	949	943	1,607	13,284
Female+	56	810	1,522	1,627	1,511	1,692	1,631	1,370	1,421	1,448	1,463	1,555	1,535	2,553	20,194
Total	103	1,527	2,779	2,896	2,525	2,623	2,626	2,211	2,220	2,413	2,413	2,504	2,478	4,160	33,478
Average age: 40 (Male+: 40, Female+: 41

Table 8.3.4: Manitoba region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	39	797	1,529	1,419	882	804	763	631	614	605	677	668	584	820	10,832
Female+	50	994	1,903	2,153	1,469	1,450	1,542	1,166	1,046	1,025	1,092	1,046	913	1,432	17,281
Total	89	1,791	3,432	3,572	2,351	2,254	2,305	1,797	1,660	1,630	1,769	1,714	1,497	2,252	28,113
Average age: 31 (Male+: 30, Female+: 32)

Table 8.3.5: Saskatchewan region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	112	1,467	2,292	2,167	1,477	1,313	1,445	1,056	1,024	983	960	859	715	1,190	17,060
Female+	156	1,683	2,783	2,986	2,373	2,465	2,310	1,961	1,640	1,496	1,470	1,357	1,251	1,964	25,895
Total	268	3,150	5,075	5,153	3,850	3,778	3,755	3,017	2,664	2,479	2,430	2,216	1,966	3,154	42,955
Average age: 31 (Male+: 29, Female+: 32)

Table 8.3.6: Alberta region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	62	831	1,332	1,383	1,005	955	912	777	704	639	606	565	454	647	10,872
Female+	70	968	1,673	1,727	1,474	1,508	1,433	1,214	1,126	975	933	793	777	1,024	15,695
Total	132	1,799	3,005	3,110	2,479	2,463	2,345	1,991	1,830	1,614	1,539	1,358	1,231	1,671	26,567
Average age: 30 (Male+: 28, Female+: 31)

Table 8.3.7: North region
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	17	171	305	353	260	252	245	208	208	240	314	311	279	554	3,717
Female+	33	193	406	528	466	473	514	430	419	389	428	445	404	791	5,919
Total	50	364	711	881	726	725	759	638	627	629	742	756	683	1,345	9,636
Average age: 41 (Male+: 40, Female+: 41)

Table 8.3.8: Total for all regions
	0-4	5-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group														Total
Male+	371	4,708	7,739	7,649	5,412	5,019	5,159	4,196	4,033	4,207	4,417	4,256	3,869	6,553	67,588
Female+	457	5,449	9,618	10,514	8,674	8,963	8,833	7,348	6,844	6,624	6,664	6,602	6,183	10,386	103,159
Total	828	10,157	17,357	18,163	14,086	13,982	13,992	11,544	10,877	10,831	11,081	10,858	10,052	16,939	170,747
Average age: 37 (Male+: 36, Female+: 37)

NIHB vision care expenditures by category: 2023 to 2024

In 2023 to 2024, new eyewear, such as eyeglasses, accounted for $40.6 million or 86.1% of all HICPS vision care expenditures. Eye exams were $5.9 million or 12.6%, followed by repairs at $282 thousand or 0.6%.

Table 8.4: NIHB vision care claimants and expenditures (Thousands of dollars) by category
Category	Claimants	Expenditures	% Change from previous year
New Eyewear	147,897	$40,579,261	6.6%
Eye Exams	82,803	$5,946,659	10.2%
Repairs	3,135	$281,744	-12.1%
Early Replacement	1,479	$241,883	20.0%
Add Ons	8,532	$77,082	-11.4%
Other	60	$8,640	-55.1%
Source: HICPS adapted by Program Analytics and Risk Mitigation

Section 9: NIHB mental health counselling expenditure and utilization data

The NIHB program provides coverage for mental health benefits as set out in the NIHB Guide to Mental Health Counselling Services. The NIHB program's mental health counselling benefit is intended to provide coverage for professional mental health counselling to complement other mental wellness services that may be available to clients or in communities. Mental health counselling is eligible for coverage when it is provided by an NIHB recognized mental health professional such as a registered psychologist. The mental health counselling benefit is offered in a way that:

recognizes NIHB mental health counselling benefit as a component of a mental wellness continuum that includes other Indigenous Services Canada, community-based and provincial or territorial mental health programming and services
supports culturally competent mental health counselling

In 2023 to 2024, a total of 38,427 First Nations and Inuit clients accessed mental health counselling benefits through the NIHB program, based on claims paid through the HICPS system. The total expenditure for mental health counselling benefits was $117.4 million or 5.6% of total NIHB expenditures.

Distribution of NIHB mental health counselling expenditures ($ millions): 2023 to 2024

NIHB mental health counselling expenditures are comprised of several distinct components. Fee-for-service mental health counselling costs paid through HICPS system represented the largest expenditure portion, accounting for $69.0 million or 58.7% of all NIHB mental health counselling costs.

The next highest component was contribution agreements, which accounted for $30.9 million or 26.4% of total mental health counselling costs. Contribution agreements are used to fund First Nations or Inuit communities and organizations and/or Territorial Governments directly for the provision of mental health counselling benefits.

Regional mental health counselling, at $17.5 million or 14.9% of mental health counselling benefit costs, refers to mental health counselling claims paid through Indigenous Services Canada regional offices.

**Chart 9.1: Distribution of NIHB mental health counselling expenditures ($ Millions)**

NIHB mental health counselling expenditures by region (Thousands of dollars): 2023 to 2024

NIHB mental health counselling expenditures totalled $117.4 million in 2023 to 2024, an increase of 19.1% from the previous year.

Saskatchewan had the highest mental health counselling costs at $31.9 million, or 27.1% of total mental health counselling expenditures, followed by Ontario at $27.4 million (23.4%) and Manitoba at $20.0 million (17.0%).

Table 9.1: NIHB mental health counselling expenditures by region (Thousands of dollars)
Region	Operating		Total Operating Costs	Total Contribution Costs	Total Costs
Region	Mental health counselling (HICPS)	Mental health counselling (Regional)	Total Operating Costs	Total Contribution Costs	Total Costs
Atlantic	$4,413	$40	$4,453	$3,335	$7,788
Quebec	$4,254	$1,675	$5,929	$1,475	$7,404
Ontario	$25,836	$0	$25,836	$1,596	$27,432
Manitoba	$7,135	$7,007	$14,143	$5,861	$20,003
Saskatchewan	$16,604	$4,709	$21,313	$10,556	$31,869
Alberta	$8,943	$4,065	$13,008	$5,208	$18,216
North	$1,801	$0	$1,801	$2,910	$4,711
Total	$68,986	$17,497	$86,483	$30,942	$117,425
Source: FST adapted by Program Analytics and Risk Mitigation

NIHB mental health counselling expenditures and annual percentage change

NIHB mental health counselling expenditures increased by 19.1% during fiscal year 2023 to 2024. Over the past 5 years, mental health counselling costs have grown by 113.0% from $55.1 million in 2019 to 2020 to $117.4 million in 2023 to 2024. Over the past 5 years, growth in mental health counselling expenditures has ranged from a high of 33.0% in 2020 to 2021 to a low of 5.2% in 2022 to 2023.

The 5 year annualized growth rate for NIHB mental health counselling expenditures is 16.3%.

**Chart 9.2: NIHB mental health counselling expenditures and annual percentage change**

On a regional basis, the highest growth rates over this period were in Saskatchewan where expenditures grew by 170.5% from $11.8 million in 2019 to 2020 to $31.9 million in 2023 to 2024. This was followed by Quebec with an increase of 136.0% from $3.1 million in 2019 to 2020 to $7.4 million in 2023 to 2024.

Table 9.2: NIHB mental health expenditures (Thousands of dollars)
Region	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Atlantic	$3,428	$6,037	$7,001	$6,918	$7,788
Quebec	$3,138	$4,493	$5,604	$6,381	$7,404
Ontario	$12,116	$15,491	$21,762	$24,491	$27,432
Manitoba	$11,475	$13,803	$16,333	$16,393	$20,003
Saskatchewan	$11,783	$16,770	$24,881	$25,194	$31,869
Alberta	$11,020	$12,843	$14,771	$15,815	$18,216
North	$2,167	$3,895	$3,333	$3,394	$4,711
Total	$55,126	$73,332	$93,686	$98,585	$117,425
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Per capita NIHB mental health counselling expenditures by region (Thousands of dollars): 2023 to 2024

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

In 2023 to 2024, the national per capita expenditure for the NIHB mental health counselling benefit was $122 per NIHB-eligible client.

Saskatchewan had the highest per capita expenditure at $188, followed by Alberta at $135. Note that mental health counselling per capita expenditures in the North are underrepresented as mental health counselling services for clients in Nunavut and the Northwest Territories are funded via contribution agreements.

**Chart 9.3: Per capita NIHB mental health counselling expenditures by region (Thousands of dollars)**

NIHB mental health counselling claimants by age group, gender and region: 2023 to 2024

Of the 959,207 clients eligible to receive benefits under the NIHB program, a total of 38,427 claimants, representing 4.0% of the NIHB client population, had at least 1 mental health counselling claim paid through the Health Information and Claims Processing Services (HICPS) system in 2023 to 2024. Of this total, 26,368 were female (68.6%) and 12,059 were male (31.4%). This compares to the total eligible population where 51% were female and 49% were male.

Note that these figures underrepresent mental health counselling utilization because they do not include clients accessing mental health counselling benefits delivered through contribution agreements or through travelling provider arrangements. This includes clients in Nunavut and the Northwest Territories, where mental health counselling services are funded via contribution agreements. As such, these claims are not captured in the HICPS system.

The average age of mental health counselling claimants was 32. The average age for female and male claimants was 33 and 31, respectively.

Table 9.3: NIHB mental health counselling claimants by age group, gender and region

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

Table 9.3.1: Atlantic region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	31	88	84	92	93	68	65	59	39	28	31	16	9	703
Female+	27	121	178	193	289	227	161	110	102	94	52	40	48	1,642
Total	58	209	262	285	382	295	226	169	141	122	83	56	57	2,345
Average age: 32 (Male+: 30, Female+: 33)

Table 9.3.2: Quebec region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	27	60	68	62	109	79	81	69	50	49	22	21	25	722
Female+	21	103	167	180	245	212	206	144	122	107	80	72	65	1,724
Total	48	163	235	242	354	291	287	213	172	156	102	93	90	2,446
Average age: 35 (Male+: 34, Female+: 35)

Table 9.3.3: Ontario region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	249	436	454	374	463	451	398	320	244	188	170	120	101	3,968
Female+	226	635	905	890	1,094	1,039	839	698	587	494	388	318	330	8,443
Total	475	1,071	1,359	1,264	1,557	1,490	1,237	1,018	831	682	558	438	431	12,411
Average age: 34 (Male+: 32, Female+: 34)

Table 9.3.4: Manitoba region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	37	126	199	172	162	167	115	111	79	51	32	23	22	1,296
Female+	66	229	398	466	445	422	322	248	157	127	91	63	52	3,086
Total	103	355	597	638	607	589	437	359	236	178	123	86	74	4,382
Average age: 31 (Male+: 30, Female+: 31)

Table 9.3.5: Saskatchewan region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	159	359	426	303	351	431	374	254	186	144	92	65	49	3,193
Female+	165	622	909	769	963	969	778	543	399	363	254	196	147	7,077
Total	324	981	1,335	1,072	1,314	1,400	1,152	797	585	507	346	261	196	10,270
Average age: 32 (Male+: 31, Female+: 32)

Table 9.3.6: Alberta region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	120	255	247	195	201	186	165	129	103	59	43	22	23	1,748
Female+	116	346	433	360	467	486	377	310	209	167	126	82	72	3,551
Total	236	601	680	555	668	672	542	439	312	226	169	104	95	5,299
Average age: 31 (Male+: 28, Female+: 32)

Table 9.3.7: North region
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	13	26	27	24	44	39	28	25	20	23	20	15	15	319
Female+	8	23	51	68	82	86	77	46	37	35	41	17	27	598
Total	21	49	78	92	126	125	105	71	57	58	61	32	42	917
Average age: 36 (Male+: 36, Female+: 36)

Table 9.3.8: Total for all regions
	0-9	10-14	15-19	20-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65+	Total
	Age group													Total
Male+	643	1,354	1,517	1,228	1,441	1,440	1,240	974	727	548	417	284	246	12,059
Female+	636	2,093	3,062	2,956	3,619	3,480	2,788	2,119	1,633	1,400	1,042	797	743	26,368
Total	1,279	3,447	4,579	4,184	5,060	4,920	4,028	3,093	2,360	1,948	1,459	1,081	989	38,427
Average age: 32 (Male+: 31, Female+: 33)

NIHB mental health counselling expenditures by category: 2023 to 2024

In 2023 to 2024, individual counselling sessions accounted for $51.4 million or 74.4% of all HICPS mental health counselling expenditures. Telehealth counselling sessions were $16.6 million or 24.0%, followed by other at $640 thousand or 0.9%.

Table 9.3: NIHB mental health counselling claimants and expenditures (Thousands of dollars) by category
Category	Claimants	Expenditures	% Change from previous
Individual Counselling Session	45,650	$51,388,164	34.6%
Telehealth Counselling Session	12,442	$16,609,563	3.5%
Other	2,881	$640,130	-8.8%
Couple/Family Counselling Session	471	$170,833	-58.0%
Group Counselling Session	511	$273,256	-43.7%
Source: HICPS adapted by Program Analytics and Risk Mitigation

Section 10: 10 year regional expenditure trends

Atlantic region

Annual expenditures in the Atlantic region for 2023 to 2024 totalled $102.3 million, an increase of 10.6% over the $92.5 million spent in 2022 to 2023. Pharmacy expenditures in 2023 to 2024 increased by 8.0% to $49.5 million, medical transportation costs increased by 4.5% to $18.3 million and dental expenditures increased by 14.1% to $14.4 million. Mental health expenditures increased by 12.6%, MS&E expenditures increased by 14.4% and vision care expenditures decreased by 3.9%.

Pharmacy expenditures accounted for almost half of NIHB expenditures in the Atlantic region at 48.4%. Medical transportation expenditures ranked second at 17.9%, followed by dental at 14.1%. MS&E, vision care and mental health counselling expenditures accounted for 5.4%, 7.6% and 3.9% of total expenditures, respectively.

**Chart 10.1: Percentage change in Atlantic region NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.1: Atlantic region annual expenditures by benefit (Thousands of dollars)
Atlantic region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$7,419	$8,380	$9,277	$11,147	$11,820	$13,910	$13,263	$15,776	$17,512	$18,294
Pharmacy	$26,278	$27,665	$28 976	$29,741	$30,448	$35,365	$37,323	$40,657	$45,819	$49,470
MS&E	$2,120	$2,449	$2,990	$3,279	$3,900	$4,359	$4,177	$4,508	$4,785	$5,473
Dental	$8,238	$8,846	$9,593	$10,610	$10,841	$11,545	$9,455	$11,801	$12,638	$14,425
Mental health	$169	$419	$601	$1,204	$1,932	$3,428	$6,037	$7,001	$6,918	$7,788
Vision care	$2,666	$3,021	$3,502	$3,632	$3,885	$4,150	$3,436	$4,158	$4,149	$3,986
Other	$21	$44	$207	$427	$516	$314	$293	$326	$666	$2,844
Total	$46,912	$50,824	$55,146	$60,040	$63,342	$73,071	$73,984	$84,227	$92,488	$102,281
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Quebec

Annual expenditures in Quebec for 2023 to 2024 totalled $138.0 million, an increase of 7.8% from the $128.0 million spent in 2022 to 2023.

Medical transportation expenditures decreased by 1.1% to $28.6 million in 2023 to 2024, pharmacy expenditures increased by 8.1% to $70.0 million and dental expenditures increased by 14.4% to $23.4 million. MS&E costs increased by 21.6%, mental health expenditures increased by 16.0% and vision care expenditures increased by 0.8%.

Pharmacy expenditures accounted for half of total NIHB expenditures in Quebec in 2023 to 2024 at 50.7%. Medical transportation expenditures ranked second at 20.7%, followed by dental at 16.9%. Mental health counselling, MS&E and vision care expenditures accounted for 5.3%, 2.8% and 3.0% of total expenditures, respectively.

**Chart 10.2: Percentage change in Quebec NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.2: Quebec annual expenditures by benefit (Thousands of dollars)
Quebec region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$23,506	$23,687	$23,501	$23,918	$24,642	$25,729	$25,379	$26,775	$28,921	$28,596
Pharmacy	$40,897	$42,554	$45,554	$46,227	$46,623	$50,747	$53,282	$58,827	$64,799	$70,023
MS&E	$1,684	$1,652	$1,890	$2,163	$2,345	$2,564	$2,379	$2,855	$3,149	$3,828
Dental	$15,799	$16,641	$17,569	$17,961	$17,882	$18,733	$14,934	$19,092	$20,427	$23,367
Mental health	$1,148	$1,148	$1,292	$1,861	$2,382	$3,138	$4,493	$5,604	$6,381	$7,404
Vision care	$1,622	$1,749	$1,762	$1,819	$1,908	$2,736	$2,814	$3,938	$4,081	$4,113
Other	$10	$258	$263	$260	$339	$490	$493	$282	$258	$700
Total	$84,666	$87,690	$91,831	$94,210	$96,120	$104,136	$103,773	$117,373	$128,017	$138,032
Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Ontario

Annual expenditures in Ontario for 2023 to 2024 totalled $414.8 million, an increase of 13.6% from the $365.1 million spent in 2022 to 2023.

In 2023 to 2024, medical transportation expenditures in Ontario increased by 18.3% to $166.0 million, while pharmacy costs increased by 5.4% to $120.0 million and dental expenditures increased by 17.7% to $79.0 million. Mental health counselling expenditures increased by 12.0%, while MS&E increased by 20.2% and vision care expenditures increased by 12.7%.

Medical transportation expenditures accounted for 40.0% of total expenditures for Ontario. Pharmacy costs ranked second at 28.9%, followed by dental at 19.0%. Mental health, MS&E and vision care expenditures accounted for 6.6%, 2.9% and 2.3% of total expenditures respectively.

**Chart 10.3: Percentage change in Ontario NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.3: Ontario annual expenditures by benefit (Thousands of dollars)
Ontario region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$65,781	$67,772	$74,890	$86,091	$98,605	$106,638	$90,646	$114,814	$140,343	$166,036
Pharmacy	$81,982	$84,232	$88,466	$99,550	$100,558	$104,760	$105,300	$112,069	$113,842	$119,964
MS&E	$4,255	$4,639	$5,634	$5,915	$6,662	$7,322	$7,297	$8,700	$10,045	$12,071
Dental	$46,759	$49,903	$52,105	$52,055	$53,667	$55,386	$47,218	$59,326	$67,128	$78,995
Mental health	$2,803	$3,021	$4,091	$6,028	$9,053	$12,116	$15,491	$21,762	$24,491	$27,432
Vision care	$5,717	$6,160	$6,223	$6,848	$6,744	$7,860	$7,346	$8,113	$8,633	$9,732
Other	$2	$11	$254	$375	$500	$883	$688	$710	$587	$567
Total	$203,043	$215,738	$231,663	$250,947	$269,127	$287,643	$273,987	$325,494	$365,069	$414,797
Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Manitoba

Annual expenditures in Manitoba for 2023 to 2024 totalled $503.1 million, an increase of 11.3% from the $451.8 million spent in 2022 to 2023. Medical transportation expenditures in 2023 to 2024 increased by 12.1% to $261.4 million, while pharmacy costs increased by 6.7% to $128.2 million. Dental expenditures increased by 14.4% to $69.0 million. Mental health counselling, MS&E and vision care expenditures increased by 22.0%, 12.9% and 12.2% respectively.

Due to the higher proportion of clients living in northern or remote communities in Manitoba, medical transportation expenditures comprised more than half of total expenditures in Manitoba at 52.0%. Pharmacy costs ranked second at 25.5%, followed by dental at 13.7%. Mental health counselling, MS&E and vision care expenditures accounted for 4.0%, 3.1% and 1.7% of total expenditures respectively.

**Chart 10.4: Percentage change in Manitoba NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.4: Manitoba annual expenditures by benefit (Thousands of dollars)
Manitoba region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$115,705	$125,308	$147,167	$155,370	$156,961	$168,686	$155,794	$184,200	$233,140	$261,374
Pharmacy	$81,059	$82,922	$88,639	$98,046	$101,250	$112,025	$106,851	$112,353	$120,207	$128,221
MS&E	$5,045	$5,075	$6,119	$6,985	$9,166	$11,966	$11,145	$13,330	$13,870	$15,661
Dental	$33,527	$36,764	$39,986	$41,949	$48,099	$52,622	$44,149	$57,381	$60,247	$68,952
Mental health	$4,099	$3,780	$5,635	$8,124	$9,705	$11,475	$13,803	$16,333	$16,393	$20,003
Vision care	$4,800	$4,212	$4,204	$4,479	$4,699	$6,935	$5,529	$7,334	$7,669	$8,605
Other	$0	$17	$240	$240	$240	$240	$245	$247	$273	$255
Total	$239,190	$258,077	$291,989	$308,208	$320,953	$351,983	$337,517	$391,177	$451,799	$503,072
Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Saskatchewan

Annual expenditures in Saskatchewan for 2023 to 2024 totalled $393.3 million, an increase of 8.3% from the $363.3 million spent in 2022 to 2023.

NIHB pharmacy expenditures increased in Saskatchewan by 8.5% to $137.5 million, while medical transportation costs increased by 0.9% to $115.9 million. Dental cost increased by 10.7% to $78.0 million. Mental health counselling, MS&E and vision care costs increased by 26.5%, 14.9% and 6.2% respectively.

Pharmacy expenditures comprised the largest portion of total NIHB expenditures in Saskatchewan at 35.0%, medical transportation costs ranked second, at 29.5%, followed by dental at 19.8%. Mental health, MS&E and vision care expenditures accounted for 8.1%, 4.5% and 2.9% of total expenditures respectively.

**Chart 10.5: Percentage change in Saskatchewan NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.5: Saskatchewan annual expenditures by benefit (Thousands of dollars)
Saskatchewan region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$51,543	$53,566	$58,902	$64,363	$75,330	$83,947	$84,951	$103,152	$114,863	$115,915
Pharmacy	$83,361	$84,129	$95,937	$119,326	$118,250	$126,963	$116,188	$120,000	$126,676	$137,470
MS&E	$6,542	$7,041	$8,145	$9,426	$10,762	$11,889	$11,908	$13,352	$15,310	$17,587
Dental	$37,679	$41,028	$47,321	$50,635	$55,603	$57,639	$47,507	$63,408	$70,480	$78,046
Mental health	$1,351	$1,631	$3,304	$6,559	$7,867	$11,783	$16,770	$24,881	$25,194	$31,869
Vision care	$6,066	$6,104	$6,533	$6,905	$7,822	$9,844	$8,493	$10,581	$10,585	$11,243
Other	$0	$4	$210	$210	$210	$210	$211	$211	$211	$1,186
Total	$180,000	$193,502	$220,352	$247,997	$265,082	$290,386	$286,028	$335,584	$363,319	$393,315
Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Alberta

Annual expenditures in Alberta for 2023 to 2024 totalled $288.1 million, an increase of 6.0% from the $288.1 million spent in 2022 to 2023. Medical transportation expenditures decreased by 3.3% to $69.5 million, while pharmacy costs increased by 6.3% to $102.6 million. Dental expenditures increased by 14.2% to $74.5 million. Mental health counselling and MS&E expenditures increased by 15.2% and 8.9% while vision care expenditures decreased by 1.0%.

Pharmacy expenditures accounted for 35.6% of total NIHB expenditures in Alberta. Dental costs ranked second at 25.9%, followed by medical transportation at 24.1%. Mental health counselling, MS&E and vision care expenditures accounted for 6.3%, 4.7% and 3.2% of total expenditures respectively.

**Chart 10.6: Percentage change in Alberta NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.6: Alberta annual expenditures by benefit (Thousands of dollars)
Alberta region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$45,756	$46,252	$48,157	$51,187	$56,870	$61,669	$59,492	$67,206	$71,908	$69,508
Pharmacy	$64,087	$64,370	$69,362	$79,343	$83,103	$93,776	$84,920	$86,680	$96,511	$102,556
MS&E	$6,487	$5,623	$7,902	$8,260	$9,127	$10,250	$9,647	$11,658	$12,503	$13,614
Dental	$35,974	$39,753	$44,315	$47,637	$51,617	$54,993	$47,741	$58,790	$65,240	$74,484
Mental health	$6,010	$6,003	$6,444	$7,761	$9,545	$11,020	$12,843	$14,771	$15,815	$18,216
Vision care	$7,084	$6,207	$6,928	$6,764	$7,696	$10,514	$8,030	$9,405	$9,446	$9,355
Other	$0	$3	$0	$291	$291	$204	$280	$360	$360	$360
Total	$158,911	$168,211	$183,108	$192,983	$209,122	$232,177	$222,953	$248,869	$271,783	$288,092
Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Northern region

Annual expenditures in the Northern region for 2023 to 2024 totalled $221.5 million, an increase of 21.8% from the $181.8 million spent in 2022 to 2023. Medical transportation expenditures increased by 25.0% to $129.9 million in 2023 to 2024 while pharmacy costs increased by 7.2% to $35.9 million. Dental expenditures increased by 27.3% to $38.6 million. Mental health counselling, MS&E and vision care costs increased by 6.9%, 25.0% and 6.9% respectively.

As with Manitoba, medical transportation expenditures comprised the largest portion of total NIHB expenditures in the Northern region at 58.7%. Dental costs ranked second at 17.4%, followed by pharmacy at 16.2%. MS&E, vision care, and mental health counselling expenditures accounted for 3.1%, 2.3% and 2.1% of total expenditures respectively.

**Chart 10.7: Percentage change in Northern Region NIHB expenditures (Thousands of dollars)**

Annual expenditures by benefit (Thousands of dollars)

Table 10.7: Northern region annual expenditures by benefit (Thousands of dollars)
Northern region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Transportation	$48,246	$50,940	$55,125	$67,413	$70,806	$76,601	$96,194	$90,286	$103,926	$129,898
Pharmacy	$23,941	$23,528	$24,283	$29,373	$31,571	$33,220	$29,479	$31,499	$33,457	$35,869
MS&E	$3,101	$3,880	$4,205	$4,018	$4,529	$4,884	$4,024	$5,647	$5,520	$6,898
Dental	$20,413	$20,936	$21,966	$25,141	$26,211	$26,546	$20,342	$26,830	$30,332	$38,600
Mental health	$0	$191	$362	$1,528	$2,172	$2,167	$3,895	$3,333	$3,394	$4,711
Vision care	$1,743	$2,564	$3,217	$3,131	$3,713	$3,929	$3,206	$4,081	$4,683	$5,004
Other	$1	$1	$0	$346	$1	$498	$524	$405	$485	$490
Total	$94,343	$102,040	$109,157	$126,933	$134,474	$142,961	$157,664	$162,080	$181,796	$221,469
Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Section 11: NIHB program administration

The roles of NIHB headquarters include:

program policy development and determination of eligible benefits
development and maintenance of the HICPS system and other national systems, such as the Medical Transportation Reporting System (MTRS)
claims verification and provider negotiations
data analysis and reporting
adjudicating benefit requests through the NIHB Drug Exception Centre and the Dental Predetermination Centre
providing expert advice through the MS&E Review Centre
producing national program communications for NIHB clients and providers and
maintaining relationships with national partner organizations, as well as with other federal departments and agencies.

The roles of NIHB regional offices include:

adjudicating benefit requests for medical transportation, mental health counselling, vision care and medical supplies and equipment
coordinating medical transportation arrangements such as flights and accommodations
maintaining relationships with partner organizations at the provincial/territorial level as well as with provincial/territorial officials
managing contribution agreements (CA) and certain contracts
managing travelling provider arrangements.

Non-insured health benefits administration costs (Thousands of dollars): 2023 to 2024

Table 11.1 outlines program administration expenditures by region and at NIHB headquarters (HQ) costs. In 2023 to 2024, total NIHB administration costs were $86.9 million, representing an increase of 17.5% over the previous fiscal year.

Claims processing contract costs are related to the administration of pharmacy, medical supplies and equipment, dental benefits, mental health counselling and vision care benefits through the Health Information and Claims Processing Services (HICPS) system.

Table 11.1: NIHB program administration expenditures by region (Thousands of dollars)
Categories	Atlantic	Quebec	Ontario	Manitoba	Saskatchewan	Alberta	North	HQ	Total
Salaries	$2,107	$2,188	$6,373	$6,083	$4,939	$5,013	$2,050	$22,987	$51,740
EBP	$569	$591	$1,708	$1,642	$1,330	$1,340	$553	$6,019	$13,753
Operating	$100	$42	$63	$73	$188	$116	$37	$2,725	$3,345
Subtotal	$2,776	$2,821	$8,144	$7,798	$6,457	$6,469	$2,640	$31,731	$68,837
Claims processing contract costs									$18,102
Total administration costs									$86,940
Source: FST adapted by Program Analytics and Risk Mitigation

Non-Insured Health Benefits administration costs as a proportion of benefit expenditures ($ Millions)

In 2023 to 2024, total NIHB benefit expenditures were $2,098.2 million, of which direct benefit expenditures totalled $2,080.1 million and expenditures for claims processing administration amounted to $18.1 million. An additional $68.8 million was spent on salaries and operating costs associated with program administration. Some administrative costs paid within contribution agreements are not captured in these data.

Total NIHB program administration costs ($86.9 million, including claims processing and other program administration) as a proportion of direct benefit expenditures ($2.1 billion) was 4.2% in 2023 to 2024. Over the past 5 fiscal years, the percentage of NIHB program administration costs as a proportion of total benefit expenditures has ranged from a high of 5.1% in 2019 to 2020 to a low of 3.9% in 2022 to 2023.

**Chart 11.1: Non-Insured Health Benefits administration costs as a proportion of benefit expenditures ($ Millions)**

Health Information and Claims Processing Services (HICPS): 2023 to 2024

Claims for NIHB pharmacy, dental, MS&E, as well as most mental health counselling and vision care benefits provided to eligible First Nations and Inuit clients are processed via the Health Information and Claims Processing Services (HICPS) system. HICPS includes administrative services and programs, technical support and automated information management systems that are used to process and pay claims in accordance with NIHB program client/benefit eligibility and pricing policies.

Since 1990, the NIHB program has retained the services of a private sector contractor to administer the following core claims processing services on its behalf:

claim processing and payment operations
claim adjudication and reporting systems development and maintenance
provider registration and communications
provider audit programs and audit recoveries and
standard and ad hoc reporting.

The current HICPS contract is with Express Scripts Canada. This contract came into force on June 28, 2020, following a competitive contracting process led by Public Services and Procurement Canada (PSPC). The NIHB program manages the HICPS contract as the project authority in conjunction with PSPC, the contract authority.

Number of active providers registered in the Health Information and Claims Processing Services (HICPS) system 2023 to 2024

Benefit providers can register with Express Scripts Canada to provide benefits to NIHB clients and bill the program directly. An active provider is a provider who has submitted at least 1 claim in the 24 months prior to March 31, 2024.

As of March 31, 2024, there were 44,484 active pharmacy, dental, MS&E, mental health counselling and vision care providers registered with the HICPS claims processor to deliver NIHB benefits. The number of active providers by region and by benefit is outlined in the table below.

Table 11.2: Number of NIHB providers by region and benefit April 2022 to March 2024
Region	Pharmacy	MS&E	Dental	Vision	Mental Health
Atlantic	885	285	1,353	517	519
Quebec	2,053	283	3,470	954	454
Ontario	4,814	931	8,788	1,726	1,749
Manitoba	553	99	1,228	200	338
Saskatchewan	497	177	923	343	581
Alberta	1,901	406	4,149	1,060	693
British Columbia	1,033	41	848	78	9
North	32	32	415	29	38
Total	11,768	2,254	21,174	4,907	4,381
Source: HICPS adapted by Program Analytics and Risk Mitigation

Number of claim lines settled through the Health Information and Claims Processing Services (HICPS) system 2023 to 2024

Table 11.3 sets out the total number of pharmacy, dental, MS&E, mental health counselling and vision care claims settled through the HICPS system in fiscal year 2023 to 2024. During this period, more than 34 million claim lines were processed through HICPS. Ontario had the highest volume of claims processed at 8.6 million, followed by Manitoba at 6.3 million and Saskatchewan at 5.9 million.

Claim lines vs. prescriptions or visits

It is important to note that the program reports annually on claim lines. This is an administrative unit of measure as opposed to a health care unit of measure. A claim line represents a transaction in the claims processing system and is not equivalent to a prescription or health practitioner visit. Prescriptions can contain several different drugs with each one represented by a separate claim line. Prescriptions for a number of drugs may be repeated and refilled many times throughout the year. In the case of repeating prescriptions, each time a prescription is refilled, the system will log another transaction (claim line). Therefore, it is possible for an individual who has a prescription that repeats multiple times in a year to have numerous related claim lines associated with the single prescription. Likewise, an appointment with a medical practitioner may result in multiple claim lines as several procedures are performed at the same time.

Mental health counselling services for clients in Nunavut and the Northwest Territories are funded via contribution agreements. As such, claim lines are not captured in the HICPS system.

Table 11.3: Number of claim lines processed through HICPS by region and benefit
Region	Pharmacy	Dental	MS&E	Mental Health	Vision Care	Total
Atlantic	1,954,356	204,940	63,050	35,881	30,601	2,288,828
Quebec	3,902,723	260,861	57,456	24,703	21,827	4,267,570
Ontario	7,492,324	802,152	83,818	177,981	55,552	8,611,827
Manitoba	5,438,905	636,643	132,128	47,220	44,020	6,298,916
Saskatchewan	4,874,494	702,871	146,927	97,881	70,674	5,892,847
Alberta	4,201,531	687,160	85,445	75,491	65,319	5,114,946
British Columbia	218,729	42,397	3,235	473	525	265,359
North	1,179,857	309,887	50,631	4,023	9,755	1,554,153
Total Claim Lines	29,262,919	3,646,911	622,690	463,653	298,273	34,294,446
Source: HICPS adapted by Program Analytics and Risk Mitigation

Claims verification activities: 2023 to 2024

As part of risk management activities for the NIHB program, Indigenous Services Canada has mandated its claims processor to maintain a set of pre-payment and post-payment processes, including claims verification activities.

During 2023 to 2024, the claims processor carried out claims verifications as directed by the NIHB program. The verifications address the need of the NIHB program to comply with accountability requirements for the use of public funds and to ensure provider compliance with the terms and conditions of the program as outlined in the appropriate NIHB Benefit Guide, Claims Submission Kit, Provider Billing Agreement and other relevant documents.

There are 5 components within claims verification activities for the pharmacy, medical supplies and equipment, dental benefit, vision care, and mental health counselling areas. These are:

Daily Claim Verification Program, which consists of a review of a defined sample of claims submitted by providers the day following receipt by the claims processor.
Client Confirmation Program, which consists of a monthly mail-out to NIHB clients to confirm the receipt of services that have been paid on their behalf.
On-Site Claim Verification Program, which consists of the selection of a sample of claims for administrative validation against a provider's records through an on-site visit.
Desk Claim Verification Program, which consists of the selection of a sample of claims for administrative validation against a provider's records and conducted at a distance.
Financial Recovery Program, which consists of a focused recovery assessment.

The following figure identifies recoveries from all components of the claims verification process during the 2023 to 2024 fiscal year.

Completion of the verification process often spans more than 1 fiscal year. Although the complete recovery for any verification may overlap into another fiscal year, recoveries from claims verification activities are recorded in the fiscal year in which they are received. Subsequent appeals to reversals may result in claim payment if confirmed services comply with the terms and conditions of the NIHB Program.

Table 11.4: Claim verification recoveries by region
Region	Pharmacy Recoveries	Dental Recoveries	MS&E Recoveries	Mental Health Counselling Recoveries	Vision Care Recoveries
Atlantic	$0	$0	$0	$0	$0
Quebec	$31,712	$5,805	$0	$0	$0
Ontario	$991	$22,104	$110,587	$136,245	$0
Manitoba	$219,764	$262,836	$77,681	$1,683	$0
Saskatchewan	$29,898	$21,294	$0	$158,236	$0
Alberta	$2,778	$51,661	$9,388	$1,020	$125
British Columbia	$0	$8,917	$0	$0	$0
Yukon	$0	$0	$0	$0	$0
N.W.T.	$14,814	$47,641	$0	$0	$0
Nunavut	$0	$49,816	$0	$0	$0
Total	$299,956	$470,072	$197,656	$297,184	$125
Source: Express Scripts Canada adapted by Program Analytics and Risk Mitigation

Section 12: NIHB policy and program initiatives

NIHB drug benefit listing and review

The NIHB Drug Benefits List (DBL) is a listing of all of the drugs provided as benefits by the NIHB program. Drugs considered for, or currently listed on, the DBL must meet established criteria. For example, they must be legally available for sale in Canada with a Notice of Compliance (NOC) and Drug Identification Number (DIN) or Natural Product Number (NPN), and be dispensed in a pharmacy. The drugs must also demonstrate evidence of therapeutic efficacy, safety, and incremental benefit in proportion to incremental cost.

The review process for drug products that are considered for inclusion as a benefit under the NIHB program varies depending on the type of drug submitted. Submissions for new chemical entities, new combination drug products and existing chemical entities with new indications, must be sent to Canada's Drug Agency (CDA-AMC), an independent organization that provides research and information about the effectiveness of drugs and other medical treatments.

Through the Reimbursement Reviews and Recommendations process, and pan-Canadian Oncology Drug Review (pCODR), CDA-AMC evaluates the clinical, economic, and patient evidence on drugs and medical technologies. Based on this information, CDA-AMC expert committees provide coverage recommendations and advice to Canada's public drug plans, including the NIHB program. These processes were established by federal, provincial and territorial public drug plans to reduce duplication of effort in reviewing drug submissions, to maximize the use of resources, and to enhance the consistency of drug reviews.

NIHB Drugs and Therapeutics Advisory Committee (DTAC)

The NIHB DTAC is an advisory body of highly qualified health professionals who bring impartial and practical expert medical and pharmaceutical advice to the NIHB program to promote improvement in the health outcomes of First Nations and Inuit clients through effective use of pharmaceuticals. The approach is evidence-based and the advice reflects medical and scientific knowledge, current utilization trends, current clinical practice, health care delivery and client healthcare needs.

More information on DTAC and its members

NIHB Oral Health Advisory Committee (NOHAC)

The NIHB Oral Health Advisory Committee (NOHAC) is an independent advisory body of highly qualified oral health professionals and academic specialists. They bring impartial and practical expert views, advice, and recommendations to the NIHB program to support the improvement of oral health outcomes for First Nations and Inuit clients. The advice and recommendations provided by the Committee follow an evidence-based approach and reflect scientific knowledge, as well as clinical and oral health care delivery and disease prevention best practices.

More information on NOHAC and its members

NIHB Medical Supplies and Equipment Advisory Committee (MSEAC)

The NIHB MSEAC is a multidisciplinary advisory committee of highly qualified health professionals and academic specialists who bring evidence-informed impartial and practical expert advice and recommendations to the NIHB program regarding both medical supplies and equipment and vision care benefits. The approach reflects medical and scientific knowledge, current utilization trends, current clinical practice, health care delivery and client healthcare needs and is intended to promote improvement in the health outcomes of First Nations and Inuit clients.

Drug Exception Centre (DEC)

The Drug Exception Centre is a call centre that provides efficient responses to all requests for drugs that are not on the NIHB Drug Benefit List or require prior approval, for extemporaneous mixtures containing exception or Limited Use (LU) drugs, for prescriptions on which prescribers have indicated "no substitution," and for claims that exceed $1,999.99.

The DEC also supports the implementation of the Problematic Substance Use Strategy to address and prevent potential misuse of prescription drugs. The program has set limits on medications of concern, and developed a structured approach towards client safety which includes the implementation of the Client Safety Program across the country.

Dental Predetermination Centre

The Dental Predetermination Centre (DPC) is a call centre that provides efficient adjudication of all dental and orthodontic predetermination requests, post-determination requests and appeals. In addition, the DPC is responsible for addressing client and provider inquiries, and for assisting clients and providers with the submission of the predetermination, post-determination, client reimbursement and appeal requests.

Medical Supplies and Equipment Review Centre

NIHB staff at the regional level manage prior approval of medical supplies and equipment benefit requests, with support from the MS&E Review Centre (MSERC) at the NIHB national office. The MSERC is staffed in-house by various health professionals, including registered nurses. In cases where advice is required by a particular specialist, such as an audiologist or an orthotist, information is forwarded to the appropriate specialist consultant for review. Consultants make their recommendations based upon the current standards of practice, best practices, current scientific evidence, program policy and recommended guidelines within their field of specialty.

Client and provider communications

NIHB is continually seeking ways to improve communications with clients, providers and partners regarding benefit coverage and administration.

The NIHB program regularly produces newsletters and updates to inform clients and providers about any changes to NIHB policy and benefit coverage. For example, NIHB enrolled providers for dental, pharmacy, MS&E, vision care and mental health counselling receive notification of policy updates and relevant information regarding benefits through regular provider newsletters, periodic bulletins and broadcast messages.

These communications are distributed to enrolled providers by Express Scripts Canada (ESC), Indigenous Services Canada's claims processing contractor, and are available via the ESC website.

The Government of Canada website is a key venue for sharing NIHB program information to clients. NIHB program updates are produced quarterly and as needed to provide information for clients regarding changes to benefit coverage. Clients can subscribe to receive email notifications when these updates are published, and those who have set up web accounts through Express Scripts Canada also receive notification of new updates. Client-focused communications are also promoted through social media on the Government of Canada's Healthy First Nations and Inuit Facebook Page and GCIndigenous X (Twitter) account. Additional social media posts promote client awareness of benefit coverage, often in conjunction with broader public health promotion campaigns. For example, a post on diabetes awareness will include a reminder about NIHB coverage of diabetes medications and supplies, and a post on vision health may include a reminder about NIHB coverage of eye exams.

NIHB strives to be accessible and responsive to clients. Clients can contact NIHB directly by calling Indigenous Services Canada regional offices, the NIHB Dental Predetermination Centre, or the NIHB Drug Exception Centre. The "Contact Us" web page for the NIHB program also provides an email address for direct inquiries to the NIHB program.

NIHB Navigators

NIHB Navigators help eligible clients to navigate and access the NIHB program. They are a resource for communities, organizations or individuals who need support or information on NIHB-related issues. Navigators are employed by regional First Nations and Inuit organizations. Their roles and activities are adapted to meet regional needs, and generally include the following:

increase understanding of the NIHB program and share information on eligible benefits
help clients and communities to resolve NIHB-related issues
link with health departments and agencies to help improve client access to NIHB benefits and related health services.

NIHB program representatives regularly engage with Navigators and support them in their work by sharing Program information, responding to inquiries, and assisting with client cases. Navigators also provide valuable support to the program by sharing their insight on client experiences, and working collaboratively to improve client-focused service.

Collaboration with First Nations and Inuit partners

Indigenous Services Canada (ISC) is engaged in a multi-year Joint Review of the NIHB program in partnership with the Assembly of First Nations (AFN). The overall objectives of the review are to identify and implement actions that enhance client access to benefits, identify gaps in benefits, streamline service delivery to be more responsive to client needs, and increase program efficiencies. The AFN conducted a robust program of client, provider and stakeholder engagement activities to gather broad input and perspectives that will inform recommendations for program improvements. The Joint Review is guided by a Steering Committee comprised of First Nations and ISC representatives.

As of March 31, 2024, joint reviews of the mental health counselling, dental, vision care, pharmacy and medical supplies and equipment benefits are complete, and the review of the medical transportation benefit is in progress. Meanwhile, the NIHB Program continues to implement many improvements to benefit coverage and administration. For more information on the Non-insured Health Benefits program joint review, including highlights of changes and improvements made by NIHB throughout the process, visit us on the web.

Indigenous Services Canada continues to work with the Inuit Tapiriit Kanatami (ITK) to improve the quality, access, and delivery of NIHB benefits to Inuit clients. NIHB and ITK representatives meet regularly to discuss issues of concern and identify opportunities for improvement. In January 2023, NIHB and ITK established a new engagement table including representatives of the National Inuit Committee on Health to discuss priorities and concerns for Inuit NIHB clients. NIHB shares information and regularly updates Inuit partners on progress made to advance priorities identified by Inuit partners.

Section 13: Technical notes

Information contained in the 2023 to 2024 NIHB Annual Report has been extracted from several databases. All tables and charts are footnoted with the appropriate data sources. These data sources are considered to be of very high quality but, as in any administrative data set, some data may be subject to coding errors or other anomalies. For this reason, users of the data should always refer to the most current edition of the NIHB Annual Report. Please note that some table totals may not add due to rounding procedures.

To address reporting challenges related to NIHB clients registered to British Columbia bands but living elsewhere, and Inuit clients living in BC, select financial and utilization data relating to the British Columbia Region have been suppressed. National totals, however, include these values.

To address reporting challenges related to the small number of NIHB clients choosing a non-binary gender designation at this time and in keeping with government practices for safeguarding the privacy of individuals and in respect of departmental privacy obligations, population and utilization data relating to individuals in the category "Another Gender" have been distributed into the other 2 gender categories and are denoted by the "＋" symbol.

"Male＋" includes men (and/or boys), as well as some non-binary persons.
"Female＋" includes women (and/or girls), as well as some non-binary persons.

Starting in 2020 to 2021, expenditures for the NIHB MS&E benefit are being reported separately from NIHB pharmacy benefit expenditures. As such, historical values reported for NIHB pharmacy will not match those reported in previous editions as those values included MS&E.

Starting in 2023 to 2024, expenditures relating to administration of the HICPS contract are being reporting only at the program level. As such, historical values reported for individual benefits will not match those reported in previous editions of the NIHB Annual Report.

Population data

First Nations and Inuit population data are drawn from the Status Verification System (SVS), which is operated by NIHB. SVS data on First Nations clients are based on information provided by the Registrar's office of Indigenous Services Canada (ISC). SVS data on Inuit clients are based on information provided by the Governments of the Northwest Territories and Nunavut, and Inuit land claim organizations including the Inuvialuit Regional Corporation, Nunavut Tunngavik Incorporated and the Makivik Corporation.

Pharmacy, MS&E, dental, mental health counselling and vision care data

Two Indigenous Services Canada data systems provide information on the expenditures and utilization of the NIHB pharmacy, MS&E, dental, mental health counselling and vision care benefits. Financial Services and Training (FST) is the source of most expenditure data, while the Health Information and Claims Processing Services (HICPS) system provides detailed information on utilization. Expenditure data prior to fiscal year 2019 to 2020 were collected from the Framework for Integrated Resource Management System (FIRMS).

Medical transportation data

Medical transportation financial data are provided through FST. Medical transportation data are also collected regionally through other electronic systems. Operational data at the regional level are tracked through the Medical Transportation Reporting System (MTRS). Contribution agreement data are also collected, but in a limited manner. In some communities, MTRS is used to collect contribution agreement data, while other communities report data using spreadsheet templates, in-house data management systems, or through paper reports.

The Medical Transportation Data Store (MTDS) serves as a repository for selected operational data, as well as the data collected from medical transportation contribution agreements, and ambulance data systems. The objective of the MTDS is to enable aggregate reporting on medical transportation at a national level to further strengthen program management, provide enhanced data analysis and reporting and aid in decision making.

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Date modified:: 2025-05-21

Age	Eligible clients	Expenditures	Incidence
0-4	3.6%	3.4%	3.4%
5-9	7.1%	7.6%	10.0%
10-14	8.7%	9.4%	11.7%
15-19	9.0%	12.0%	11.3%
20-24	8.4%	9.5%	8.7%
25-29	8.5%	9.0%	8.5%
30-34	8.6%	8.5%	8.1%
35-39	7.3%	7.2%	6.8%
40-44	6.3%	5.9%	5.7%
45-49	5.7%	5.2%	5.0%
50-54	5.7%	5.2%	5.0%
55-59	5.5%	5.2%	4.8%
60-64	4.9%	4.6%	4.3%
65+	10.6%	7.3%	6.6%
Total	100.0%	100.0%	100.0%

Atlantic region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$46,912	$50,773	$55,079	$60,040	$63,342	$73,071	$73,984	$84,227	$92,488	$102,281
Total benefits annual % change	1.9%	8.2%	8.5%	9.0%	5.5%	15.4%	1.2%	13.8%	9.8%	10.6%

Quebec	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$84,666	$87,690	$91,831	$94,210	$96,120	$104,136	$103,773	$117,373	$128,017	$138,032
Total benefits annual % change	5.0%	3.6%	4.7%	2.6%	2.0%	8.3%	-0.3%	13.1%	9.1%	7.8%

Ontario	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$203,043	$215,738	$231,663	$250,947	$269,127	$287,643	$273,987	$325,494	$365,069	$414,797
Total benefits annual % change	4.7%	6.3%	7.4%	8.3%	7.2%	6.9%	-4.7%	18.8%	12.2%	13.6%

Manitoba	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$239,190	$258,077	$291,989	$308,208	$320,953	$351,983	$337,517	$391,177	$451,799	$503,072
Total benefits annual % change	4.1%	7.9%	13.1%	5.6%	4.1%	9.7%	-4.1%	15.9%	15.5%	11.3%

Saskatchewan	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$180,000	$193,502	$220,352	$247,997	$265,082	$290,386	$286,028	$335,584	$363,319	$393,315
Total benefits annual % change	6.7%	7.5%	13.9%	12.5%	6.9%	9.5%	-1.5%	17.3%	8.3%	8.3%

Alberta	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$158,911	$168,211	$183,108	$192,983	$209,122	$232,177	$222,953	$248,869	$271,783	$288,092
Total benefits annual % change	9.1%	5.8%	8.9%	5.4%	8.4%	11.0%	-4.0%	11.6%	9.2%	6.0%

Northern region	2014 to 2015	2015 to 2016	2016 to 2017	2017 to 2018	2018 to 2019	2019 to 2020	2020 to 2021	2021 to 2022	2022 to 2023	2023 to 2024
Total expenditures ($M)	$94,343	$102,040	$109,157	$126,933	$134,474	$142,961	$157,664	$162,080	$181,796	$221,469
Total benefits annual % change	2.5%	8.2%	7.0%	16.3%	5.9%	6.3%	10.3%	2.8%	12.2%	21.8%

Fiscal year	NIHB benefit expenditures ($M)	% Administrative costs
2019 to 2020	$1,519.5	5.1%
2020 to 2021	$1,490.6	5.0%
2021 to 2022	$1,695.3	4.2%
2022 to 2023	$1,891.7	3.9%
2023 to 2024	$2,098.1	4.2%