Funding of Vitamin D Testing Based on Clinical Evidence
Regulation - LGIC
Bill or Act:
Health Insurance Act
Summary of Decision:
The regulation was amended and came into force on December 1, 2010. The Ministry of Health and Long-term Care (MOHTLC) provides Vitamin D testing as an insured service to Ontarians with the following conditions: Osteoporosis, Rickets, Osteopenia, Malabsorption Syndromes and Renal Disease; or Ontarians who are on medications that affect Vitamin D metabolism.
The amendment ensures that insured vitamin D testing is provided based on the best medical evidence, increasing value for the health care system by restricting insurance coverage for testing that is not deemed medically necessary.
Testing continues to be accessible as an uninsured service to Ontarians who do not meet the medical criteria, but who would still like to pay for testing.
August 13, 2010
Summary of Proposal:
The Ministry of Health and Long-term Care (MOHTLC) will be improving the quality and value of health care based on the best medical evidence available by providing Vitamin D testing as an insured service to Ontarians with the following conditions: Osteoporosis, Rickets, Osteopenia, Malabsorption Syndromes and Renal Disease; or Ontarians who are on medications that affect Vitamin D metabolism. This proposal is aligned with the Excellent Care for All Act that will improve quality, value and promote evidence-based health care. The Act will ensure that future investments get results and improve health while preserving the health care system for future generations.
Studies of the general population suggest a relatively low prevalence, approximately 5%, of Canadians had Vitamin D deficiency, and between 10% and 25% had low Vitamin D levels. Since 2005, reports have promoted Vitamin D testing and have contributed to the sharp increase in demand for Vitamin D testing in Ontario. Annual billing data shows that Vitamin D testing volumes increased 2500% from 2004/2005 to 2009/2010. If this trend continues, billings could reach up to $155M by 2011/12, for both medically necessary and unwarranted tests.
Vitamin D testing is currently insured for all Ontarians under OHIP. However, there is no evidence that routine testing of Vitamin D levels encourages adherence to Health Canada’s guidelines. At present, the most efficient way to ensure adequate Vitamin D levels in healthy individuals is to promote Health Canada’s guidelines for maintaining sufficient levels.
In June, Ontario’s Health Technology Advisory Committee (OHTAC) concluded that the routine use of Vitamin D testing could not be justified based on current evidence. OHTAC’s membership consists of a minimum of 12 health experts, including representatives of the Ontario Medical Association and the Ontario Hospital Association.
The proposed amendment seeks to ensure that the testing provided is based on the best medical evidence, increase value for the health care system by eliminating testing that is not deemed medically necessary and promote quality and sustainability by helping to ensure that the health care system is there for future generations.
The Ministry will continue to regulate Vitamin D testing in accordance with the principle of evidence-based healthcare, and it will seek updates as required to incorporate new medical evidence. Testing would continue to be accessible as an uninsured service to Ontarians who do not meet the medical criteria, but who would still like to pay for testing.
Ministry Contact Address:
Ministry of Health and Long-Term Care
Health System Strategy Division
80 Grosvenor St., 8th Floor, Hepburn Block, Queen’s Park
Toronto, ON M7A 1R3
December 1, 2010