







































Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian 
Prosthetics & Orthotics Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

 
 

 
 

 

 

 

 

 

ISSN: 2561-987X 

VOLUME 2, ISSUE 2 

 2019 

 

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PROFESSIONAL OPINION 

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  1 

 
OPEN  ACCESS 

CANADA’S PROSTHETIC COVERAGE 

Volume 2, Issue 2, Article No.4, 2019 

 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

 

PROFESSIONAL OPINION 

 

CANADA’S PROSTHETIC COVERAGE: A REVIEW OF PROVINCIAL PROSTHETIC POLICY   

 
Howard C.W1*#, Saraswat D.K2#, McLeod G3, Yeung A3, Jeong D4, Lam J5 
 

1
 Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 

2
 Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. 

3
 Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 

4
 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 

5
 Faculty of Medicine, McGill University, Montreal, Québec, Canada. 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

Following loss of a limb, proper prosthetic treatment allows 

patients to perform activities of daily living and improves 

general health and wellness.1 Conversely, improper 

prosthetic care can lead to serious long-term 

complications and comorbidities including increased risk 

of falls, pain, and significant musculoskeletal and 

dermatological complications.2 Patients who lack access 

to prosthetic care entirely may become sedentary, 

exacerbating many comorbidities that are common in this 

population such as diabetes mellitus and cardiovascular 

disease.3  

The average age-adjusted incidence of lower limb 

amputation in Canada was reported as 22.9 per 100,000 

individuals, increasing over the years 2006-2011.4 

According to estimates by the War Amputations of 

Canada, approximately 50,000 Canadians are living with 

limb loss.5 Amputation occurs due to a variety of causes, 

including complications of diabetes, vascular disease, 

infection, cancer, trauma, and congenital disorders.6 

Regardless of the cause, patients living with amputation 

experience a loss in their daily functioning and face life-

long physical and emotional challenges. Proper prosthetic 

care leads to improved functional outcomes, reduced 

comorbid disease and hospitalizations, and lower 

healthcare costs.7 Therefore, it is crucial to provide the 

optimal prosthesis for the patient.  

Unfortunately, acquiring prosthetic limbs can be 

challenging for patients. A major barrier is the high costs 

of these devices, which includes not only the prosthetic 

components, but also the entire prosthetic treatment 

process, auxiliary parts for the limb, repairs of the limb, and 

eventual replacements.5 High costs may be driven by a low 

demand for prosthetic devices due to the relatively low 

incidence of amputations in the general population as well 

ABSTRACT 

The Canadian healthcare system serves as an example of equity and federal service 

to citizens across the world. However, it is not without its challenges. Prosthetic 

coverage across Canada is highly variable and largely unable to provide equal 

coverage for Canadian persons living with amputation. Many persons with limb loss 

are forced to rely upon personal resources, fundraising, or the charity of non-

governmental organizations in order to meet this basic healthcare need. This disparity 

in the Canadian healthcare system is unusual and largely undescribed in the literature. 

We thus explore the nature of Canadian healthcare prosthetic coverage across 

Canada, investigating the variability in coverage, presence of prosthetic coverage 

policies, clarity of policy, eligibility criteria, and interval of prosthetic replacement. Our 

findings highlight potential areas for improvement within current Canadian healthcare 

policy. 

CITATION 

Howard C.W, Saraswat D.K, McLeod G, 

Yeung A, Jeong D, Lam J. Canada’s 

prosthetic coverage: a review of 

provincial prosthetic policy. Canadian 

Prosthetics & Orthotics Journal. 

2019;Volume2, Issue2, No.4. 

https://doi.org/10.33137/cpoj.v2i2.33489 

 KEYWORDS 

Prosthesis, Amputees, Amputation, Limb 

loss, Healthcare, Rehabilitation, 

Healthcare, Prosthetic coverage 

*CORRESPONDING AUTHOR 

Calvin W. Howard 

Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 

Phone: +1 (587) 987-7723 

E-mail: calvin.howard@ucalgary.ca 

ORCID: https://orcid.org/0000-0001-5576-9608 

# Howard C.W and Saraswat D.K Contributed equally. 

DOI: https://doi.org/10.33137/cpoj.v2i2.33489 

ARTICLE INFO 

Received: December 23, 2019 

Accepted: February 12, 2020 

Published: March 16, 2020 

 

https://jps.library.utoronto.ca/index.php/cpoj/index
https://doi.org/10.33137/cpoj.v2i2.33489
mailto:calvin.howard@ucalgary.ca
https://doi.org/10.33137/cpoj.v2i2.33489


 

 

Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

2 

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Howard et al. 2019 

 CANADA’S PROSTHETIC COVERAGE 

as the need to customize the prosthesis to each patient. 

Furthermore, the total cost of prosthetic care can vary 

greatly depending on the level of amputation and 

functional needs. Although objective Canadian data is 

unavailable, research from the United States’ Department 

of Veteran Affairs suggests that 5-year projected unilateral 

upper limb prosthetic costs range between $31,129 to 

$117,440, while 5-year projected lower-limb prosthetic 

costs range from $82,251 to $228,665 for veterans with 

limb loss.8 

In Canada, healthcare is largely a provincial responsibility, 

with the exception of eligible Indigenous people, Canadian 

Forces personnel, veterans, inmates of federal prisons, 

and certain groups of refugees for whom the federal 

government is responsible for providing healthcare.9 To 

provide provincial healthcare, the provinces and territories 

created thirteen insurance plans, one for each province or 

territory. Notably, the Canada Health Act only requires 

provinces to cover hospital services, physician services, 

and surgical-dental services provided by hospitals, 

medical practitioners or dentists.10 While provinces may 

choose to cover further services, they are not required to 

do so, which has resulted in considerable variability 

between provincial service coverage. 

In general, funding for prosthetic devices can come from 

federal or provincial programs, (including workers 

insurance for work related injury), private health insurance 

plans, philanthropic organizations such as the War 

Amputations of Canada or a combination of these sources. 

Often, a part of the cost is covered by a patient’s personal 

resources or through individual fundraising campaigns. 

Examining governmental coverage of prosthetic devices 

across Canada reveals considerable variation from 

province to province. We sought to assess these 

variations to determine the extent to which interprovincial 

access to prosthetic care in Canada is equitable, 

according to policy. 

METHODOLOGY 

Policy Review 

Information was first gathered through communication with 

relevant stakeholders (listed in Table 1), such as: 

government officials involved with Pharmacare or the 

Ministries of Health; national and provincial 

representatives for persons with limb loss identified 

through conversation with the War Amputations of 

Canada; organizational leaders, such as the president of 

persons with limb loss associations; and prosthetists and 

physiatry specialists in amputation rehabilitation care, 

identified by communication with the aforementioned 

stakeholders. Initial conversations with stakeholders 

allowed a holistic approach to appraising prosthetic 

policies guided by values of stakeholders across the 

country. At least two sources were used for each province. 

Prosthetic device coverage information was then identified 

by review of provincial policy documents and provincial 

websites. We extracted the most up to date information 

relevant to coverage of prosthetic devices from the 

prosthetic provincial policy documents. Each document’s 

sections relevant to prosthetics; replacement; eligibility; 

advanced devices; and coverage were read. Specific 

phrases were searched using keywords: “3R106”, 

“12K42”, “knee”, “elbow”, “humeral”, “femoral”, “myo-“, 

“myoelectric”, “advanced”, “micro”, “microprocessor”, 

“eligible”, “eligibility”, “criteria”, “replacement”, and “year”. 

Information was then condensed and paraphrased to fit 

within Table 2.  

We compared four factors between provinces: patients’ 

eligibility for prosthetic coverage, the coverage available 

for basic prosthetic components, the coverage available 

for advanced prosthetic components, and replacement 

intervals. In our search, we defined a “basic prosthetic 

component” as a device not enhanced by myoelectric 

capability, micro-processing chips, or other features 

relying on onboard programming to modulate activity. 

Advanced prosthetic components were defined as any 

devices with myoelectric capability, micro-processing 

chips, or other electrical features.  

For the purposes of this paper, only provincial health 

coverage was assessed, specifically including British 

Columbia, Alberta, Saskatchewan, Manitoba, Ontario, 

Quebec, New Brunswick, Nova Scotia, Prince Edward 

Island, and Newfoundland and Labrador. Health coverage 

in the territories, federal funding programs, and workers’ 

compensation insurance programs were not examined. 

Primary focus was placed on coverage within the 

province’s primary healthcare policy.  

Patient Eligibility Criteria for Prosthetic Coverage 

Prosthetic policy documents for each province were 

reviewed for inclusion or exclusion criteria regarding 

patients qualifying for prosthetic device coverage.  Further 

criteria for eligibility of prosthetic device funding were 

identified and compared.  

Basic Prosthetic Device Funding Comparison 

We chose the Ottobock Ergoarm 12K42 (mechanical 

body-powered elbow joint), valued at $4552, and Knee 

3R106 (pneumatic polycentric knee), valued at $1923, as 

representations of basic function prosthetic components 

due to their ubiquitous nature across healthcare funding 

schedules and being considered base-function by the 

prosthetic community. Wholesale costs as of July 10th, 

2019 were obtained from a Canadian prosthetic retailer. 

However, these values do not account for additional lab 

fees charged for time, product, and skills, or for the 

prosthesis socket fitting (i.e. the value of the entire 

prosthetic device treatment). It is likely that the use of 

component prices as a surrogate for overall prosthetic 

coverage may result in an overestimation of  funding 

coverage for prosthetic services. However, these methods 

yield insight into general funding policy trends across 

different policies. Funding catalogues and coverage plans 

for each province were investigated and used to compare 

the proportion of basic-level prosthetic component 

covered. Percentage of basic-level component covered 

was expressed as the wholesale cost of the prosthetic 

component divided by the maximum funding value or the 

maximum percentage covered as per prosthetic coverage 

policy.  

https://doi.org/10.33137/cpoj.v2i2.33489


 

 

Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

3 

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Howard et al. 2019 

 CANADA’S PROSTHETIC COVERAGE 

Advanced Prosthetic Device Funding Comparison 

Prosthetic policy documents for each province were 

reviewed for any description of funding of advanced 

prosthetic devices. Due to variance in advanced prosthetic 

coverage policies, general policy for “advanced prosthetic 

devices” as described in policy documents were recorded. 

If further specification of advanced prosthetic device was 

made, the highest amount funded was documented. No 

standard advanced prosthetic component could be used 

to compare funding due to variance in prosthetic coverage 

policies across Canada.  

Replacement Interval 

All prosthetic policy documents for each province were 

reviewed for frequency at which prosthetic devices could 

be replaced under their respective prosthetic programs. As 

all provinces allowed replacement upon medical need and 

review, only the typical interval of replacement was 

recorded. Any variation of typical replacement interval 

program was also reported. 

 

Province  Provincial Policy Document Provincial Official 
Clinician Contact (Physiatrist and/or 
prosthetist) 

Person with Limb Loss 
Stakeholder 

BRITISH COLUMBIA 
PharmaCare, 
Prosthetic and Orthotic Program 

PharmaCare N/A WarAmps Canada 

ALBERTA 

Alberta Aids to Daily Living, General Policy & 
Procedures Manual 
 
Alberta Aids to Daily Living, 
Orthotic and Prosthetic Benefits 

N/A 

Glenrose Amputation Rehabilitation 
Program 
 
Community Prosthetic Facility 

Alberta Amputee and 
Sports Association 
 
WarAmps Canada 

SASKATCHEWAN 
Saskatchewan Aids to Independent Living 
Program, General Policies 

Extended Benefits, Drug Plan 
and Extended Benefits 
Branch, Ministry of Health 

N/A WarAmps Canada 

MANITOBA 
SMD Foundation, 
The Assistive Technology Funding Guide 

Manitoba Health, Seniors and 
Active Living 

N/A WarAmps Canada 

ONTARIO 
Limb Prostheses Policy and Administration 
manual 

N/A Ottawa Rehabilitation Centre WarAmps Canada 

QUEBEC 

Schedule 1, 
Tariff for Devices which Compensate for a 
Motor Deficiency and Insured Related 
Services 

N/A 
Amputee Program Institut de 
Réadaptation Gingras-Lindsay de 
Montréal 

WarAmps Canada 

NEWFOUNDLAND  
& LABRADOR 

N/A N/A 
Regional Adult Rehabilitation, Palliative 
Care, and Geriatrics Program 

WarAmps Canada 

NEW BRUNSWICK 
Social Development Prosthetic Program Policy 
 

N/A 
Institute of Biomedical 
Engineering/Atlantic Clinic for Upper Limb 
Prosthetics 

WarAmps Canada 

NOVA SCOTIA 
Arm & Leg Prostheses Program, 
Prosthetists Guide 

N/A N/A WarAmps Canada 

PRINCE EDWARD 
ISLAND 

Health PEI, 
PEI Pharmacare Formulary 

N/A N/A WarAmps Canada 

 

Table 2: Traits of prosthetic coverage across the provinces. Policy documents were reviewed and details are reported to the extent which they are 

reported in policy documents. Coverage is defined as a percentage covered according to policy and procedure list of a basic upper prosthetic 

component (Ergoarm 12K42, 4552$), and a basic lower prosthetic component (Ottobock 3R106, 1923$). 

Province 
Coverage 

Basic Prosthetic 
Replacement Interval 

Coverage 

Advanced Prosthetic  
 Reference(s) 

BRITISH COLUMBIA 
Upper limb: 75% 

Lower limb: 100% 
3 years: general  

Myoelectric coverage: no information 

Microprocessor knee: no coverage 
11,12 

ALBERTA 
Upper limb: 93% 

Lower limb: 100% 

2 years: basic functionality devices 

3 years: myoelectric arm 

5 years: microprocessor knee 

Myoelectric coverage: requires pre-approval 

Microprocessor knees: grant up to $6000 
13,14 

SASKATCHEWAN 
Upper limb: 100% 

Lower limb: 100% 
3 years: general  

Myoelectric coverage: case-by-case 

Microprocessor knees: up to $15 000 
15 

MANITOBA 
Upper limb: 100% 

Lower limb: 100% 
2 years: general  

Myoelectric coverage: no information 

Microprocessor knees: no information 
16 

ONTARIO 
Upper limb: 75% 

Lower limb: 75% 

3 years: basic functionality devices 

3 years: externally powered devices  

Myoelectric coverage: Up to 75% or maximum limit 

Microprocessor knees: no information 
17,18 

QUEBEC 
Upper limb: 100% 

Lower limb: 100% 
Present, not further described 

Myoelectric coverage: up to $8000, variable by product 

Microprocessor knees: no information 
19 

NEWFOUNDLAND & 

LABRADOR 

Upper limb: N/A 

Lower limb: N/A 
N/A N/A 20,21 

NEW BRUNSWICK 
Upper limb: 100% 

Lower limb: 100% 
5 years: general 

Myoelectric coverage: ineligible 

Microprocessor knees: maximum $20 000 
22 

NOVA SCOTIA 
Upper limb: 100% 

Lower limb: 100% 

4 years: adults 

2 years: children 

Myoelectric coverage: $5089 maximum 

Microprocessor knees: maximum $6511 
23 

PRINCE EDWARD 

ISLAND 

Upper limb: N/A 

Lower limb: N/A 
N/A N/A 24 

 

Table 1: Sources of prosthetic device coverage information by province and source type.   

https://doi.org/10.33137/cpoj.v2i2.33489


 

 

Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

4 

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RESULTS  

Eligibility for coverage of prosthetic devices 

We found eight provinces to have formal government 

policies regarding prosthetic device coverage (Table 1). In 

all the provinces offering governmental coverage of limb 

prosthetic devices, coverage eligibility requires that the 

device is medically necessary and prescribed as such by 

a certified medical practitioner (e.g. physician, nurse 

practitioner), and the device be fabricated and provided by 

a licenced prosthetist.12,14–16,18,19,22,23 However, in some 

provinces additional variable stipulations on whom is 

eligible to receive coverage beyond the prior mentioned 

baseline criteria. British Columbia, Saskatchewan, 

Manitoba, Ontario, and Prince Edward Island all require no 

additional governmental funding.12,15–18,24,25 Prince Edward 

Island also requires no membership with the Royal 

Canadian Mounted Police nor Canadian Armed Forces.25 

Notably, in New Brunswick, patients must have 

demonstrated financial need and be registered with Social 

Development Health Services in order to be considered 

eligible for any prosthetic funding from the provincial 

government.22  

Policies and procedures vary across the provinces, as do 

their clarity. For example, British Columbia requires pre-

approval of a device to consider funding its cost, and 

requires pre-approval for device repairs over $400,12 

although retroactive approval may be possible. Other 

provinces such as Alberta and Québec require patients 

access governmental programs outside of healthcare to 

receive funding.14,19 Within Alberta Aids to Daily Living, the 

governmental program which manages prosthetic devices, 

the bureaucratic process of funding a prosthetic device is 

outlined.13 However, this is not the case amongst the 

majority of provinces, and stakeholders anecdotally 

reported confusion in navigating governmental systems 

during our interviews.  

According to our investigations, two provinces may not 

administer any government funding for prosthetic limbs. 

Prince Edward Island (PEI) does not employ a formal 

governmental coverage policy at the time of this writing;24 

however, according to personal correspondence with a 

representative from Health PEI, basic model prosthetic 

devices may be covered in full by the PEI government, 

implying a case-based approval system. Additionally, 

Newfoundland and Labrador do not have an available 

prosthetic device policy,20,21 although correspondence with 

Eastern Health Newfoundland & Labrador has revealed 

that they provide case-by-case funding for those in 

financial need. 

Coverage of basic prosthetic devices varies widely by 

province 

“Basic device” is a term which must be defined separately 

from basic function, as most provincial policies denote a 

mandate to provide devices which will achieve “basic 

functionality.” Despite this similar mandate, there is wide 

variation in the devices which are deemed necessary to 

achieve basic function. Some policies implicitly assert, via 

absence of funds for advanced components, that basic 

devices should always be sufficient to enable basic 

functioning. Other policies acknowledge, via funding 

availability, that advanced components may be needed to 

achieve basic functioning. This discrepancy may be partly 

due to different definitions of “basic function”, with some 

referencing activities of daily living, others instrumental 

activities of daily living, and others referencing ability to 

function and work more broadly. For example, Manitoba’s 

policy identifies a mandate to provide prosthetic devices to 

“assist in the basic activities of daily living”.16 Activities of 

daily living (ADLs) standardly refers to grooming, dressing, 

toileting, transferring/ambulating, and eating.26 British 

Columbia’s policy also contains a mandate to help patients 

“achieve or maintain basic functionality”,11 although this is 

defined on a case-by-case basis.12 Alberta uses a 

classification system similar to the U.S Medicare 

Functional Classification Level to determine whether a 

patient will benefit from a prosthesis and therefore whether 

they are eligible for funding for certain prosthetic 

components.27 Saskatchewan refers to activities of daily 

living in a broader sense including higher-functioning 

activities like physically-demanding gainful employment in 

manual labour.15 

In addition to variation in definition of basic function, for 

provinces offering coverage of prosthetic limbs, the benefit 

limits by device vary widely, as demonstrated by our 

comparison of the degree of coverage for the Ottobock 

Ergoarm 12K42 elbow joint and Ottobock Knee  

3R106  knee joint (Table 2). Direct province-to-province 

comparison was hampered by non-standard terminology 

and generally disparate policy approaches. Half of 

provinces achieved 100% coverage of both basic 

components: Saskatchewan, Quebec, Nova Scotia, New 

Brunswick, and Manitoba. Alberta achieved 93% coverage 

of the elbow and 100% of the knee. British Columbia 

achieved 75% elbow coverage and 100% knee coverage. 

Ontario achieved 75% coverage for both, up to a maximum 

benefit amount. Some provinces have alternative 

programs providing additional coverage for specific 

groups, such as those on social assistance due to 

disability or other causes (Table 2). Notably, Prince Edward 

Island and Newfoundland have no enshrined prosthetic 

policy, simply stating funding is determined on a case-by-

case basis with no data regarding degree of coverage.  

Coverage of advanced prosthetic devices varies 

widely by province 

Given the significant variability in advanced prosthetic 

coverage (Table 2), we highlight the differences. Ontario 

and Saskatchewan provide the most coverage for 

advanced prosthetic devices when deemed necessary for 

a given patient. Ontario offers $15,000 towards 

myoelectric upper limb devices, up to a maximum of 

$17,690 for select advanced components.17,28 

Saskatchewan covers microprocessor knees up to 

$15,000, and considers myoelectric coverage amounts on 

a case-by-case basis.15 Alberta and Québec offer some 

additional funding for advanced components relative to 

basic components, but the benefit limits are in the $5,000 

- $8,000 range, similar to those of basic devices.14,19 

Alberta only contributes up to $6000 towards the cost of 

microprocessor knees, for example, and less for other 

advanced prostheses.14 Alberta policy also indicates that 

myoelectric upper extremity devices will be funded with 

prior approval after at least one year of body-powered 

prosthesis use, but without reference to other specific 

https://doi.org/10.33137/cpoj.v2i2.33489


 

 

Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

5 

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criteria.13 New Brunswick lies in the middle of these 

examples: the province offers up to $20,000 or $10,000 for 

above- and below-knee prostheses respectively and up to 

$10,000 for arm prostheses; however, myoelectric 

prostheses are explicitly excluded from this coverage.22 

Unlike the aforementioned provinces, Manitoba and British 

Columbia provide no additional funding for advanced 

components. British Columbia and Manitoba may allow 

residents to select an advanced device in lieu of a basic 

device, with the benefit limit for the corresponding basic 

device applying.12,22 In both of these provinces the benefit 

limit for any device does not exceed $5,000,12,16 which may 

cover only a small proportion of the cost of an advanced 

device.  

Maintenance and repair of prosthetic device varies by 

province 

Provinces differ in the replacement interval for prosthetic 

limbs, ranging from 2 years in Manitoba to 5 years in New 

Brunswick.16,19,22 Fortunately, claims for repairs and 

adjustments are considered throughout the device lifespan 

when necessary due to damage, a change in the patient’s 

medical condition, or growth.12,14–16,18,19,22,23 

DISCUSSION  

Coverage Eligibility and Availability 

While most provinces allow all residents to access basic 

prosthetic care, significant shortcomings exist. Our review 

of existing policy documents details that only 30% of 

provinces have policy documents detailing eligibility 

criteria beyond basic requirements. There is no indication 

that the criteria are appropriately inclusive or restrictive, or 

if they were developed with the input of stakeholders. 

Notably, 20% of provinces require applicants to 

demonstrate financial need to access provincial funding 

for prostheses, while an additional 20% of provinces 

require demonstration of financial need to waive co-

payments or co-insurances.  

The criteria to demonstrate financial need can be 

restrictive and vary by province; for example, within New 

Brunswick a life insurance policy may count as an asset 

and thereby disqualify patients from financial assistance in 

purchasing a prosthetic device. Furthermore, 50% of 

provinces exclude a patient from receiving healthcare 

funding if they are eligible for funding from other 

governmental programs. These exclusions may lead to 

inequitable access to prosthetic devices and may prevent 

patients from achieving 100% coverage of a prosthetic 

device by combining coverage policies. Additionally, 

Newfoundland and Labrador and PEI have no publicly 

available documented coverage policy, and PEI coverage 

is organized within the Queen Elizabeth Hospital itself. 

Individuals in these provinces who are unable to afford 

prosthetic devices via personal means or private 

insurance may thus be denied the opportunity to receive 

them, resulting in inequitable access to prosthetic care. 

Variable and Insufficient Prosthetic Coverage  

From our review of the provincial funding for prosthetic 

devices, we saw a wide range in the maximum funding 

available to cover various prosthetic components. Only 

50% of the provinces surveyed had 100% coverage of 

both the upper and lower limb basic prosthetic 

components (Table 2). The degree of funding was variable 

across provinces, and it is notable that Alberta and Ontario 

require patients to cover at least 25% of their device, 

although in the case of Alberta, there is a maximum cost-

share portion. In both of these provinces, patients with 

demonstrable financial need (such as receiving social 

assistance) can receive 100% coverage of basic 

prostheses. In provinces without coverage policies, it is 

impossible to know what proportion of value patients will 

pay as cases are considered on an individual basis. 

Comparing access to funding is difficult due to the 

variability in existing procedural policies for applying to 

receive funding for prosthetic devices, with some 

provinces having a defined procedure in place13 but other 

provinces such as Manitoba lacking procedural definition 

entirely.13,16 Given the high upfront cost of prosthetic 

devices and variable coverage policies, patients suffer 

either uncertainty or a significant cost burden, especially 

those who do not have alternative funding sources or 

personal savings.  

For those provinces with a prosthetic coverage policy, 

there is a general aim to provide funding for “basic” 

functionality prosthetic devices; however, there is a lack of 

consistency between provinces on what constitutes basic 

functionality and which types of prosthetic devices may be 

necessary to achieve it. Not only are definitions variable, 

which results in variable prosthetic coverage, but the 

definitions can result in exclusive coverage; for example, 

while many provinces require no other governmental 

funding, Prince Edward Island will not cover members of 

the Royal Canadian Mounted Police nor Canadian Armed 

Forces (Table 2).25 Saskatchewan and Alberta currently 

lead as examples of clear definitions to guide funding 

devices that will return patients to their optimal functional 

level, not just provide minimal functionality, although 

correlating this classification method with the device 

funding actually received was beyond the scope of this 

review. 

An additional source of provincial variation in coverage 

amounts may be the outdated nature of benefit schedules. 

For example, Ontario and BC benefit amounts appear to 

have been last updated in 2012.12,18 If benefit amounts are 

outdated, they may be insufficient to cover the full amount 

of current prosthetic devices on the market. If more current 

models of prosthetic devices are not listed in the funding 

schedule, they may not be covered. This is especially 

pertinent in the age of advancing prosthetic technology, in 

which new prosthetic devices may not be covered solely 

due to policy update neglect.  

Provision of advanced prosthetic devices has been 

demonstrated to be cost-effective.29-32 Despite evidence of 

cost-effectiveness and higher levels of safety,30 provincial 

approaches to coverage of advanced prosthetic devices 

are variable. Coverage for devices with advanced 

functionality is generally more restrictive and fluctuant 

across Canada, with 40% of provinces having no coverage 

policy (Table 2). For provinces that do have a coverage 

policy, benefit amounts range from $5000 to $20,000.  

Given that a microprocessor knee may cost upwards of 

$40,000 to $45,000, even a maximum co-insurance 

funding amount leaves patients paying a significant portion 

https://doi.org/10.33137/cpoj.v2i2.33489


 

 

Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

6 

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Howard et al. 2019 

 CANADA’S PROSTHETIC COVERAGE 

personally, which may be impossible for middle-income 

earners who may not qualify for financial assistance but 

lack the resources to bear these costs on their own, further 

increasing the burden on patients.17 Furthermore, the 

success of funding requests and resultant provision of 

devices remains unknown, complicated by the case-based 

review system in some provinces with unstated criteria. 

Advanced prosthetic coverage remains limited, with the 

majority of provinces lacking coverage, provinces being 

highly particular in what prosthetic devices are covered, 

and coverage plans falling far short of total coverage.  

Variable Prosthetic Replacement Interval 

Our work demonstrates that 50% of provinces have 

replacements offered every three years (Table 2). No 

difficulties with replacement interval were noted during our 

literature review, interviews with persons with limb loss, 

nor discussion with clinicians. However, difficulties may 

still arise. Prosthetics are at variable risk of degradation 

dependent upon prosthetic quality, activity level, and 

anatomic location. For example, a farmer utilizing a below-

the-knee prosthesis daily may have significant wear and 

component failure within three years, prior to allowed 

replacement. This may lead high-activity and high 

functioning patients to suffer significant repetitive financial 

drain associated with repeat co-payment for necessary 

prosthetic maintenance.  

Coverage of Prosthetic Devices: Canada’s Equality 

Prosthetic access and coverage should be based on need, 

irrespective of a patient’s identified province of residency. 

The described interprovincial inequality is unfortunately 

consistent with other growing healthcare inequalities 

across Canada.33 The widening gap in healthcare between 

provinces may be attributed to differential fiscal capacities 

of provinces, along with differing provincial government 

priorities.34 Differences in populations that comprise each 

province may also play a role, where there is a growing 

young population in Alberta while the aging population is 

on the rise in Maritime provinces, and variable prevalence 

of diabetes may result in proportionately variable 

prosthetic demands.34 The specific example of prosthetic 

coverage reveals the lack of a national standard as a 

contributing factor to the observed disparities between 

provinces. Altogether, this issue highlights the important 

need to establish a standard to allow for equal access to 

appropriate funding of prostheses across Canada.  

A recent report released by the College of Family 

Physicians of Canada has outlined the responsibilities of 

the federal government as “providing adequate funding, 

establishing national standards, enforcing legislation, and 

ensuring all regions of Canada receive equal and 

appropriate resources”.35 Similarly, the World Health 

Organization (WHO) has recently advocated for the 

prioritization of universal health coverage for prosthetic 

and orthotic devices and services.36 Our work 

demonstrates that these goals are not being met in 

Canada. Importantly, the WHO has published an 

implementation manual for the standardization of 

prosthetic and orthotics services.36 This document 

provides a thorough summary of different domains which 

should be addressed and can serve as a valuable 

resource in the development of federal standards as 

advocated by the College of Family Physicians of 

Canada.35  

Another area the WHO emphasizes is the accessibility of 

cost-effective prosthetic devices, even those which are 

deemed “sophisticated” or expensive. In Canada, there is 

notable resistance to the implementation of advanced 

prosthetic devices, as seen in the number of provinces 

which do not routinely fund devices such as myoelectric 

prostheses and microprocessor knees. Despite the higher 

costs of these devices, these types of prosthesis provide 

meaningful benefit to a patient’s quality of life and overall 

health. For example, the Canadian Agency for Drugs and 

Technologies in Health, a federal organization which 

reviews the evidence behind medical interventions, 

concluded in 2009 that there is cost benefit in the use of 

microprocessor knees,37 congruent with other work.29–32 In 

2016 the National Health Service of England instituted a 

policy which provided coverage for microprocessor knees 

based on evidence of its cost-effectiveness.38 Currently, no 

provinces in Canada have a policy to fully fund these 

documented cost-effective devices.  

Limitations and Future Directions 

Some inherent limitations are posed by the nature of this 

work. The lack of standardized policies across provincial 

coverage documents results in difficulty achieving 

comparability. While some provinces have extensively 

detailed lists of prosthetic devices which are funded and to 

what degree, other provinces may only list a handful, if any 

at all. Analysis of degree of coverage also relies upon 

knowing the cost of a given prosthetic component. 

However, the cost of a given prosthetic device is not 

readily available to the Canadian public, as most openly 

available information details government funding rather 

than specific market values. Similarly, the value of 

prosthetic devices we achieved in discussion with a 

Canadian prosthetics retailer represents wholesale cost, 

which means markup associated with skills and services 

cannot be accounted for, yet they are crucial components 

of adequate care and provision of devices. In addition, we 

analyzed only single components of the prosthetic device, 

not the entire prosthesis system that is required to treat a 

patient. This means we likely overestimate the degree to 

which provinces cover prosthetic devices, and therefore 

underestimate the degree to which funding of clinical 

services is necessary to ensure optimal outcomes.  

It should be emphasized that the presented results are 

based on published policy, and do not take into account 

actual success rates of funding applications. In discussion 

with stakeholders, difficulty accessing full governmental 

funding was commonly stated as a barrier to selecting the 

right component for the individual patient. Future survey of 

Canadian prosthetic users, prosthetists, physiatrists, and 

government officials would be a useful endeavour to 

identify potential areas of policy development. For 

example, assessing the degree to which eligibility criteria 

or lack thereof have been problematic for prosthetic users 

across the provinces would validate the need for such 

policies. Given the lack of information regarding how 

prosthetic users fund their devices and to what degree 

they obtain less than ideal solutions due to funding 

limitations would yield crucial information in understanding 

the state of prosthetic coverage. Collection of such data 

https://doi.org/10.33137/cpoj.v2i2.33489


 

 

Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

7 

CPOJ 

 

Howard et al. 2019 

 CANADA’S PROSTHETIC COVERAGE 

would require a multi-institutional effort and would be a 

critical future direction. 

CONCLUSION 

Funding for prosthetic devices at the provincial level 

should be updated and equalized across provinces to 

reflect the realities in the cost of prosthetic care and 

services. Failure to do so causes an unfair burden on the 

individual living with an amputation, often with 

dependence on geographic location. Emphasis should 

also be placed on providing the right prosthesis for the 

right patient, with the goal of restoring optimal function and 

reducing complications and comorbidities. Within an era of 

advancement of prosthetic technology, policy must adapt 

to ensure patients receive the best possible care.39 Without 

such changes, it is the persons with limb loss and their 

health that suffer the consequence of a system that has 

failed them. Our work has demonstrated the inability of the 

Canadian Healthcare System to provide both equitable 

and uniform prosthetic device coverage within all 

provinces, corroborating previous speculation.39 As such, 

the Canadian healthcare system has difficulty meeting the 

standards set both by itself and the WHO.36,40 Canada 

currently lacks uniform accessibility to prosthetic device 

coverage, uniform and equitable coverage of both basic 

function as well as advanced prosthetic devices, and 

uniform replacement intervals. Adequate coverage has not 

only been demonstrated to increase quality of life, but also 

to be cost-effective in the long-term.30,31,41 We have 

identified core deficiencies in prosthetic device care that 

should be addressed for the betterment of Canada and 

Canadian patients. 

ACKNOWLEDGEMENTS 

We would like to thank Dr. Jacqueline Hebert  for her 

integral role in guiding us through the process of creating 

this manuscript. 

DECLARATION OF CONFLICTING INTERESTS 

The authors have no personal nor financial relationships 

to disclosure, nor any further conflicts of interest. 

AUTHOR CONTRIBUTION 

• Calvin W. Howard, 

conceived the idea for the project, led data collection, 

and led manuscript writing. 

• Dave K. Saraswat,  

conceived the idea for the project, led data collection, 

and led manuscript writing. 

• Graham McLeod,  

assisted in manuscript preparation and data collection. 

• Albert Yeung,  

assisted in manuscript preparation and data collection.  

• Danielle Jeong, 

assisted in manuscript preparation and data collection. 

• Jack Lam, 

assisted in manuscript preparation and data collection. 

SOURCES OF SUPPORT 

This manuscript received no external supports.  

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Howard C.W, Saraswat D.K, McLeod G, Yeung A, Jeong D, Lam J. Canada’s prosthetic coverage: a review of provincial prosthetic policy. Canadian Prosthetics & Orthotics 
Journal. 2019;Volume2, Issue2, No.4. https://doi.org/10.33137/cpoj.v2i2.33489 

8 

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