Choosing a hospital for hip or knee replacement in Canada is not simply a matter of finding a national ranking. Joint replacement is delivered through provincial and territorial health systems, and patients are commonly referred through regional orthopedic programs rather than choosing any hospital in the country without restrictions. Clinical needs, surgeon expertise, the complexity of the joint problem, rehabilitation resources, location, and waiting-list rules can all affect where treatment takes place.
This guide highlights prominent Canadian academic hospitals and specialized orthopedic centres that provide joint replacement or closely related orthopedic services. They are presented as institutions worth researching, not as a numbered national ranking. It also explains how Canadian coverage works, what patients may have to pay for, how waiting times should be interpreted, and which questions are useful before accepting a surgical date.
The information is educational rather than individualized medical advice. Hospital programs, referral requirements, surgeon rosters, eligibility rules, and uninsured fees can change, so patients should confirm current details with their provincial health authority, hospital, surgeon, and insurer where applicable.
What Joint Replacement Surgery Involves
Joint replacement, also called arthroplasty, removes damaged portions of a joint and replaces or resurfaces them with artificial components. Hip and knee replacements are by far the procedures most people mean when searching for Canadian joint replacement hospitals, although replacements can also involve the shoulder, ankle, elbow, and other joints.
Osteoarthritis is a common reason for hip and knee arthroplasty, but surgery may also be considered for some people with inflammatory arthritis, previous injuries, bone damage, deformity, or failure of an earlier implant. Replacement surgery is normally considered after an orthopedic assessment rather than simply because imaging shows arthritis.
Not every person with joint pain needs an operation. Treatment decisions may consider symptoms, function, medical history, imaging, previous nonsurgical treatment, surgical risk, and the likely effect of surgery on mobility and quality of life. Patients should discuss those factors with a qualified orthopedic professional.
Primary versus revision joint replacement
A primary joint replacement is the first replacement of that joint. A revision replacement involves replacing or reconstructing some or all components of an existing artificial joint. Revision surgery can be more complicated because of implant loosening, infection, bone loss, fractures around the implant, instability, or other problems.
For patients needing revision surgery, the most convenient hospital may not necessarily be the most appropriate one. Complex cases can require surgeons who routinely perform revision arthroplasty, specialized imaging, infectious-disease consultation, reconstructive equipment, blood-management services, or tertiary-care support.
Leading Orthopedic Hospitals and Programs in Canada
There is no single official Canadian government ranking that identifies one hospital as the country’s universally “best” institution for hip or knee replacement. The hospitals below are established academic, tertiary, or specialized centres with orthopedic services relevant to joint reconstruction. Inclusion should not be interpreted as proof that one centre produces better outcomes than another for every patient.
| Hospital or Program | Location | Relevant Focus | Official Website |
|---|---|---|---|
| Holland Orthopaedic & Arthritic Centre, Sunnybrook | Toronto, Ontario | Hip and knee arthritis, joint replacement, orthopedic rehabilitation | Sunnybrook Health Sciences Centre |
| Toronto Western Hospital, University Health Network | Toronto, Ontario | Academic orthopedics, arthritis and complex musculoskeletal care | University Health Network |
| Vancouver General Hospital and UBC Hospital | Vancouver, British Columbia | Tertiary orthopedics and elective orthopedic surgery | Vancouver Coastal Health |
| The Ottawa Hospital | Ottawa, Ontario | Academic orthopedic surgery and adult joint reconstruction | The Ottawa Hospital |
| London Health Sciences Centre | London, Ontario | Academic orthopedics and adult reconstructive surgery | London Health Sciences Centre |
| Hamilton Health Sciences | Hamilton, Ontario | Orthopedic surgery within a major academic health system | Hamilton Health Sciences |
| Montreal General Hospital, McGill University Health Centre | Montreal, Quebec | Academic orthopedic and tertiary musculoskeletal care | McGill University Health Centre |
| Misericordia Community Hospital, Covenant Health | Edmonton, Alberta | Orthopedic surgery including hip and knee care | Covenant Health |
Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre
Location: Toronto, Ontario
Official website: sunnybrook.ca
Sunnybrook’s Holland Orthopaedic & Arthritic Centre is one of Canada’s best-known specialized orthopedic facilities. Its clinical focus includes arthritis and orthopedic care involving the hip and knee, making it particularly relevant to people researching primary joint replacement and postoperative rehabilitation.
A dedicated orthopedic setting can be valuable because successful replacement surgery involves more than the operation itself. Preoperative assessment, physiotherapy, discharge planning, mobility training, and follow-up can influence the patient’s experience and recovery pathway.
Who may want to research the Holland Centre?
Patients with advanced hip or knee arthritis who have been referred for an orthopedic surgical assessment may wish to ask whether the Holland Centre is available through their Ontario referral pathway. People with previous replacements should specifically ask whether their condition requires a surgeon with revision expertise rather than assuming a standard primary arthroplasty pathway will apply.
Before scheduling, ask which surgeon will perform the operation, where the surgery will physically occur, what prehabilitation is expected, what discharge pathway is normally used, and how postoperative physiotherapy will be arranged.
Toronto Western Hospital, University Health Network
Location: Toronto, Ontario
Official website: uhn.ca
Toronto Western Hospital is part of University Health Network, a major academic health organization affiliated with the University of Toronto. Its orthopedic and arthritis services make it particularly relevant to patients with complex musculoskeletal problems as well as those who may need multidisciplinary evaluation.
UHN’s academic environment can be useful when a joint problem is accompanied by other challenging orthopedic or medical issues. That does not mean a tertiary hospital is necessary for routine primary replacement. Many uncomplicated hip and knee replacements are appropriately performed at regional hospitals closer to a patient’s home.
Questions for complex joint-reconstruction patients
If the case involves a previous replacement, substantial bone loss, suspected infection, deformity, or multiple previous operations, ask the referring physician whether a tertiary joint-reconstruction assessment is appropriate. The exact surgeon and program matter more than the health system’s general reputation.
Patients should also confirm whether follow-up will occur at UHN or closer to home, especially if they live outside Toronto.
Vancouver General Hospital and UBC Hospital
Location: Vancouver, British Columbia
Official website: vch.ca
Vancouver General Hospital and UBC Hospital operate within Vancouver Coastal Health and are associated with the University of British Columbia’s academic medical environment. Orthopedic services within the system encompass both complex tertiary care and elective orthopedic surgery.
For someone considering a hip or knee replacement in British Columbia, however, hospital reputation should be considered alongside the province’s referral and surgical-booking system. Patients may be assessed through regional pathways and should not assume they can obtain publicly insured surgery at any B.C. hospital simply by contacting it directly.
What B.C. patients should clarify
Ask whether a referral goes to an individual surgeon or a centralized orthopedic intake program, whether another qualified surgeon could offer an earlier assessment, and where postoperative physiotherapy is provided. Patients travelling to Vancouver should also plan for transportation and temporary mobility limitations after discharge.
The Ottawa Hospital
Location: Ottawa, Ontario
Official website: ottawahospital.on.ca
The Ottawa Hospital is an academic health sciences centre associated with the University of Ottawa and provides orthopedic surgical services within Eastern Ontario. Its scale and tertiary-care role make it a relevant institution for patients researching adult orthopedic reconstruction in the region.
Patients should distinguish between receiving an orthopedic consultation at a health system and having a particular type of replacement offered by a particular surgeon. Surgeon practices can differ according to subspecialty, and operating locations can change as hospitals redistribute elective surgical capacity.
Useful preoperative questions include whether the planned operation is primary or revision arthroplasty, what anesthesia assessment is required, whether same-day or short-stay discharge is being considered, and what support will be necessary at home.
London Health Sciences Centre
Location: London, Ontario
Official website: lhsc.on.ca
London Health Sciences Centre is a large academic health organization serving Southwestern Ontario. Orthopedic surgery is among its major surgical disciplines, and its teaching environment makes London relevant for patients requiring specialist evaluation for more complicated musculoskeletal conditions.
Patients considering treatment in London should ask their referring clinician whether the proposed surgeon routinely manages the specific problem involved. That question becomes particularly important after previous joint replacement surgery, major deformity, fractures around an implant, or suspected prosthetic-joint complications.
Travel is another practical consideration. Repeat appointments, preoperative testing and postoperative follow-up can make a distant academic centre less convenient than a strong regional program for straightforward cases.
Hamilton Health Sciences
Location: Hamilton, Ontario
Official website: hamiltonhealthsciences.ca
Hamilton Health Sciences is an academic hospital network associated with McMaster University and provides orthopedic care across its hospital system. It is particularly relevant to residents of Hamilton and surrounding communities who require specialist orthopedic assessment, while the health system also manages complex surgical and trauma care.
The name of the overall hospital network is less informative than the exact orthopedic pathway assigned to the patient. Ask which site provides the consultation, which facility will perform the operation, and whether the surgeon focuses on hip reconstruction, knee reconstruction, revision surgery, or another orthopedic subspecialty.
For older adults or patients with significant medical conditions, availability of coordinated perioperative medical services may also be an appropriate factor to discuss with the surgical team.
Montreal General Hospital, McGill University Health Centre
Location: Montreal, Quebec
Official website: muhc.ca
Montreal General Hospital is part of the McGill University Health Centre and provides tertiary and academic orthopedic care. It is one of the major institutions to research for complex musculoskeletal treatment in Montreal.
Quebec residents should verify the referral process with their physician and the applicable regional health system. As elsewhere in Canada, publicly funded access is shaped by medical need and provincial processes rather than by a consumer-style national hospital marketplace.
Language preferences, travel distance, rehabilitation arrangements, and the need for tertiary expertise can all influence the practical choice of facility. Patients with a previous implant problem should make clear at referral that they are seeking assessment for a revision or complication rather than a first replacement.
Misericordia Community Hospital, Covenant Health
Location: Edmonton, Alberta
Official website: covenanthealth.ca
Misericordia Community Hospital in Edmonton provides orthopedic surgical services and is part of Covenant Health. It is a relevant institution for Alberta patients researching hip and knee surgical care in the Edmonton region.
Alberta uses coordinated orthopedic referral and surgical pathways, so patients should pay close attention to how their referral is processed rather than focusing exclusively on a hospital name. Provincial programs may coordinate assessment, surgical consultation, optimization, and rehabilitation across more than one facility.
The Alberta Health Services website is a useful starting point for understanding provincial services and current referral information.
How to Decide Which Canadian Orthopedic Hospital Is Best for You
A hospital’s national reputation is only one piece of the decision. For many people, the more useful question is: Which surgical team is most appropriate for my particular joint problem?
1. Match the surgeon’s expertise to the operation
Ask whether the orthopedic surgeon regularly performs the procedure you need. A surgeon who specializes in primary knee replacement may not have the same practice focus as one handling infected prostheses or complicated revision hip replacements.
Relevant issues can include:
- Primary versus revision replacement
- Hip versus knee specialization
- Major deformity or previous fracture
- History of previous orthopedic operations
- Possible implant infection or loosening
- Need for complex reconstruction
- Significant medical conditions affecting surgical risk
2. Look beyond procedure volume alone
Procedure volume may provide useful context, but it should not be treated as a guarantee of a good outcome. Ask about the hospital’s approach to infection prevention, blood-clot prevention, postoperative pain management, early mobility, discharge planning, and management of complications.
Where reliable hospital-specific outcome information is publicly available, examine how the measure is defined before comparing institutions. Raw complication numbers can be misleading when tertiary hospitals treat more complicated patients.
3. Evaluate the full rehabilitation pathway
Joint replacement recovery continues after the patient leaves the operating room. Some people return home quickly and complete rehabilitation as outpatients, while others require additional support because of mobility, medical, or social factors.
Before surgery, clarify how physiotherapy will be organized, who will assess mobility aids, what support is expected at home, and whom to contact if recovery does not progress as expected.
4. Consider travel realistically
Choosing a famous hospital several hours away can introduce practical problems that are easy to underestimate. The patient may need preoperative appointments, investigations, surgery, postoperative review, physiotherapy, and possible unscheduled reassessment.
For an uncomplicated primary replacement, a high-quality regional joint program may be more practical than travelling to a distant academic institution. Complex revision cases may justify travelling farther when specialist expertise is required.
Joint Replacement Wait Times in Canada
Waiting time is one of the most common concerns among Canadians considering hip or knee replacement. There is no reliable single waiting-time number that applies to every hospital or patient.
The Canadian Institute for Health Information wait-time resources track priority procedures, including hip and knee replacement. Provincial governments may also publish their own surgical wait-time information.
Two patients at the same hospital can wait different lengths of time because of clinical priority, surgeon availability, operating-room capacity, medical optimization, cancellations, referral date definitions, and other factors. Published data may also measure different stages of the patient’s journey.
Understand what the waiting period measures
One statistic may measure time from referral to specialist consultation, while another measures time from the decision to operate until surgery. Combining those figures without understanding their definitions can create an inaccurate picture of total waiting time.
A patient who is flexible about surgeon or hospital may sometimes have different options from someone requesting a specific surgeon, but availability varies by province and region.
Questions to ask about waiting time
Ask the orthopedic clinic which date starts its quoted waiting period, whether the estimate refers to consultation or actual surgery, whether the patient can join a cancellation list, and whether another appropriate surgeon or regional facility may be available sooner.
If symptoms worsen substantially while waiting, patients should contact their healthcare provider for appropriate reassessment rather than independently assuming that the original priority category still applies.
How Joint Replacement Is Paid for in Canada
Canadian hospital financing differs substantially from the U.S. insurance system. Under Canada’s publicly funded healthcare framework, eligible residents receive coverage through provincial or territorial health insurance plans for medically necessary insured physician and hospital services, subject to the rules of their province or territory.
Health Canada provides an overview of the Canadian healthcare system and the federal framework surrounding publicly funded care.
A medically necessary hip or knee replacement performed through the public system is therefore not normally priced to an eligible resident as a single consumer package containing the surgeon, operating room, and hospital stay.
That does not mean every expense surrounding surgery is necessarily covered.
| Expense | General Canadian Cost Consideration |
|---|---|
| Medically necessary hospital surgery | Generally covered for eligible residents when provided as an insured service under provincial or territorial rules. |
| Surgeon’s insured professional service | Generally covered through the applicable provincial or territorial public plan when medically necessary and insured. |
| Private or semi-private room upgrades | May involve additional charges unless covered through supplemental insurance or another arrangement. |
| Mobility aids and equipment | Coverage varies by province, program, insurance plan, and device. |
| Prescription drugs used at home | Coverage varies according to provincial drug programs and private insurance. |
| Outpatient physiotherapy | Public coverage and eligibility vary; some patients use employer or private extended-health benefits. |
| Travel, accommodation and parking | Usually personal expenses unless a specific assistance program applies. |
| Uninsured or non-resident treatment | Charges can be substantial and must be confirmed directly with the provider. |
Why there is no useful single Canadian “joint replacement price”
Publishing a nationwide dollar estimate for Canadian hip or knee replacement would be misleading for residents treated through provincial insurance. Hospital funding, physician payment, implant procurement, public coverage and patient eligibility do not operate like a standard retail transaction.
For uninsured patients, visitors, or international patients, costs may depend on the hospital, surgeon, implant, operating-room requirements, imaging, laboratory tests, anesthesia, length of stay, complications, rehabilitation, medications, and follow-up. A quote from one institution should not be presented as a national Canadian price.
Private health insurance and employer benefits
Supplemental insurance in Canada can help with expenses not fully covered by provincial plans, depending on the policy. Examples may include eligible physiotherapy, prescription medication, certain medical equipment, or upgraded hospital accommodation.
Patients should read their actual benefit document rather than relying on the insurance company’s general marketing page. Check annual physiotherapy limits, prescription formularies, equipment limits, preauthorization requirements, exclusions, and whether a medical referral is required for reimbursement.
International and Non-Resident Patients
Canada should not be treated as though every publicly funded hospital operates an international self-pay joint-replacement program. Hospitals principally serve patients through provincial healthcare systems, and policies for non-residents vary.
An international patient should contact the hospital directly before arranging travel and confirm that elective orthopedic treatment is available to non-residents. Do not assume that obtaining a visitor visa, referral letter, or ability to pay automatically guarantees acceptance for surgery.
Ask for a written financial explanation
If a Canadian institution agrees to assess an uninsured patient, ask whether the estimate includes the surgeon, assistant surgeon where applicable, anesthesia, hospital facility, implant, imaging, laboratory work, medications, postoperative visits, rehabilitation, and potential additional hospital days.
Also determine what happens financially if complications extend the admission or additional surgery becomes necessary. Travel insurance should never be assumed to cover planned elective surgery unless the policy explicitly states that it does.
Preparing for Hip or Knee Replacement
Hospitals increasingly use structured preoperative pathways to identify factors that may affect surgical safety or recovery. The exact requirements depend on the patient and institution.
Medical optimization
A preoperative assessment may review cardiovascular and respiratory health, diabetes, medications, previous blood clots, anemia, kidney function, infection risk, smoking, weight-related considerations, allergies, and home circumstances.
Patients should bring a complete medication and supplement list and follow instructions provided by their surgical and anesthesia teams. Do not stop prescribed medications independently because some medications require individualized perioperative planning.
Prepare the home before surgery
Planning ahead can make discharge safer. Patients may need to arrange transportation, temporary help with meals or household tasks, suitable footwear, mobility equipment, and a clear walking route through the home.
The hospital or physiotherapy team should provide specific instructions about walkers, canes, stairs, exercises, bathing, driving, wound care, and activity restrictions. Those instructions take priority over generic advice found online.
What to Ask an Orthopedic Surgeon Before Joint Replacement
A productive consultation should help the patient understand both the proposed operation and realistic alternatives. Useful questions include why surgery is being recommended now, whether additional nonsurgical treatment remains reasonable, and what improvement the surgeon expects for the patient’s particular condition.
Other useful topics include the surgeon’s experience with the specific operation, the expected hospital stay, anesthesia options, pain-control strategy, implant selection, rehabilitation schedule, expected restrictions, possibility of revision in the future, and the main complications relevant to the patient’s medical history.
For revision surgery, ask why the existing replacement appears to be failing and what tests are needed to establish the cause. Revision for infection, instability, wear, fracture, or mechanical loosening can require very different treatment plans.
How to Compare Joint Replacement Programs Without Relying on Rankings
A strong comparison uses information that matters clinically and practically rather than choosing whichever hospital appears most often on a consumer ranking.
| Factor | What to Investigate |
|---|---|
| Clinical fit | Does the surgeon regularly manage your type of primary or revision joint problem? |
| Referral access | Can you access the program through your province or regional intake pathway? |
| Complex-care resources | Are tertiary services available if your case requires them? |
| Rehabilitation | How are physiotherapy, mobility training and discharge support organized? |
| Travel burden | Can you realistically return for follow-up appointments or unexpected problems? |
| Waiting time | Which stage of care does the published or quoted waiting period measure? |
| Costs | Which non-insured services, equipment, drugs or travel expenses could you face? |
Use Canadian outcome data carefully
The Canadian Institute for Health Information maintains the Canadian Joint Replacement Registry, an important source for understanding hip and knee replacement activity and implant-related information at a national level.
Registry data are valuable for health-system analysis, but patients should not convert national or provincial statistics into claims that a particular hospital or surgeon has a specific success rate unless reliable institution-level evidence supports that claim.
Frequently Asked Questions
What is the best hospital in Canada for knee replacement?
There is no single government-endorsed hospital that can responsibly be described as Canada’s best knee-replacement hospital for every patient. Sunnybrook’s Holland Orthopaedic & Arthritic Centre, University Health Network, Vancouver Coastal Health hospitals, The Ottawa Hospital, London Health Sciences Centre, and other major regional programs are among institutions patients may research.
The better choice depends on where you live, your provincial referral pathway, whether the surgery is a primary or revision replacement, the surgeon’s expertise, medical complexity, rehabilitation needs, and travel requirements.
What is the best hospital in Canada for hip replacement?
The answer depends on the patient’s clinical problem rather than a single national ranking. A routine first hip replacement and a complicated revision involving infection or bone loss require very different expertise.
For straightforward arthritis, a strong regional arthroplasty program may be appropriate and much more convenient than a distant tertiary hospital. Patients with complex previous surgery may benefit from asking their referring clinician about a tertiary revision-reconstruction centre.
Is hip or knee replacement free in Canada?
For an eligible resident, medically necessary insured hospital and physician services are generally funded through the applicable provincial or territorial healthcare plan rather than billed to the patient as a retail surgical package.
That does not make every related expense free. Prescription drugs outside hospital, some physiotherapy, mobility equipment, private-room upgrades, travel, accommodation, parking and other services may have separate coverage rules. The patient’s province and any supplemental benefit plan should be checked before surgery.
How long do you have to wait for joint replacement in Canada?
There is no single national waiting period that applies to every patient. Waits vary by province, hospital, surgeon, clinical priority, operating capacity and the stage being measured.
CIHI publishes Canadian wait-time information for priority procedures, including hip and knee replacement. Provincial health authorities may publish additional data. When comparing figures, determine whether the waiting period begins at referral, specialist consultation, decision to operate, or another point in the pathway.
Can I choose which hospital performs my knee replacement?
Choice depends on the province, referral structure, availability, surgeon practice, and medical circumstances. Some areas use centralized orthopedic intake systems that may distribute patients among surgeons or facilities.
If hospital or surgeon choice matters to you, discuss it when the referral is created rather than after a surgical booking has already been made. You can also ask whether accepting another qualified surgeon could alter the waiting period.
Can I get a second opinion before joint replacement surgery?
Patients can discuss seeking another orthopedic opinion with their healthcare provider, particularly when they are uncertain about the diagnosis, proposed procedure, or alternatives. How another consultation is arranged depends on the provincial system and local referral process.
A second opinion can be particularly useful in complicated revision cases where several surgical strategies may be possible. It should be based on your actual medical history, examinations and imaging rather than generic online recommendations.
Does private insurance cover joint replacement in Canada?
Provincial and territorial plans are the principal source of coverage for medically necessary insured hospital and physician services for eligible residents. Private extended-health insurance commonly operates around that public system rather than replacing it.
Depending on the policy, supplemental benefits may cover eligible prescription drugs, physiotherapy, medical equipment or upgraded hospital accommodation. Coverage limits and exclusions vary substantially, so patients should verify benefits directly from their policy documentation.
Can international patients travel to Canada for joint replacement?
Possibly in limited circumstances, but international patients should not assume a Canadian public hospital will accept them for elective joint replacement. Policies differ among institutions, and provincial hospitals primarily serve patients through Canada’s public health systems.
Before arranging travel, obtain confirmation that the institution accepts the case, determine referral and immigration requirements, and request written information about deposits and charges. Ask whether surgeon, anesthesia, hospital, implant, rehabilitation and complication-related costs are included.
How long does recovery from hip or knee replacement take?
Recovery varies considerably according to the procedure, age, preoperative function, medical conditions, home environment, complications and rehabilitation progress. Some milestones occur during the first days and weeks, while strength, endurance and function can continue changing for considerably longer.
The treating surgeon and physiotherapist should provide individualized guidance about walking aids, exercises, driving, work, bathing, stairs and return to activities. Generic timelines should not override those instructions.
Is a university hospital always better for joint replacement?
No. Academic tertiary centres can be particularly valuable for complicated reconstruction, revision procedures and patients needing multiple specialties. A routine primary hip or knee replacement, however, may be very effectively managed through a regional hospital with an established arthroplasty program.
Rather than choosing according to academic status alone, compare the surgeon’s relevant expertise, referral access, postoperative pathway, rehabilitation services, distance from home and the resources required for your particular medical condition.
Choosing the Right Canadian Joint Replacement Centre
The most useful way to choose among orthopedic hospitals in Canada is to match the healthcare team to the patient’s actual condition. Specialized institutions such as Sunnybrook’s Holland Orthopaedic & Arthritic Centre and large academic systems such as UHN, Vancouver Coastal Health, The Ottawa Hospital, LHSC, Hamilton Health Sciences and MUHC are reasonable places to research, but a prestigious name alone does not determine whether a facility is the right choice.
Start with the diagnosis and determine whether the proposed operation is a primary or revision replacement. Then compare the surgeon’s relevant expertise, regional referral rules, hospital resources, rehabilitation pathway, travel requirements and realistic waiting time. Eligible Canadian residents should also distinguish publicly insured medical services from expenses such as outpatient medication, equipment, transportation and supplemental rehabilitation that may follow different coverage rules.
For complicated cases, ask directly whether tertiary or revision-joint expertise is needed. For routine cases, a qualified regional program closer to home may provide a more practical treatment and recovery pathway. Final decisions should be made with the orthopedic surgeon and other healthcare professionals familiar with the patient’s medical history.
Medical Disclaimer: This article is for general informational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Hospital programs, referral rules, costs, wait times and insurance coverage can change. Confirm current information directly with the hospital, provincial health authority and appropriate insurance provider.