Finance committee  I can't overstate how excellent this news is. Provided the budget is passed, we really view it as a win-win-win situation. My statistics are accurate, that over three million Canadians—from my in-laws who live in Peterborough to over 600 indigenous communities across Canada—are provided care primarily by nurse practitioners.

Finance committee  Thank you. I've timed my speaking to less than five minutes. I'm a registered nurse myself, and I'm here representing the CNA, the professional association for close to 140,000 nurses in Canada. I'm pleased to speak today about the measures related to nurse practitioners in Bill C-44.

Finance committee  I mentioned that the CNA has entered national consultations with the Canadian Home Care Association and The College of Family Physicians of Canada. Our specific question was on our recommendations to the federal government around home care and integrated care. We were able, through input in one form or another from over 500 expert Canadians, to come up with specific recommendations in a number of areas.

Finance committee  I think it depends on how these things are couched, but I can reference similar accountability frameworks being put in place, for instance, in previous budgets around housing, and to our knowledge that was accepted and effective. I think that since we all have the same goals and taxpayers and patients are looking for these services, they would be supportive of that approach.

Finance committee  Thank you for this invitation to present on behalf of the Canadian Nurses Association, which represents 139,000 registered nurses and nurse practitioners in Canada. Like Mr. Blakely, I'd like to thank the committee for previous recommendations related to home care and to an accountability framework around the proposed new health accord.

International Trade committee  We haven't heard any arguments in favour, but I do defer to those who work in the industry.

International Trade committee  The linkage there is that the federal government is the provider of health services, including medications, to first nations and Inuit health in Canada. They are both a funder and a provider, so they're going to be hit doubly by any changes to the cost of drugs in Canada.

International Trade committee  Yes.

International Trade committee  I don't remember specifically.

International Trade committee  Yes. I would add that the three combined account for over 60% of health care expenditures in Canada each year, but I'm afraid I can't give you the specific breakdown.

International Trade committee  Both the implementation of NCLEX in Canada and the reliability and validity of NCLEX in testing nursing competencies relevant in Canada are questionable. What is unclear right now is whether or not the Canadian regulators will find that to be problematic enough to make a decision to revert to a Canadian entry-to-practice system.

International Trade committee  The determinants of health are multivariate. They are related to physical health, genetics, the environment, and other social factors such as housing, income, employment, education, etc. To say that the cost of pharmaceuticals, as an example relevant to this conversation, is the only or the most important determinant of health would be giving undue weight to that particular dimension of health.

International Trade committee  Actually, I'd like to process your question, so I'll let him make his comments first.

International Trade committee  If you look at the most recent report, the 2015 report from CIHI, the top three costs that are increasing steadily year over year are hospitals, physicians, and drugs.

International Trade committee  Thank you for that question. It's an important component of this discussion. My personal strength is not in economic analysis. What we've been able to bring to the table are the unbiased and non-business interested analyses by other groups. These analyses are those in which we have trust.