Finance Committee on Nov. 6th, 2013

[The Chair, Conservative, James Rajotte]

Could we have a brief response, please.

[Owen Adams]

There's no question there is large variability across regions, and I think income is probably the key factor.

People say that the health care system itself contributes about 25% and the majority is from these other determinants. It's a very common finding in major cities and other locales.

[Raymond Côté, NDP, Beauport—Limoilou, QC]

Thank you very much, Mr. Chair.

[The Chair, Conservative, James Rajotte]

Colleagues, as you see, we have a 30-minute bell. With your consent, I will push it as far as I can. We will have a bus waiting outside in about 15 or 20 minutes. We will continue with our questions, and the chair will take the next round here.

First of all, I want to follow up on Mr. Brison's comment on the Alzheimer's strategy and the motion. I appreciate all the work you've done on that. Mr. Adams, I did appreciate your follow-up from our last year's session on that.

Specifically, I want to ask Ms. Bard and perhaps Mr. Adams about the second recommendation by Ms. Bard.

Mr. Adams, the CNA is recommending authorizing nurse practitioners to provide drug samples under the signatories on the federal forms. Does your organization, or do you, have any comment on that recommendation?

[Owen Adams]

Essentially, this was the CNA's recommendation. I think nurse practitioners have been legislated now in every jurisdiction. The federal forms and trying to make these forms easier to fill out and easier to complete, and more understandable to work with for patients have actually been a big preoccupation with the CNA.

It might be a case of be careful what you ask for, because they can be burdensome.

[The Chair, Conservative, James Rajotte]

Okay, you're willing to transfer the burden over.

[Rachel Bard]

For us, what it means is that we want to increase access for patients in terms of services. We believe that nurse practitioners are a point of entry. We would actually then help physicians address those who need their care, while nurse practitioners would be able to address some of the care.

It's really all about increasing access and removing barriers, federal legislative barriers.

[The Chair, Conservative, James Rajotte]

Very quickly on the Alzheimer's strategy, Ms. Bard, you're recommending that this be grouped in a more comprehensive aging strategy.

[Rachel Bard]

That's correct, an overall comprehensive approach.

[The Chair, Conservative, James Rajotte]

Again, going back to Mr. Adams, is that your preference, or are you agnostic on whether it's a separate strategy or together? What's your feeling?

[Owen Adams]

I think it would make sense to have the comprehensive kind of strategy that we are recommending to be part of that.

[The Chair, Conservative, James Rajotte]

I appreciate those comments very much.

Dr. Gauthier, in your submission, with respect to red tape reduction, you talked about the independent blue ribbon panel. You talked about the finance committee's report and its recommendations as well. You talked about some departments moving forward on some of those recommendations, and some other departments not moving forward as quickly on some of those recommendations in terms of reducing the red tape burden on charities.

I want to give you an opportunity to address that recommendation in your brief. Perhaps you could provide some examples of any departments you want to encourage us to move more quickly on in adopting those recommendations.

[Dr. Michelle Gauthier]

Thank you. In fact, I think what we are looking for is an all-of-government approach to this. That was underlying the blue ribbon panel and then the subsequent government action plan on this.

When I think of the work of the former HRSDC, they have a committee that's been struck and has engaged with a number of charities and other organizations to try to move forward more quickly on some of these recommendations. Some of the recommendations, obviously, also depend on the appropriate fiscal framework.

We would like to see full cost recovery. We know from the “Talking about Charities” survey that Canadians are still concerned about administrative costs and the time it's taking for charities to have to deal with red tape. Efforts to be able to ensure full cost recovery on grants, efforts, where feasible, to be able to provide three-year or multi-year funding agreements so that there can be an effort upfront to apply for the grant, and then know for a three-year period that one can move forward and get the work done in communities, become important.

I think HRSDC is one of the departments where there has been more significant work done, and we would welcome a broader strategy across the full government in that regard.

[The Chair, Conservative, James Rajotte]

I appreciate that. My time is quickly running out.

I just want to quickly get your feedback. You talk about Mitacs as an example of a program in which barriers should be removed. Do you have other examples you want to provide to the committee today?

[Dr. Michelle Gauthier]

Yes, there are a number of different programs. IRAP, the industrial research assistance program, would be one. BDC, would be another, as would the community futures program. There are a number of programs that are in place.

Our understanding is that it's not necessarily legislative change that may be required. It may be just the way the program has been conceived or explained to the program officials who are delivering it.

We feel we could work constructively with government to both heighten awareness from charities and make sure that when they're coming to the door and asking for that support that any administrative barriers are removed.

[The Chair, Conservative, James Rajotte]

Because it's simply an eligibility issue.

[Dr. Michelle Gauthier]

In some instances it is. In some instances, we'll call the program on one day and we'll have a sense there's an opening to charities, and we might call back six months later and there's not. In other instances, as in Mitacs, it's a specific change that would need to be made in the contribution agreement. Even that wouldn't require legislative change, from what I've been told.

[The Chair, Conservative, James Rajotte]

Thank you. I appreciate that very much. My time is up. I'll cut myself off here.

We'll go to Mr. Rankin for his round, please.

[Murray Rankin, NDP, Victoria, BC]

Thank you very much, Mr. Chair.

Welcome to all of the panellists.

I want to first of all ask Regional Chief Googoo a question. It's just a bit of clarification about his recommendations.

In your second recommendation, quite a startling figure appears, and I just want to make sure I've grasped it.

You indicate that the ongoing cost of the status quo in terms of lost productivity and increased support is over $12 billion a year. Your research, and I want to ask you where this research comes from, indicates that raising graduation levels among first nations to levels comparable to the Canadian population, in general, by 2026 would lead to cumulative economic benefits of more than $401 billion, in addition to the $115 billion in avoided government expenditures over the same period. Those are staggering figures, and it's really quite optimistic if that could be achieved.

What is the source of that research? Is that using Stats Canada information?

[Morley Googoo]

It's the Centre for Study on Living Standards.

[Murray Rankin, NDP, Victoria, BC]

I see.

Your fundamental recommendation to achieve that is stable, predictable, and fair funding for first nations education. That's where you see it. The world turns around that particular need for stable predictable funding from the federal government.

Is that right?

[Chief Morley Googoo]

Yes. It's important that we produce those graduation rates. It's important that we have aboriginal children be part of the economy and no longer part of poverty or dependency.

[Murray Rankin, NDP, Victoria, BC]

The benefits you talk about are quite staggering for the investment. In fact, you say that to bring first nations children up to the poverty line it would cost $580 million, or 11% of the budget of the department, which presumably isn't a lot of money when you consider the enormous amount of money that's being spent.

I appreciated the research very much. Thank you for bringing it to us.

My next question is for Mr. Adams.

The seventh recommendation in your work refers to the need that I know has been identified in the past, for a program for pharmaceuticals in Canada. It's a program that, as you say, is in consultation with the provinces and others. It would be a program to establish a comprehensive prescription drug coverage program.

Again, I was struck by your research. You cite from Ipsos Reid, which showed that one in five households doesn't have supplemental insurance coverage for prescription drugs. It's 20% of the population that has to find the money and often can't do so.

Then you said that this means many people are unable to manage treatable conditions and end up in the hospital, and there's an additional cost as a result of that.

Has the CMA done any costing of such a program? Have you envisaged how it might work and how much it might cost for such a program?

[Owen Adams]

The model we put forward in our policy position is essentially based on the Kirby recommendation of 2002. The federal government would contribute, say, 90% of the cost above a certain threshold. I mean, most of the people at the time were talking about a figure of around $1 billion to do something at that level. Of course, you could cap that at a threshold. I don't think you'll ever again have another open-ended cost-sharing program in that area.

That was the way we looked at it. That was essentially the model we put forward at the time, and that could probably still be obtained.

If you look at provinces like Prince Edward Island, they have just put in place a sort of plan, and New Brunswick is contemplating it, but they could still use assistance to do that, in trying to create a more level playing field.

[Murray Rankin, NDP, Victoria, BC]

Again, Mr. Adams, one of the things you said today was quite startling. You talked about these so-called ALC beds, alternative level of care beds, which is really that you don't know where to put them. I think you put it very well.

You mentioned that a hospital bed costs $842 a day to fill versus $126 for a long-term care bed. It would save Canadians $2.3 billion if we could move these patients from hospital beds to long-term care facilities, but as you said, there's a shortage of these beds and a shortage of home-care assistance to make that possible.

If you were the federal government, specifically knowing how most health care is administered provincially, how could we do that? How could the feds incent that?