Evidence of meeting #16 for Health in the 40th Parliament, 3rd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was staff.
A recording is available from Parliament.
9:45 a.m.
Director General, Health Management, Department of Citizenship and Immigration
Nobody is responsible for finding a health care professional. This works as insurance, and it's up to the client to find their own health care provider. Through the claims administrator, we then pay for the care.
9:45 a.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
So if there are shortages of physicians, the clients are directly affected the same as everyone else?
9:45 a.m.
Director General, Health Management, Department of Citizenship and Immigration
That's right. Our role is only to provide payment. We have a mandate to provide payment for the services, not to ensure access.
9:45 a.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
So then access is totally up to the client, and there are no issues with your department as far as language issues, or foreign-trained...or your understanding of different cultural issues are concerned? Are those totally up to the client?
9:45 a.m.
Director General, Health Management, Department of Citizenship and Immigration
Well, our department is quite involved in working with service providers and looking at issues of integration and language. But that doesn't come under my area of responsibility; I am responsible for health.
So if you are interested in issues of integration and the health aspects of integration, then I would have to ask a colleague from our integration branch to talk to you. But, definitely, that is an area where our department is very involved—but not my branch.
9:45 a.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
You have a third-party claims administrator, and you've just said that you're switching administrators in January, but how often do you do an RFP? How often is this evaluated, first of all? And then what is the term of the contract you're normally looking at?
9:45 a.m.
Director General, Health Management, Department of Citizenship and Immigration
The claims administrator we currently have has been working under the same contract for a period of three years, but they also had the contract before that. It wasn't the first time they had the contract.
This new contract is going to be for five years, with the possibility of being renewed twice for two years at a time.
9:45 a.m.
Conservative
Patricia Davidson Conservative Sarnia—Lambton, ON
When I look at the program expenditures from the chart that you've given us, and I recall your opening remarks where you said there is a considerable increase in program expenditures—reflecting the fact that the cost of obtaining health services has grown significantly from 2001 to 2009, an eight-year period—I see that we're looking at a greater than 50% increase in expenditures, from $42.5 million to $90.8 million. While I know you're looking at more clients, there is no comparison here for the number of claims. Has the cost itself risen that much in the eight-year period?
9:45 a.m.
Director General, Health Management, Department of Citizenship and Immigration
We could provide you with the cost per client also. We have that information. If you wish, we could also provide you with that information. The cost per client has increased. The number of claims has increased. The number of clients has increased. We haven't drilled down into more of an analysis. Our intuition is that the population of clients is in situations where they have a lot more health problems. They come from much more difficult situations and they need more health care. So there are a variety of factors.
9:50 a.m.
Conservative
The Chair Conservative Joy Smith
Thank you, Ms. Scott.
We're now going to go into the second round. It's going to be very, very tight. We will have Ms. Murray and possibly one other question to make sure we get all our questions in.
So it's a five-minute round, Ms. Murray, and I'll be tight on time.
Ms. Murray, do you want to start?
9:50 a.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you, Madam Chair.
I'd like to find out from Ms. MacLean, of the psychologists, psychiatrists, social workers, and therapeutic workers, what percentage are working specifically with clients and what percentage are doing policy work?
9:50 a.m.
Assistant Commissioner, Health Services, Correctional Service Canada
The very rough rule of thumb is that most of our health professionals are in our institution. I can give the detailed breakout by profession as an undertaking to the committee, Madam Chair, but, for example, of the nurse component I spoke to earlier, of the 750 nurses--
9:50 a.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Sorry, I listed the mental health and drug workers. Do you have a rough rule of thumb on how many are doing policy work? What percentage?
9:50 a.m.
Assistant Commissioner, Health Services, Correctional Service Canada
The complement for psychologists is very small at the national headquarters level. For example, 5 of the 340 psychologists are at our national headquarters. Those would, of course, be our people working principally in the policy area. We don't--
9:50 a.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you. Because the time is so tight and I have five questions, I'm going to go through them quite quickly.
Do you do work to assess the care provided in terms of mental health and drug addictions? What's working and what's not working?
9:50 a.m.
Assistant Commissioner, Health Services, Correctional Service Canada
For our addiction programming, we have both formal program evaluation and annual publication of our correctional results in our report on plans and priorities. For the mental health component, some aspects of the funding are quite new. They came in in 2005, 2007, so we're actually going to be doing an evaluation of our mental health strategy over the next year or so.
9:50 a.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Can you tell us again--the back of the envelope--how much of the medical and mental health and addiction problems were brought in by the clients and how much is attributed to being incarcerated? How much is either? Do they actually get the hepatitis C from being in the prison? How many of those problems are exacerbated through incarceration as opposed to whether there was a natural state before they came in?
9:50 a.m.
Assistant Commissioner, Health Services, Correctional Service Canada
I'll respond at the high level first. The Correctional Service does not have an electronic health record, so our ability to track detailed health conditions by inmate or to do population health analysis is limited by that. I could give you some of our most recent data on infectious disease, however, because I do have 2008 data. It shows, for example, on HIV/AIDS, in 2008, we had a population of 219 inmates with HIV/AIDS. We also had 87 people admitted that year with HIV/AIDS, 90% of whom already knew they had HIV/AIDS. Similarly, for hepatitis C, where again our most recent data is 2008, of a population of 3,903 people with hepatitis C, 935 were admitted that year with it, 85% of whom already knew.
9:50 a.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
So can I summarize that some come in with mental health problems, drug addictions, and diseases, and some acquire them while incarcerated?
My last question.... We have been told by the Parliamentary Budget Officer that the potential cost of the government's punishment agenda would be $2 billion over five years, which is 10 times what had been assessed by the government itself. My question is this. Have you been asked to assess what the needs and costs related to this increase in number and time of incarcerated Canadians might be? How do you see the current shortages changing with this punishment agenda that will be increasing the number and length of stay in prisons?
9:55 a.m.
Assistant Commissioner, Health Services, Correctional Service Canada
Our commissioner has been giving testimony before the national security and public safety committee on the impact of the possible change in inmate population, and my understanding is that of the funds budgeted for an increase in offenders, there will be funds for providing health services to inmates as well.
9:55 a.m.
Conservative
9:55 a.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Thank you, Madam Chair.
First, I was a little surprised in terms of there being no electronic health record, so I'm just wondering, are there plans? Have you put your application in? Where is that at?
9:55 a.m.
Assistant Commissioner, Health Services, Correctional Service Canada
I'd be happy to speak to our efforts on that. The front-line staff ask me about it every time they see me.
We actually had been going through a formal request for proposal last year. That effort failed, so we are now working to assess, both with other federal partners who deliver health services and provinces and other suppliers, any possible outlets for us to collaborate with others and have a partnership that would enable us to give an electronic health record to our front staff. It's critical to continuity of care and supporting them in excellent health services.
9:55 a.m.
Conservative
Cathy McLeod Conservative Kamloops—Thompson—Cariboo, BC
Okay, so you have the funding available; you just have not found the product that's going to meet your needs as of yet. Is that accurate?