Evidence of meeting #7 for Indigenous and Northern Affairs in the 39th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was report.
NDP
Jean Crowder NDP Nanaimo—Cowichan, BC
To follow up on that, my understanding is that the current subcontractor is an aboriginal-owned organization.
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
No. ESI is a--
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
We have a current contractor and it is an aboriginal-owned corporation.
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
That's right. As we re-tender that contract, because I think they've had that contract for almost ten years--
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
The period--
NDP
Jean Crowder NDP Nanaimo—Cowichan, BC
Why wouldn't the set-aside provision be considered again? I mean, you have an aboriginal organization that's delivering the service now.
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
As I've said, the policies that we would follow would be those governing large procurements, which are asking the government to ensure that there are a reasonable number of bidders in order to ensure quality and value for the money the government is spending, but they also include a provision that would ensure aboriginal benefit in this particular case.
Conservative
The Chair Conservative Colin Mayes
Okay, thank you.
I'm going to follow up on that question, as it's the government's turn. I have a question with regard to the delivery of the dental benefits to first nations.
I had a presentation made to me by the Canadian Dental Association with regard to some of the challenges they have in providing the dental benefit. It seems that there's an $800 cap on the amount of dental work to be done at one time. The challenge is that quite often for first nations people who come from a remote community there is a significant cost involved in having to travel to a centre where there is dental care provided.Then they can only get a certain amount of work done and then they have to go back and then go back again. You're incurring more expense just in the travel than you are on the actual dental work.
The other thing is the challenge of the audits on the dentist providing the work. It seems to be quite costly. Would you think that maybe it would be easier to find a private sector dental benefit plan on which we could put first nations people and pay that way, rather than the way we're operating now?
Mr. Potter.
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
I'm pleased to answer that.
The issue that was raised with you by the Canadian Dental Association has been resolved, in that the $800 cap has been removed. It was removed in July 2005. So we no longer have a financial limit on pre-approvals. Like almost every dental plan, there are some procedures that do require pre-approval, but there is no financial limit any more.
With respect to audits, the program we operate has no co-payment and no participation fee from the individuals. This is a policy that the government has accepted. In managing the process, though, it does put a higher degree of scrutiny on the shoulders of the payer, which in this case is the government. When we've discussed this approach with corporate private sector organizations, in terms of managing a program like this, they would see the same requirements of management review and audit.
We have tried to work very diligently with the regional dental associations to come to an arrangement--and we actually have a variety of different types at work--so that we can do them in collaboration, if that's possible.
In our audits, we do not look at the question of the professional competencies. We only look to see that the procedures for which the government is being billed were actually required and were performed.
Conservative
The Chair Conservative Colin Mayes
Thank you.
I'd like to turn to the Liberal Party now. Madam Karetak-Lindell, please.
Liberal
Nancy Karetak-Lindell Liberal Nunavut, NU
Thank you, Mr. Chair.
Thank you to Ms. Fraser for appearing before the committee. May I take this opportunity to also thank you for coming up to my riding last summer, because we always say you can read all about the north, but you have to experience it to fully understand the points we're trying to make. So I appreciate that.
I have two areas of concern, some of which I know has been covered by other questioners. My two areas are the non-insured health benefits program and the food mail.
The non-insured health benefits process at times seems to be a bit of an impediment in procuring prescription drugs. It is just so cumbersome for pharmacies, and I know some medical offices actually refuse to take patients who have to submit claims to the non-insured health benefits program, and that then limits the number of doctors or dentists we can access, because they just don't want to deal with trying to get money from non-insured health benefits.
I have also had people, especially nurses in remote communities, tell me of the length of time they have to wait for the approval process for a drug that has been prescribed but is not on the approved list. Because we have no pharmacists in many of these communities, the waiting time is increased by the time it takes. Once the approval process is completed, they have to fly the drug to the community. So a patient could go for weeks without getting the actual prescribed drug.
I don't understand. I use non-insured health benefits, along with my other plan. For one plan, claims are submitted by Internet, but for the non-insured one, there has to be a paper submission. So for these two different medical plans, one just goes automatically from a doctor's office and the other one has to be done by paper submission. I'm wondering if that's one of the options we have to streamline non-insured health benefits, and maybe Mr. Potter can help answer this question.
We seem to experience so much difficulty in dealing with that cumbersome process. There has to be some way of streamlining, as you say, the way of submitting claims, because I do know for a fact that some offices are very reluctant to take a patient if they know that they're going to have to deal with non-insured health benefits.
I'll let you answer that one, and then I'll get to the food mail one.
Auditor General, Office of the Auditor General of Canada
I would just like to say that my visit to Arctic Bay was a wonderful experience. I saw some of the realities of living in the north: I wanted to take my children with me until I found out that the airfare would be $4,000 each, so I said I would bring home pictures. But it was a wonderful experience.
Unfortunately, on the health benefits audit we didn't look at the actual process. Mr. Potter might be able to respond to that. We were looking more at the monitoring that the department does on the issue.
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
I'm not quite sure I understand the question fully. I will try to answer it. If I haven't quite answered it, maybe you could just tell me where I'm wrong.
The process we have for submitting pharmacy bills is automatic. It's an Internet-based system, so when a client goes to the pharmacy, the pharmacy automatically enters it into an Internet system--
Liberal
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
There may be a couple that don't, but 99.9% submit that way. We are moving the dental benefits to be the same, so it's all going to be Internet-based.
Liberal
Nancy Karetak-Lindell Liberal Nunavut, NU
But the dental ones aren't at the moment, as far as I know.
Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health
Some are and some aren't. Our plan is to have it all in there as fast as we can. While almost every pharmacy in Canada has an Internet connection and is capable of dealing with that, some dental offices haven't gone that way. But most claims are being submitted that way.
In terms of paying, we're running a system that runs quite quickly. Some drugs are on a limited availability list, and these are called drug exceptions. There are a number of reasons why they would be on that list. The drug may be of a higher risk when people use it; it may be a very expensive drug, where there are more cost-effective interventions available, or there may be some other medical reason why it's on that list.
In those circumstances, the doctor has to contact the drug exception centre, which operates five days a week for about twelve hours a day. If a person arrives when that centre is closed, they can get a prescription for a short period of time. So hopefully it's not an impediment.
Sometimes the actual shipping of the drug—which is not our responsibility but is the responsibility of the pharmacy—is a problem in getting it to the individual, depending on where the person is, or where the pharmacy is connected in its wholesale distribution system.
Hopefully I have captured the essence of your question.
Liberal
Conservative