Good afternoon.
First of all, I would like to acknowledge the unceded territories we are on.
We thank the members of the committee for allowing us to outline the issues related to the administration of the non‑insured health benefits program and access by first nations to this program.
My name is Jessie Messier. I am non‑native, and I am the interim manager of health services with the First Nations of Quebec and Labrador Health and Social Services Commission. With me today is Isabelle Verret, who is Wendat, and who is the advisor for health access services for the same organization.
We'll begin by highlighting the complexity of the processes for accessing program services. Indeed, these processes don't take into account the realities or the real needs of first nations.
The administrative burden required to provide access to non‑insured health benefits, or NIHB, has frustrated professionals, who view it as a significant overload of work. In recent years, many professionals have decided to stop working with the program, leaving patients to pay for services and seek reimbursement on their own. Sometimes it can take several weeks between the request for pre‑approval for a service and the response from the program indicating whether the request is accepted or refused. This reality is of great concern, especially for remote and isolated areas where the number of professionals located close to the community is limited.
The lack of awareness by professionals and first nations of the program's services is an additional barrier to access. All eligibility criteria for services and treatments are not transmitted, which is a major barrier for professionals who must determine the best treatment plan for their patients. This issue creates unacceptable delays for patients and professionals, who must take specific steps to have some of these services covered by the program.
This reality can have a significant impact on the health of our populations. As a result, the program forces first nations to justify certain medical treatments that are available to the vast majority of Canadians. This contributes to the continued systemic discrimination against first nations in the health care system.
In order to improve the knowledge of program professionals and the accessibility of services for patients, several strategies should be put forward. For example, information on the realities of first nations and the specifics of the services offered to them should be included in university training programs as well as in training offered in the provincial health system. Eligibility criteria should also be communicated openly to professionals working with this clientele.
Better support, adapted to the local reality of first nations, would increase access to services for a population with urgent health needs, given, among other things, the prevalence of chronic diseases.
Further complicating access to the program is the fact that the management of the various program services is shared between the NIHB national office and the NIHB regional office.
In recent years, the administration of some services that were previously managed regionally has been centralized in Ottawa. We note that this centralization has distorted the collaboration and communication that existed between the regional administration, the communities, the beneficiaries and the service providers. The adapted approach, the proximity and the relationship of trust that were established facilitated better access to services and minimized the effects of several administrative difficulties. Regional management also provided a better understanding of the specific needs of first nations at the local level.
The support and accompaniment provided to suppliers is now diluted in a uniform national approach that is rigid in relation to our reality in Quebec. While we understand that the goal of centralization was to better manage federal government resources, in reality, this has created significant challenges, including delays in authorization and reimbursement for services. It is essential that quality control mechanisms be established and closely monitored, all in cooperation with first nations.
As is the case with many programs and services for first nations, the NIHB program operates at the margins of programs established by provincial governments and is implemented without any real alignment.
First nations' eligibility for some provincial programs is often ambiguous and inconsistent across provinces and territories in Canada. Flexibility in access to the NIHB Program would allow for services that are tailored and complementary to what is offered by provincial and territorial governments.
The issue of responsibility for payment of services is also an issue we would like to draw your attention to. The NIHB program requires first nations to approach private or government insurance programs in advance of any application to the federal government. In addition to causing significant and unreasonable delays, this can be very complex for individuals who are not familiar with this type of approach or for whom English or French is not the first language.
The elements we are bringing to your attention today are just concrete examples of the many challenges first nations face when accessing services under the NIHB program.
It is essential that the work begun in 2014 as part of the joint review of the program continue in partnership with first nations to find concrete and sustainable solutions. Until then, the federal government must ensure that first nations are kept at the heart of any decision affecting the management of and access to the program.