Thank you for inviting me to speak to you today.
My name is Marceline Tshernish, and I am Innu. I belong to the Uashat Mak Mani-Utenam community, on the north shore. I am the director of the health sector, and I am here representing my organization, Innu Takuaikan Uashat Mak Mani-Utenam, or ITUM.
During my presentation, I will focus on some of the challenges around health care accessibility faced by members of my community, especially those families who are most vulnerable. The main challenges we face as members of first nations revolve around health care and services, as well as access to information regarding the benefits available to first nations communities.
The process to access health benefits is onerous, and the wait times, significant. Those wait times affect the quality of care received by community members. The red tape involved in accessing health benefits contributes to a lower quality of life for first nations members, who have to go through two levels of government in order to access care and services. For care that is not covered by the Régie de l'assurance maladie du Québec, members have to turn to the NIHB program for first nations and Inuit, and submit another claim. If their claim is denied, they have to initiate an appeal process, which is extremely complex, both for patients and for health care professionals. They may have to go through a number of steps and appeals.
As Mr. Malak pointed out, access to pharmaceuticals is a tremendous challenge for members of my community. The approval process for exception drugs under the NIHB program is hard to understand and involves so much red tape that it erodes access to pharmaceuticals, in contrast with the provincial process and system that apply to the rest of Quebec's population. This highlights the inequity between the two jurisdictions.
Access to information related to the benefits procedure is also a challenge for members of my community.
Mr. Malak gave examples of what members of the population experience when trying to access medical supplies and equipment. Generally speaking, these are patients with permanent conditions, who have to go through the claims process over and over again to access the care and basic equipment they need. That is extremely onerous.
In addition, when patients do receive information, it is often quite incomplete. The procedure for the supporting documents patients have to provide is not explained clearly. I would also say that the health care professionals, themselves, do not fully understand the procedures for the NIHB program.
Palliative care is another example where patients face restrictions in accessing pharmaceuticals. When a physician prescribes a medication such as a narcotic to alleviate pain, the pharmacy receives the prescription and must then send the physician a palliative care form to fill out and return. Finally, the pharmacy has to send the completed form to the NIHB program. That gives you a sense of the extensive red tape involved before the suffering of a patient at the end of life can be alleviated. In some cases, it can take up to 48 hours for the patient to receive the medication.
Now, I would like to turn to another aspect of the NIHB program, medical transportation. In Uashat Mak Mani-Utenam, we provide the coordination for that part of the program, but it is underfunded and coverage is limited.
We have neither the ability to tailor the eligibility criteria so that the services meet the needs of first nations members nor the ability to provide culturally safe services.
In many ways, the cultural safety dimension of health care is ignored because the eligibility criteria do not take into account the holistic approach advocated by first nations, including in relation to escort claims.