National Defence Committee on March 6th, 2008

[Sheila Fraser]

That stems from the fact that the Canada Health Act does not provide for military members to receive provincial health care. They must have private insurance to access that care. That may be due in part to a shortage of professionals who work for National Defence, or simply for other laboratory services and so on. We also didn't audit the analysis they conducted of this new model or whether they had assessed the alternative cost that that would have added if they offered the services themselves. Perhaps you can ask the departmental representatives if they have done that kind of analysis.

[Claude Bachand, Bloc, Saint-Jean, QC]

Very well.

Now I'd like us to talk about the distribution of doctors. We know a little about that in Quebec, since we sometimes have to ensure that doctors practise in certain areas where they don't necessarily want to go. Sometimes they prefer to live in Montreal or in other urban centres. I was surprised to learn that there is a major difference between the number of cases handled by one doctor and the number handled by another. One doctor may see as many as 100 patients a day, and another 40.

Wouldn't it be beneficial for the department to require a fairer distribution for the Canadian Forces as a whole?

[Sheila Fraser]

Indeed, we see that there should be far more data in order to manage the system and identify places where doctors are more available. Perhaps they could do a better distribution. Once again, that goes back to management of the system as a whole and to the lack of basic information. Obviously there is information on a clinic-by-clinic basis, but there is an information shortage in the system as a whole. The department is talking about putting a system in place, but that will take a few more years. It also appears that they won't necessarily put the entire system in place as a result of budget cuts.

[Claude Bachand, Bloc, Saint-Jean, QC]

I'm also surprised to see that nearly 40% of all doctors don't see any patients at all: they are assigned to administrative duties. That seems to me to be a poor distribution of the workload. Usually, a doctor is a doctor. For example, a doctor at the Hôpital du Haut-Richelieu in Saint-Jean-sur-Richelieu won't spend 40% of his time doing administrative work.

Don't you think that's a bit high?

[Sheila Fraser]

We noted it because we think it's worth examining. A number of doctors are working on policy development, for example. They spend all their time on administration. That doesn't necessarily mean that they work with patients for one part of their time and do administrative duties for another. I also think it's up to the department to review that percentage, in view of the shortage of doctors and of what it would cost to hire doctors on a contract basis to provide services to military members.

[Claude Bachand, Bloc, Saint-Jean, QC]

Now I'd like to ask a question which you may perhaps not be in a position to answer. In Canada, the real health services experts are the provinces. I know that one provision of the National Defence Act states that health care must be provided by the Canadian Armed Forces. If we said it would be better to transfer the entire issue of health and dental health to the provincial public sector, and if we reached a federal-provincial agreement, with transfers of tax points or cash, how would you react? Are you going to answer that that's a political decision and that you can't comment on it?

[Sheila Fraser]

I see you already know the answer. I'll also say that it must be acknowledged that National Defence has fairly specific needs. Those people want military members to have immediate access to the required services. I think that one of the barriers to simply transferring care delivery to the provincial system is that military members would like to continue receiving services when they want them. Another of the problems that was noted in the 2002 surveys was continuity of service. National Defence has worked very hard to ensure continuity and availability of services.

[The Chair, Conservative, Rick Casson]

Thank you.

We'll go to Ms. Black.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Thank you, Mr. Chair.

Welcome to the committee again. It's nice to see you again.

As you know, the study we're undertaking right now is on health care with an emphasis on mental health care. I note that in your opening remarks you talked about a 2002 survey. I'm wondering if that is the one Dr. Brunet did. He came to our committee last week. You mentioned that only 25% of the respondents in that study, who had reported symptoms of mental health problems or disorders, considered that they had received sufficient help with them.

One of the other figures Dr. Brunet gave us from his study, if it is the same study, showed that 57% of those members of the Canadian Forces who had a recognizable mental health problem had not received any treatment. I am wondering if you're aware of that research.

[Sheila Fraser]

The survey we mention is done by Statistics Canada, and it is the same.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

It is based on that study.

[Sheila Fraser]

Yes, that's right.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

I'm wondering if you're aware that 57% of the people who were identified with a disorder did not receive—

[Sheila Fraser]

Yes, I'll let Ms. Loschiuk respond to that.

[Wendy Loschiuk]

As I understand it, the study you're speaking of used the same data Statistics Canada used back in 2002. Of course, those findings are from that timeframe. I really couldn't give you an update. You'd have to ask the department where the situation stands today.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

You were also very concerned about the credentials of medical practitioners. Does that also include mental health practitioners? Did you look at that specifically?

[Sheila Fraser]

We didn't break down the practitioners by area of specialty, but, for example, we looked across the whole system at the health care practitioners, be they doctors, nurses, or whatever. The department, at the time of the audit, at least, did not have a system in place to ensure that the practitioners were appropriately certified or licensed.

We did a check of all the doctors to make sure there were no issues there, and we found that was fine, but we didn't go through, for example, all the nurses to make sure they had the proper credentials. I understand that now the department has put in place a system that will require annual certification of the professionals.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Is that in both physical and mental health?

[Sheila Fraser]

Yes, that's my understanding.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

Good.

Did you find any differences in the performance of delivery or spending on mental health services as compared to general health services? Did you look at that?

[Sheila Fraser]

Again, we didn't break it out specifically.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

I understand that in your next study—the study you've just taken was in Canada—you will look at services provided outside Canada. Is that correct? If it is correct, will your staff travel to Kandahar airfield, or have they already?

[Sheila Fraser]

We are looking at the supply chain, the support to deployed operations. That will be tabled in May, we hope. Yes, the staff did go to Kandahar.

[Dawn Black, NDP, New Westminster—Coquitlam, BC]

You looked at both mental health services and—

[Sheila Fraser]

We did not look at the health services. It's more the supply chain for goods going in and the supports to the operations there. We didn't look at health care for the moment anyway.