Yes, you are, Mr. Chair.
Mr. Chairman, members of the committee, Madam Auditor General of Canada, ladies and gentlemen, I am Major-General Walter Semianiw, Chief, Military Personnel. I am accompanied by Brigadier-General Hilary Jaeger, the Surgeon General of the Canadian Forces.
In my capacity of Chief, Military Personnel— I am an infantry officer, not a doctor—I am responsible for the CF health care system, while Brigadier-General Jaeger is, in addition to being the Surgeon General, also the Director General, Health Services, and the Commander of the CF Health Services Group.
It's indeed a pleasure and a privilege that we're both here today to appear before you in order to address the Auditor General's report on military health care.
More importantly, we're here today to outline those activities we are currently undertaking to improve health care for our sailors, soldiers, airmen, and airwomen at home and abroad that address the recommendations in this report.
Firstly, as already noted by the Auditor General, the department fully accepts the recommendations outlined in this report. Our view is that the report is a fair and balanced assessment of the state of a military health care system in transition.
As a number of you are aware, Rx2000 and the Canadian Forces health information system programs represent very significant reforms that began in the year 2000. Granted, work remains to be done to fully implement these programs and to continually improve care. Nevertheless, we are fully confident that many of the initiatives already under way as part of those two programs will serve us well in addressing not only the Auditor General's recommendation but more importantly the building of a modern patient-focused military medical system.
Next I would like to acknowledge the comments of the Auditor General where she noted that previous concerns about accessibility and continuity of care have been addressed by Canadian Forces health care reform, that a high percentage of Canadian Forces personnel are satisfied with the health care they receive, and that the new model for health care is considered a best-practice approach.
Indeed, many of the changes undertaken by the Canadian Forces health services reform, such as collaborative practice and electronic health care records, were advocated in the 2002 Kirby report entitled “The Health of Canadians: The Federal Role” and the 2002 Romanow report entitled “Building on Values: The Future of Health Care in Canada”, and they continue to be supported by the Health Council of Canada.
As you are all well aware, the report itself makes eight recommendations centred on four key themes. Allow me to make a few comments relating each of these themes to the provision of high-quality health care to the men and women in uniform.
The first area of concern is that of cost. All Canadians certainly understand that health care is expensive. Providing a very comprehensive range of services for a relatively small population across national and international boundaries and subsequently meeting the CF needs and expectations as well as those of its personnel when illness and injuries occur costs more than providing a less comprehensive range of services to a more static and more centralized population. A health care system such as the Canadian Forces is therefore more expensive.
The Canadian Forces health services group runs a public health care system that has an education organization that delivers essential professional development. The Canadian Forces health services group also provides unique occupational and environmental health care that must be prepared to operate effectively under hostile conditions in any climate and terrain in the world, and it experiences frequent extraction of its health care providers for associated training and tasking requirements. But the Canadian Forces believe that it is not just a cost but also an investment that is worthwhile not only in meeting our obligations to the Canadian Forces personnel, the men and women in uniform for this nation, but as a means of fostering operational capability.
As noted by the Auditor General in a 1990 review of the health services, willingness to fight is influenced by members' general state of health and by their confidence in the health system's ability to provide prompt evacuation and treatment of casualties.
I was pleased to note that Madame Fraser recognizes these unique military health system requirements and acknowledges that drawing a direct comparison with the cost of running a civilian health care system is indeed difficult. While the Canadian Forces health services currently capture significant cost data, full implementation of the Canadian Forces health information system will help to refine further analysis of the relative impact of different cost drivers.
The next area of discussion is performance measurement. A number of Office of the Auditor General recommendations revolve around choosing performance indicators, setting standards of care, and measuring activities against these standards and indicators.
A recently instituted Canadian Forces health services performance measurement advisory group has begun to develop a performance measurement framework to define applicable performance indicators into set benchmark standards and reporting requirements. The list of indicators chosen will be in keeping with the pan-Canadian primary health care and population health indicators that were recently developed in consultation with the Canadian Institute for Health Information.
It's worth noting that Canadian Forces health services will be among the organizations taking a lead in institutionalizing these practices in a multidisciplinary primary care setting.
The third concern that needs to be addressed is the accreditation of health care providers. As part of the Rx2000 reforms, it was decided to reinstitute external accreditation of CF health services. As part of this process, a Canadian Forces national credentialing cell was recreated in mid-2007. To date the cell has achieved license verification for 100% of physicians and dentists, 96.7% of pharmacists, and 79.9% of nurses. A new Canadian Forces credentialing policy is set for release in February 2008.
Let me now turn to governance of the Canadian Forces health care system. It's not the sole purview of the providers of health care and services to determine which medical and dental services, treatments, and items should be provided at public expense to entitled personnel. After a review of the terms of reference for the spectrum of care review committee, which makes health care entitlement determinations, I sought and received approval to raise the level of oversight of this committee to the leadership of the Canadian Forces.
Having the Armed Forces Council, the leadership of the Canadian Forces--the Chief of Defence Staff, the Vice-Chief of Defence Staff, the Chief of the Air Staff, the Chief of the Maritime Staff, and the Chief of the Land Staff--make decisions about Canadian Forces personnel health care entitlements will help Canadian Forces health services ensure that costs incurred are indeed related to patient requirements and operational needs.
Mr. Chairman, members of the committee, Auditor General, ladies and gentlemen, this completes our introductory remarks.