EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
So that’s the two options.
The third option of course is a private stay.
Sometimes the Tammaativvik is full and there is no other option but for Non-Insured Health Benefits for people under the NIHB, then they have a private accommodation stay.
In those cases, the people who let a patient stay at their home receive 50 dollars.
That’s the amount that’s allowed under the duty travel amount.
And that again, is reimbursed by the federal government, that’s the amount that they allow us to charge.
The government employees, if they should go for medical reasons, are their expenses covered under this 28 million 226 thousand dollars?
Hon. Ed Picco: No, Mr. Chairman. That money would be under the Minister of Finance’s Budget, as well as the HR Minister under his insurance program.
That would not be in the Health Budget.
Even if they go to the hospital as a patient?
Yes, Mr. Chairman, because the Health Insurance Plan is under the Department of Finance I believe that coverage is there.
For non-insured benefits, for people who don’t have insurance, that amount is right here, and that is what is covered.
If you are a government employee, as are the members in this House, you have insurance under the Green Shield, when you have medical travel; you have the right to stay in commercial accommodations.
And those costs, premiums, and so on, and any extra costs to this government would be found in that other department.
It would not be here because it is not a cost that we pay in the Department of Health and Social Services.
My other question is in regards to the rising cost of living.
With transportation, groceries and so on, 50 dollars per day is nothing.
Has this been raised as a concern or are you going to consider raising the 50 dollar rate sometime in the future?
Mr. Chairman, the rate has been increasing.
At one point it was 30 dollars, then 35, 38, and now it’s increased, we had some negotiations and it is up to 50 dollars.
And I agree with the member, when you have two or three patients staying with you, 50 dollars is not very much, especially for food and so on.
That is part of the ongoing negotiations that we have with the federal government.
That is the amount that they actually reimburse us for.
I would like to get further clarification in regards to the statement that he made.
In regards to the 8 million dollars for Winnipeg, Ottawa, and also some other cities that they use, I am sure that I misunderstood it.
I don’t know if I misunderstood it or not, in regards to the 8 million, because it is at the end of the 20 million under Contract Services.
I was wondering if the minister is willing to clarify to me if it is used for Ottawa, Winnipeg, or Edmonton, how much money is utilized from this Contract Services?
I was wondering if the minister is willing to state that for me.
Mr. Chairman, the total under the Non-Insured Health Benefits that I had mentioned before was 8 million 897 thousand and 973 dollars.
That includes medical transportation, for example, under the Non-Insured Health Benefits for escorts, patient referrals, as well as co-payments and for boarding.
The amount for clarification Mr. Chairman, for the hospital boarding homes that we run, would be inclusive of 5 million, 308 thousand, 900.
The total under the Non-Insured Health Benefits for medical transportation is the 8 million, 897 thousand, and 973 dollars.
This 8 million and 5 million dollars, if you have a surplus, what would happen to them and what would they use half of the funding for?
Under the Non-Insured Health Benefits we only receive what we invoice for or what we spend.
So on this line item there would not be a surplus.
We have had deficits in this line item but we would not have a surplus because we can only bill up to what the expenditures are.
And there is a cap put in place by the federal government, what the maximum amount as the government that we can bill under the Non-Insured Health Benefits.
That’s part of the negotiations that we’ve had and are ongoing with the federal government to try to increase the amount under that line item for Non-Insured Health Benefits.
I believe that your department is always lacking sufficient funds annually but since the Nunavut population is increasing and there are more people coming in for jobs that come from outside of Nunavut and I’m sure that it’s effecting the departments, so I was wondering how fast or how rapidly it is affecting the contract services.
So I would like some information on those potential effects.
Mr. Chairman, 85% of the population of Nunavut is Inuk and in the case of the Non-Insured Health Benefits, the majority of people that have come to the territories have been non-aboriginals.
If they are aboriginal for example, they could be Dene, Gwitch’in from the west, or First Nations from the south, Inuit from Northern Quebec, they would also be included under the Non-Insured Health Benefits but the total number has not been extreme or to the point where it has caused any concern.
Indeed it’s been a very, very minimal number under our program.
The program that we have in place with the Non-Insured Health Benefits, the concern that we have in the negotiations with the federal government is where we haven’t received, we believe, as a government, enough money to cover and carry out programs that the federal government has set and they have a cap, although it’s a soft cap, they have a cap on how much we can actually bill.
So, as an example, if we spend 21 million dollars under hospital physician services and the federal government only allowed 17 million dollars, we would have to cover off the difference.
Total operations and maintenance 28 million 226 thousand dollars.
Health protection.
Total operations and maintenance 3 million 735 thousand dollars.
A couple of questions on 10-11; the projected budget for health protection programs have been increased by over a half a million dollars.
What changes have been made in this area?
Mr. Chairman, the two largest increases are 323 thousand dollars for variphat which is a chicken-pox vaccine and we have new initiative funding for that, as well as study money of 135 thousand dollars which is for the study of cynkaemea, negivinis and respiratory viruses.
Mr. Chairman, that is the lower tract respiratory infection that was published over a year ago, which made national news on the lower respiratory tract infection in the children.
We are continuing with the second phase of that study and 135 thousand is budgeted to complete that study.
The minister indicated yesterday the shocking figures about sexually transmitted infections.
We’ve heard some reports over the media about these kinds of matters including AIDS, even though the department really has not publicly admitted any kinds of data or stats since its creation.
Can the minister provide an update on the status of communicable diseases in Nunavut?
Mr. Chairman, there are several communicable diseases that are recorded and registered as part of law.
For example, HIV infections have to be recorded in a central database, for the Government of Canada.
Tuberculosis and other communicable diseases have to be reported and so on.
I would suggest to you as I said yesterday, Mr. Chairman, that the rate for example of STDs I believe is about 17 times the national averages.
One of the health promotion areas that we’ve been moving forward on and we talked about that a little bit yesterday was the introduction of safe sex condoms as well as safe sex messaging with our young people.
Our CHRs at the community level have been I think, really doing a good job over the past year on promoting safe sex.
I guess the message would be Mr. Chairman, that if you’re going to have sex, you should have protected sex.
That would cut down on several of the communicable diseases that the member talks about.
On the other issue, for example, on Tuberculosis, we’ve stepped up our TB surveillance program and we’ve hired additional staff as well as testing for school aged children where needed.
We’ve just had a review of serious cases of TB in Arviat that has been documented in the local media and several other communities.
So I would suggest, Mr. Chairman that communicable diseases, like sexually transmitted diseases, like TB, and so on are seemingly increasing.
At the same time, we need to be able to put more emphasis on the preventative side of medicine as well as health promotion.
I think we’re doing that with the extra work that we’ve put into the CHRs as well as our health promotion branch.
And we’ve also hired just recently, I’ve been told, a new position; we have a communicable disease specialist that we’re bringing on in regards to exactly the areas, to address the areas that the member talked about.
What about the communities that don’t have CHRs.
Who is doing these kinds of initiatives, delivering these initiatives in the communities if they don’t have a CHR.?
Mr. Chairman, in communities where we don’t have CHRs and the majority of our communities do, through the health centre itself, part of the role and responsibility of health, community health nurses is actually the promotion and prevention of diseases.
In those communities, well babies say for example, post-natal, pre-natal programs are carried out as well as community prevention and promotion areas for example, on STDs and so on.
There are at least two different areas in communities officially through the Department of Health and Social Services which carry out those promotion issues.
Although, he may have answered some of the questions I was going to pose, as Nunavummiut are the majority of all the negative things compared to the Canadian provinces, as Inuit people, our population is approximately 27 to 28 thousand.
In regards to the figures you have stated, why do the statistics say that we have the highest rate of all the diseases and negative things whether it be Hepatitis B, whether it be HIV or Tuberculosis?
Comparing our population to the other provinces or other countries, we are a very small population; there are only approximately 28 thousand people in the population.
Even though the other jurisdictions’ populations are high in numbers why do we always get the highest rate when our population is so small?
Chairperson (interpretation):
Hon. Ed Picco: Mr. Chairman when you are looking at statistics especially on health care for example, you take a general population and in our case we belong to the Canadian population, Canadian Government, Canadian people, we are Canadian.
So, generally when you look at the numbers that we have you take a rate of a 1000 people, if you took a 1000 people in Canada, ten out of a thousand people in Canada may have TB. That would be the rate, that would be let’s say the normal rate.
When you take a thousand people in Nunavut it may be 27 out of 1000 so that means that the rate would be 5 times, 3 times, or 2 times higher than the national average.
It has nothing to do with the small population; it has to do with the general population.
When you look at the general population for example of say heart attacks and the national averages, the Nunavut rate is considerably lower than the Canadian general averages.
When you look at diabetes, for example, the rate in Nunavut is considerably lower than the general rates in Canada.
Other instances, for example, suicide rates, sexually transmitted disease rates, tuberculosis rates, when you compare the Canadian general population number our rate is considerably higher.
So, I hope that helps clarify the member’s question.
Yes I understand.
Can you give us information on the statistics from Canadian Statistics in regards to the figures?
Maybe you can table or give the information to the regular members or table it in the House so that the Nunavummiut can have clearer understanding.
I’m sure the public out there will have a clear understanding how the system, how they formulate the rates, comparing it to the other jurisdictions because they say every time they do statistics we always have the highest rate of smoking, whether it be TB or STDs for anything negative we always have the highest rates.
So, when I hear that we have the highest rates that we as Inuit people are in a very negative situation and there’s only 26 thousand of us or 28 thousand of us in Nunavut.
It seems like I call it negative thing or we are denigrating ourselves and that we are bad at doing things and that’s how I interpret it when I hear that we have the highest rate of all these diseases as compared to the other jurisdictions and other countries when they do that to us.
So, I was wondering if you can clarify how the statistics are done or how you figure out the numbers.
I don’t think anyone in Nunavut, you know, should feel that we are less than anyone else in Canada based on those numbers, because in a lot of different areas we are actually the very best.
For example, heart attacks, diabetes, blood pressure the rates in Nunavut are far, far below what the Canadian averages are.
In other areas for example smoking we are higher.
But those are only proportions and ratios.
When you take the general population, as I said before of a 1000 people and you compare them to the Canadian national averages that’s how you get the numbers.
So, I would agree with the member to try and provide some of the information that he has requested, for example, Canadian averages for other communicable diseases as well as some of the other instances, for example suicide rates and diabetes, heart attacks, blood pressure and so on.
Yes, as true-blue Inuit we sometimes have a hard time trying to figure out how they formulate the numbers by percentages.
Although I can clarify parts of it if we use three Inuit people, if they pull their fingers and test their strength, that’s how at times the survey is done to make sure, to find out which has the majority of this or that.
I have no other names on my list for Health and Social Services.
Health Protection.
Going on to the next page, Health and Social Services.
Treatment programs.
Total operations and maintenance, 68 million 351 thousand dollars.
There are two questions I have on this page.
The 29 million 574 thousand dollars for travel and transportation, I’m not quite clear where it states travel and transportation because I don’t know the different meanings.
Perhaps it’s for travelling; 29 million 574 thousand dollars.
Is that for medical transportation, either by charter, medivac or scheduled airline?
Is that only used for medical patients and not for staff?
Mr. Chairman, that’s correct, that’s all medical transportation and medivac transportation; the numbers are 29 million 574 thousand dollars in the Main Estimates.
Mr. Arvaluk (interpretation): It doesn’t include the boarding homes?
It’s got nothing to do with the boarding homes, money that is spent on the boarding homes?
Hon. Ed Picco: No, that is correct Mr. Chairman.
Twenty nine million 574 thousand dollars; yesterday I thought that it cost me a lot of money to get my dental work done but this is a quite a huge amount of money, over one million dollars for every person in Nunavut.
I’m sorry but Mr. Iqaqrialu, you were asking about the numbers but if the population of Nunavut is 27 thousand, tomorrow it will probably be about 30 thousand and the next day 31 thousand according to the birth rate in Nunavut.
It seems like there’s one million dollars spent for every person; is there any other way that we can make travel and transportation cheaper, like buy your own plane say for medical travel and just for the sole use of transporting patients; wouldn’t that be a little bit cheaper?
Mr. Chairman, the amount of 29 million 574 thousand dollars is approximately a thousand dollars per patient or per person in Nunavut.
So if there were 29 thousand people in Nunavut, it would be about a thousand dollars.
That’s if everyone in Nunavut was medically transported.
And the member is correct it is very, very high.
We are in the process right now, Mr. Chairman, of doing a transportation study to look at, for example waste and economies of scale, of trying to save money on the transportation budget and to look at ways of being more efficient.
For example we are doing that in place with the co-operation and in concert with the Community Government and Transportation Department, to see what avenues are available to us for example, setting up a main dispatch.
Is there an opportunity to have a plane dedicated for patients?
Would that be cost effective?
So, a lot of these issues will be answered in the KPMG study on air medical transportation costs and the transportation system itself in Nunavut through medical travel with that report.
Mr. Chairman, I’m prepared to present to committee the copies of the terms of reference which were asked for.
They are now translated and I’ll be able to provide that to the committee.
Under 10-12 on the same page, I think the NWT Government took over the health services from the federal government at that time.
Like we wanted to take over the health services from the federal government but I think there was a mistake when they took over the health services.
I’ll just use as an example 29 million on contract services in the amount of 9 million 87 thousand dollars, just use those as an example.
How much money do we get from the federal government for the year, for those services, transportation and contract services?
Mr. Chairman, I couldn’t agree more with the member.
In 1988 the government of the day in the Northwest Territories was very hot for taking over health services and I believe at that time the government of the day signed a not a very good agreement for the people of the Northwest Territories or Nunavut.
In 1999, when the Government of Nunavut was set up, of course at that time the grandfathered policies and programs and services delivered by the Northwest Territories including the Federal programs came into Nunavut.
We’ve spent the last three year negotiating with the federal government.
And a good example of that is what the member was talking about.
Right now, Mr. Chairman, the federal government does not give us any money for escort travel.
So when a patients travels, the federal government does not pick up that cost.
We have to pay the 100% cost of a ticket cost for an escort for any of our patients.
At the same time for patient travel, the federal government only pays 250 dollars per ticket.
Mr. Chairman, that 250 dollars came about as a composite number that was averaged out in 1988 – 1989 during the health care transfer of the federal government to the Northwest Territories.
It hasn’t increased.
Your government Mr. Chairman, has been the last three years, negotiating with the federal government. Including a meeting I had with the Premier, with Minister Ann McCollum, Minister of Health to explain why we felt the 250 dollars as an example, was not, not only was it not acceptable, it was an affront to us a jurisdiction to have to cover those costs.
We believe there is a fiduciary responsibility of the federal government for aboriginal health care and we want the same deal the other jurisdictions are getting.
If you’re an aboriginal patient in Northern Quebec and are flown south for a treatment or in Labrador, or in Northern Alberta, the federal government certainly picks up more than the 250 dollar payment we get.
So, the member is correct and there needs to be more negotiations.
I can say Mr. Chairman, that the cabinet has agreed to a negotiating position for the Department of Health and Social Services and we have been aggressive in that negotiating stance with the federal government.
We’ve had some small successes, like on the dental side of travel, but we have not had the major breakthroughs that I believe we need under health care.
I think it’s very important also to note Mr. Chairman, that the total cost of medical travel continues to go up by anywhere between 7 to 14% a year.
And the member is correct.
If you’re here next year, Mr. Chairman, when a member’s here 3, 4, 5, years from now, the cost of medical travel to this government, could be 10, 15, 20, million dollars more.
It increased from a budget we had of about 18 million last year to an actual cost of over 27 million.
So this is a very serious issue.
I don’t know where the future governments will be able to get that money to pay for it.
So we need to continue to work with the federal government to make sure that they understand that.
I thank the minister for responding to that question and the knowledge that he has on the transfer from the federal government to NWT government.
The minister stated that the federal government does not recognize the increase in cost each year but he stated about the aboriginal people living elsewhere besides NWT, they are run by the aboriginal groups not by their government.
The aboriginal people anywhere in Canada when they get health services they are well provided for.
I was just wondering whether you have considered talking with the federal government, the Minister of Health whether they realize that the high cost is being accrued by the Nunavut Government every year.
Wouldn’t you be in a better position to talk to NTI and your department about the health services that are increasing yearly?
Mr. Chairman the member is correct.
In the negotiations that we have had with the federal government and part of the information package that we have been putting together in seeing what the best practices have been in other jurisdictions.
The Northwest Territories, the Yukon as well as ourselves are in a similar position with healthcare costs.
However, a good example is with the federal programming for aboriginal issues.
When the federal government announced 125 million dollars for FAS/FAE money, it was strictly for on-reserve and for First Nations in the south.
There was nothing for Inuit.
So when the Government of Nunavut tried to access FAS/FAE money we were unsuccessful.
NTI has made the same point, Mr. Chairman, on several different occasions and in our NIHB negotiations with the federal government we’ve actually involved, for example, in the past, NSDC on the tack that we were taking as a government along with the mandate that the Cabinet has given our department in the negotiations.
However after saying all that Mr. Chairman, the federal government is like any government, if they see the cost to them rise like 40 or 50 or 60 million dollars then maybe they’re a little a bit intransient in moving on it.
We are trying to bring the best case forward and the negotiations are continuing with the federal government.
Have you talked with the bodies such as NTI and other agencies perhaps using NTI to deliver the Non-Insured Health Benefits?
Like the federal government recognized NTI as a representative for the people, Inuit people.
So have you had discussions with the federal government or NTI to see whether NTI can take over Non-Insured Health Benefits?
Mr. Chairman Yes there have been meetings with NTI as well as our department on the negotiating with NIHB.
The former Assistant Deputy Minister of the department now with Community Government and Transportation, Richard O’Brien had meetings with NTI and as I said earlier NSDC.
I think it’s also important to point out that it doesn’t seem from our perspective that officials from Health Canada had a mandate to actually look at negotiating enhancements to our NIHB agreement and that’s were we are trying to follow that up with the political, on the political level.
Mr. Arvaluk (interpretation): This will be my last question Mr. Chairman.
I’m not really quite clear on this one here and I’d like to get some clarification.
The aboriginal people are being looked after by the federal government, and we are aboriginal people but we have lost our status because of the land claims.
The services that we are receiving, I think it’s got something to do with, like the federal government have to look after the Aboriginal people and Non-Insured Health Benefits, so with that, wouldn’t they listen to us better if NTI was to take over and negotiate with the federal government because NTI does not, we don’t pay taxes to NTI so maybe it would be better for NTI to look after the health money for the Inuit people.