EdinburghNLP/nunavut-hansard-plusplus huggingface dataset:
At that time, the government of the day was so hot to take over health care, we believe the deal wasn't all that equitable on this side.
That's why the negotiations are ongoing right now.
You might note Mr. Chairman, that the NWT themselves have come out and said that they want the federal government to take over NIHB again because of the concerns.
We're not at that stage yet, Mr. Chairman.
We've negotiated with the federal government.
We've been able recoup almost 1 million dollars for example on travel that we used to pay for on the dental contracts.
So those types of things are ongoing.
We believe there are some other opportunities for us there.
But the member's suggestion of a briefing, on the whole complexity of the non-insured health benefits is a good one.
That's something maybe we could schedule for the session in Cambridge Bay.
My staff are here.
They're taking notes.
That's something we'll try to facilitate.
Mr. Arvaluk: Thank you, Mr. Chairman. You may want to include some of the possible loopholes in findings from the land claims agreement and the old Indian Act that may not have been under the NWT Act.
It might not be constitutional for the NWT to make an agreement on behalf of all the Aboriginal people without negotiations for the health insurance program purposes.
So all this, I think should be included in the presentation.
Mr. Chairman, the constitutional challenge or charter challenge being brought forward by Mr. Ward out of Edmonton who is an Inuk who was adopted into the south and is a lawyer, I believe he's the first Inuk lawyer.
That would have some bearing on some of the things you just talked about because I believe under this charter challenge constitutionally, he is trying to move in that regard.
At the same time, government to government negotiations on the NIHB will continue with the government of Nunavut and with Health Canada.
Plus the members’ statements are well taken.
That's something maybe we will include in the briefing that we could probably deliver in Cambridge Bay.
Maybe just for the minister's, just let him know that the members are going to be back here for standing committee meetings at the end of, in April sometime or maybe, that might be a good time to get that briefing as well.
On the section here on the health insurance programs, is this where all of the prescription drugs are for beneficiaries that get them, the beneficiaries don't have to pay for drugs and different medical services, do they fall under this category.
The member is correct that's part of the 10 million 926 thousand dollars under the non-insured services agreement.
That includes all the Pharma Care drugs that prescribed that are in NIHB.
What, you know, I understand in talking to the pharmacists here, that there's a list of drugs that are covered under this section and that basically they have no control over any changes that are made into drugs that are allowed or are no longer taken off that list.
I'm just wondering if the minister can explain, you know, what role they play if any in determining what the, how drugs come off of that plan or go on.
I mean that sincerely.
There have been major concerns every time I go to a federal/provincial health care meeting about how Health Canada picks and chooses what drugs are used under the Pharma Care Program and that's the case the member's referring to.
There are some cases, for example, Mr. Chairman, we have generic drugs and let's say as an example they have a generic aspirin pill and that may be worth X number of dollars and that's what we've been using.
That's what the pharmacist has been using then Health Canada drops that from the preferred list of drugs that are covered on the health plan.
That's the concern that’s been brought by the pharmacists not just here in Nunavut but across the country.
The role that we play in that Mr. Chairman, is that when we have an opportunity to be at a federal/provincial meeting we bring up your concerns and discuss them.
We joined with our colleagues across the country on concerns in the way Health Canada declares what drugs are included in that list.
Mr. Chairman, I know that there's always like the minister indicated, new drugs come along and I think no matter what kind of drug is out there, they don't always have the same side effects or different things.
A lot of times when doctors prescribe certain drugs they take a look at and consider what the possible side effects are tailored to the conditions or each individual patient.
You know, each patient, each person reacts differently to different drugs and I think that's taken into consideration when prescribing. there are cases where you may have a normal drug that's prescribed to an individual for a certain reason that they didn't want to give this one that is funded under the program because of the side effects and when they give the individual another one, that isn't covered.
You know I think I really think we need to do something.
We don't have the luxury of having the volume of stock to pick and choose the perfect one, the perfect drug that is going to work for everybody that is covered under this plan.
I think some work should be done or there should be consultations done with the physicians and the pharmacists to take a look at any drug that may have come off the plan or has the potential of coming off. We should look at ways of keeping and ensuring that those types of things are covered because as it is right now some people have to pay for prescriptions.
Some of them can't.
If the physician knows that they can't afford to pay for it, they prescribe this other one that could have some more harmful or irritating side effects on the individual just because they can't afford the other drug.
Does that mean that they have to go through those types of potential side effects and things for those reasons.
I don't think that is right.
So I'd like to just maybe ask I don't know if the minister can commit to consulting with the physicians and pharmacists and looking at pursuing this issue further with Health Canada.
As Nunavut grows and gets more diverse and has more of a population, you get what the member is talking about.
For any Inuk that is under the NIHB when you go to a doctor and the medication is prescribed and that medicine is paid for through the NIHB, they get that.
In the case of a person who has Green Shield or Blue Cross, some of the medications prescribed by physicians the member is correct, may not be covered under that program.
The member is correct again when he says because of our smaller capacity and volume some of the drugs that may be more generic may be out of the price range for that individual.
So you made a good point.
That is something that we may be able to pursue.
The instances today Mr. Chairman, that I am aware of that have been brought to my attention are very few.
That is something that we’d be able to follow up as Nunavut gets more diverse and more population and people moving in.
You start to see more of this type of incident.
I think one of the main reasons that you don't hear much about it is because a lot of people don't know and just take for granted what they are given from the pharmacists.
So in a lot of cases I would imagine the patient is just taking for granted that is what they get and they don't know whether there is something better or not there.
Another thing in here not only prescriptions but other dental services that are also covered under this area.
I understand Health Canada is also taking some of those other things off the list of things that are covered as well.
For example, in certain dental procedures now that aren't totally covered.
As an Inuk, these things should be covered and someone will go to get it done until you have to pay for it.
I know an instance here in town where a young gentleman had to get braces and he got told that he had to pay for himself.
Things like that I think are things that I've seen covered under this program before and if the minister wishes I could bring this to his attention after.
But just talking more in general of certain things that are being taken off the table that are no longer being covered.
I have a big concern like the minister has indicated that these are things that we end up getting stuck with or else we end up having members of the public out there that aren't getting the attention they need because they can't afford it.
That leads to further costs on the system over time.
Mr. Chairman it goes back to the issues that James was talking about before.
You know, if you use the scenario, let's say James, Mr. Arvaluk as an example leaves tomorrow and goes to Ottawa and he's living there for a year and then he needs to get physiotherapy.
If he went to the Ottawa General for physiotherapy as an Inuk, OHIP, the Ontario Health Plan would be paying for him.
They would be charging back that cost to NIHB, non-insured health benefits.
Here, I have to do that.
If you need mental services for an example, if you are given a referral, through psychiatric counselling if you went down to Ottawa and you were living there for a year and needed psychiatric counselling and went to the Ottawa General Hospital, I'm sure the Ontario government wouldn't be billing their OHIP program they would be billing the federal government.
Yet those services have to be delivered by the Nunavut government.
It's the same thing as some of the issues surrounding the dental contract, which is part of the non-insured health benefits that the federal government has on the table.
We're in negotiations today with some of these key issues like I said, we're just recouping almost a million dollars, just a little over a million dollars of our travel which we weren't paying before.
Chairperson (Interpretation): Thank you. Mr. Tootoo anything else.
We'll get back to, there are no more names on my list.
Health insurance programs. Total operations and maintenance, we are on page 10-10, 26 million 226 thousand.
Carried. Total expenditures, 26 million 226 thousand.
Chairperson: Turning the page.
Health and Social Services, branch summary. Health protection. Total operations and maintenance, 2 million 761 thousand.
We have a few employees here worth 2.3 million dollars.
A couple of years ago, a few years ago, there was a fairly active AIDs prevention program taking place throughout Nunavut.
I think that has to be very good for especially school populations and the smaller communities, it has certainly raised attention in the population.
Are you still active in the AIDs prevention program under that.
Because the concern here is especially in Iqaluit we have a lot of transients that are coming from the south.
I'm not saying that they are, it's just that there is a limited access of visitors and some of them come up here to work etc. that, is there a program that is still active as before on that, that's being promoted as a good prevention program.
Mr. Chairman, under health protection, the member is correct, we have an area under communicable diseases.
On those diseases, sexually transmitted diseases in this case, the member asked specifically about HIV, ongoing work, Mr. Chairman, by the department.
CHRs are our key on that, Community Health Representatives, who do promotional programs services as well as treatment programs in Nunavut, every mother who wishes to, giving birth, we test, if they allow us, we test for HIV.
When women go for example, on an annual or regular basis, for PAP smears, on a regular basis, that's another way, Mr. Chairman, to look for sexually transmitted disease.
So under the health promotion branch, under CHRs and so on for the regular check ups, that type of program is still in place.
We haven't begun any type of specific awareness, but we have been working on sexually transmitted diseases or STDs per se.
Some of the organizations like Pauktuutit have though, Mr. Chairman, and we have been assisting them on AIDS awareness and so on.
We have an AIDS day walk and that's continuing.
Mr. Arvaluk: Yes, annual check ups of anyone who is wanting an annual check up for tuberculosis and blood pressure and any other health protection, is this STD especially, the HIV or AIDS, testing included in the annual check up of individuals like ourselves or any citizens of Nunavut.
Hon. Ed Picco: Mr. Chairman, at any given time, any individual can request a blood test for HIV so it's not contingent on doing a regular physical check up.
If a person is sexually active, Mr. Chairman, then a good suggestion to that person who is sexually active, on a regular basis is that when they do a physical every six months or a year to do a regular check for HIV and that's male or female.
As a policy or a regulation or so on, we don't test people.
That's their personal choice.
I'm having a hard time with that one because how do you decide my heart is personal and my blood is not.
My heart is not personal but my blood is personal but my lungs are not personal and other things are personal.
I think what concerns we should be having on this is we should be communicating to our own people.
Especially through Health & Social Services that everybody is vulnerable and I think the program has been very effective in telling everybody that it's an indiscriminate disease and citizens should be watching out for it.
Here we are again to your statement, that culturally sensitive programs that, somebody in the south, a system of medical practices decided what was personal and what was not personal, might not be very relevant up here.
I think that should also be discussed as a way of improving the program.
Mr. Chairman, we don't have much opportunity in this House some times to talk about serious issues.
I don't mean that in a flippant way.
The member brings up a good point on HIV and sexually transmitted diseases and especially with a lot of our young people, 40% of the population of Nunavut is under the age of 15.
Mr. Chairman, I should point out that we don't make people take a blood test for HIV but we've done and I'll give you some specs here, and this might shock some of the members, about 90% of women who are pregnant are tested by consent for HIV.
That means Mr. Chairman, in Nunavut, 750 approximately a year in Nunavut have tested for HIV.
When people are diagnosed with an STD or sexually transmitted disease, syphilis, gonorrhoea, chlamydia, chlamydia being the most popular sexually transmitted disease in Nunavut, between 50 and 75% of them agree to be tested for HIV.
We encourage anyone, Mr. Chairman, on a regular basis, the pregnant women, and people with STDs to be tested for HIV.
We encourage them.
We are putting together more resources, to promote public awareness on HIV and AIDS in collaboration and partnership with many other organizations.
But as you can see Mr. Chairman, we are regularly testing.
Women are getting pregnant.
They're getting pregnant from men.
When you test over 750 women a year, almost 19% of pregnant women that gives you a good indication of what's happening.
There are a few known HIV positive people in Nunavut and when you look at the statistics of sexually transmitted diseases and so on, there is a potential of concern with HIV and AIDS.
Back to the estimates.
Health & Social Services, branch summary. Health protection.
Total expenditures, 2 million 761 thousand dollars.
Correction. Total operations and maintenance, that was the first one.
Chairperson (interpretation): Page 10-12, Health & Social Services, branch summary. Benefits. Total operations and maintenance, 53 million 450 thousand dollars.
Travel and transportation, is that all medical travel.
Medivacs, patient travel.
Mr. Chairman, under that category the majority is medical travel, there is also staff travel.
Mr. Chairman, I know, airfares haven't gone down lately, and I know more people are being transferred or travelling to hospitals in the south.
Is that just a plug figure or is that an actual figure that he thinks he'll spend this year, and how much does he think he'll spend this year.
Hon. Ed Picco: Thank you, Mr. Chairman. Mr. Chairman, no it's not a plugged figure Mr. Chairman.
The amount reflects what we believe we're going to recoup from the federal government from the ongoing negotiations on medical travel.
Can you explain that just a bit more in detail.
But just a little bit more in detail.
Chairperson (interpretation): Thank you, Mr. McLean. Minister Picco.
Mr. Chairman as we said earlier we were able to recoup a little over a million dollars in the dental travel.
This was in medical travel.
We believe in the negotiations that are coming forward right now we should be able to recoup the 3 million dollars difference that you see here under medical travel from the federal government.
So that's why we indicated that there.
There's not a lot of that of course, that money was in the budget for the program.
Just if the minister can give me another brief explanation.
The new medical travel, patient travel that was brought forward.
How has that been received by the department as a whole, have there been many complaints about it or has it been generally been received well.
One of the recommendations made last year by the committee, Committee of the Whole, was for the Department of Health and Social Services to come in for this fiscal with its own supply and travel policy that would reflect the integration of the three health boards into the department.
For the first time Mr. Chairman, we actually built in the appeal process, because we’ve never had the opportunity for appeal if you were turned down for medical travel.
So far Mr. Chairman that has been a success.
We're quite happy with the standardization of the travel policy.
There still needs to be some work again with the way it's been set up and that's one of the things we'll be doing over the next four months.
We'll be reporting back then to the cabinet with some of our work on that travel policy.
Ms. Williams (interpretation):Qujannamiik Itsivautaq.
There's almost increase of close to 10 million dollars to the, on the compensation and benefits.
Did you get a lot of staff this year or are you expecting a lot of staff.
Mr. Chairman under compensation and benefits, it reflects the approved organizational charts and it also reflects some of the social services positions that were previously listed under the branch healthy families and communities.
On our staffing, as an example, right now in the Baffin region for nurses, we're at 96% staff.
So we have been actually pretty successful in staffing at 96% for nurses.
In the Keewatin for another example, we're at 85% positions staffed.
So some of the work that we've done on the NYAT report, which was the recruitment and retention, has paid off.
Travel and transportation, I'm really confused with the bookkeeping system here.
Shouldn't we put under 10-12 transportation, travel and transportation the actual amount we think we are going to spend this year rather than saying 18 million 703 thousand.
If it's the same as last year deduct whatever, come up with 15, 565 and put the difference where we think we will be recovering from the federal government or through negotiations or recovery summary or something.
Or like Mr. McLean says is that what you think you are going to use is 15 million 565.
Because in the other explanation you actually put the actual amount then are you deducting approximately 3 million here not in any other columns.
Mr. Chairman that's why they're the main estimates, it's an estimate.
We believe when this time comes next year that we will have successfully concluded and I don't want to undervalue the department by not anticipating it.
So that's what we try to do we try to anticipate things.
At the same time as the member knows we still have some concerns with the deficit in the department.
So it's an estimate, or guesstimate and that's what we think we can cover.
I don't have anybody else on my list but Mr. Nutarak.
Mr. Nutarak (interpretation): The travel and transportation, the 15 million 565.
Last year they estimated they used 18 million and it decreased this year.
Last year was the estimate, did you estimate too much.
Hon. Ed Picco: Under the main estimates last year we had budgeted 18 million 703 and the actual was 22 million 091.
As we said, we've actually recouped some of those costs and we used to pay them last year, for example the million dollars in travel for dentistry, which would help them.
Mr. Nutarak (interpretation): The actual was 22 million, over 22 million and it had to be increased.
So why would you decrease what might actually be spent if it was not enough last year.
Why would you estimate less than the time before.
A couple of reasons for that.
One it is an estimate of what we think we are going to spend.
We believe this time next year in 12 months we will be successful in the negotiations for extra money for travel.
We believe and we know we have extra work with telehealth and that should be able to cut down some of the travel.
So there are different reasons.
We've recouped a million dollars on travel for dentistry as an example.
So we did one million in dental but if I picked up another 2.5 on other travel, which is not very much I will have the 3 million.
So, that's what we are talking about there Mr. Chairman.
That was the reason for it.
It's an estimate of what we think we will continue to spend.
So it has to be framed in the context of total expenditures for the whole department.
Welcome Peter.
Mr. Nutarak (interpretation): When we talk about treatment programs or the, one patient who was sent to another community to get a second opinion at that community was sent to the hospital.
Do they not send patients when they need to be sometimes.
Mr. Chairman. This case is not dependent on any other case or circumstance.
In most cases if you're in a community and you need medical referral, you're referred to a community that would have the expertise for that referral.
For example, Mr. Chairman, if you were living in Clyde River and you needed to see an ear, nose and throat specialist you would be referred to that specialist, if that specialist is in Iqaluit, or Ottawa.
In the Kitikmeot region, you would be referred from Pelly Bay to let's say Yellowknife or Edmonton.
It's based on where services, the special services or the services that you require for your condition are.
That's where you would be medivaced.
When you speak, talk closer to the microphone.
Mr. Nutarak (interpretation): Is it because they're trying to save costs.
Is that why they don't send some patients out.
If a diagnosis is made by the medical profession that a person needs to go, then they're sent.
We don't think about the costs.
That's why, we just talked about it in the estimates, we may go over budget in what you try to estimate because you're not worrying about the costs.
So that's not the case.
It depends on what the medical professional has decided.
I don't have anybody else on my list. We'll go back to page 10-12.
Health & Social Services, branch summary. Treatment programs. Total operations and maintenance, 53 million 450 thousand dollars.
Chairperson (interpretation): Total expenditures, 53 million 450 thousand dollars.
We’ll go back to 10-6. Health & Social Services, branch summary. Directorate.
This was approved. Agreed to.
We'll go to 10-5. Health & Social Services, program summary. Details of expenditures.
Total operations and maintenance, 119 million 164 thousand dollars.
Chairperson (interpretation): Total expenditures, 123 million 364 thousand dollars.
Looking at other departments, I find this out of the directorate at 14% comparatively high.
What is the reason for having 14% rather than 6% or 5% like other departments.
Mr. Chairman, the directorate is basically the headquarters, the headquarters function of the department.
We've tried to concentrate the majority of our dollars and everything on the ground at delivering services in the communities and so on.
I think the 14% in the directorate reflects that we're a service department actually delivering services.
Mr. Arvaluk: It must be late if I can’t understand.
If you want to do an efficient job you have higher directorate expenditures whereas Education has one percent.
I don't get the rationale behind it.
Mr. Chairman, perhaps if he can explain a little bit more.
If you do the groundwork you have more in the directorate.
Less in percentages in the field.