Minister Abernethy, do you have any points to clarify that?
---Interjection
Sorry, Mr. Abernethy. Can I get that on the record?
Okay. Ms. Bisaro, do you have any further questions?
No, I have no more questions on this page, Mr. Chair.
Alright. Mr. Bromley.
Thank you, Mr. Chair. Just to follow up on that, the hospital care and medical care for status Indians and Inuit, a couple pieces of revenue there. Is that not the Non-Insured Health Benefits revenue contribution?
Thank you, Mr. Bromley. Minister Abernethy.
Thank you, Mr. Chair. I’m going to go to Ms. Mathison for that, but this is not Non-Insured Health Benefits.
Ms. Mathison.
Thank you, Mr. Chair. This money is money from the federal government that is in our base revenue. It’s a recovery of 95 percent of our expenses for hospital and physician services to Indians and Inuit.
Thank you, Ms. Mathison. Mr. Bromley.
Thank you, Mr. Chair. Okay, so it’s a different… It’s not related to Non-Insured Health Benefits, NIHB.
I know in the past we have been concerned because of transfers, I believe, for these expenses. I believe it’s an annual transfer that we receive and this department is up 8 percent this year and that’s not atypical, and that’s not atypical for hospital and medical care to go up at that rate in the Northwest Territories, yet the federal government only increased their contribution by 2 percent or 2.2 percent per year. This has been, obviously, a bone of contention. That’s a significant additional burden for us every year.
What is the status of that? It sounds like now there’s perhaps a new formula where we get 95 percent of costs of whatever they are and our liabilities are limited to 5 percent. I’d just like to ask if I understand that correctly. Thank you.
Thank you, Mr. Bromley. Minister Abernethy.
Thank you, Mr. Chair. NIHB covers things like dental and other extended benefits like medications and whatnot. The provision of care is provided within our facility for what would be considered more of the standard care. This covers that and it’s negotiated with the federal government. It was negotiated many years ago and I believe – and if I’m wrong, correct me – we have a 2 percent standard flat rate. So our rate here increases by about 2 percent a year, which is less than the 8, obviously.
Okay, so just so I’m understanding this, there are other expenses that are covered elsewhere for these two categories. Is that correct and how do we fund them?
Thank you. I don’t understand the question. Maybe the Member could clarify a little bit, that would be great.
I believe I heard that this represents 95 percent of the costs, these two figures added together, about $30 million of some costs and we pay the other 5 percent and perhaps that expense is listed in here somewhere. Maybe the Minister can give me a heads-up on where that shows up in our O and M on the other side of the equation here. But I’m assuming that there are other costs beyond these. How and where are they covered?
Thank you. In different jurisdictions in the country things are funded in different ways on reserves and whatnot in southern Canada. By way of example, health services are paid by the NIHB First Nations Inuit Health Branch. In Canada, in the Northwest Territories rather, when we devolve down the responsibility for health care, we agreed to pay all those costs within our system. These dollars that you’re seeing here, as far as revenues, were negotiated back then. They grow at, I think, about 2 percent a year. Our costs have far exceeded that. So anything that is not covered by these dollars coming in basically we eat as a health and social services system because we are committed to providing quality care to all residents of the Northwest Territories.
Thank you. I think I understand that. Perhaps I could ask the Minister to provide what total additional amount has summed up to over the last decade of additional costs that we are taking on because of the failure of the federal government to transfer payments at the rate that the real world is dictating and we have to suffer.
Thank you. We can certainly go back and pull out main estimates for the last 20-some years and show what was budgeted here and what was received here, but as far as what we spent or the cost for providing services to the Aboriginal people only would be darn near impossible to provide back that far.
Thanks. I’m willing to accept an estimate. We certainly know what the department has increased each year; it’s reported in these big thick documents. So just apply that and compare that to the 2.2 percent with it. That would be good to know.
It’s something obviously we’ve been talking about for a long time. I know we were actively negotiating pushing in the 16th and I’d love to hear that we’re still getting serious with the federal government on this. Thank you.
Once again, this is based on formula financing and the amount we get as revenues increases 2 percent annually. We will go back and see, we’ll be able to pull out from the mains what was there. So we’ll get an idea of what we expected to come in. What we actually spent, we’ll do our best. I don’t believe we’ll be able to go back 10 years, but we’ll go back as far as we can and some of it still might be projections because it would be really impossible to figure out just for Aboriginal people what the cost of health care was in the Northwest Territories, but we will do our best and we will try to get something to Members.
Yes, I would very much appreciate that and I realize that that sort of level of estimate would be good. I don’t want to make this too onerous. I’d also appreciate learning how long this situation has existed. When did we enter this agreement that started at the 2.2 percent escalation rate and, also, is this an agreement that expires? Is there an end date to this? Thank you.
Thank you. It started in 1988 and it’s a set agreement. There is no end date, there is no opportunity to renegotiate.
That’s all I have. Thank you, Mr. Chair.
Thank you. Next on my list I have Mr. Hawkins.
Thank you, Mr. Chairman. Mr. Dolynny’s questions kind of got me wondering and I’m aware of some of the reciprocal billing problems with Nunavut and sometimes there have been many occasions where they just outright refused the bills and refused to pay. Of course, there was a gap in that and I know that had been somewhat sorted out a number of years ago. What year I don’t remember exactly, but I am familiar that that had been sorted out. So we had been actually subsidizing the Nunavut citizen and I do have some great concerns about this process, just in general, because does it come at a cost to our citizens. In other words, are we sending experts who are specialists in their areas, be it physicians or other types of skilled professionals to Nunavut, and does it come at a cost to our citizens and how are we covering these costs? Are we actually making money off this under this situation? So I guess that’s kind of my first question.
How do we assess the cost? Do we make any money on this and is there any analysis? As we’re trying to make money off this situation, are we missing out on opportunities to serve our citizens, which really we should be doing first? Thank you
Thank you, Mr. Hawkins. Minister Abernethy.
Thank you, Mr. Chair. I remember during the last Assembly there was a lot of discussion around this because there was a fair amount owing at a particular point in time and there were some issues. I believe those issues, actually I know those issues were resolved before the end of the last government. Right now we have an inter-jurisdictional agreement that’s based on cost recovery. We don’t make money on this from Nunavut, but at the same time other provinces don’t make money off of us when our residents are receiving services out of jurisdiction. We collect the dollars, as I said to Mr. Dolynny, that we bill and we get everything that we bill.
Thank you. I’m going to say maybe broadly I don’t disagree with the philosophy then that if we don’t make money other jurisdictions don’t make money that, in essence, we’re covering costs, I understand that philosophy and perhaps maybe in the wash it all works out in the bigger picture.
The issue I’m really trying to boil down to here – and I’m going to try to directly put my finger on it – is what type of cost analysis do we look at? For example – I’ll use it by way of example – we sent a physiotherapist to, say, Cambridge Bay and I’m hearing that we’ve covered the costs of the flight to Cambridge Bay, those types of things, we’ve probably covered the cost of our physiotherapist we’ve taken out of Stanton to send there, but is there any analysis done on our patients having to wait for services back here, be it in Yellowknife or any other region they should be on we’ll call it the physiotherapy circuit? So, is there a cost and impact on our residents, because I can only assume so. I mean, I’ve heard, albeit not as of late, but I’ve heard people having trouble getting into these types of specialized services because these services are on circuit serving Nunavut residents, not NWT residents. Thank you.
Our health facilities, Stanton, by way of example based on the staff, provide services based on demand. So, if there is an increased demand as a result of Nunavut, they have built that into their planning process so that they can ensure that residents receive timely services.
Is the Minister saying, so I understand, that there is availability at all times and we are not refusing clients or we are not booking them further down the road for treatment or therapy, whatever the particular case may be, because of the availability of staff? Is he saying that there is more than enough staff and capacity built into our Stanton facility to address for those types of anomalies? As I understand it, they will travel for a week or close to a week servicing these things. That said, I just want to make sure that our residents aren’t waiting unnecessarily, aren’t able to book timely appointments at a cost, in essence, because we are serving other clients that are not residents.
Mr. Chair, as I indicated, they staff based on demand, and demand does include Nunavut residents who are coming for services. Granted, those numbers are fairly low. Most of our residents, the vast majority, are obviously from the Northwest Territories. If there were no Nunavut patients, we may be in a position where there would be fewer employees at Stanton because we would have less demand. Stanton bases their employment structure and how many people they staff based on their demand.
I think I’m saying what the Member is saying. It doesn’t have an adverse effect on our residents because, if you took Nunavut out of the mix, our staff size would decrease and we would be providing the same level of services to our northern residents.
Just changing gears, same kind of concept though. I understand we have a team that does an amazing job at fixing that equipment over at Stanton, that tech crew. I’m not sure what the exact name is and I almost feel embarrassed that I don’t know the name of it, but the tech crew there that works on all the fancy equipment in Stanton certainly provide regional support and they get out to our regions. In essence, do we bill for other regions on that? Do we bill across authorities on that? Who picks up the cost of that? One of the Stanton folks who is a tech, who is an expert in fixing some of these heart monitor machines, has to go to Inuvik or has to go to Cambridge Bay or has to go to Rankin. How do those costs work? Maybe if they can explain that and the concerns about capacity and ability.
On the last tour we had as MLAs there, to say it bluntly, they looked overwhelmed by the amount of work that they do, and with the amount of work that they do I’m impressed on the amount of quality they punch out. It looks like it’s a treadmill shop, that’s for sure. Thank you.
The bio-med team that does the repairs on medical equipment throughout the Northwest Territories are employees of Stanton. They do, through agreements between Stanton and the other authorities, individual agreements, go out and provide services on those authorities’ equipment as necessary and it is billed back directly. This is one of the areas that we talk about on a regular basis being part of the back office and the shared services, because we could certainly benefit from economies of scale by having them providing services at a territorial level with not having to bill every time they go to a different authority.
I’m curious. How do we know the capacity level there is appropriate? I thought we also worked and serviced Nunavut equipment as well. Can the Minister speak to that? Thank you.
Stanton manages their contract and their employees with respect to the bio-med services, I do believe. They do provide services to Nunavut but it’s the same way they provide services to the other authorities. They have contracts with those authorities and they staff based on the contracts that they have for provision of services.
Maybe just a follow-up on another perspective to Mr. Dolynny’s question. I think the Minister had pointed out we bill and we get paid for it. I guess he’s going to provide some type of spreadsheet information on what’s billed and what’s covered. Can he also include what is billed and refused on this stuff? Thank you very much.
Mr. Chair, that will come out in the report that we promised.
I appreciate the comment there that they will provide that information. Is the Minister in a position to speak about the disallowances in 2008-09? It looked like about $34,000 in 2009-10, $52,000 the following year. The following year of 2010-11 is $610,000 but there is no information or allocation for the years 2010-11 and 2012-13. Thank you.
I’m going to have to get that information from the Member because I’m not sure what he’s actually talking about.
It’s under Non-Insured Health Benefits five-year summary of expenses by authority and total revenue recoveries and it’s my understanding it’s actually from the Minister’s office. It’s an internal document. Thank you.
Mr. Hawkins, can I just get clarification what page you are referring to?
I think it all links back to the reciprocal billing.
Minister Abernethy.
Thank you, Mr. Chair. We’ve gone back to 8-37 on this. I think the information he’s referring to is some detail we provided after discussions on the mains with committee. We will get more information for the Member on that.
Obviously we are running out of time this round, but I wouldn’t mind some details as to medical travel. I would assume that we would have a revenue, if it’s listed here on this page, that points to, for example, third-party insurance coverage. If it isn’t on this particular page, I’m curious as to where it would show up and how much it would be.
To give a specific example, in my view the territorial government shouldn’t be picking up all the costs. Insurance companies should be the first whistle stop on some of these expenses. As far as that goes, whether it’s automobile accidents or, for example, federal employees, they have individual insurance that should be covering some of these things. What it ends up having to be is it’s aggregated right down to the territorial taxpayer, which I’m not necessarily sure should be the first stop. It is, of course, the catch-all and that’s what it’s there for. That will be my last question on this particular one.
Where do I see how much money for a third-party billing when it comes to things like medical travel? I assume we have some revenue stream or line here. Thank you.
Thank you, Mr. Hawkins. Ms. Mathison.
Third-party revenues for such things as the Member mentioned, like WSCC and other insurances, show up in the authority revenues as presented in their individual audited financial statements.
