Here’s why health care funds for First Nations children aren’t being spent
There have been countless reports about First Nations children on reserve not getting access to proper medical care, and the culprit is often assumed to be lack of proper funding.
But as physicians working with children in these communities, we’ve seen firsthand that the problem isn’t just a lack of money; it’s a failure to establish clear guidelines to connect available funds to the communities and patients who need them.
Health care for First Nations on reserve falls almost entirely under federal, rather than provincial, jurisdiction. In 2007, the House of Commons passed Jordan’s Principle, which establishes that First Nations children should have the same access to medical services as other Canadian children. In situations where it is unclear whether provincial or federal government should pay for medical devices and services, Jordan’s Principle holds that treatment must be provided immediately, with funding disputes to be resolved later.
To see to this immediate treatment, the federal government earmarked $382 million over three years to Jordan’s Principle back in July 2016. But recent reports show that only $11.5 million has been spent so far.
Much of the problem, especially in fly-in communities in northern Ontario, is getting funding to send these children to see appropriate health care providers who can perform specialized assessments, order medical devices and provide appropriate therapies for conditions like developmental delay and autism.
The issue is that the cost to travel is often not covered by Health Canada’s Non-Insured Health Benefits (NIHB) travel policy, which has been interpreted by NIHB adjudicators in northern Ontario to apply strictly to providers who bill OHIP directly (e.g. physicians) and not to salaried providers who are publicly funded through hospitals (e.g. physical, occupational and speech therapists) or those who are funded through other provincial bodies (e.g. the Ministry of Children and Youth Services, which provides most services for children with special-needs).
Without travel coverage to see necessary specialists, these kids can’t get the approvals they need; denial of travel is essentially denial of service.
Here’s an example: to qualify for a wheelchair funded through the Ontario Assistive Devices Program (OADP), a child in Ontario must first be seen and assessed by an OADP-approved therapist. Yet most of these therapists are salaried hospital employees, and thus, travel for First Nations children is not covered under the NIHB.
It’s the same issue for kids who need hearing aids — they can’t get them without a hearing test — or kids who need school-based behavioural or learning accommodations — they can’t get them without a psychoeducational assessment. Physicians cannot perform any of these assessments, meaning that children living on reserve without access to these specialized services are not getting the help they need.
That’s why earmarked funds sit unused. While these services are theoretically available to all children, the extraordinary cost of air travel out of fly-in communities poses a near-insurmountable barrier.
Opaque appeals process
Another barrier is the opaque process of filing requests and appeals. If an initial request for, say, travel for a child and an adult to an audiologist for an assessment is denied by the NIHB, an appeal can be filed on the basis of Jordan’s Principle.
Yet the government website for Jordan’s Principle provides little information about exactly how to file an appeal beyond providing the contact information for regional Indigenous and Northern Affairs Canada (INAC) and Health Canada offices. Patients thus are left in limbo waiting for assessments and not getting the devices and services they need. As busy physicians, we don’t have time to navigate the bureaucratic nightmare that is the federal appeal process, and would much rather spend our time actually seeing patients.
The good news is that this problem is fixable, and it has to start with rewriting and clarifying NIHB policy to include travel for all types of medical assessments — not just those provided by a physician. Policies must be applied consistently across Canada, and Health Canada should be held accountable for any unreasonable delays or denials of care.
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The federal government must also give clear guidance to families and health care providers about how to access necessary devices and services, and they must establish, without delay, the promised case management services for children with complex needs. If a particular request is denied, there must be a clear appeals process with designated contact people to assist with the appeal.
It is not enough to simply allocate funding for First Nations children’s health and developmental services, do nothing to simplify the processes for accessing that funding and then act surprised to find the money isn’t being spent. We need to remove bureaucratic barriers preventing First Nations children from receiving the medical help they deserve, and that to which they are legally entitled.
Sarah Giles is a locum family physician in various First Nations communities in Ontario. Lindsay Hancock and Lisa Letkemann are family physicians with the Sioux Lookout First Nations Health Authority.
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