Medevacs growing in Nunavut, pushing up medical travel costs
Territory budgeting for an estimated 2,400 medevacs this year
The Government of Nunavut says there were about 2,400 medevacs in 2018-19, a number that is growing at a rate of roughly eight per cent by year. (Image courtesy of Keewatin Air)
The number of medical evacuations in Nunavut is growing at a rate of about eight per cent a year—and pressing the Department of Health’s budget to keep up.
Nunavut’s health minister, George Hickes, said there were roughly 1,500 medevacs in the territory in 2013-14.
“Now we’re almost a thousand medevacs more than that just five years later,” Hickes told the legislature on Tuesday, Feb. 26, during a review of the Health Department’s budget.
“We’re very conscientious of the increased costs in medical travel.”
The department is forecasting 2,400 medevacs this coming year, based on that growth. That’s compared to about 33,000 planned medical travel trips planned for the year.
The territory’s newly released budget reflects that growth; the government increased its medical travel allocation by $2.7 million, bringing the overall budget to $92.3 million.
“There’s a big increase in the amount budgeted for medical transportation,” noted Arviat North-Whale Cove MLA John Main, inquiring whether the Department of Health would need additional funds through supplementary appropriation.
“An increase in allocation to this line item is something we have been requesting for a number of years,” Hickes responded. “With our forecasting, we’re hoping that this will be sufficient.”
As part of the territory’s review of its medical travel program, Hickes said the department is looking at ways to minimize the number of patients flying out of their communities for care.
That includes increasing doctors’ visits to communities and, as has been done more recently, sending surgeons into communities to do consultations ahead of surgery.
Hickes said the department continues to look at ways to use tele-conferencing to host medical appointments as a way to cut down on travel costs.
“It’s something that we’re being very cognizant of,” he said.
“I know I have spoken many times about statistics that we’re trying to gather and really digging down into the root of whether these medevacs can be diverted to scheduled medical travel.”
In the future AI and robots might alleviate this.
Unfortunately, increasing social dysfunction is partially to blame, as is the ever-increasing population in small hamlets with no economic reason to exist where they are. It leads to a lot of despair and poor health.
Actually using the telehealth services to hold appointments is an excellent idea, especially when specialists mostly start with verbal assessments on people and then send them for tests based on the interview. The referral process could be initiated in many cases while the patient is still in the community, saving at least that first trip out to meet the specialist and get started.
Would also be proper to recruit more Nurse practitioners to the remote communities which would further reduce the need for patients to be sent out of the community. Nurse practitioners in Nunavut have similar scope of practice as family doctors and able to care for acute and chronic conditions beyond that of the regular nurses in the communities.
At present there is no incentive for NPs to work in Nunavut as the pay is on par with all other provinces, but the cost of living in so much more.. so for a NP to practice in Nunavut it would be a financial loss. The GN should be creative with resources and not simply focus on increasing the number of doctor visits to the communities… that isn’t the solution!
Having done this job for 2 years and having worked in Iqaluit and Rankin Inlet I can attest the the growing number of unnecessary medevacs. Young doctors are trying to protect their licences and are often forced to medevac people that are improving. They also are relying on the assessments of community nurses that are trying to mitigate their own risk. It is contributing to a massive deficit as a result. Growing at 80% per year? Most of the people walk into the plane. It’s an absolute joke. If you can walk on the plane you can take a scheduled flight
A very interesting comment from someone who should know.
Wouldn’t it be great if there was some non-adversarial mechanism to allow front line employees (both government employee and contractor) to let the policy makers and bureaucrats know where the “system” is and isn’t working.
Being from a business background I know that any suggestions would go to a manager or director, get actioned immediately, or put onto a weekly meeting agenda at a director level.
Anyone know how the GN would handle an issue?
The suggestion would disappear into never never land. I submitted several suggestions during the years I worked for the GN. Not only were they not acted upon, they were not even acknowledged.
The GN doesn’t need a formal system for identifying issues or inefficiencies. Employees who have feedback to share can pass it onto their Manager/Director. Good ideas are constantly passed upward and provided to department leaders. Ideas are great but action on them is where there are challenges and insurmountable road blocks sometimes.
If you’ve been paying attention the GN is looking into medical travel right now. We spend almost $100M on medical travel each year. There are most certainly efficiencies to be gained and improvements that can be made. What the public doesn’t understand or have the capacity to wrap their head around is that it’s ridiculous to have 25 mostly unsustainable communities so spread out. The federal government and GN should evaluate consolidation efforts. Every department and service is stretched to the Max because we have a poor/no economy to sustain the support required for people to live in so many remote areas. These communities exist because of poor government planning. Will anyone have the balls to change this? Likely not considering the constant feelings of resentment and anger from how Nunavut and it’s make up came to be in the first place.
You only see the job from your end of things, flying in and flying out and it is so easy to be critical but those nurses have people’s lives in their hands and those young MDs you disparage have to take the information they are given and look at things in terms of what is the worst it could be. No one wants to bet someone’s life against the cost of the medevac.
The numbers are questionable. At $93.2M (5% of total annual NU operating budget and 25% of total annual health care budget) for 35,400 medical-travel trips in 2019, the cost per trip averages $2,633. That feels like the average cost of a return airfare from nearly any NU community to another or to the outside. Many trips include an “escort”, overnight hotel accommodations, meals and taxis. The cost of health care provided is not included in this $92M figure, whether administered in another NU community or in another territory or province.
With or without considering health care travel costs, it is apparent why the vast majority of citizens in Nunavut exist in third-world conditions and systems. For that small portion of the population that benefits most by the despair in their third-world, it is helpful that the conditions (under which the majority of their fellow citizens exist) be maintained or worsened. It is equally essential that systems be entrenched to support that small minority’s own position of influence. Further, it is key for the controlling-minority that outside forces are seen as the cause of those conditions, that their cohort be seen as the one most able and willing to relieve those conditions and that they suffered equally or worse than their fellows.
There are many cloaks available to perpetrate and perpetuate this system. I will be glad to share them. One prime example is the slick diatribe called “Dear Qallunaat – 22 points” that was written recently by Sandra Inutiq and kindly published by this outlet.
I call that controlling minority “brokers”. Aren’t they fun? Really on-task to find solutions (NOT!).
Sandra Inutiq’s piece didn’t run on Nunatsiaq, I would remember the comments (I bet she didn’t share it with Nunatsiaq for that very reason – oh the microaggressions!). That was an interesting screed though, confirming just how intellectually bankrupt yet zealous the brokers are.
Sandra’s “screed” doesn’t confirm anything except her own agnst and biases and the biases of those who reflexively accept her “screed” as an accurate reflection of how the world is and how “white people” are. Reality, of course, is much more complex.
My sense is that her real audience was less ‘white people’ and more her own tribe; that is, her goal was to reaffirm the place she feels she deserves among the Inuit intellectual class, and at the leading edge of this discourse; though after reading I don’t think that place is deserved.
Why not?
It doesn’t deserve the title of an intellectual exercise as it didn’t yield any new, interesting or even useful insights. Instead it was a simplistic, populist diatribe that hurled invective at the long accepted ‘scapegoat or ‘boogeyman’ of the north. The “White person’ in her piece was ultimately a cliched archetype.
I’m glad Nunatsiaq didn’t print it, it didn’t deserve anything more that it’s status as a facebook post.
Thanks Woke Broke(ers). I believe you are right about the DQ 22 piece. It was mentioned here in a few comments but was published on cbc.ca and Nunavut News (.com).
I don’t like to underestimate oppressors – whether it be the likes of DT or SI. Intellectually bankrupt, no. Morally, yes. Pride of any kind, whether in the guise of ancestry (racism in disguise) or under the cloak of ambition (which too often masks greed) is dangerous. As often as not, it seems that intellect without humility, leads to corruption.
We don’t have to look afar or too deeply into history. Whether we see the marginalization and oppression in Haiti, Uganda, 18th century streets of London, modern drug ghettos of LA, recent cesspools of church orphanages or Nunaslums – oppression is always imparted by those closest to the victims and by those who have most to gain from the victims’ plight. When detached from the victim, the assailant is nearly always just pain-old psychotic. When oppressors are white, they are white; where they are black, they are black; ….
Nothing in society is more important than human nature and nothing is less relevant than ancestry.
There is no overarching oversight and accountability within the Department of Health when its management consist of majority non-Inuit who do not care about Nunavummiut, a population that consists of majority Inuit. The approximate 80 positions at the top management level are likely primarily held by employees who are transients and stay only a few years, with no care about how to find solutions to fix the problem (take for example, the Chief Medical Officer position). If Inuit were given some leeway into the decision making at the top level, the direction of health care services would likely improve, because they would care and understand what health care services they would need. Way back before 1999, Inuit did have oversight and control over health services, through Regional Boards of Health. At that time, Nunatsiaq News reported that Department of Health was concerned about ballooning medical travel costs of a measly $4 million annual budget. By taking away the health board’s authority from Nunavummiut, the Department of Health has actually made it a lot worse. So, Dear Qallunaaq – you’ve actually highlighted the very reason why Sandra Inutiq had to write that piece – you treat us as stupid yet give no real contributions to the issues we face. It’s any wonder why we get frustrated and tired of health officials that just come and go with no long-term planning, such as building up primary health care services to lessen the need for medical travel.
Dear Bureau,
Please reread your post – as if someone had written it to you. I think you will find that the ONLY thread of truth there is that the majority of managerial positions are held by non-Inuit.
That aside, why is that the case? Beneficiaries are excluded from recruitment competitions? Fairly unlikely. Beneficiaries are incapable of learning? Definitely unlikely. Beneficiaries are unqualified for the positions? Probably.
Since inception in 1999. nearly all of the MLA and minister positions in Nunavut have been occupied by Inuit. Similarly, nearly all of the Hamlet mayor and councillor positions have been held by Inuit. Nearly all of the board and chair positions in each community and region (DEAs, HTOs, justice committees, alcohol committees, housing associations, regional Inuit association, Inuit corporations … ad infinitum) have been held by Inuit.
In addition, Inuit have been the majority employees at nearly all of those aforementioned organizations – both in staff and managerial positions. Inuit have worked as student support assistants in schools, community liason officers, health centre staff, …………… all since 1999 and before. They see the careers – teachers, principals, nurses, doctors, engineers, accountants, lawyers,… There is endless opportunity for SI, NTEP, Nursing, law school, doctor, engineer.
Surely there is one person in each community who is/was capable of acquiring professional licences over the past 20 years. Just one for each of 25 communities. In 20 years. Who are our MLAs? Former HTO managers and hamlet councillors. Open your eyes and see around you. Who is running the show? Which beneficiaries are benefiting in each community?
I think the real problem is your assumption that southerners, by default, don’t care, or that by default treat you like you are stupid. This is about the same quality of logic Sandra used, an exercise in ‘othering’ steeped in stereotypes, cliches, and your own biases. It’s unfortunate to read this, but it’s simply not true.
There were 2 Inuit medical doctors in Canada in 1995. One was a new general practitioner, the other was an experienced surgeon.
https://ammsa.com/publications/windspeaker/newfoundland-woman-first-female-inuit-doctor-0
It’s twenty-four years later and Nunavut cannot / will not hire any Inuit doctors.
Perhaps this is something the new Minister of Human Resources could investigate.
Maybe they “can not and will not” hire inuit doctors because a) there probably aren’t any/many new ones and b) they might not want to work in Nunavut. There are barely even any inuit nurses, and they rarely work in the communities. Besides, how would a preferred skin colour reduce the number of medevacs? It’s not like patients are being dragged out against their will, there are more people who want to be medevaced who don’t go because their illness doesn’t warrant it. People would be expecting more medical travel from an inuit doctor, not less, people don’t push tribalism to get reduction in benefits.