Nunavut has high hopes for Romanow report

The people who run Canada’s most stressed-out health-care system may know today if help is on its way, with the release of a report that could influence Canada’s health-care system for decades.

On Nov. 28, former Saskatchewan premier Roy Romanow’s Commission on the Future of Health Care in Canada released its long-awaited final report, one day after this week’s issue of Nunatsiaq News went to press.

Health Minister Ed Picco said this week that the Nunavut government hopes Romanow’s report will cast a spotlight on the territory’s badly underfunded health-care system, and persuade Ottawa to put more money into Inuit health care.

“I would hope that he would provide some indication that the federal government needs to come to the table, in a meaningful way,” Picco said.

He added that the Nunavut government’s rapidly growing health budget now adds up to $5,407 per resident. Across Canada, provincial and territorial health spending amounts to only $2,355 per person.

But despite that level of spending, Picco says Ottawa does not give Nunavut enough money to properly serve Inuit living in small communities.

A special federal program, called the NIHB (Non Insured Health Benefits), is supposed to cover the extra costs of providing health care in remote communities — such as medical travel.

But Picco said the NIHB isn’t working for Nunavut.

“Under the NIHB, we probably get roughly $60 million for all programs but our budget is $160 million to run the health and social services program, so the money is just not coming,” Picco said.

That means that one of Romanow’s expected recommendations won’t help Nunavut unless it’s supported by other measures aimed at northern, remote and aboriginal communities.

Romanow has already said that the federal government should increase the amount of money it gives the provinces and territories every year for health care, and that Ottawa should not be allowed to let its health-care contributions fall below a certain minimum level.

“While recent federal budgets have seen the beginning of improved funding, the federal government still contributes less than it did — and less than it should,” Romanow said in a speech last week in Winnipeg.

That contribution from Ottawa is made through a program called the CHST, or Canada Health and Social Transfer. When the federal government agreed to increase the CHST in September 2000, however, Nunavut got little help.

“The $4.2-billion increase in federal CHST funding agreed to at the premiers’ meeting in the fall of 2000 only gave us $3.2 million a year,” Picco said.

That’s because CHST money is divided up among provinces and territories on a per capita basis — so many dollars per resident. With its tiny population, Nunavut gets less from the CHST than any other jurisdiction, with little consideration for the territory’s high transportation costs and high disease rates.

Nonetheless, federal Finance Minister John Manley said in a speech this past Wednesday that Ottawa needs to “increase the federal contribution to health care in the billions of dollars.”

Picco hopes Romanow’s three-day visit to Nunavut this past spring influenced the commissioner to make special recommendations for isolated regions of the country.

“I think he’s now very familiar with the issue of northern and rural health,” Picco said.

In a set of health indicators issued at the end of September across the country, Nunavut was revealed to be the unhealthiest jurisdiction in Canada.

For example, the indicators showed that a person born in Nunavut in 1999 can expect to live 10 years less than the average Canadian, with a life expectancy of 68.6 years, compared with 78.8 years nationally.

At the time, Picco said those numbers are “unacceptable and an embarrassment for a territorial or provincial jurisdiction in a G8 country like Canada.”

The Romanow report is expected to contain recommendations aimed at helping provincial and territorial governments find ways of paying for expensive new diagnostic technologies.

But Romanow will likely recommend against the idea of allowing private companies to offer new technologies like MRI scanning and laser mammography — a position Picco agrees with.

“On the service side of things, the government of Nunavut is definitely opposed to private, for-profit health care…. That was one of the concerns that we had with the private mammography clinic [in Rankin Inlet]. It should not be based on what money you have available in your wallet.”

Prime Minister Jean Chrétien said this week that the Romanow report will be discussed at a special first minister’s conference on health care in late January or early February.

The Romanow report is also expected to recommend:

• Expansion of medicare to cover aspects of home care and pharmacare. Right now, medicare only covers hospital and physician services.

• Greater accountability in the spending of federal health money. Right now, provinces and territories don’t have to report on how they spend federal transfer money.

• Maintenance of a single-tier health system in which care is delivered according to need, not ability to pay. That means no user fees, and measures to stop private diagnostic clinics.

• Primary care reform involving teams of doctors, nurses, physiotherapists and pharmacists working together in integrated units.