Thank you, Mr. Chairman. In the area of the health insurance programs, my understanding of this initiative is it is one that was planned for a while. I understand it was supposed to save dollars. What I have been hearing so far is in fact it is going to cost almost $3 million more per year. Is that correct?

Thank you, Mr. Roland. Mr. Handley.

Thank you, Mr. Chairman. That is correct, Mr. Chairman, but it will provide better services such as a fuller complement of doctors. Thank you.

Thank you, Mr. Handley. Mr. Roland.

Thank you, Mr. Chairman. Can the Minister inform us how it will improve services?

Thank you, Mr. Roland. The question was, how will it improve services? Mr. Handley.

Thank you, Mr. Chairman. Mr. Chairman, it will, first of all, provide 26 full-time positions who are spending their time doing what they are trained for rather than managing clinics. There is as well more assurance of us maintaining the full complement of doctors here.

Thank you, Mr. Handley. Mr. Roland.

Thank you, Mr. Chairman. How can we do that better than the existing system today?

Thank you, Mr. Roland. Mr. Handley.

Mr. Chairman, I will turn that one over to the Minister responsible for Health and Social Services since she is here now.

Thank you, Mr. Handley. Mrs. Groenewegen.

I am sorry, I missed the first question so I am not sure what we were talking about. Could Mr. Roland just repeat the question in the context of what we are talking about?

Thank you, Mrs. Groenewegen. Mr. Roland.

Thank you, Mr. Chairman. My understanding of this process was this move was to save money and improve efficiency of the delivery system. I understand that under the existing system through payments to the doctors and clinics we already pay for everything that occurs in those facilities. My understanding of taking them over would be, in fact, to save dollars in health delivery. In fact, as the Finance Minister stated, we are going to spend almost $3 million more per year.

Further to that, he also stated that by doing this we will be able to ensure we have more doctors. I am saying, how will we improve on that? How can we improve on the system now? Are there guarantees in place for this?

Thank you, Mr. Roland. Mrs. Groenewegen.

Thank you, Mr. Chairman. One of the problems was in Yellowknife specifically, where this is mostly being invested, which is, we need between 22 and 24 physicians here in Yellowknife. Yellowknife Stanton Hospital is not just, as I heard someone say, a regional hospital, it is a territorial hospital.

Our system does not work without physicians. We were down to 14 physicians. We need between 22 and 24. Part of the recruitment problem with getting physicians to come here is we could not tell them what they would get when they arrived, on a fee-for-service basis.

Also, the recruitment effort to try and get physicians was complicated by the fact that there is now an extreme shortage nationally. This is a trend in Canada right now to put together compensation packages which are comprehensive, not fee-for-service, salaries with clearly defined pay, benefits and remuneration considerations.

The primary care model that will go into effect here in Yellowknife, which is the first stage to buy the clinics and get the doctors to move from fee-for-service to salary, may cost more right now, but as Minister Handley already said, we do have a lot of forced growth and increased costs in health anyway.

We had to stabilize the Yellowknife situation because this is where a lot of people in the Northwest Territories receive services. For example, 75 percent of the babies born in the Northwest Territories are delivered by Yellowknife physicians. People come here for a surgery. This is a territorial hospital.

If we cannot have a stable pool of physicians here, we cannot cover emergencies. GPs provide anesthetic services in the emergency room here, there are GPs with a special designation for providing anesthetics, all of these things. We were down to 14 physicians and we needed to implement a system that would stabilize things. We now hope to build on that and improve the way in which we deliver the service.

Anyway, it is a long answer to your question, but it is all interrelated. It is all part and parcel of improving the system territorial-wide.

Thank you, Mrs. Groenewegen. Mr. Roland.

Thank you, Mr. Chairman. I do not dispute the fact that Stanton Hospital treats territorial patients. I have visited many patients from Inuvik in that facility. That is not my concern here. My concern is the fact that this is going to be, for a number of years at least, going to be costing more to deliver the same level of service.

You are saying the doctor level at this date is down to 14. Is that what you are stating? You used that figure a couple of times. Has this in fact already occurred? Thank you.

Thank you, Mr. Roland. Mrs. Groenewegen.

No, Mr. Chairman. What I said was, Yellowknife was down to 14 physicians. With 14 physicians carrying a community this size, plus all of the out of community work they do, the situation was going to be deteriorating very, very quickly. We are back up to 22 physicians in Yellowknife. Part of the recruitment that was successful was the change in compensation package that the Yellowknife Health and Social Services Board was able to come up with and recruit doctors. We are up to 22 doctors in Yellowknife at the present time.

Those Yellowknife doctors do not just serve Yellowknife. They also serve the communities. They do community visits in Lutselk'e, Wha Ti, Wekweti and Fort Resolution. The are also providing support services to the nurses in the Deh Cho when there are no resident doctors available, and they designate time to provide support and services to the Deh Cho region as well.

The boards are not charged for this, either. This is done out of Yellowknife and there is no charge for the community visits and the work that is done from here. If it seems like it is a little bit rich for Yellowknife here, think of it in the context of it being a territorial facility.

Thank you, Mrs. Groenewegen. Mr. Roland.

Thank you, Mr. Chairman. The Minister is still trying to convince me. She is already preaching to the converted, as people would say. I am not disputing the fact that this is a territorial hospital. I said I agree with that. My understanding is that this was supposed to be a move to improve efficiencies. For example, under the old system every time a doctor grabbed a tray off of the shelf there was a billing fee for that. In those fees were included the insurance for their buildings, for providing care, to put staff at the front desk.

Just a little bit further, the Finance Minister stated that there is an increase in staff to take over some of these responsibilities. When I look at this, there was already staff. There was already a full complement of staff in place dealing with the administration. In fact, there was probably more because each clinic was on its own fighting for its own survival. They probably had their own finance people and so on. Now that we have them under the same roof, would you not think the staff at Stanton Hospital would take over that administration portion?

As well, does every clinic now need its own separate system, so to speak? I initially believed this was to save some dollars, improve the service, and save some dollars. I agree, it is a territorial facility and we need a certain level of doctors in place. You do not have to convince me on that portion. It is just the move and the extra expense we are going to go through in the next few years, as the Finance Minister stated, $3.9 million, or $2.9 million, I think it is.

That is the concern. I agree we need a certain level of hospital expertise to provide to residents of the Territory. How long will it go before we actually start seeing a savings? The concern I have is there is a certain level of service already committed to through the billing that happened in the old system. The fact is, I agree. There is a shortage across Canada for nurses and doctors, but do we expect that to turn around rather quickly? That is where I am coming from. Thank you, Mr. Chairman.