Thank you, Ms. Lee. Please be seated. Good afternoon. Item 2, Ministers' statements. The honourable Minister responsible for Transportation, Mr. Handley.

Mr. Speaker, I am pleased to announce that as of April 1, 2002 the Department of Transportation will extend over-the-counter permanent document licensing services to the communities of Deline, Fort Good Hope, Fort McPherson, Fort Providence and Tuktoyaktuk. This would include driver licences, vehicle registrations and general identification cards.

Up until now, people in these communities have had to make do with temporary driver's licences and vehicle registrations until the permanent documents were processed and sent back to them. Now these communities will have the same licensing services that are available in the larger centres.

A direct electronic link to the motor vehicle information system and about $75,000 worth of licensing equipment have made the improvements possible. The department expects to extend this improved service to the communities of Aklavik, Holman, Tulita and Fort Resolution in the near future.

The new and improved licensing services, Mr. Speaker, shows that so far as possible, the Department of Transportation tries to offer the same quality of services in smaller communities as it can in the larger ones. Thank you, Mr. Speaker.

-- Applause

Thank you, Mr. Minister. Item 2, Ministers' statements. Item 3, Members' statements. The honourable Member for Deh Cho, Mr. McLeod.

Thank you, Mr. Speaker. Mr. Speaker, the Government of the Northwest Territories, through the Department of Health and Social Services, administers two separate health benefit programs. One is the GNWT Supplementary Health Program, which is both funded and administered by the Government of the Northwest Territories.

Mr. Speaker, the programs include the Extended Health Benefits Program for seniors, the Chronic Disease Program, Metis Health Benefits and the Indigent Health Benefits Program. Mr. Speaker, the second health benefits program is funded by the federal government and is also administered by the Department of Health and Social Services. This program is for registered First Nations and Inuit, regardless of age, income or place of residence in Canada.

Mr. Speaker, the Department of Health and Social Services has policies for all of their programs that are modelled on their services and provisions of the NIHB program. This was done to ensure some equity amongst all residents of the Northwest Territories.

All these programs, Mr. Speaker, say that they are insurers of last resort. This means that if any resident has private health insurance through their employer or company, they are expected to use that insurance first.

Mr. Speaker, over the past several years, there have been many statements made by First Nations leaders expressing concern that there appears to be an erosion in the level of benefits allowed under the NIHB. Even Ministers of this government have expressed concern in this Assembly about an increase in the number of services being disallowed under NIHB guidelines, resulting in an increased cost to the Territories.

Mr. Speaker, a Dene elder cannot decide that the benefits are better under the extended health seniors' benefits program and apply for benefits under that policy. If he or she does not have private insurance, they must take what is allowed under the NIHB guidelines.

I am concerned, Mr. Speaker, that different rules are being used to determine eligibility for supplementary health benefits, especially in the area of medical transportation. Mr. Speaker, I will be asking the Minister questions on this issue during question period. Thank you, Mr. Speaker.

-- Applause

Thank you, Mr. McLeod. Item 3, Members' statements. The honourable Member for Mackenzie Delta, Mr. Krutko.

Thank you, Mr. Speaker. People in the communities of Aklavik, Fort McPherson and Tsiigehtchic often have to go to Inuvik for medical services and treatment, which is not available in our communities. As a result, patients from communities on the Dempster Highway or the winter road system are usually sent by taxi or shuttle bus, rather than by aircraft, to Inuvik.

Mr. Speaker, the trip from Aklavik or Fort McPherson can take up to two-and-a-half hours or more, and costs approximately $200 one way by taxi. In the summer, you have to take the ferry from and to Tsiigehtchic and Fort McPherson, which runs once per hour and takes about 45 minutes to cross. For many patients, Mr. Speaker, the trip by taxi or private vehicle is not a great hardship, but there are those patients, especially those who are very frail, have a serious illness and are our elders, that have a hard time taking the long trip. Worse, Mr. Speaker, the patient has serious breathing problems and because of the trip being taken during the summer, it is very dusty travelling over a gravel road such as the Dempster Highway.

Mr. Speaker, Aklavik and Fort McPherson have scheduled air service to Inuvik twice daily during the break-up and freeze-up periods of the year. The cost from Aklavik is $140 and from Fort McPherson it is about $160 return. That trip takes about 25 minutes and 50 minutes from Fort McPherson back to Inuvik.

Mr. Speaker, I have received complaints from people who are asking the question, "Do we have a choice in regard to how travel is being done and who makes that choice, by road or by air?" Also, there are questions of the cost.

Is it clear, Mr. Speaker, that if it is necessary to go by road or by air, do the patients have a say in consideration of the comfort, the pain that the effect of travel on some of our patients may cause while travelling between Inuvik and our communities? Mr. Speaker, I see unanimous consent to conclude my statement.

Thank you. The honourable Member is seeking unanimous consent to conclude his statement. Are there any nays? There are no nays. You may conclude, Mr. Krutko.

Thank you, Mr. Speaker, and thank you, colleagues. Mr. Speaker, while travelling to Inuvik to see a doctor with regard to pain that they may have, it would be better if we had a say in the process of how travel would be taken so that people who travel from our communities to our regional health centres can have a say with regard to how this takes place. Mr. Speaker, I will be following up on this with questions for the Minister later today. Thank you.

Thank you, Mr. Krutko. Item 3, Members' statements. The honourable Member for Hay River North, Mr. Delorey.

Thank you, Mr. Speaker. Mr. Speaker, I rise today to discuss an issue with regard to medical travel. The issue I would like to bring to light, Mr. Speaker, is the issue of public awareness with regard to programs and services offered by the Department of Health and Social Services.

Mr. Speaker, we are all aware that at the time of initial diagnosis of a potential disease, or during a period of severe illness, patients are extremely anxious and uncertain. They are unsure of exactly what the diagnosis or illness entails. Mr. Speaker, very often, patients are just referred for medical travel without a thorough explanation of exactly what will transpire, never mind the impact of the potential costs involved.

Mr. Speaker, there are many assumptions made by the Department of Health and Social Services that people will just naturally have an understanding of everything involved when they have to travel for medical reasons or access a program or service offered by the Department of Health and Social Services.

I would like to state, Mr. Speaker, that the pamphlets, publications and brochures distributed by the Department of Health and Social Services are very well done. Of particular note is the seniors' handbook, which was produced in 2001.

However, Mr. Speaker, while these brochures and pamphlets are well done, there is no mention of a co-payment in any of these brochures. Many people are required to pay the co-payment of $250 when they travel for medical reasons. The co-payment of $250 is very cost prohibitive for a number of people.

Mr. Speaker, I believe the Department of Health and Social Services and their myriad of employees need to take a step back and simply view things from a user perspective. It is very simple, Mr. Speaker, for health care employees to recite policy over and over to people. It must be realized that these patients are distressed in many instances. A little information goes a long way.

Mr. Speaker, I would hate to think that a badly needed medical procedure would be passed over by a patient due to the fact that they were ill-informed, or worse yet, that the co-payment was too much of a financial burden for them.

Mr. Speaker, with all of the talk of the upcoming implementation of the department's action plan, it is my sincere hope that departmental officials have spent long hours discussing the best ways to get the pertinent information out to the people who require it the most, that being the patients.

Mr. Speaker, I feel strongly that...

Mr. Delorey, your time for your Member's statement is over. Mr. Delorey.

Mr. Speaker, I seek unanimous consent to conclude my statement.

Thank you. The honourable Member is seeking unanimous consent to conclude his statement. Are there any nays? There are no nays. You may conclude your statement, Mr. Delorey.

Thank you, Mr. Speaker. Thank you, colleagues. Mr. Speaker, I feel very strongly that we as legislators need to ensure that we have a strong, viable health care system. If there are constructive changes made to our health care system, we need to be assured that our programs are delivered in such a way as to ensure both accountability and efficiency. At the appropriate time, Mr. Speaker, I will have questions for the Minister. Thank you.

-- Applause

Thank you, Mr. Delorey. Item 3, Members' statements. The honourable Member for Yellowknife South, Mr. Bell.

Thank you, Mr. Speaker. My statement today is about medical travel co-payments. All residents in the Northwest Territories are eligible for territorial health insurance coverage. However, sometimes not all insured services are available in the communities or in the North. In these instances, people have to travel to the nearest centre that can provide the insured service.

Mr. Speaker, the cost of this medical travel is not always fully covered. Some residents have to pay a co-payment when they travel outside of their home communities for medical reasons. If you are a federal or territorial government employee, or if you work for one of the larger companies, Mr. Speaker, then you likely pay dues into a private insurance plan that will pick up the $250 co-payment.

Mr. Speaker, registered Indians and Inuit registered in the Northwest Territories have their co-payment paid by the Government of Canada under the Non-Insured Health Benefits Program. The Extended Health Benefits Policy and the Metis Health Benefit Policy provides the co-payment for indigenous Metis residents as well as for seniors, infants under two years of age and those residents who are verified indigent.

Who is not covered, Mr. Speaker? Typically, non-aboriginal or non-indigenous aboriginal people who do not work for the larger companies or who do not pay into a private insurance plan. Many of these residents will qualify to have the co-payment waived if their illness is a specified illness listed under the Extended Health Benefits Program.

Mr. Speaker, it seems that for the apparently small number of residents who are left to pay the co-payment by themselves, this government ought to be able to find a way to reduce the cost to those individuals. Often these people are employed in low-paying service jobs and do not meet the means test to qualify as indigent, but yet they cannot readily afford a payment of $250. This is especially so if more than one trip is necessary.

If the appropriate insured service is not available in the Northwest Territories, Mr. Speaker, then perhaps we should look at a mechanism to provide group insurance that includes all people who cannot afford a co-payment. Thank you, Mr. Speaker.

-- Applause

Thank you, Mr. Bell. Item 3, Members' statements. The honourable Member for Frame Lake, Mr. Dent.

Thank you, Mr. Speaker. Mr. Speaker, I too would like to address the issue of medical travel, and in particular, the co-payment required of our residents. This is one issue that I hear about frequently from a number of my constituents. That is because many of my constituents have been burdened with the expense of medical travel when they simply cannot afford it.

Medical needs and the subsequent cost to the patient are already too much for one to deal with. The co-payment is adding to many of our constituents' suffering. What is worse is it is usually the people who cannot really afford the expense who are having to deal with it.

Mr. Speaker, those who can afford it, higher income earners, are usually employed by larger companies who have medical benefits for their employees, so it is largely the middle and lower income earners who are not receiving these benefits through their employers or who otherwise qualify to have this co-payment covered, who are most affected.

Mr. Speaker, right now, unless it is an emergency, the patient must pay the co-payment charge before they get on the plane. That can be a difficult task for many. Not many people plan to have to travel for medical reasons, and $250 is not something that many people have sitting in their bank accounts. Many people live from pay-day to pay-day. In fact, Mr. Speaker, it is often likely that if they have purchased medication or taken time off work, they are already struggling.

Mr. Speaker, even in conservative Ontario, they charge less for their co-payment to northern residents. Manitoba used to charge $50 as the co-payment but, Mr. Speaker, they have dropped that. Other jurisdictions take the approach of capping the co-payment on an annual basis but here, patients are charged trip in, trip out, trip in, trip out. Mr. Speaker, people will often have recurring conditions that require more than one trip each way.

Mr. Speaker, we are setting our middle and lower income earners up for failure with the current policy. I urge the Minister to revisit this item with a view to eliminating this burden for our residents. Thank you, Mr. Speaker.

-- Applause

Thank you, Mr. Dent. Item 3, Members' statements. The honourable Member for Hay River South, Mrs. Groenewegen.

Thank you, Mr. Speaker. Mr. Speaker, in keeping with the theme of medical travel and extended health benefits, today I would like to articulate a gap in the support that our government provides for persons requiring medical attention outside of their home community.

At present, the government policy is that when you are referred for medical assessment or treatment, the patient is responsible for the first $250 in travel associated with that referral. I will not go over all of the list of people who are excluded from having to pay that co-payment because my colleagues have already done that but, Mr. Speaker, if you are not included in these various groups that have been referred to, you are on your own.

The excluded persons in most cases are people working for small business in the private sector. Most such employers do not have access to readily affordable coverage for their employees.

Yellowknife, on the other hand, with its territorial hospital, has the good fortune of having many resident specialists who are qualified to diagnose and treat more than general practitioners, who generally serve the smaller communities. Another half of the population may be quite less affected by this co-payment because they live in Yellowknife and can be referred by their family physician to a number of different specialists. It affects them when a referral is required to the south, but I would suggest that this is much less likely to occur than what is experienced by those living in communities like Hay River.

Mr. Speaker, I would like to see the Department of Health and Social Services determine how many people in the North are not covered by benefits through government or employee plans. When that number has been established, I would like to see the government facilitate a group insurance plan whereby those who are negatively impacted financially by this gap could elect to pay an affordable premium, which might cover even more than just medical travel. It could also cover things like dental, pharmaceutical and eyeglasses. It is the volume of people who would participate, which could make it affordable for the average working person or family.

Once a monthly premium for this insurance is established, small employers may even elect to pay it on behalf of their employees because their own numbers make the purchase of a plan too costly.

Mr. Speaker, this would not cost the government anything other than the administrative cost of acting as a facilitator. It would bring a level of fairness to Northerners who are not currently eligible for any other assistance. Later today, I will have questions for the Minister of Health and Social Services regarding this co-payment. Thank you, Mr. Speaker.

-- Applause

Thank you, Mrs. Groenewegen. Item 3, Members' statements. The honourable Member for Tu Nedhe, Mr. Nitah.

Thank you, Mr. Nitah. Item 3, Members' statements. The honourable Member for Inuvik Boot Lake, Mr. Roland.

Thank you, Mr. Speaker. Mr. Speaker, I would like to start by sending greetings back home to my family. Mr. Speaker, although Inuvik does have a hospital, not all services and treatments are available. Many people have to travel to Yellowknife or to southern Canada for specialized services. In some instances, Mr. Speaker, a patient is treated by a physician in southern Canada and advised to come back to follow up in a few weeks or months. The follow-up appointment often consists of a three-hour trip and an overnight stay for a 15-minute appointment, where the specialist determines that the initial treatment was successful. I cannot help but think, Mr. Speaker, that we could be using telehealth technology in many of these situations.

Mr. Speaker, I will show an example to illustrate the point. One of my constituents broke his leg and was referred to an orthopaedic surgeon in Edmonton, where his broken leg was set. He was sent home to recover and a physician in Inuvik removed the cast after time. The specialist had stated that he wanted to see him again in three months, so an appointment was again arranged in southern Canada. The specialist reviewed an x-ray and pronounced the leg healed.

Mr. Speaker, there should be a way of using video conferencing technology and electronic transfer of diagnostic images to link the doctor and patient in the Northwest Territories with a specialist in southern Canada. Not only would it reduce the cost of travel, but it would also provide a better standard of care to the patients in the North.

I recognize, Mr. Speaker, that not all services and treatments lend themselves to this type of technology, but there are areas where we could focus attention and take a few small steps.

Mr. Speaker, the Minister of Health and Social Services recently presented the Northwest Territories Health Services Report, 2000. The report was prepared to inform interested parties about the patterns of utilization of health services in the Northwest Territories. Mr. Speaker, I think it would be useful to analyze that information with a view to determining what types of services might be provided or enhanced with the use of telehealth technology at the community level.

Many First Nations governments have projects underway where technology is used to enhance the care at the community level. These include televisitation for patients in the hospital, education and conferencing support to occupational and speech therapists who travel to provide services in the community. Mr. Speaker, I will be following up with questions on this topic at the appropriate time. Thank you.

-- Applause

Thank you, Mr. Roland. Item 3, Members' statements. The honourable Member for Range Lake, Ms. Lee.

Thank you, Mr. Speaker. Mr. Speaker, I too would like to bring attention today to the issue of medical travel. More specifically, to the lack of, or inadequate information systems available in tracking who travels where and for what.

Mr. Speaker, I am one of those who believe that we have a very generous and compassionate Medical Travel Program. I also know from my own personal experience, and from talking to my constituents, that the program can be improved so as to make maximum use of the resources available and to use the dollar where it is most needed.

The most often mentioned problem with medical travel seems to be the inconsistent application, or the lack of uniformity on who travels where, for what. In talking to a local medical specialist, Mr. Speaker, I am advised that currently the information about who goes where for what is not consistently kept track of. In fact, whoever is approving the medical travel most often uses what is known as DCI codes, which basically means disease, condition, illness unknown.

While this is understandable, Mr. Speaker, because chances are, unless one gets the proper diagnosis upon the completion of medical appointment by travelling, this may not be known. We have to have an information system in place that does a proper follow-up, so the health authorities know the details of the travel and properly analyze the data, so proper responses could be taken in the future.

For example, Mr. Speaker, if so many people from one community travel for a knee problem or one similarly related illness or condition, a protocol could be worked out at the local level where a specialist could be sent to the community. At this moment, the lack of an information system does not allow that.

Mr. Speaker, I understand that there are limited medical information personnel in the department. I would advise the Minister to look into this further to make sure that this section is well resourced and well used. Thank you, Mr. Speaker.

-- Applause

Thank you, Ms. Lee. Item 3, Members' statements. The honourable Member for North Slave, Mr. Lafferty.

Thank you, Mr. Lafferty. Item 3, Members' statements. The honourable Member for Great Slave, Mr. Braden.

Thank you, Mr. Speaker. Also on the theme of medical travel, I can follow up very directly with the comments by my colleague from Tu Nedhe, who spoke of the need to move around the North by a number of means, by aircraft, by car, sometimes by boat or even snowmobile. Those are all major challenges for the patient but, Mr. Speaker, what I would like to talk about today is highlighting the needs of the families and the caregivers of patients.

In the NWT, Mr. Speaker, my understanding is that we have very limited facilities, if any at all, for the assistance of the families and caregivers to be with loved ones and with close friends when they are forced to be out of town for medical care. This is something that I know has great value and benefit to both the patient and their extended family and friends. To help serve this genuine need, there are institutions in southern Canada and other parts of the world. I think the one most familiar to Northerners would be Ronald McDonald House, which is a corporate system that provides exactly this kind of service.

Here in the North, our medical and our health care system is still growing and maturing. Mr. Speaker, I wanted to highlight the needs of caregivers and family members in support of patients who are out of town, either in various facilities in the NWT or perhaps in southern Canada. During question period, Mr. Speaker, I will be asking the Minister about what kind of information and what kind of assistance our government provides for this.

-- Applause

Thank you, Mr. Braden. Item 3, Members' statements. The honourable Member for Thebacha, Mr. Miltenberger.

Thank you, Mr. Speaker. As the MLA for Thebacha, I as well have some questions about medical travel...

-- Laughter

...however, today I would like to recognize in this House a significant milestone of one of my constituents. As we speak, there is a birthday party going on in the Northern Lights Special Care Home for Dora Tourangeau, who is 97 years old today.

-- Applause

On behalf of myself and the Members of this House, I would like to extend to her our best wishes. This fine lady, one of the respected elders of our community, has lived through a tremendous part of the history of the Northwest Territories, parts that none of us will ever know and can only read about in the history books. Some of this stuff we will never read about in the history books. She is a fine lady. I know her well and I would like to thank you for your support as we wish her the best on this, her 97th birthday. Thank you.

-- Applause

Thank you, Mr. Miltenberger. I believe she is well known to Fort Smith folks as Auntie Dora, and happy birthday to her. Item 3, Members' statements. The honourable Member for Nahendeh, Mr. Antoine.

You will be there in spirit, Mr. Antoine. Item 3, Members' statements. Item 4, reports of standing and special committees. The honourable Member for Frame Lake, Mr. Dent.

Thank you, Mr. Speaker. I have a report on medical travel in the Northwest Territories presented by the Standing Committee on Accountability and Oversight.

Mr. Speaker, health care in the Northwest Territories continues to be a top priority for many residents and for this Legislature. As our population grows and ages, we can expect to see additional demands on the health system, particularly in the area of medical travel. Many insured services are not available in the smaller communities. Therefore, residents must travel to regional centres for services and/or treatment. Even in the regional centres, not all hospitals are fully equipped to provide all insured services, and in these instances, the Government of the Northwest Territories has a medical travel policy that applies to eligible persons.

Mr. Speaker, the policy states that:

The Government of the Northwest Territories will provide medical travel benefits to eligible persons in the Northwest Territories who must travel in order to access necessary and appropriate health services.

That is from Medical Travel Policy 49.06.1, statement of policy.

Mr. Speaker, the policy further states that the Government of the Northwest Territories will adhere to the following principles in implementing this policy:

1. The Canadian health care system is based on universal access to insured health services;
2. The cost of medical travel should not be an economic barrier to insured health services; and
3. The Government of the Northwest Territories is committed to reducing the economic barriers to insured health services.

Mr. Speaker, that is from Medical Travel Policy 49.06.2.

Mr. Speaker, members have raised concerns respecting the application of various aspects of the policy, including eligibility, provision and level of benefits on medical travel, inter-community transportation, escorts, patient boarding and local transportation of indigent patients.

The Standing Committee on Social Programs, in its report on the review of the 2002-2003 Main Estimates, had this to say about medical travel, and I quote:

The Standing Committee on Social Programs has commented on their concerns about the application of the department's medical travel policy in past reports to this Assembly. Many of the complaints that MLAs get from their constituents are about the uneven application of the medical travel policy by the individual health authorities.

As well, because many extended families have relatives in different health authorities, they talk about the differences of application for each authority. The lack of perceived consistency breeds resentment between communities and families.

Members of the committee look forward to the results of the review of the extended health benefits that is currently underway. There is hope that as a result of this study, a clear, concise and evenly applied policy on medical travel can be developed and communicated to the residents of the Northwest Territories.

Mr. Speaker, members of the Standing Committee on Accountability and Oversight have chosen to use the theme of medical travel in their Members' statements and questions today. Mr. Speaker, that concludes the report of the Standing Committee on Accountability and Oversight on medical travel in the Northwest Territories.

Therefore, I move, seconded by the honourable Member for Hay River North, that Committee Report 5-14(5) be received and adopted. Thank you, Mr. Speaker.

Thank you, Mr. Dent. There is a motion on the floor. The motion is in order. All those in favour? Thank you. All those opposed? Thank you. The motion is carried. Committee Report 5-14(5) has been received and adopted.

Item 4, reports of standing and special committees. Item 5, returns to oral questions. Item 6, recognition of visitors in the gallery. Item 7, oral questions. The honourable Member for Deh Cho, Mr. McLeod.

Thank you, Mr. Speaker. Mr. Speaker, my question is for the Minister of Health and Social Services. Mr. Speaker, our communities are small and close-knit in the North and people share their experiences. They discuss issues such as health and medical travel. They compare notes.

I would like to ask the Minister if he can tell me what the criteria or the approval process is for non-medical escorts. Who has the authority to approve escorts? Thank you, Mr. Speaker.

Thank you, Mr. McLeod. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, the Member pointed out an issue that we have recognized, which is the lack of consistency of the application of this policy. There is a medical travel unit in Stanton. As well, it is administered through Inuvik, Yellowknife and Fort Smith. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. McLeod.

Thank you, Mr. Speaker. The Minister has indicated that there are some problems in the Non-Medical Travel Program. I understand there are two different programs. One is federally funded and the other one is GNWT funded. I would like to ask the Minister, can he tell me if the criteria for the escorts is the same for both programs? Thank you.

Thank you, Mr. McLeod. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, as far as I know, they are the same.

Thank you. Supplementary, Mr. McLeod.

Thank you, Mr. Speaker. I would like to ask the Minister, as the administrator of the fund, does the department have the authority to grant approval on behalf of the NIHB program, the Non-Insured Health Benefits Program? It is my understanding that there is a requirement for prior approval for this program. Thank you.

Thank you, Mr. McLeod. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, I am not quite sure of the question. I know that we administer the NIHB program and there are prior approvals required in the case of some procedures and some specific issues. We use the chart of benefits as provided by NIHB. Thank you.

Thank you, Mr. Minister. Final supplementary, Mr. McLeod.

Thank you, Mr. Speaker. Just recently, I had the opportunity to review the medical travel policy and the criteria for non-medical travel escorts. I was surprised to find that there is a provision for a second non-medical escort. It is only provided in rare situations. I have requested compassionate travel and different types of approvals before and have never been successful. What are the circumstances that the Minister will approve a second escort under?

Thank you, Mr. McLeod. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, those are looked at on a case-by-case basis. It is an approval that is granted by the deputy. Thank you.

Thank you, Mr. Minister. Item 7, oral questions. The honourable Member for Mackenzie Delta, Mr. Krutko.

Thank you, Mr. Speaker. Mr. Speaker, regarding my Member's statement on travel and transportation from communities to regional centres and who makes those decisions, I would like to ask the Minister of Health and Social Services, can he tell me the policy on how people from communities I represent are transported to the hospital, say in Inuvik?

Thank you, Mr. Krutko. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, clearly the intent is to ensure the patient being referred is transported to the nearest medical centre in the most efficient way possible. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Krutko.

Thank you, Mr. Speaker. Mr. Speaker, I would like to know who makes the decision about what type of transportation is used. Is it going to be road transportation, air transportation? Who makes that decision?

Thank you, Mr. Krutko. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, it would be, as far as I am aware, the call of the people on the ground where the patient is and where the requirement is. The determination would be made between the community and the facility they are being transported to. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Krutko.

Thank you, Mr. Speaker. Mr. Speaker, I think one of the fundamental problems we see in our small communities is the lack of consistency in services, like doctors and specialists, coming into our communities. Right now, it is pretty apparent that this medical travel is a necessity to basically get to a doctor or a specialist.

Could the Minister tell me, is there anything in the works to ensure that we will have a means of transporting people without having to follow this policy? If it is apparent that it is a policy that is the only means of getting that service, will that be allowed without having to go through this policy?

Thank you, Mr. Krutko. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, very clearly, we have recognized that there are issues with this particular policy. In fact, with the whole supplementary health benefits program. That is why we are taking the steps to do the review I indicated during the review of the main estimates.

The issues raised by my colleagues in their Members' statements, the co-payments, the medical travel, the coordination issues, the lack of consistency, are all things that we are going to be looking at. We are going to be coming back to the Legislature and the committees, as well as the health boards and other stakeholders, to make sure we come up with a policy that better reflects the realities we face today. Thank you.

Thank you, Mr. Minister. Final supplementary, Mr. Krutko.

Thank you, Mr. Speaker. I was not too sure if that was a yes, maybe or we are not too sure, but my next question flip-flops my original question. If you are not able to ensure that travel will be a means of providing medical service, will you increase the amount of doctors and specialists that go into our communities? Instead of having a doctor go in once a month, they go in two or three times a month so we do not have to continue to transport our people to the regional centres?

Thank you, Mr. Krutko. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, in addition to trying to improve the Medical Travel Policy and the other supplementary health benefits programs, we are also, through the action plan, looking at the service model we are going to use and the service levels in the communities.

We recognize once again, very clearly, that the service into the smaller communities with specialists, dentists and doctors would be better if it could be improved. We are also trying to make sure that we staff the existing vacancies amongst doctors.

I would like to say that yes, we are attempting to improve both of those areas. Thank you.

Thank you, Mr. Minister. Item 7, oral questions. The honourable Member for Hay River North, Mr. Delorey.

Thank you, Mr. Speaker. Mr. Speaker, as I alluded to earlier in my Member's statement, the Department of Health and Social Services has a number of brochures outlining current programs provided under the auspices of the department. This does provide some information to patients having to travel outside of their home communities for treatment, but I think more needs to be done in the area of accurate information sharing with regard to medical travel.

Would the Minister please advise where in the brochures put out by the department is there mention of a co-payment for patients having to travel outside of their home communities for medical attention? Thank you, Mr. Speaker.

Thank you, Mr. Delorey. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, based on my colleague's Member's statement and his review of the brochures that he commented on in terms of their quality, with the exception of the one gap that nowhere is the $250 mentioned, I would say that it is not mentioned. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Delorey.

Thank you, Mr. Speaker. Would the Minister please advise how the Department of Health and Social Services deals with a patient who is above the indigent income level but given the circumstances, just cannot afford the co-payment of $250 that is required for medical travel outside of their home communities? Thank you, Mr. Speaker.

Thank you, Mr. Delorey. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, very clearly, the policy is there to be followed. I do not believe that in any case, our patients and residents have been denied any kind of critical medical treatment, but the policy is there to be followed. There are probably some exceptions. Are there specific exceptions? I would have to get the Member to give me the specific instances and we would have to look at that. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Delorey.

Thank you, Mr. Speaker. Mr. Speaker, could the Minister inform us what level of involvement private citizens have had as stakeholders in the current review of the action plan being administered by the department? Thank you, Mr. Speaker.

Thank you, Mr. Delorey. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, the action plan is based on about eight to ten years of work of consultants, special committees, Ministers' forums, where there were thousands of people interviewed and recommendations made. It is also based on input from the health boards and authorities, the department itself and various other stakeholders within the Northwest Territories.

The action plan that was developed had significant input. We are also ensuring, through the new structures, policies and approaches with the health boards and authorities, that the department and the authorities and the communities they represent are at the table. Thank you.

Thank you, Mr. Minister. Final supplementary, Mr. Delorey.

Thank you, Mr. Speaker. Mr. Speaker, the Minister may have alluded to this before, but would the Minister commit to reviewing the current brochures produced by the Department of Health and Social Services, in view of having more information disseminated to the public? Specifically in the area of co-payments for patients having to travel outside of their home communities for medical travel. Thank you, Mr. Speaker.

Thank you, Mr. Delorey. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, I would like to thank the Member for his perception, observations and suggestions. Yes, we will definitely consider and deal with the issue he has identified as a gap as we look at the overall supplementary health care programs. Thank you.

Thank you, Mr. Minister. Item 7, oral questions. The honourable Member for Yellowknife South, Mr. Bell.

Thank you, Mr. Speaker. My question is for the Minister of Health and Social Services as well. It is about third-party insurance. I am wondering if there is any reason why this government cannot set up a scheme to act as a third-party insurer for people who are not eligible under any other plan? Thank you.

Thank you, Mr. Bell. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, I and the department are prepared to look at any options that would improve health care services to all of our people and eliminate any gaps or barriers that may be there, perceived or otherwise. Is there a particular impediment? I am willing to look at anything that the Member, the Social Programs Committee or this Legislature would suggest as we look at this particular component of the health care system. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Bell.

Thank you, Mr. Speaker. I am glad to hear that the Minister is willing to look at that, because I believe we are already a third-party insurer. If you look at the example of the Metis Health Benefits Policy. That is a perfect example, Mr. Speaker. Would the Minister agree that we are already in the business of providing third-party insurance in some cases? Thank you.

Thank you, Mr. Bell. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, I would agree that we provide services to all people in the Northwest Territories in one form or another, and that the issue my colleague raised is one I am committed to look at. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Bell.

Thank you, Mr. Speaker. I guess what I am saying is, rather than having different policies to cover Metis, seniors, children under two, the indigent, I am hoping this Minister would look at one policy that would provide health benefits assistance to residents who do not qualify. Would the Minister look at amalgamating these programs and expanding them to include everybody? Thank you.

Thank you, Mr. Bell. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, very clearly, the intent of this review is to come up with a better way of providing this service. I look forward to the results of the committee doing the work, the working group doing this review, and what they bring back.

My colleague has raised some very important points. As we speak, we all know there are officials in the department making note of the concerns. As well, we will be looking at Hansard to make sure we have all of the concerns correctly. Thank you.

Thank you, Mr. Minister. Final supplementary, Mr. Bell.

Thank you, Mr. Speaker. Just quickly, I am wondering if the Minister can tell us when we can expect the results of this review? Thank you.

Thank you, Mr. Bell. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, given the difficulty we have had, having put out two RFPs and the fact that we are now having to do this internally as the best way to do this, I would hope that by the fall session we would have a package, if not before, to put before the Social Programs Committee and this House. Thank you.

Thank you, Mr. Minister. Item 7, oral questions. The honourable Member for Frame Lake, Mr. Dent.

Thank you, Mr. Speaker. Mr. Speaker, my question is for the Minister of Health and Social Services. It also relates to the issue of medical travel. Mr. Speaker, if a person cannot afford the co-payment, where do they go for help? Thank you.

Thank you, Mr. Dent. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, the Indigent Health Benefits Program is there to assist those who are not able to afford that particular cost. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Dent.

Thank you, Mr. Speaker. The Minister did not answer the question. Where do they go for help? How does someone become certified as indigent? Do they have to be living on the small basket of food that we saw out in the Great Hall yesterday, living in abject poverty before they can qualify? Thank you, Mr. Speaker.

Thank you, Mr. Dent. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.

Thank you, Mr. Speaker. Mr. Speaker, we will be using similar criteria in terms of what I believe is what is done with income support. Abject poverty and the terms my colleague used are not ones I would necessarily agree with. It is a process to ensure that no one falls through the safety net and if there is a gap, hopefully we can identify that and close it. Thank you.

Thank you, Mr. Minister. Supplementary, Mr. Dent.

Thank you, Mr. Speaker. Mr. Speaker, is there any distinction between the emergency medical travel and non-emergency medical travel when it comes to the co-payment? Do we charge the co-payment in both situations?

Thank you, Mr. Dent. The honourable Minister responsible for the Department of Health and Social Services, Mr. Miltenberger.