Thank you very much, Madam Chair. Madam Chair, I wanted to continue my line of questions that I had from the health and social programs that was out of scope of that section because it's in scope here. And my questions were in regards to specialty services or access to services that are available in the south. And one of the things that we're seeing is that there's a fairly long wait time for different services. And so people are going on to either a waitlist for something that's available down south, or if they can't -- if it's something that is only available down south, they're going on a waitlist for down south. If it's something that is available here and they're on a really long waitlist, they're also pursuing it down south. So it's kind of -- it's two different streams there. And what I'm noticing is that if somebody has a referral for a specialty service and they are on a really long waitlist for down south and they choose to pay out of pocket for that service, they're able to jump the queue. My concern is that is that covered by out-of-territory services for residents? So are residents able to access services they're referred to out-of-territory through this funding pot here in order to gain access to specialty services that they need? Thank you.

Thank you. Minister of Health and Social Services.

Yes, thanks. Thanks for that question. I want to acknowledge that there are waitlists for services and some of that has been driven by COVID, a lack of availability, and that the NTHSSA is developing a catch-up plan for people who are waiting for diagnostic services as well as treatment. So we can't pay for people to jump the queue. That really is contrary to the principles of the Canada Health Act.

So the pathway is a referral from the NWT health practitioner and to provide the services in-territory if at all possible, and if not, then to make a referral to Alberta for the services. And it's worth knowing that if Alberta can't provide the service itself, they sometimes contract those services out to private service providers, but the pathway is still the same. They have to have a referral from here. So my hope is that -- that we will see a catch-up plan for clearing these waitlists but knowing that in some cases, they're quite far behind and the service delivery time could be extended. But, you know, we hope to be able to present you with that information and answer questions once the plan has been completed. Thank you.

Thank you. Member for Kam Lake.

Yeah, thank you very much, Madam Chair. And I think even though the government won't pay for people to jump the queue, people are paying for people to jump the queue. And so I'm going to use I guess a very specific example of that of Northerners travel out-of-territory, for example, to go get an MRI, and they go on a waitlist to go and receive that service. They're referred by a doctor to do that. They go down to Alberta to access that service. But they have to wait on a waitlist to do that. What some residents are able to do is to phone a clinic, get on a list, get down to Alberta, do an MRI, and come home. My concern is is that even though we're -- even though that person is on a waitlist for Alberta, if they set up it themselves, is -- and they have the referral, is the GNWT willing to support that, because, really, they're helping us on that catch-up plan; they're helping us move through that list; and so they're just getting there a different way but still with the same path of having the referral. And so all I'm looking for is us being able to kind of open up how we are working through that catch-up plan by people being able to be a bit more proactive. Because my concern is that if the GNWT can't support that, then healthcare becomes a means of people with means. And so if you don't have the finances to pay for that upfront and somebody else does, then really, it's not equitable access to healthcare. That's my concern there. Thank you, Madam Chair.

Thank you. Minister of Health and Social Services.

Yes, thank you, Madam Chair. Yes, I understand the point that the Member for Kam Lake is making. But I think it's premature to say, yes, that's the path we're going to go. I think that we need to see this catch-up plan. We need to see what kind of services and what the demand is for services before we commit to new ways of meeting that demand, which may include the ideas that the Member has. But at this point, I feel like we need to get a grip on supply and demand in order to understand what that would cost and whether it's feasible. Equitable healthcare is very important, and so I want to endorse that as a principle for looking at this. But the solution is not in hand right now. Thank you.

Thank you. Member for Kam Lake.

No, thank you, Madam Chair, and I appreciate that, and I really look forward to seeing this plan. I think that it'll make a difference to a lot of people. And I guess in creating that plan, I just encourage Health and Social Services to consider all the aspects of someone's life and potentially quality of life and inability to continue to work if their service requirement impacts their ability to go to work. So just those items. Thank you.

Thank you. Are there any further questions from Members under out-of-territory services?

Seeing none, Health and Social Services, out-of-territory services, operations expenditure summary, 2022-2023 Main Estimates, $77,688,000. Does committee agree?

Thank you, committee. We will now move to page 192, 193, with information item on 194. Supplementary health benefits. This is where extended health benefits, medical travel benefits, Metis health benefits are under. Questions? Member for Yellowknife North.

Thank you, Madam Chair. Actually, can the Minister just remind me whether there is a review planned under this area, supplementary health benefits? Thank you.

Thank you. Minister of Health and Social Services.

The status of these different areas is that Metis health benefit qualification was reviewed at the end of 2022 to enable more people to participate. That work is complete. The medical travel was reviewed, and a number of changes were suggested, and that review is complete. The extended health benefits are being reviewed on a phased basis, and so the most recent initiative in this area is the biosimilar initiative, or as they're more commonly called generics. So we are asking patients and doctors to switch to biosimilars, to have those conversations over the next -- I guess there's about four months left in this period now. Over the next four months to look at switching people from biologic drugs to biosimilar drugs. There are more changes planned in this area but they're being phased in over time. Thank you.

Thank you. Member for Yellowknife North.

Thank you, Madam Chair. Yeah, I saw that work being done on biosimilar, and I think it's great work, will save us some money there.

My question is there's been this kind of longstanding question of whether -- so, you know, people get covered under NIHB, seniors get covered under extended health benefits, and over in Finance we have an even bigger section that covers GNWT workers for extended health benefits, and then most employers cover it, and then there's this small section of the working poor who do not have any benefits in the NWT. And we're a very rare jurisdiction in that it is truly a small percentage of people compared to everyone else those other programs getting covered. I'm just wondering if we've done a review of whether extending benefits to them is feasible? And I don't really even know how that would work given it would kind of trigger all of these other employee -- employer provided benefits. But I'm just wondering if that question has been looked into in more detail? Thank you, Madam Chair.

Thank you. Minister of Health and Social Services.

Yes, thank you, Madam Chair. For an answer to this question, I'm going to ask the deputy minister.

Thank you. Deputy minister Cooper.

Thank you. Member for Yellowknife North.

Thank you, Madam Chair. Yeah, that -- I'm very excited to hear that. I think there is a possibility we'd need to be a bit of a leader here in needs testing this and bringing those people in, especially given the -- you know, the variety of other ways you can define extended health benefits.

I guess I had one last question here and whether that review or this phased approach will address the question of dental at all? Dental's also one of those similar areas where there's lots of different ways you can get coverage but there's a percentage of people who in the NWT don't get any coverage. I'm wondering if that's included in this at all. Thank you.

Thank you. Minister of Health and Social Services.