Thank you, Mr. Chairman. The standing committee on legislation considered Bill 3, An Act to Amend the Medical Care Act, on two occasions, May 25th and June 16th of 1992. At each meeting, the standing committee was grateful to the Minister of Health, the Hon. Nellie

Cournoyea, and her officials for attending to present the bill and to respond to questions and comments from committee Members.

The standing committee also appreciates input received from the NWT, Medical Association and the NWT Health Care Association as part of the new and more public legislative process that has been adopted by this 12th Legislative Assembly.

Mr. Chairman, Bill 3 would amend the Medical Care Act to make it possible for the Medical Care Plan to make payments to physicians who choose to be paid on a basis other than a fee-for-service basis. The current act does not provide this option with respect to medicare funds. This amendment would allow other forms of payment such as salary, contractor sessional remuneration, where appropriate, based on agreements with the department's director of medical insurance.

Presently within the NWT, some physicians employed by hospital boards or regional health boards are paid by salary. Other physicians are engaged by contract on a per diem basis. These arrangements can be made through health and hospital board budgets but not directly by medicare.

The Department of Health has taken the position that this is inefficient and obscures actual costs. The stated intent of amending the Medical Care Act, then, was to remove a cumbersome administrative process whereby funds had to be processed from medicare accounts to the Territorial Hospital Insurance Services program in order to facilitate payments to doctors who wish to be remunerated on an other than fee-for - service basis.

During its review, the standing committee on legislation received input from the Health Care Association, which represents hospital and health boards across the NWT, and from the NWT Medical Association, which represents physicians. Both these organizations raised concerns about the degree of consultation that had taken place to date with medical practitioners and about a general lack of understanding about this bill which exists within the medical and hospital communities.

As the standing committee considered this consultation issue further, the Minister and her officials assisted by providing a summary of the consultations process that had been undertaken as the bill was being developed. Generally, there does appear to have been a satisfactory level of consultation during the earlier stages of this bill's preparation. Any remaining confusion about the principle and substance of the bill can hopefully be cleared up through the use of normal information-sharing channels between the department and the medical community and perhaps even more effectively through information-sharing channels within the medical community itself.

A second point also received considerable attention from Members of the standing committee on legislation and eventually resulted in amendments being made to Bill 3.During the May 25th public meeting, Members of the standing committee raised concern over potential implications for the health and hospital boards. Currently, the only way in which physicians can be paid on other than a fee-for-service basis is for funds to be made available through Territorial Hospital Insurance Services. This process involves the boards of our hospital and health regions. Bill 3 would have amended the Medical Care Act to enable the director of medical insurance, a senior management position within the Department of Health, to make agreements with physicians for payments other than a fee-for-service basis. The standing committee on legislation expressed concern that this amendment might then create a potential for the Department of Health to circumvent the involvement of hospital and health boards when making contract or salary arrangements with physicians.

It is important to emphasize that the Minister of Health stated clearly at both public meetings that it was not the intention of her department to, in any way, diminish the authority of the boards. However, Members of the standing committee were of the opinion that this should be established right in the legislation, and the May 25th consideration of Bill 3 was stood down so that amendments could be prepared. The new legislative process, approved earlier by the 12th Assembly, includes a procedure whereby bills can be amended at the committee stage. At its evening meeting on June 16th, the standing committee on legislation invoked this procedure and carried a motion to amend Bill 3.

As amended, Bill 3 would still allow the director of medical insurance to enter into agreements for services and make payments other than on a fee-for-service basis. However, in order to do so, the director would first have to obtain the approval of any regional health boards or hospital boards which have been established in areas where residents might be affected by the provision of services under the agreement. That is, if the director of medical insurance wishes to enter into an agreement to pay a salary position directly from medicare funds in Inuvik, the director would, by law, need to obtain the approval of the Inuvik Regional Health Board before doing so. The same would be true for agreements respecting the provision of services in areas served by the Baffin Regional Health Board, Stanton Yellowknife Hospital Board, the Keewatin Regional Health Board, and so on.

Under the new legislative process, the Minister's concurrence is required before a bill can be amended at the committee stage. In this case, the Minister of Health concurred with the standing committee's motion to amend Bill 3. Therefore, the bill that is before honourable Members today differs from the one voted on by this House at second reading in that it includes the requirement that the director of medical insurance must obtain the approval of the respective health or hospital board.

Following the passage of this amendment, Members of the standing committee on legislation were quite satisfied with the bill and at the end of the June 16th meeting passed a motion that Bill 3 was now ready for committee of the whole.