Conducted by Medicine Creek Solutions & Summit Innovations A Policy Issue Paper on Manitoba First Nation Foot Care Services Patient Wait Times Guarantee

Conducted by Medicine Creek Solutions & Summit Innovations

A Policy Issue Paper on Manitoba First Nation Foot Care

Services

Patient Wait Times Guarantee Project


Purpose

• The independent policy review is one component of the PWTG Project’s 3rd phase of activities


Approach

• Document/Literature Review

• Documented Personal Knowledge

• Interviews

• Discussion of Impacts

• Suggested Policy Alternatives


Who is the Problem Affecting?

MFN demographic information– 8.9 % of Manitoban population– 43.35% living off-reserve in 1999– Population figures by tribal council for 1998

and 2008


Who is the Problem Affecting?

Diabetes & Diabetes-Related Complications

• rates for Canadians 45/1000 vs MFNs 203/1000

• 91% of MFN amputations due to diabetes-related complications


What is the Problem?

• Amputation rates 18% higher for MFNs when prevalence of diabetes 4.2 x greater

• Inequitable, inconsistent provision of preventative foot care services in the Region


Who are the Players & Who Offers What?

• Manitoba Health

• Family Services and Housing

• Indian and Northern Affairs (INAC)

• First Nations & Inuit Health (FNIH)– Non-Insured Health Benefit Program (NIHB)– Foot Care Program


Who are the Players & Who Offers What? cont’d

Manitoba Health– Foot care/podiatry is not an insured service in

MB but is in other jurisdictions– The Act provides for prosthetic & orthotic

devices but interpretation limits to post-amputation insoles

– Unclear why preventative care not funded when downstream costs exponentially greater



Family Services & Housing– MFNs living off reserve and receiving

provincial EIA are eligible for MD prescribed foot care services (9 visits per year @ $32 per visit)

– PCH residents must first liquidate personal assets before approved

– Prosthetic & orthotic devices not covered as considered an insured service



Indian and Northern Affairs (INAC)– foot care is considered a health related

provision under NIHB – No provision for foot care services for MFNs

living in PCHs– Discrepancy in entitlements for MFNs based

on place of residency



First Nations & Inuit Health – NIHB– Allied Health Services (including podiatry)

delisted in 1998 as offered through provincial insurance plans

• Resulted in service gaps and inequities

– Cover custom made/modifed foot wear & orthotics but not therapeutic foot wear

– Travel costs for fittings not covered– Travel for podiatry discontinued in 2005– Travel for traditional healers covered


NIHB vs Other Federal Plans

– Veteran’s Affairs– RCMP Benefits– Inmate Benefits

NIHB covers considerably less



FNIH – Foot Care Program: a 3 tiered system

– Where funding exits the levels are disproportionate to the population

34

21

9

0 5 10 15 20 25 30 35

Number of Communities

None

Basic

Basic & Advanced

Lev

el o

f S

ervi

ce

Chart 1: Levels of Community-Based Foot Care Services


What Were the Policy & Practice Shifts?

Chronology of Foot Care Related Events

1998

NIHB delists AHS

$176K goes to

Foot Care Program

In MB

2000

Some southern

cmtys accessing services;

SOAs sought for

equity

May 2000

NMU offers U of M funded

Pilot project in

IL

2002/03

Begin negotiating

CAs;NMU

prepares Cost-

BenefitAnalysis

2004

NMU contract$150K

For Island Lk &

Norway House

Jan 2003

NMU Proposal

Not funded

2005

FNIH Internal

ProposalNot

funded;Medical

Transpor Changes

2007/08

NMU contract

expanded $258K

add SE fly-ins

Apr 2007

MFN- PWTG Pilot

Project funded

Sep 2008

NMU servicing 9

communities

2005

MFNDC proposal revised;

DIP funded

2002

MFNDCProposal

Not funded


How Concerned Should We Be?

Diabetes-related amputations projected by Blanchard, Wadja, and Green

370

95

535

185

690

300

850

445

0

100

200

300

400

500

600

700

800

900

No

. o

f A

mp

uta

tio

ns

1995 2005 2015 2025

Year

Chart 2: Projected Number of Lower Limb Amputations Among Manitobans with Diabetes By Status

General

Status


How Concerned Should We Be?

Immeasurable Costs to MFNs and considerable costs to the healthcare system

$7.70

$15.05

$24.40

$36.19

$0

$5

$10

$15

$20

$25

$30

$35

$40

Co

st i

n M

illi

on

s

1995 2005 2015 2025

Year

Chart 3: Projected Costs for Diabetes-Related Amputations For Manitoba Registered First Nations


Estimated Regional Foot Care Program Costs

NMU Proposal 2003– $914,000

Internal FNIH Proposal 2005– $1.027 Million


What Needs to Change?Policy Alternatives

First Nations and Inuit Health

1. Recognize program provisions, accept mandate for foot care programming, develop policies, secure program funding from TB

2. Equity—all communities have access to basic foot care—implement original plan.

3. Consistency—develop a funding formula to ensure programs are adequately resourced to decrease wait times

4. Funding Envelopes5. NIHB Travel—provide travel for urgent podiatry visits and

shoe fittings6. Therapeutic Shoes—reimburse clients for therapeutic shoes


What Needs to Change? Policy Alternatives

Indian and Northern Affairs

1. Increase PCH institutional funding to include foot care programming

2. Cover the foot care costs for clients in off-reserve PCH


What Needs to Change? Policy Alternatives

Manitoba Health

1. Cover Podiatry as an insured health service

Documents

Conducted by Medicine Creek Solutions & Summit Innovations A Policy Issue Paper on Manitoba First Nation Foot Care Services Patient Wait Times Guarantee