A Policy Issue Paper on Manitoba First Nation Foot Care Services

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A Policy Issue Paper on Manitoba First Nation
Foot Care Services

• Patient Wait Times Guarantee Project

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Purpose

• The independent policy review is one component of
  the PWTG Projects 3rd phase of activities

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Approach

• Document/Literature Review
• Documented Personal Knowledge
• Interviews
• Discussion of Impacts
• Suggested Policy Alternatives

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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

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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

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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

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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

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Who are the Players Who Offers What? contd

• 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

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Who are the Players Who Offers What? contd

• Family Services Housing
• MFNs living off reserve and receiving provincial
  EIA are eligible for MD prescribed foot care
  services (9 visits per year _at_ 32 per visit)
• PCH residents must first liquidate personal
  assets before approved
• Prosthetic orthotic devices not covered as
  considered an insured service

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Who are the Players Who Offers What? contd

• 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

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Who are the Players Who Offers What? contd

• 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

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NIHB vs Other Federal Plans

• Veterans Affairs
• RCMP Benefits
• Inmate Benefits
• NIHB covers considerably less

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Who are the Players Who Offers What? contd

• FNIH Foot Care Program a 3 tiered system
• Where funding exits the levels are
  disproportionate to the population

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What Were the Policy Practice Shifts?

• Chronology of Foot Care Related Events

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How Concerned Should We Be?

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

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How Concerned Should We Be?

• Immeasurable Costs to MFNs and considerable costs
  to the healthcare system

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Estimated Regional Foot Care Program Costs

• NMU Proposal 2003
• 914,000
• Internal FNIH Proposal 2005
• 1.027 Million

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What Needs to Change?Policy Alternatives

• First Nations and Inuit Health
• Recognize program provisions, accept mandate for
  foot care programming, develop policies, secure
  program funding from TB
• Equityall communities have access to basic foot
  careimplement original plan.
• Consistencydevelop a funding formula to ensure
  programs are adequately resourced to decrease
  wait times
• Funding Envelopes
• NIHB Travelprovide travel for urgent podiatry
  visits and shoe fittings
• Therapeutic Shoesreimburse clients for
  therapeutic shoes

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What Needs to Change? Policy Alternatives

• Indian and Northern Affairs
• Increase PCH institutional funding to include
  foot care programming
• Cover the foot care costs for clients in
  off-reserve PCH

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What Needs to Change? Policy Alternatives

• Manitoba Health
• Cover Podiatry as an insured health service