INSIGHTS: Gaps in federal oversight leave First Nations patients behind

By Guest Opinion

The Non-Insured Health Benefits (NIHB) program is meant to provide eligible First Nations and Inuit people with access to healthcare services not covered by other publicly funded systems. In principle, it is meant to function seamlessly. In practice, it’s disjointed. 

Bureaucratic hurdles mean both patients and their providers struggle to navigate a system that too often works against those it is meant to serve, creating dangerous gaps in access to care, particularly for people already made vulnerable by addiction, trauma, and chronic illness.

Often, I see a patient at the First Nations Health Centre where I practice who needs a life-saving medication right away.  For most Ontarians, getting access to lifesaving medications that require special approval is relatively easy: providers like me go online and fill out an Exceptional Access Program form for drugs that are not covered on the provincial drug formulary. We do it in real time as part of the process for writing a prescription. 

But if the patient is First Nation, Metis, or Inuit, the process becomes infuriating – and dangerously slow 

The NIHB has no downloadable forms for these situations. A clinician like me must prescribe the medication, then have a pharmacist attempt to fill it, which triggers a rejection at a federal office in Ottawa. The office then faxes a form to me – and that can take 72 hours –  to fill out and wait on an approval.  

In the past, these approvals for payment could take up to 6 weeks – we try to follow up on every rejection for clarification, and have been successful at getting this down to a one week delay. 

But a week is too long. It is little comfort for someone arriving on your doorstep in crisis who is homeless, phoneless, and dealing with nausea or worse from opioid or alcohol withdrawal and needs access to medication immediately.  From a patient or clinician perspective, the process has historically been opaque and difficult to navigate – helpline numbers are buried in small print and that are only staffed from 8am to 4pm Monday to Friday.  

For the average family physician who work in very busy clinics, these limited office hours are almost impossible to follow up with for any rejection and until recently, there is no additional compensation for the hours spent by physicians who work in a fee for services system.

Other barriers to timely care exist too. Dental care is hugely important to the patients I see.  The vast majority of my patients have significant oral health issues and have far less access to dental care than the general population.  The burden of oral health issues is higher in First Nations communities than the general population.  

It is impossible to get a list of dentists or mental health professionals who are NIHB approved.  Patients, clinicians, and administrators are burdened with the additional task of trying to figure out which providers are approved by NIHB for mental health or dental care.  They do not publish or give their lists out which is a significant roadblock for accessing timely care.  

Even worse, the NIHB has a very poor track record of paying dentists and mental health clinicians in a fair and timely manner.  Many procedures or therapies require prior approval and onerous documentation to be submitted in advance.  This results in multiple delays to time sensitive care, prolonged suffering, and ultimately, poorer health outcomes in which family physicians like myself have insufficient skills and training to address these issues on their own beyond intermittently treating acute dental infections with a rotating course of antibiotics.  The hassle and delays are a deterrence, decreasing the number of clinicians who are willing to provide services to First Nations People in the community.  

Finally, the vetting process is quite opaque for these professionals, as outlined in the Investigative Journalism Bureau’s series, and this further undermines the trust by First Nations Communities and by practicing clinicians when they do access NIHB approved mental health or dental clinicians.

The Federal government must be held accountable for the disjointed NIHB, which is failing First Nations and Inuit patients. Urgent fixes must be a priority so that urgent care is equitable and available when its needed.