Non-insured Health Benefits for First Nations and Inuit People: an Overview for Information Providers

Abstract

The Non-insured Health Benefits (NIHB) program provides First Nations and Inuit people in Canada with coverage for a limited range of medically necessary goods and services. These can include prescription drugs, dental care, vision care, medical supplies and equipment, short- term crisis counselling, and medical transportation (1). This article provides health librarians and other providers of consumer health information with some background on the program, differing perspectives on the legal and treaty requirements for service provision, the health literacy implications, and the role of a Treaty 7 NIHB Navigator in service delivery. Background and perspectives on the provision of NHIB Health care has been perceived in vastly different ways by government and First Nations people. Government support of medical services for First Nations, Inuit, and Metis people has a long history and various departments have been responsible over the years. The Medical Services Branch of Health Canada (MSB) was created in 1962 when various field services were merged with the Indian Health and Northern Health Services. MSB was renamed the First Nations and Inuit Health Branch in 2000 and now administers NIHB (2). The federal government claims the NIHB program supports registered First Nations and recognized Inuit in reaching an overall health status comparable to other Canadians. Though their health status is not equal and comparable, First Nations and Inuit people continuously work to ensure their health needs are met and are equal to other Canadians, and they assert that health benefits are an inherent Aboriginal and Treaty right and are constitu- tionally protected (3). In 1974, the federal government's position was written in a policy that stated there were no statutory or treaty obligations for providing health services to Indians, though the federal government would provide services and give financial assistance when medically necessary (2). They had also previously noted in 1957 that under Treaty Six medical care was an obligation, but medical services for all Indians were provided on humanitarian rather than on legal grounds (4). This difference in perspective creates barriers and jurisdictional issues around access to health care for First Nations and Inuit people. Treaty Six is the only treaty that specifically mentions health care in its text, which includes the clause for a medicine chest to be held at the Indian agent's home and offers emergency help, for example during epidemics. These clauses have been interpreted in various ways, particularly around the extent of care (4). However, the Supreme Court affirmed that the terms of treaties are not limited to the text in the treaty, but rather include the actual agreements between the parties (3). Historical documents show that several other treaty negotiations included discussions about the provision of medical services, but those discussions did not appear in the final text of the treaty (4). In addition to these specific clauses in Treaty Six, there are other supporting arguments around treaty rights and health care. Historical events support the First Nations assertion that medical care was tied to treaty rights. The connection between treaty and health care was solidly entrenched, with doctors frequently in attendance when treaty annuities were paid out, so much so that people at York Factory in Treaty Five spoke out in anger when no doctor accompanied the annuity treaty payments of $5 in 1915 (4). From a First Nations historical perspective, disagree- ments over jurisdiction and responsibility for the delivery of medical services influence current obstacles to access for First Nations and Inuit patients. These obstacles can include funding for the NIHB program, effective commu- nication, limited transportation, and in many cases, limited access to provincial health services and programs if clients reside on reserve. When the Assembly of First Nations (AFN) assessed the NIHB program in 2005, they found that increases in funding levels were only limited to an estimated population growth rate. Health needs and cost drivers were not considered as part of the funding equation (3). As well, cutbacks in the 1990s confused clients as benefits were delisted, eligibility and access changed, and generic drugs were encouraged; these changes continue today. Before certain medications could be accessed at a