Non-Insured Health Benefits Program Research Articles

First Nations and Inuit mental health and the Non-Insured Health Benefits program: Urgent priorities for evaluation.

The mental health needs and disparities facing First Nations and Inuit in Canada far exceed those of the general population and yet accessing culturally safe care remains a serious challenge. One means for accessing mental health care is through the Non-Insured Health Benefits (NIHB) mental health counselling program run by Indigenous Services Canada. However, evaluations of the efficacy of the NIHB's mental health counselling program remain entirely absent in the academic literature and this is startling given that this program receives significant federal funding to care for a population that experiences extreme marginalization. The following commentary will present three challenges observed with the present state of the program in the areas of service accessibility, the need for an Indigenous mental health workforce, and culturally safe care. For each challenge presented, we make recommendations on how to improve the program in its current state. The conclusion of this article advocates for a broader evaluation of the NIHB mental health counselling program from the perspective of its service users and its registered mental health professionals. This type of evaluation is commensurate with the Calls to Action outlined by the Truth and Reconciliation Commission of Canada.

Policy for First Nations Self-Determination in Health: An Analysis of Problems, Politics, and Policy Related to Medical Travel in Northwest Territories

Medical travel, where a patient travels to a larger centre for services not available in their home community, is a critical element of the Northwest Territories (NT) health care system. For residents with a valid NT health care card who do not have other coverage for medical travel, the territorial government administers some travel benefits through the NT Medical Travel Program as well as the federally funded non-insured health benefits program. The Gwich'in Tribal Council (GTC) recognizes that medical travel constitutes a major burden and presents extraordinary challenges for Gwich'in living in small remote communities in NT. In 2020, the GTC conducted research that suggests current policy and programs provide only partial access to care. Informed by Gwich'in medical travel stories and drawing from literature on the concepts of health care access, knowledge, power, and Indigenous rights, this article reframes prevailing understandings of the problems, politics, and policy associated with medical travel in NT. The authors contend that relevant and equitable medical travel in NT depends on policy-making that engages First Nations as equal partners with different levels of government and describe key considerations relevant to policymakers in NT and throughout Canada.

A Comparison of Pharmaceutical Budget Impact Analysis (BIA) Recommendations Amongst the Canadian Patented Medicine Prices Review Board (PMPRB), Public and Private Payers.

The Canadian budget impact analysis (BIA) guidelines were published by the Patented Medicine Prices Review Board (PMPRB) in 2007. Some Canadian federal, provincial and territorial (F/P/T) drug plans have updated their BIA guidelines since then. The aim of the present review was to provide a comprehensive list of the key BIA recommendations from the various Canadian F/P/T drug plans and private payers and to highlight the differences between those guidelines and the recommendations that were in the Canadian PMPRB 2007 BIA guidelines. We searched the websites of fifteen F/P/T public drug benefit programs including the Canadian Agency for Drugs and Technologies in Health (CADTH) and Non-Insured Health Benefits Program (NIHBP) and five private payers’ websites. An Excel-based data abstraction form was designed to highlight differences between recommendations relating to the BIA key elements made by different guidelines. Eight BIA guidelines (PMPRB 2007, Alberta, British Columbia, Manitoba, Ontario, Quebec, CADTH, and Medavie Blue Cross) were identified and reviewed, and a comprehensive list of recommendations was abstracted. Recommendations were similar to the 2007 guidelines in terms of time horizon duration, comparators, target population assessment and use of direct drug costs in BIAs. Differences were mostly related to actual acquisition cost, such as whether or not to include markups and dispensing fees, the patients’ perspective, cost of supplies, cost of health care utilization, and scenario analysis. The recommendations that were not included in the PMPRB 2007 guidelines but were included in at least one of the Canadian F/P/T or private guidelines were related to the inclusion of the patients’ perspective (i.e., co-payment), the costing, the handling of uncertainty and the reporting format. The present study is a comparative review of recommendations between the Canadian PMPRB 2007 guidelines and the F/P/T or private payers’ BIA guidelines, and provides a most up-to-date list of recommendations for revising the Canadian BIA guidelines, with applicability for both public and private plan new drug submissions in Canada.

Variable access to antiviral treatment of chronic hepatitis B in Canada: a descriptive study.

Antiviral treatment for chronic hepatitis B is costly, which presents challenges for universal drug coverage for the estimated 480 000 people with the disease in Canada. We appraised criteria for reimbursement of chronic hepatitis B antivirals by public drug plans in Canada. In this descriptive study, we reviewed the reimbursement criteria for lamivudine, adefovir, tenofovir, entecavir, telbivudine, pegylated or standard interferon, and emtricitabine-tenofovir in the 10 provinces and the Yukon Territory as well as 3 federal programs: Correctional Services Canada, Veterans' Affairs and the Non-Insured Health Benefits Program. We extracted data from publicly available formularies. The primary outcomes extracted were prescriber details, reimbursement regulations and published list price. All public drug insurance plans limit access to antiviral treatment in patients with chronic hepatitis B based on viral characteristics, fibrosis stage and/or specialist approval. Lamivudine use is restricted only in British Columbia and Ontario. Six plans (43%) cover entecavir or tenofovir with no restriction, and 8 plans (57%) cover these agents if patients have advanced fibrosis/cirrhosis. Nine plans (64%) provide coverage of interferon, although 4 of these programs reimburse only nonpegylated interferon, which is not currently recommended for chronic hepatitis B treatment. We found substantial variability among jurisdictions in reimbursement criteria for the treatment of chronic hepatitis B in Canada. The findings can inform health policy and support the development and adoption of a national chronic hepatitis B strategy to ensure equitable and timely access to treatment no matter where patients reside in Canada.

Variations in survival time for amalgam and resin composite restorations: a population based cohort analysis.

To estimate the association between the restorative material used and time to further treatment across population cohorts with universal coverage for dental treatment. Cohort study of variation in survival time for tooth restorations over time and by restoration material used based on an Accelerated Failure Time model. Primary dental care clinics. Members of Canada's First Nations and Inuit population covered by the Non-Insured Health Benefits program of Health Canada for the period April 1, 1999 to March 31, 2012. Tooth restorations using resin composite or amalgam material. Survival time of restoration to further treatment. Median survival time for resin composite was 51 days longer than amalgam, for restorations placed in 1999-2000. This difference was not statistically significant (p⟩0.05). Median survival times were lower for females, older subjects. Those visiting the dentist annually, and decreased monotonically over time from 11.2 and 11.3 years for resin composite and amalgam restorations respectively placed in 1999-2000 to 6.9 and 7.0 years for those placed in 2009-10. Resin composite restorations performed no better than amalgams over the study period, but cost considerably more. With the combination of the overall decrease in survival times for both resin composite and amalgam restorations and the increase in use of resin composite, the costs of serving Health Canada's Non-Insured Health Benefits population will rise considerably, even without any increase in the incidence of caries.

Inconsistencies in eligibility criteria for medication assessment programs.

I found the January/February 2014 issue of CPJ to be fabulous. I literally read the issue from cover to cover. Kudos to all of the authors and editors. I had one comment on Pammett and Jorgenson’s1 article about eligibility requirements for community pharmacy medication review services. Table 1 in this article summarizes community pharmacy medication review programs in Canada. I note that the eligibility requirements for the Saskatchewan Medication Assessment Program (SMAP) in the table are missing a bit of information—not all individuals age 65 and over and living in the community can access this program. While our pharmacy has embraced the new Medication Assessment Program, it is unfortunate that we cannot provide this service to the 40% of our patients who are First Nations individuals, due to their federal (rather than provincial) drug coverage. In October 2013, I forwarded correspondence to a variety of stakeholders requesting that SMAP coverage be extended to all residents of the province. The only reply I received was from Saskatchewan Health’s Drug Plan and Extended Benefits Branch, which stated, “A decision on the provision of professional pharmacy services such as medication assessments to First Nations individuals would rest with the NIHB [Non-Insured Health Benefits program] at Health Canada.” I have no expectations of any response from NIHB. The conclusion of Pammett and Jorgenson’s article states, “The eligibility criteria used by provincially funded medication review programs in Canada are inconsistent and highly variable, raising doubt that all patients in need of such services are eligible to receive them as an insured health benefit.” Isn’t it unfortunate that across Canada we have such inconsistencies and that even within provinces there are ethnicity-based gaps in program access!

Should vitamin B12 tablets be included in more Canadian drug formularies? An economic model of the cost-saving potential from increased utilisation of oral versus intramuscular vitamin B12 maintenance therapy for Alberta seniors

ObjectiveThe aim of this study was to estimate the cost-savings attainable if all patients aged ≥65 years in Alberta, Canada, currently on intramuscular therapy were switched to oral therapy, from...

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

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

Clinical and Economic Effects of a Therapeutic Substitution Policy for Proton Pump Inhibitors in Aboriginal Patients in Northern Communities in Canada???s Northwest Territories

Background and objective Proton pump inhibitors (PPIs), which are used to treat gastroesophageal symptoms, can vary in price, but are thought not to differ in clinical benefits. Health Canada’s Non-Insured Health Benefits Program instituted a therapeutic substitution policy for PPIs as a cost-containment strategy in 2005. The objective of this pilot study was to identify signals of what might be occurring as a result of this policy in Aboriginal people in northern, isolated communities.