Negotiating barriers, navigating the maze: First Nation peoples' experience of medical relocation

Abstract

This study documents the policy framework that shapes First Nations' experience of relocating to access medical care. We analyzed policy documents and government websites, interviewed individuals who have experienced relocation, family members, healthcare providers, health administrators, and conducted two focus groups with government representatives. Federal and provincial program managers interpret policies, make decisions on eligibility, to extend or deny coverage. Decisions are shaped by shrinking budgets, fragmented program coverage, and jurisdictional confusion. Provider advocacy can help, but also perpetuate perceptions of arbitrariness and distrust. National policy renewal is required to redress this issue.Sommaire : La pr esente etude documente le cadre strat egique qui façonne l'exp erience de d eplacement des Premières Nations pour avoir accès aux soins m edicaux. Nous avons analys e des documents de politiques et des sites Web gouvernementaux, interview e des personnes qui ont dû d em enager, des membres de ces familles, des prestataires de soins de sant e, des administrateurs de services de sant e, et avons men e deux groupes de concertation avec des repr esentants gouvernementaux. Les gestionnaires de programmes f ed eraux et provinciaux interprètent les politiques, prennent des d ecisions relatives a l'admissibilit e, pour accorder ou rejeter la couverture. Les d ecisions sont dict ees par des compressions budg etaires, une fragmentation des champs d'application de programmes, et une confusion d'ordre juridictionnel. Les activit es d'intervention men ees par les prestataires peuvent aider, mais elles peuvent egalement perp etuer des perceptions de proc edure arbitrale et de d efiance. Un renouveau de la politique nationale est n ecessaire pour redresser cette situation.

Implementing Indigenous community control in health care: lessons from Canada

“…16 Funding for community health services is based on historical expenditures in that community, and this is for the most part non-negotiable. 6 Once the community health plan has been approved by the federal government, community control can be implemented. Communities can choose to sign an agreement alone or as part of a multicommunity consortium.…”

“…In the Canadian context, community control over these services has been constrained by a disconnect between resourcing and needs, as well as some contractual inflexibilities, which, at times, undermine responsiveness. 6,7 Australia has established a multiplicity of Commonwealth, state and territory funding programs for community-controlled PHC 8 in response to community activism in the 1970s. The Aboriginal Community Controlled Health Organisation (ACCHO) sector has grown substantially over the past 40 years, largely through the funding of community-initiated submissions.…”

Is geographical isolation associated with poorer outcomes for Northern Manitoba First Nation communities?

“…Second, Indigenous scholars and proponents have advocated for many years for shifting the focus of research to be more We acknowledge that this study has limitations. First, the hospitalization rates for ACSC do not reflect the quality of acute care and supportive services in the community, nor does it reflect delays in diagnosis, and medical transportation issues in FN communities (30). Also, the study does not control for many social determinants of health (e.g.…”

Medicare and the care of First Nations, Métis and Inuit

“…Only if denied would the IHS consider some assistance. This may be understood as the birth of the payer of last resort principle, now entrenched in FNIHB's policies (Lavoie et al, 2015). IHS staff were directed to focus on prevention and education, and to continue to work to 'get out of the hospital business' (Lux, 2016: 130).…”

“…Examples include the demise of the FNIHB dental programme, the on-going erosion of the prescription drug formulary, and capped funding for on-reserve health services. Collectively, the result has been declining per capita health care expenditures at a time when communities are managing more and more complex health care needs (Lavoie et al, 2005(Lavoie et al, , 2015Lavoie, 2016). These disinvestments in prevention and early intervention programmes are likely to contribute to the disproportionate rates of preventable hospitalization documented for First Nations and Inuit (Shah et al, 2003;Lavoie et al, 2010;British Columbia Provincial Health Officer, 2009;Carrière et al, 2016).…”