1. A Policy Issue Paper on Manitoba First Nation Foot Care Services
Patient Wait Times Guarantee Project
Conducted by Medicine Creek Solutions & Summit Innovations

2. Conducted by Medicine Creek Solutions & Summit Innovations
Purpose
The independent policy review is one component of the PWTG Project’s 3rd phase of activities
Conducted by Medicine Creek Solutions & Summit Innovations

3. Conducted by Medicine Creek Solutions & Summit Innovations
Approach
Document/Literature Review
Documented Personal Knowledge
Interviews
Discussion of Impacts
Suggested Policy Alternatives
Conducted by Medicine Creek Solutions & Summit Innovations

4. 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
Both population figures included to demonstrate populations at the onset of foot care funding in the region as well as the population growth since that time.
Conducted by Medicine Creek Solutions & Summit Innovations

5. 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
Both population figures included to demonstrate populations at the onset of foot care funding in the region as well as the population growth since that time.
Conducted by Medicine Creek Solutions & Summit Innovations

6. Conducted by Medicine Creek Solutions & Summit Innovations
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
Conducted by Medicine Creek Solutions & Summit Innovations

7. 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
Conducted by Medicine Creek Solutions & Summit Innovations

8. Who are the Players & Who Offers What? cont’d
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
Conducted by Medicine Creek Solutions & Summit Innovations

9. Who are the Players & Who Offers What? cont’d
Family Services & Housing
MFNs living off reserve and receiving provincial EIA are eligible for MD prescribed foot care services (9 visits per $32 per visit)
PCH residents must first liquidate personal assets before approved
Prosthetic & orthotic devices not covered as considered an insured service
Conducted by Medicine Creek Solutions & Summit Innovations

10. Who are the Players & Who Offers What? cont’d
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
ie Dakota Oyate Lodge in Sioux Valley
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11. Who are the Players & Who Offers What? cont’d
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
Implied that these services were available nation wide, which is not the case
Conducted by Medicine Creek Solutions & Summit Innovations

12. NIHB vs Other Federal Plans
Veteran’s Affairs
RCMP Benefits
Inmate Benefits
NIHB covers considerably less
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13. Who are the Players & Who Offers What? cont’d
FNIH – Foot Care Program: a 3 tiered system
Where funding exits the levels are disproportionate to the population
Conducted by Medicine Creek Solutions & Summit Innovations

14. What Were the Policy & Practice Shifts?
Chronology of Foot Care Related Events
Conducted by Medicine Creek Solutions & Summit Innovations

15. How Concerned Should We Be?
Diabetes-related amputations projected by Blanchard, Wadja, and Green
Conducted by Medicine Creek Solutions & Summit Innovations

16. How Concerned Should We Be?
Immeasurable Costs to MFNs and considerable costs to the healthcare system
Note the costs associated with amputations in 2005 were $15M
Conducted by Medicine Creek Solutions & Summit Innovations

17. Estimated Regional Foot Care Program Costs
NMU Proposal 2003
$914,000
Internal FNIH Proposal 2005
$1.027 Million
Conducted by Medicine Creek Solutions & Summit Innovations

18. 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
Equity—all communities have access to basic foot care—implement original plan.
Consistency—develop a funding formula to ensure programs are adequately resourced to decrease wait times
Funding Envelopes
NIHB Travel—provide travel for urgent podiatry visits and shoe fittings
Therapeutic Shoes—reimburse clients for therapeutic shoes
Conducted by Medicine Creek Solutions & Summit Innovations

19. 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
Conducted by Medicine Creek Solutions & Summit Innovations

20. What Needs to Change? Policy Alternatives
Manitoba Health
Cover Podiatry as an insured health service
Conducted by Medicine Creek Solutions & Summit Innovations