Opening Statement to the Standing Committee on Public Accounts

Health Canada - First Nations Health: Follow-up
(Chapter 15 - October 2000 Report of the Auditor General)

Mr. Chairman, thank you for the opportunity to present the results of our follow-up audit of First Nations Health, reported in Chapter 15 of our October 2000 Report. With me today is Ronnie Campbell, the principal who was responsible for the audit.

We found that Health Canada had initiated action to address the observations and recommendations in our 1997 audit. However, we are concerned that it has not made sufficient progress to fix many of the problems we identified.

Some of the corrective action, particularly relating to funding recipients' responsibility, requires that Health Canada work with First Nations leaders and health professionals. It has more control in other areas such as designing programs and specifying contract requirements.

We are concerned, Mr. Chairman, that the Department's management of contribution agreements is still weak. There is still some overlap between program objectives, many of which are not clear. While there is still considerable room for improvement, Health Canada has had some success in working with First Nations to improve the reporting required of them under contribution agreements.

The Department continued its initiative of transferring health programs to First Nations control, providing greater flexibility in how they deliver programs. However, there remain important reporting requirements - some of which are not being met. These include updating Community Health Plans, and meeting requirements for audits, annual reports and evaluations.

Another concern is the Department's management of Non-Insured Health Benefits. A point-of-service system was put in place to facilitate timely intervention by pharmacists when the system identifies potentially inappropriate prescription drug use.

We found that Health Canada had not adequately monitored pharmacists' overrides of these warnings; nor had it conducted sufficient analysis to indicate how clients were getting very large numbers of prescriptions.

The Department did have some early success intervening in cases where misuse of prescription drugs was suspected. This intervention involved following up with clients, physicians, pharmacists, and professional bodies.

Despite some positive impact, however, this intervention was stopped in May 1999 because management was unsure that this approach was appropriate in the absence of either client consent or specific statutory authority for the program. The number of cases of access to large amounts of central nervous system drugs started to increase again. The Department needs to follow up on these cases.

At the time of our audit, Health Canada was considering options to address this situation. Your Committee, Mr. Chairman, may wish to ask Health Canada for information on its progress.

We remain concerned about Health Canada's management of its claims-processing contract. We observed that the Department has been slow to develop an appropriate audit strategy and that there was a significant gap between the depth of the audit coverage and the overall risk of the program. In addition, the contractor had completed few of the required on-site audits of pharmacies and dental providers.

We did find, Mr. Chairman, that the Department has resolved the problems with the system edits that identify duplicate claims. It also has successfully implemented a pre-determination process for dental benefits that has resulted in substantial savings.

Improving the health of First Nations is a complex task. We believe that timely and complete implementation of our recommendations would contribute to improving the health services to First Nations.

Mr. Chairman, that concludes my opening statement. I would be pleased to answer your Committee's questions.