NWT explores more virtual care as travel costs rise 43% in 5 years

The NWT’s health minister says the cost of medical travel has increased by 43 percent in the past five years, driven by higher travel prices, more complex cases, and more non-medical escorts.

Minister Diane Thom gave the figure in response to questions from Kam Lake MLA Caitlin Cleveland in the legislature on Tuesday. Medical travel is the assistance provided to residents heading south for treatment they can’t access locally.

In the NWT’s most recent budget, $15.8 million is earmarked for medical travel benefits. However, almost $20 million was spent in 2018-19 – around $2 million more than budgeted.

The Department of Finance also sets aside $8.8 million for medical travel assistance provided to territorial government employees.

Last year, medical travel co-payment fees increased for some NWT residents. At the time, the territorial government said the change was needed because the cost of running the program kept going up.

“Number one, the cost for transportation and accommodation has increased,” Thom told the legislature on Tuesday.

“Number two, we have a number of complex cases where patients require travel beyond Edmonton for more specialized care, and also for longer periods of time.”

Thom said there was also an “increased number of non-medical escorts” accompanying patients who needed to travel.

The minister said some steps are being taken to bring costs down. For example, some services – like injections for migraines, skin surveys, and allergy testing – may soon be provided in the NWT, negating the need for a trip south.

What does virtual care mean?

Cleveland wants the territory to combat medical travel costs by significantly investing in improvements to “virtual care” – an evolution of telehealth where medical professionals use technology to deliver care to patients remotely, without travel.

Virtual care is essentially any real-time contact you have with healthcare staff that isn’t in-person. It often involves a patient and doctor meeting long-distance via audio or video for a diagnosis or follow-up.

More complex virtual care could involve southern specialists assisting remotely. At its most basic, virtual care can simply refer to booking an appointment online or emailing healthcare staff.

Those activities may sound simple, but they are by no means readily available.

For example, two 2018 Canada Health Infoway surveys suggested 71 percent of Canadians would like to book appointments online but only nine percent of family physicians offered the option. Sixty-three percent of Canadians would like to email their healthcare provider, the surveys reported, but only 24 percent of family physicians allowed it. (Figures specific to the NWT were not available.)

“Given our growing medical travel costs and the spectre of pandemics, such as the threat of Covid-19,” said Cleveland, referring to the new coronavirus, “now is the time to increase our use of virtual care.

“This will enable the GNWT to sharpen the focus on preventive care and continue to meet the healthcare needs of all northerners in the most cost-effective way possible.”

Asked by Cleveland if the territory’s health officials are developing a virtual care strategy, the minister said that may be coming soon.

“Yes, the department is certainly looking at developing what we are calling a digital care strategy,” said Thom.

“This digital care strategy will help us make decisions about when to use technology to improve patient care in the Northwest Territories.”

National task force

Dr Ewan Affleck, one of the NWT’s most experienced physicians, co-chaired a national “virtual care task force” whose report was published last month.

In that report, the territory is praised for its creation of “a single patient chart shared by all physicians and virtually all health care providers” – allowing a resident’s health information to be easily shared between medical staff. Affleck says the work to achieve that took 17 years.

Stating that “the exchange of health information is the foundational activity for all virtual care,” the report suggests the NWT is well-positioned to expand virtual healthcare.

The task force made 19 national recommendations, including work to make sure health information is more readily exchanged; making it easier for doctors to provide care across regional boundaries; introducing clear, revenue-neutral payment models; and training staff for a world of digital healthcare.

Other recommendations included a “framework for Indigenous virtual care standards” and national accreditation standards for virtual care, similar to those currently used for hospitals and other brick-and-mortar facilities.

The report states: “While the majority of Canadian physicians’ offices and healthcare facilities now use some form of digital record-keeping, and a majority of households have internet access, there is a long way to go in terms of the use of digital technology to provide publicly insured, virtual care.”

Cleveland said on Tuesday: “The demand for virtual care in southern Canada is growing to meet public desire in the digital age. In the North, however, virtual care could literally mean the difference between a person’s access to healthcare or not.

“It is not a desire, but a need.”