Lavoie, Josee GForget, Evelyn LBrowne, Annette J2019-09-252019-09-252011-02-2120101705-7841http://hdl.handle.net/20.500.12424/176371This paper focuses on how the Indian Act 1985, is contributing to the disintegration of the parallel health care system designed to serve the needs of First Nations people living on-reserve. We use data from the province of Manitoba to illustrate trends that are happening across Canada. Specifically, we estimated First Nations health expenditures for the year 2003–04 for all agencies which share a responsibility for First Nations health services. We then projected these expenditures to 2029. Based on an analysis of First Nations health, we estimate that by 2029, First Nations Health Organizations may face an additional $23M (2004 constant dollars) in health care costs for which they receive no funding. In the last decades, federal policy frameworks have shifted their focus from assimilation to participatory processes and some measure of political autonomy. While attractive, our study shows that current policies entrench jurisdictional gaps, which will result in significant cost-shifting from the federal government to provincial and First Nations authorities. Current funding mechanisms are, however, impervious to this shift. The implication is a potential reduction in access to appropriately funded and responsive primary health care for First Nations people in Canada.engWith permission of the license/copyright holderindigenious ethicshealth ethicslegal ethicsPolitical ethicsMethods of ethicsBioethicsCommunity ethicsEthics of political systemsEthics of lawRights based legal ethicsGovernance and ethicsGeneral and historicalMedical ethicsHealth ethicsEthnicity and ethicsMinority ethicsArticle