This 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

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