By Ryan Meili
Extra-billing in Ontario, private MRIs in Saskatchewan and user fees in Quebec: violations of the Canada Health Act are on the rise across the country. Canadian doctors are concerned about this trend’s impact on patients and on our public health-care system.
Health Canada publishes an annual report detailing how provincial and territorial health-care insurance plans have (or have not) satisfied the conditions for payment under the Canada Health Act. Provinces not in compliance are to be penalized with reduced Canada Health Transfer (CHT) payments.
This year’s report showed that in 2014-15, the only penalized province was British Columbia. Its payment was docked $241,637. That’s about half the amount in extra billing a 2012 audit found was committed just by Dr. Brian Day’s Cambie Surgery Centre in Vancouver in just one month. B.C. is also the only province seeking to enforce the act, by cracking down on Cambie’s activities.
Physicians and clinics have quietly been charging extra fees for health services for many years, yet calls for the federal government to enforce the act have been ignored. Coming down hard on extra-billing may not sound as exciting as announcing new funding for specialized medical services, but it is the job of provincial and federal health ministers to protect the Canada Health Act and guarantee equitable access to health care.
In Ontario alone, the frequency of such charges has grown at an alarming rate — yet it seems to have escaped the notice of provincial and federal auditors and health ministers. The Ontario Health Coalition published a report in 2014 listing dozens of instances where independent health facilities (e.g. eye surgery, colonoscopy, diagnostic and executive health clinics) charged extra fees for medical consultations, examinations, diagnostic testing and other “upgraded services.” These fees are for services covered by the health system. This is otherwise known as extra-billing, which is against federal and provincial law.
Despite these contraventions, Canada Health Act reports show that Ontario has never been penalized.
This year’s report can be the springboard for federal Health Minister Jane Philpott to assert her government’s commitment to defending medicare, Canada’s most treasured social program.
Where better to start than reminding the premiers of Saskatchewan and Quebec that their recent actions violate the Canada Health Act?
In November 2015, the Saskatchewan government voted to introduce pay-per-use MRI services, allowing those who can pay to jump the queue and receive priority treatment. Premier Brad Wall argued that implementing a parallel diagnostic system would alleviate wait times, ignoring the evidence to the contrary from Alberta’s foray into private MRIs a decade ago. As Wall noted in 2009, these clinics violate the principle of accessibility in the act.
But Philpott can help to stem the tide of privatization in Saskatchewan’s health-care system.
She can also crack down on Quebec, where the National Assembly approved Bill 20 last fall. It enables physicians to charge extra fees for services already insured under public medicare, with no clearly established limits. In fact, many physicians in the province had been charging extra fees for a long time. The government included provisions for extra billing in response to pressure from the Quebec College of Physicians. Instead of coming down against extra-billing as was hoped, Health Minister Gaétan Barrette worked to normalize the practice.
Breaches of the act have never been addressed in Quebec. That’s despite the admission of physicians instituting user fees and extra billing, and calls to stop from Quebec organizations such as Médecins Québécois pour le Régime Public and Fédération des Médecins Omnipraticiens du Québec.
User fees, access charges and extra billing all come down to one thing – inequitable access to Canadian health care.
Charging patients at the point of care for medically necessary services strikes at the heart of the principle that access to health care should be based on need rather than ability to pay. It undermines equity, increases system costs and reduces commitment to universal coverage.
Prime Minster Justin Trudeau’s government promised real change. Philpott, an acclaimed physician, should take a new approach to defending health care by sending a strong statement that the provinces must adhere to the act.
It is time for Philpott to show there is a doctor in the House and ensure medicare will be there for all Canadians in their time of need.
Ryan Meili is a family physician in Saskatchewan, vice-chair of Canadian Doctors for Medicare.