Ottawa plans to crack down on doctors charging for medically necessary health care
Health minister warns federal transfers could be cut if patients are charged for care
Health Minister Jean-Yves Duclos is telling the provinces to put a stop to patients being charged for medically necessary care — and warns that Ottawa will claw back federal health transfer payments if the charges continue.
"I am very concerned with the recent increase in reports of patient charges for medically necessary services," Duclos says in a letter sent Thursday to all provincial and territorial health ministers. Federal officials provided CBC News with a copy.
"No matter where in the country Canadians live or how they receive medically necessary care, they must be able to access these services without having to pay out of pocket."
- Have you paid for a virtual appointment with a doctor? Let us know about your experience in an email to ask@cbc.ca.
Companies charging patients for virtual visits with a family physician are the chief targets of the federal crackdown, according to a senior government official.
Health
Minister Jean-Yves Duclos is telling the provinces to put a stop to
patients being charged for medically necessary care and warns that
Ottawa will claw back federal health transfer payments if the charges
continue. (Tony Davis/CBC)
Although the Canada Health Act prohibits charging "insured persons" for medically necessary services, there has been an explosion recently in the number of companies across the country offering online doctors' appointments and charging fees in the range of $50 to $100 per visit.
Companies that charge a fee get around the Canada Health Act prohibition by connecting the patient to a physician in a different province. Under the medicare rules in the province where the doctor practises, the patient technically would not qualify as an "insured person."
Some critics have called this a loophole in the Canada Health Act.
In his letter, Duclos says expanded access to health care using virtual platforms must remain "true to the spirit and intent of the Canada Health Act."
Duclos says he will give provinces and territories a document clarifying that charges for medically necessary services are not allowed, regardless of where the patient lives.
"The complexities of modern family health, virtual and surgical care, including its provision across jurisdictions, and expanding scopes of practice of health workers, should not be used to permit these charges," the letter says.
Dr.
Pascal-André Vendittoli looks at images of a patient's knee replacement
surgery. He is medical director of the Duval Clinic, a private facility
in Laval, Que., specializing in joint replacements for fee-paying
patients. (Louis-Marie Philidor/CBC)
"As our health care system evolves, it must do so while respecting the Canada Health Act."
One of the biggest players charging for virtual physician care is Maple, which describes itself as "Canada's top-rated virtual care app" and charges $69 or more for an appointment.
"We charge a fee for our services only when they are not covered by provincial health plans," says the company's website.
"We'd love to be eligible for public coverage consistently across Canada and we're working hard to ensure Maple is included in provincial coverage as soon as legislation allows."
It's not clear from Duclos' letter whether the Trudeau government will also crack down on other examples of doctors charging for medically necessary care, recently revealed by CBC News:
- Some for-profit surgical clinics are charging patients who travel from another province up to $28,000 for a hip or knee replacement.
- Doctor's offices in Ontario are offering virtual and in-person appointments with a nurse practitioner for a subscription of about $30 a month.
Nurse
practitioner Olivia Kavanagh sees a three-year-old patient at
Kindercare Pediatrics in Toronto. The clinic is offering patients the
option of rapid access to appointments with a nurse practitioner, for a
monthly fee. (Craig Chivers/CBC)
Duclos' move comes at a time of growing debate over the role of the private sector in the delivery of publicly funded health care in Canada, particularly as provinces struggle with surgical backlogs and staff shortages stemming from the COVID-19 pandemic.
In Parliament in recent weeks, the New Democrats have repeatedly argued that the Trudeau government is allowing increasing privatization of the health system and that for-profit companies are playing a growing role in providing care.
The federal government struck a deal with the provinces and territories last month for a 10-year boost to its annual Canada Health Transfer funding arrangement.
Duclos' letter warns that those transfers could be reduced if patients are charged fees for medical care.
"Canadians pay for their health care services through their tax dollars, and should not be asked to pay again by way of patient charges when they need to access those services," Duclos writes.
"Where instances of patient charges for these services are present, I will pursue a reduction in federal health transfers by an equivalent amount."
Maple
is one of the biggest players in the sector, selling virtual visits
with Canadian physicians starting from $69 per appointment. (Carolyn Ryan/CBC)
Different provinces have different approaches to coverage of virtual medical appointments, and some of the rules have been shifting as the COVID-19 pandemic has waned.
- How do you feel about doctors charging for virtual health care? We want to hear from you. Send an email to ask@cbc.ca.
For instance, as of last December the Ontario Health Insurance Plan (OHIP) covers the cost of virtual or phone consultations only when the patient has an ongoing relationship with a doctor. "Virtual walk-in clinic" visits — with a doctor the patient has not seen face-to-face — are not covered.
That switch hampered the business model of another company offering virtual appointments — Rocket Doctor, which now charges $55 for a doctor visit.
"Virtual primary care and urgent care services are unfortunately no longer a service that patients can access for free on Rocket Doctor," says the company's website, which urges patients to sign a petition calling for that policy to be reversed.
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Federal government to claw back $1.3M of New Brunswick health funding
Amount includes deductions for abortion services, private diagnostic imaging
CBC News · Posted: Mar 10, 2023 4:32 PM AST
Federal government to claw back $1.3M of New Brunswick health funding
Amount includes deductions for abortion services, private diagnostic imaging
"There should be no fees for medically necessary health-care services, wherever people may live in this country," Health Minister Jean-Yves Duclos said at a news conference Friday in Ottawa.
A total of $1,277,659 will be taken back based on a federal estimate of how much New Brunswickers paid for diagnostic imaging such as MRI and CT scans in 2020-21.
A further $64,850 is being clawed back because of abortion access in the province.
The $1,342,509 total represents a sliver of the $1 billion Canada Health Transfer payment from the federal government to New Brunswick for 2023-24.
It represents an even smaller portion of the $3.2 billion the province planned to spend on health in the current fiscal year.
Overall, the federal government is clawing back $82.5 million from provinces across the country. Half of that is from Quebec.
The Canada Health Act prohibits charging "insured persons" for medically necessary services.
The minister said the deductions could be refunded if provinces change their approach so people don't pay fees for medically necessary care. Duclos pointed to British Columbia, which has seen its deductions reduced after making changes.
The deduction for abortion relates to the lack of abortion services outside hospitals in New Brunswick.
The New Brunswick government has refused to cover the cost of abortions provided at Clinic 554 in Fredericton. (Jon Collicott/CBC)
Abortions up to 13 weeks of pregnancy are covered by Medicare at two hospitals in Moncton and one in Bathurst.
However, it has refused to fund the procedure at the private Clinic 554 in Fredericton. The province has said the hospital services are sufficient to meet demand.
A federally commissioned study on the issue is expected to be completed in June.
The province said in a statement Friday that it is aware of the federal decision and is assessing its implications.
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