As for-profit health care expands across Canada, doctors are fighting back

Posted on August 2, 2024 in Health Delivery System

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TheStar.com – Business
July 30, 2024.   By Kenyon Wallace, Business Reporter

The Canadian Medical Association is calling on governments across the country to enforce the Canada Health Act and ensure access to care is based on need, and not on the ability to pay.

A national group of doctors says the practice of patients being charged membership fees or bundled payments to gain access to primary care covered by universal health care needs to end.

In a draft policy laying out its positions on the growing intersection of for-profit business with the public health care system, the Canadian Medical Association is calling on governments across the country to ensure medically necessary care is based on need and not on the ability to pay.

This includes enforcing a provision in the Canada Health Act that bans making patients pay fees as a condition of receiving publicly insured health services, a practice employed by some private medical clinics.

That’s one of nearly two dozen recommendations the CMA made this past week in a proposed revision to a more than 15-year-old policy document that informs the advocacy work of the organization, which represents some 54,000 doctors across the country.

“Health care should not privilege those who can afford to pay for services,” said Dr. Kathleen Ross, co-president of the CMA and a family doctor in British Columbia. She said the recommendations are the product of a yearlong series of consultations with health-care providers, policymakers and the public to offer up solutions to Canada’s access-to-care crisis.

“This updated policy is really rooted in the values that we heard the most.”

The draft recommendations come at a time when for-profit medical care is expanding across the country, including through private clinics — some offering primary care and others providing select surgical and diagnostic procedures — as well as through virtual-physician platforms in which patients pay out-of-pocket for medically necessary care.

“We see this growing reliance on private clinics and private health care providers to help address the current crisis,” Ross said, and “there really isn’t a lot of consistency or transparency or even accountability for this hybrid model.”

On that point, the CMA is recommending that any time governments contract with for-profit clinics to provide publicly-funded services, it is done so with an open-tendering process and regulations governing the sale of additional services or products, known as upselling.

“The use of private providers must demonstrate a positive impact on patient outcomes and cost effectiveness, and reduce wait times for the population without increasing access barriers for patients,” the policy says.

Dr. Melanie Bechard, a pediatric emergency physician in Ottawa and chair of Canadian Doctors for Medicare, said the recommendations are a reflection of where the nation lies in the public-private health care debate.

“The voice of Canadian doctors is clear: the debate is settled and privatization will not solve problems in the health-care system,” she said.

Among the CMA’s other recommendations: ensure that 80 per cent of Canadians have access to publicly funded primary care provided by teams of doctors and other health care practitioners within 10 years; prohibit or restrict duplicative insurance models where patients can buy private insurance to access medically necessary care already covered under the Canada Health Act; study options to help seniors offset costs of long-term care, including private insurance and tax-deferred savings programs similar to RRSPs; and allow patients to receive publicly-paid care outside their province/territory — or even the country — when timely access to care is not possible.

The organization also wants provincial and territorial health insurance plans to fund virtual-care services and remunerate doctors commensurate with what they would be paid to see patients in person. It is estimated that about 1 in 5 Canadians do not have access to a family doctor.

Last year, the federal government warned provinces could face clawbacks in health funding if they failed to uphold the Canada Health Act. Then-Health Minister Jean-Yves Duclos stressed the government would not tolerate the public paying out-of-pocket for publicly insured health care, as has occurred in many jurisdictions with the provision of primary care by nurse practitioners, many of whom charge for care at private clinics.

The Act did not contemplate the expansion of primary care to health-care providers outside of doctors and hospitals when it was passed in 1984.

Current Health Minister Mark Holland is expected to issue an interpretation letter soon to address whether primary health care providers other than doctors, such as nurse practitioners, can charge for medically necessary care.

“We need the letter yesterday,” said Bechard. “Until governments clarify which health-care providers and providers are covered under the Canada Health Act, we’ll continue to see corporations exploit these gaps.”

Kenyon Wallace is a Toronto-based business reporter for the Star.

https://www.thestar.com/business/as-for-profit-health-care-expands-across-canada-doctors-are-fighting-back/article_90cc8ecc-4b6a-11ef-a009-2fc405421844.html

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