Social Policy in Ontario

Crackdown on extra-billing is long overdue

Posted on September 23, 2016 in Health Debates

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TheStar.com – Opinion/Commentary – Federal Health Minister Jane Philpott has served notice that she will enforce the Canada Health Act in Quebec. Good for her.
Sept. 22, 2016.   By THOMAS WALKOM, National Affairs Columnist

Federal Health Minister Jane Philpott has served notice that she will enforce the Canada Health Act in Quebec. Good for her. It’s about time.

The Canada Health Act is the federal statute governing medicare. It lists the standards provinces must meet if they are to receive money from Ottawa for health care. And it gives the federal government the right to cut transfers to any province that doesn’t meet these standards.

In particular, it imposes a duty on the federal health minister to financially penalize any province that allows physicians operating within medicare to bill patients for extra, out-of-pocket fees.

Successive federal governments have been reluctant to use this power. They have usually done so only when the offence is so obvious that it cannot be ignored.

From the Canada Health Act’s inception in 1984 until 2015, Ottawa clawed back a net total of $10 million from five provinces that permitted extra-billing.

Alberta, British Columbia and Manitoba were the biggest offenders although Newfoundland and Nova Scotia also got nicked.

Compared to the billions the federal government spent on health transfers over the period, these penalties were pittances. But they did make the point that medicare is indeed a national program.

And in every province except B.C., where the issue has morphed into a constitutional court case, the extra-billing problem was apparently resolved.

However, until now no federal government has had the nerve to take on serial offender Quebec.

Quebec has been allowing its doctors and clinics to charge extra user fees since 1979. The province’s current health minister, Gaetan Barrette, freely acknowledges this.

In some cases, these fees were truly exorbitant. The Montreal Gazette reported last year that some colonoscopy clinics were charging patients an extra $600 for medications – on top of the publicly paid medicare fee.

Many Quebecers were outraged. The provincial Liberal government’s somewhat peculiar response was to pass a bill codifying the practice of extra-billing but giving itself the authority to regulate it.

In March 2015, the then-Conservative government in Ottawa formally notified Quebec that it would be looking into the issue.

This March, Liberal Philpott sat down with Barrette to discuss the practice.

On Sept. 6, she sent her provincial counterpart a letter threatening cutbacks to Quebec’s health transfer. A few days later, Barrette announced that extra billing will end as of next January.

It is hard to gauge the importance of Philpott’s threat. User fees have become widely unpopular in Quebec. That alone may have been enough to drive the provincial government to disavow them.

Still, it was bracing to see a federal health minister publicly standing up for the principles of medicare. It is not an everyday occurrence.

It is particularly interesting that she targeted a province that is notoriously touchy about what it sees as federal interference.

Perhaps she will do more.

Certainly, more needs to be done. The latest annual report on the Canada Health Act filed with Parliament notes that private MRI clinics in British Columbia, Alberta, Quebec, New Brunswick and Nova Scotia are charging user fees to patients.

It says some hospitals are avoiding the ban on charging for drugs by routing the sick through outpatient clinics – which do charge.

It also notes that the portability requirement of medicare, which allows Canadians to receive care outside their home provinces, is routinely ignored.

Quebec routinely refuses to fully reimburse other provinces that provide health services to Quebec residents. Yet it has never been penalized by Ottawa for this.

Nor have an unspecified number of other provinces that, at one time or another, did the same.

Except for Prince Edward Island, the report says, no province appropriately reimburses residents who obtain medical care outside Canada.

Such patients aren’t necessarily entitled to the full cost of their out-of-country care. But they are entitled to be reimbursed for the amount it would have cost them to be treated in their home province.

To work as a national program, Canadian medicare needs two things.

First, the federal government must put up enough money to give it a real financial role in the system. The 2002 Romanow royal commission suggested that Ottawa provide at least 25 per cent of medicare funding. That figure still makes sense.

Second, Ottawa has to use its financial clout to enforce those few national standards that do exist.

A former Liberal health minister, Diane Marleau, tried to do this back in the 1990s. She was sandbagged by Jean Chrétien, the prime minister of the day.

Let’s hope Philpott has better luck.

Tags: budget, Health, ideology, jurisdiction, mental Health

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