Federal health minister dings Ontario for private billing

Posted on March 11, 2023 in Health Debates, Health Delivery System

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TVO.org – Article/First impressions
Mar 10, 2023.   John Michael McGrath

Due to breaches of federal policy, Ottawa will be giving less health-care money to eight provinces this year. Will this be enough to change behaviour?

Just the facts: Federal health minister Jean-Yves Duclos announced Friday that he will be reducing the Canada Health Transfer to eight provinces, including Ontario, for breaches of federal policy regarding billing patients for medically necessary costs. Some provinces also saw their CHT reduced for the use of private surgical clinics or for charging patients for insured abortion services. The entirety of Ontario’s deductions — $32,800, according to the government’s release — comes in the second category and is not related to patients being billed for medically necessary costs.

Other provinces saw much larger deductions. Duclos announced over $82 million in total clawbacks, with $41 million of that coming from Quebec alone; British Columbia and Alberta were also penalized, seeing more than $10 million each.

The deductions from the CHT all relate to the 2020-21 fiscal year and therefore do no reflect more recent policy changes made by provinces like Ontario, which has announced a greater reliance on private surgical clinics as part of its recovery from COVID-19.

“Provinces and territories have taken meaningful steps, but more work is needed to ensure that there are no patient charges for insured health services,” Duclos said earlier on Friday. “This is not acceptable and will not be tolerated.”

The federal government says that provinces can have these deductions reduced or reversed entirely if they “eliminate the patient charges and the circumstances that led to them” within the next two years.

First impressions: The amount of money the federal government is deducting from the Canada Health Transfer is relatively small and almost certainly won’t be enough, on its own, to change provincial behaviour. For example, in 2020-21, the total CHT was $45.9 billion, meaning the deductions announced Friday amount to a penalty of less than 0.18 per cent of the total. Ontario’s share of the CHT that year was $16.2 billion, and the province’s relatively small deduction amounts to 0.0002 per cent of the transfer received from the federal government that year.

However, if the federal government continues with a policy of reducing the CHT for cases in which provinces use private clinics to deliver publicly insured procedures, that could lead to much larger charges in future years, since Ontario has made expanded use of private clinics part of its plans to stabilize the hospital system.

Further, Duclos signalled that Friday’s announcement will not be the end of the measures the federal government is considering to reinforce the public aspect of Canada’s health-care system.

“It is clearly seen and felt that there is such a loophole in the [Canada Health] Act, which has been there for many years,” Duclos said of rules that some provincial systems have used to expand private, for-profit care. “It’s impacting the ability of people to have access to a surgery … we are mindful of that, and we are going to work on that.”

Today’s announcement could therefore signal the start of a much longer, and more expensive, dispute between the federal and provincial governments.

(TVO.org reached out to health minister Sylvia Jones’ office for a reaction to the federal announcement. We have not received a response prior to publication.)

https://www.tvo.org/article/first-impressions-federal-health-minister-dings-ontario-for-private-billing

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