Is paying out-of-pocket for medically necessary care allowed? Doctors and nurses say patients need to know now

Posted on November 20, 2024 in Health Policy Context

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TheStar.com – Business
Nov. 20, 2024.   By Kenyon Wallace, Business Reporter

The Canada Health Act bans the practice of making patients pay fees to access care that is insured under provincial and territorial health insurance plans. But because of when it was enacted, the Act does not address medical care provided virtually or by practitioners other than doctors.

Physicians, nurses and health advocacy groups are urging Health Minister Mark Holland and Prime Minister Justin Trudeau to issue a long-awaited interpretation of the Canada Health Act stipulating that all necessary care, no matter how it is provided, must be paid for by provincial health plans — and not patients.

Health workers across Canada, including doctors and nurses, say patients can wait no longer to know whether paying out-of-pocket for medically necessary care is allowed when delivered virtually or by providers other than physicians, such as nurse practitioners.

Canadian Doctors for Medicare, along with the Canadian Health Coalition and the Canadian Federation of Nurses Union, say Prime Minister Justin Trudeau and Health Minister Mark Holland must not delay in issuing a long-awaited interpretation of the Canada Health Act stipulating that all necessary care, no matter how it is provided, must be paid for by provincial health plans — and not patients.

“I am worried that even in our country with universal health care, some of my patients have to pay for access, and many more cannot afford it,” Melanie Bechard, a pediatric emergency physician and chair of Canadian Doctors for Medicare, said during a press conference on Parliament Hill Tuesday. “The federal government has proposed a viable solution but we’ve been waiting over a year and a half for them to implement it.”

More than 18 months ago, the federal health ministry warned provinces and territories that federal health funding would be held back if they failed to uphold the Canada Health Act, which says public health insurance must cover medically necessary care offered by doctors and hospitals. The Act, passed in 1984, bans the practice of making patients pay fees to access care that is already insured under provincial and territorial health insurance plans. But because of when it was enacted, the Act does not address medical care provided virtually or by practitioners other than doctors.

In March 2023, then-federal Health Minister Jean-Yves Duclos said he would be issuing a Canada Health Act interpretation letter clarifying that patients must not pay out-of-pocket for medically necessary care. Since then, no letter has been forthcoming.

“As technology and new approaches evolve to provide essential health-care services, we need to guarantee that the Canada Health Act is respected and followed,” said Steven Staples, national director of policy and advocacy for the Canadian Health Coalition, a group of front-line workers’ unions, community groups, students and others advocating for public health care.

Over the past several years, and particularly during the COVID-19 pandemic, Canada has seen a rise of for-profit medical care in which patients pay out-of-pocket to access primary care through private clinics, virtual platforms or nurse practitioners, who are not covered by provincial health plans. An estimated 6.5 million Canadians do not have access to a primary care provider.

“Why has the prime minister failed to work with Health Minister Holland to protect patients from unfair charges by for-profit corporations delivering virtual care, or nurse practitioners who have been given additional scope to practice but little public funding to do so?” Staples said during Tuesday’s press conference. “Is the Liberal government stalling because big business, telecom giants and insurance corporations are lobbying to prevent the government from doing as it promised to protect patients?”

The Prime Minister’s Office referred the Star’s inquiries to the federal health ministry.

Matthew Kronberg, press secretary for Holland, said the federal government is “committed to building a stronger public healthcare system so Canadians can get the care they need.”

He added that the interpretation letter process involves extensive consultation with provinces and territories so that provinces, territories and Health Canada can determine how best to address the underlying causes of patient charges, and understand the implications of a new policy interpretation under the Canada Health Act.

“As jurisdictions explore further integrating physician-equivalent services and virtual care into their public health care insurance systems, we will continue to engage with them to ensure our health care system is dynamic,” Kronberg said. “We hope to have more to say on the upcoming letter soon.”

In April, Ontario Health Minister Sylvia Jones wrote to Holland lamenting that the Canada Health Act’s silence regarding non-physician health-care providers creates a loophole “that certain health-care providers and their clinics are taking advantage of, knowing there is no legal consequence or risk of getting shut down.”

She urged the federal government to work with provinces and territories to close this loophole and prohibit non-physicians from charging for publicly funded services.

“While provinces may have tools at their disposal to bring in some provisions to put this practice to an end, this may lead to non-physician providers, like nurse practitioners, leaving Ontario to work in another province,” Jones wrote. “A national solution is necessary to ensure Ontarians, and Canadians, can connect to publicly funded health care services, including primary care, no matter where they live.”

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

https://www.thestar.com/business/is-paying-out-of-pocket-for-medically-necessary-care-allowed-doctors-and-nurses-say-patients/article_3e3d8152-a6a0-11ef-a24f-4b66176a7c64.html

 

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