Medicare: the ‘plan’ needs monitoring

April 7, 2016   ·   0 Comments

AMONG THE MANY CHALLENGES faced by the new federal government, few will be as tough as those involved in protecting and improving our health-care system in the face of an aging population and a weak economy.

From time to time we hear horror stories about the Ontario Health Insurance Plan’s refusal to cover some costly, life-preserving medications or complex surgeries performed in the United States.

But this week we received a thoughtful opinion piece from a Saskatchewan doctor about the need for the Trudeau Liberals to do something about provincial governments that he says have been violating the Canada Health Act, the legislation that requires the provinces to provide universal access to health care in return for annual grants from the federal government.

Ryan Meili, vice-chair of Canadian Doctors for Medicare, cites extra-billing in Ontario, private MRIs in Saskatchewan and user fees in Quebec as among violations of the Canada Health Act that are on the rise across the country.

Under the Act, provinces not in compliance with its terms are supposed to have their federal grants reduced, but Health Canada’s latest annual report on compliance showed that in 2014-15 the only penalized province was British Columbia, and its grant was cut only $241,637, “about half the amount in extra billing a 2012 audit found was committed just by Dr. Brian Day’s Cambie Surgery Centre in Vancouver in just one month.”

Dr. Meili says physicians and clinics “have quietly been charging extra fees for health services for many years, yet calls for the federal government to enforce the act have been ignored. Coming down hard on extra-billing may not sound as exciting as announcing new funding for specialized medical services, but it is the job of provincial and federal health ministers to protect the Canada Health Act and guarantee equitable access to health care.”

He says that in Ontario, the frequency of such charges has grown at an alarming rate, yet it seems to have escaped the notice of provincial and federal auditors and health ministers. “The Ontario Health Coalition (OHC) published a report in 2014 listing dozens of instances where independent health facilities (e.g. eye surgery, colonoscopy, diagnostic and executive health clinics) charged extra fees for medical consultations, examinations, diagnostic testing and other ‘upgraded services.’ These fees are for services covered by the health system. This is otherwise known as extra-billing, which is against federal and provincial law.

“But despite these contraventions, Canada Health Act reports show that Ontario has never been penalized.”

Dr. Meili says the OHC report “can be the springboard for federal Health Minister Jane Philpott to assert her government’s commitment to defending medicare, Canada’s most treasured social program.”

Saying the investigation should include actions or non-actions by the Saskatchewan and Quebec governments, he singled out Saskatchewan’s introduction in November of “pay-per-use MRI services, allowing those who can pay to jump the queue and receive priority treatment,” and Quebec’s allowing doctors to charge extra fees for some services already insured under public medicare.

He says the Quebec government included provisions for extra billing in response to pressure from the Quebec College of Physicians.

“Breaches of the act have never been addressed in Quebec,” he said, adding: “User fees, access charges and extra billing all come down to one thing – inequitable access to Canadian health care.

“Charging patients at the point of care for medically necessary services strikes at the heart of the principle that access to health care should be based on need rather than ability to pay. It undermines equity, increases system costs and reduces commitment to universal coverage.”

Noting Prime Minster Justin Trudeau’s promise of “real change,” he said Dr. Philpott, “an acclaimed physician, should take a new approach to defending health care by sending a strong statement that the provinces must adhere to the Act.”

We most certainly agree.

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