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Canada Newswire Mon Sep 29 2014

TORONTO, Sept. 29, 2014 /CNW/ - As Ontario's new Health Minister Dr. Eric Hoskins sits down with provincial and territorial Health Ministers for their fall meeting this week, experts and patient advocates hope that he'll carry a strong message. Across Canada advocates are calling on the B.C. Health Minister to hang tough on the Medicare court challenge which threatens open season on patient user fees for surgeries, diagnostics and other procedures. The case was scheduled to begin on September 8, but lawyers for both Brian Day, owner of one of the largest private clinics in Canada, and the B.C. government asked the court for a delay in order to negotiate a settlement. Negotiations are now happening behind closed doors and the court date is delayed until March 2015.

Following a provincial audit in 2012 which revealed that Day was charging hundreds of thousands of dollars in unlawful user fees to patients, Day filed a Charter Challenge to nullify the laws that he was violating. His case aims to bring down the laws that protect single-tier Medicare and forbid clinics like his from extra-billing patients and charging user fees for care that currently must be provided without charge under the public health care system. The litigation has far-reaching implications for the entire country. Day's clinics were first exposed by patients who complained they were unlawfully billed for medical procedures. The B.C. government responded by trying to audit the clinics. Day refused to let in auditors until forced by a court order, and even then the clinics did not fully comply with auditors. Auditors had access to only a portion of the clinics' billings and only one month's worth of data. Nevertheless, what they found was astonishing. In a period of about 30 days, patients were subject to almost half a million dollars in user charges. The five patients who brought the initial legal petition have had their trial delayed while Day's Charter Challenge to the laws upholding single-tier Medicare is heard. They are still waiting for redress.

Despite raising concerns about the prevalence of user fees in Quebec, among other violations of the Canada Health Act, Health Canada hasn’t penalized the province for more than a decade while other provinces have been fined repeatedly. A Montreal Gazette review of Health Canada’s annual reports since 2002-2003 has found that the federal agency has warned Quebec more often than not about a wide range of contraventions against medicare — most recently, last year about user charges — but has not deducted penalties from funding transfers to the province. By comparison, Health Canada has penalized British Columbia, Alberta, Manitoba, Nova Scotia, as well as Newfoundland and Labrador for a total of $10.1 million in that time period. In its latest available report last year, Health Canada noted that it “wrote to the Quebec Ministry of Health concerning patient charges by physicians, when they provide certain publicly insured health services in their offices or private clinics. Health Canada’s consultation with Quebec on this issue is ongoing.”

The Montreal Gazette’s review has found that, unlike most other provinces, Quebec routinely declines to provide Health Canada with relevant statistical information about its private for-profit clinics. The issue of enforcing the Canada Health Act (CHA) arose last week after patient-rights groups across Quebec filed a lawsuit against the federal government to compel Health Canada to put an end to illegal extra billing and user charges in the province. Dr. Isabelle Leblanc, president of the pro-medicare group Médecins québécois pour le régime public, said she was taken aback over the fact that Quebec hasn’t been fined in more than a decade despite the proliferation of two-tier medicine in the province and the growth of so-called accessory fees, such as $200 eye drops. “The principles of the Canada Health Act should be the same throughout Canada,” Leblanc added. “If the federal government acts on non-compliance in one province, they should do it for all other provinces.” The CHA, adopted in 1984, gives the federal government the power to assign financial penalties over medicare violations. The penalties are deducted from federal funding transfers to the provinces.

British Columbia and Alberta have been fined the most of all provinces since 2002-2003, but Leblanc argued that queue-jumping, extra billing and user charges — all violations under the CHA — are just as widespread in Quebec, perhaps more so in recent years. Leblanc suggested that Health Canada might be more reluctant to crack down on medicare violations in Quebec for political reasons. “It’s probably different for the federal government to do something in Quebec than the other provinces,” she said. “Quebec has a different perception of what is a provincial duty and what is a federal duty.”

Some claim that user fees are benign because they discourage only frivolous use. That assumes that most people have the expert knowledge to know what care is needed. A host of studies have found the opposite. One U.S. study published in the New England Journal of Medicine involving fairly healthy adults showed that user fees led to a 20 per cent increase in risk of death for people with high blood pressure because people were less likely to see a doctor and get their blood pressure under control.

Vancouver Sun Thu Feb 19 2015

The federal government deducted a little more than $500,000 from transfer payments to B.C. over the last two years as a penalty for extra-billing charges patients paid at private or public hospitals and diagnostic clinics. User fees for medically necessary, government-insured treatments contravene the federal Canada Health Act and provincial statutes.

To discourage the extra charges, the federal government requires provinces to submit statements of the fees paid by patients. The latest annual Health Canada report (2012-13) shows $280,019 was deducted from B.C.'s Canada Health Transfer payments for that year.

by Laura Rosella, Andrew Pinto & Jeremy Petch (Show all posts by Laura Rosella, Andrew Pinto & Jeremy Petch) May 8, 2015

Once a patient is older and has developed multiple chronic conditions, it may be that a substantial portion of the health care resources they consume are medically necessary, and simply can’t be significantly reduced through better coordinated care or fewer visits to the emergency department. If the central policy goal of concentrating on high-cost users is to save money, then the best approach may not be to focus so exclusively on people who are already high-cost users, but also strive to prevent people from becoming high-cost users in the first place.

So what, at a fundamental level, is driving high-cost use? In a word, poverty.

Montreal Gazette Tue Dec 1 2015

Parents who are being directed to a private children's clinic in Notre-Dame-de-Grâce by the Mc-Gill University Health Centre are upset that they now have to pay a $25 fee for parking in addition to being charged for certain allergy and blood tests.

The MUHC Users' Committee contends that the parking fee at 5100 de Maisonneuve Blvd. constitutes a "barrier to care," given that parents are already being asked to pay fees for tests that used to be covered under medicare at the former location of the Montreal Children's Hospital on Tupper St. The outdoor parking lot is part of a property at that is being managed by the MUHC.

Quebec's medicare board is now taking an aggressive approach in cracking down on private clinics that charge patients illegal user fees.

Among the services charged to patients are "nursing accompaniment" during an operation, "teaching services" and a post-operative follow-up phone call.

RAMQ is seeking at least $73,000 in fees that Rockland MD charged patients, based on the findings of eight patients

Posted on May 6, 2015

The introduction of user-pay MRI scan legislation by the Government of Saskatchewan is the beginning of two-tier health care, says CUPE. “Allowing those able to pay for private MRI scans to get access to health care more quickly – regardless of need – is the introduction of two-tier health care,” said Tom Graham, President of CUPE Saskatchewan. “While those with large wallets can get MRIs quickly, the rest of us will have to wait.”

By Lisa Brandt on March 25, 2014

The Ontario Health Coalition says people are being charged user fees at private clinics and it’s a violation of the Canada Health Act. It claims six researchers phoned a variety of private clinics and that the majority informed the callers they would be charged user fees ranging from $50 – $3500, depending on the service provided.

“We are not the first province to think about it. In fact we are one of the last provinces to think about it.

The Sinha report was commissioned as part of the province’s Seniors Strategy announced a year ago.

Sinha told a news conference the older population in Ontario is going to double in the next 20 years

Montreal Gazette Wed Oct 14 2015

With a federal campaign in full force grabbing the majority of the headlines, a significant threat to Canada's most treasured national program is going largely unnoticed. For many years, certain physicians and clinics have quietly been charging extra fees for health services. In some provinces, the frequency of such charges has been increasing. These include hidden charges for medications that are many times their actual cost or access fees of hundreds of dollars for examinations such as colonoscopies. Because these fees are for services that are covered by the health system, this is, in effect extra-billing, a practice that is against federal and provincial law.

In Quebec, Health Minister Gaétan Barrette has identified these fees as a problem, as have many others for many years. You might expect Barrette to clearly inform patients and practitioners that this practice is illegal and put an end to it. Instead, he is trying to regulate and "normalize" these fees, in direct contravention of the Canada Health Act.

Quebec will ban medicare user charges; 'There won't be any fees, period' for necessary care: Barrette Montreal Gazette Thu Sep 15 2016 Page: A1 / Front Section: News Byline: CAROLINE PLANTE Dateline: QUEBEC Source: The Gazette

Patients in Quebec will no longer have to pay user fees for medically required procedures covered by medicare, Health Minister Gaétan Barrette has announced. The minister told reporters Wednesday the measure was approved by cabinet and will come into effect in January 2017. For example, it will be illegal for doctors to charge patients $200 for eye drops before they undergo exams or treatments, or $150 to open their file, Barrette said. "When a medical service is covered by RAMQ, there are sometimes fees added to that. It's overbilling. Those fees will be illegal, totally illegal," he told reporters. "There won't be fees of $50, $70, $25 or $10, there won't be any fees, period ... No more over-billing."

"We made a huge effort as a society to go back to a balanced budget. Now we need to go on and put measures in place which will improve our health-care system," Barrette said. The change will not apply to medical procedures that are not covered by medicare, such as laser eye or cosmetic surgery, the government said, and Quebecers will still have to pay for doctors' notes because it is considered an administrative fee. Moreover, it will be possible for doctors to charge up to $15 for the transportation of blood samples to and from laboratories, and $5 for samples that do not contain blood. Barrette said he is abolishing add-on fees by rolling them into doctors' salaries. He estimated it would cost doctors between $10 million and $13 million a year. "When you have a total envelope of $7 billion, I think it's fair to ask that they incorporate those fees. The specialists have said that they will incorporate those costs for those services ... and as for general practitioners, there are no surgeries, so there is no reason for them not to incorporate those costs into their envelope," Barrette said.

Toronto Star Fri Sep 23 2016

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 that 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.

May 10, 2016

QUEBEC — Extra fees charged in private clinics for procedures covered by medicare are not being controlled and may be abusive, the province’s auditor general said in a report Tuesday. Extra billing has been in dispute ever since the government of Quebec adopted Bill 20 in November. The bill aimed, among other things, to regulate add-on fees by creating a standardized price list. The situation remains ambiguous, confusing and misunderstood, auditor general Guylaine Leclerc wrote in her report.

Doctors have argued in the past that they need the extra money to pay their operating costs, but the report recommended the health department take time to really “assess the operating costs of clinics, determine the funding to be granted and consider the funding already paid.”

The most depressing element of Canada’s on-again, off-again medicare debate is its repetitiveness. The country is forced to fight the same battle again and again. It’s as if our political elites learn nothing. I was reminded of that this weekend when Reform Party founder Preston Manning showed up on CTV’s Question Period to — again — make his pitch for two-tier health care.

Manning has been pushing two-tier medicine since 2005. That’s when he and former Ontario premier Mike Harris wrote that Canada’s medicare system should be replaced by a narrowly defined scheme focused on catastrophic illness and financed, in part, by user fees. All other health care would be paid for privately.

Any number of studies have demonstrated that so-called single payer public insurance systems like Canadian medicare are more efficient than two-tier schemes

The provisions of the Canada Health Act, which discourage extra-billing and user charges for insured health services in a province or territory, are outlined in sections 18 to 21. If it can be confirmed that either extra-billing or user charges exist in a province or territory, a mandatory deduction from the federal cash transfer to that province or territory is required under the Act. The amount of such a deduction for a fiscal year is determined by the federal Minister of Health based on information provided by the province or territory in accordance with the Extra-billing and User Charges Information Regulations (described below).

and informing the Minister of possible non-compliance and recommending appropriate action to resolve the issue.

ns in order to provide advice to the Minister on possible non-compliance with the Act. Sources for this information include: provincial and territorial government officials and publications; media reports; and correspondence received from the public and other non-government organizations.

Home care, a growth area in Canada’s health care system, is an existing solution that helps make aging at home a reality. In fact, seniors who access home care support — privately or publicly—have a 40 percent reduced likelihood of admission to a nursing home facility.

In Ontario, more than 10,000 seniors are waiting- for 262 days, on average- to access home care services, which calls for the private sector to bridge the gap between the services available and the urgent need for home care.

In 2010, the private home care sector accounted for $1.48 billion and is expected to continue to grow as publicly available services become more restrictive and the senior population continues to grow. Though the volume of paid care reached 60 million hours per year in addition to 90 million hours of government subsidized care, the rising need for private care continues to grow, along with the aging population that it serves.

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Provincial News: More than 3,000 Take to the Streets to Stop Massive Hospital Cuts, Closures and Privatization Contributed by admin on Nov 21, 2014

TORONTO, Nov. 21, 2014 /CNW/ - More than 20 bus loads of people from across Ontario were joined by thousands in Toronto to stop the aggressive and systematic dismantling of our community hospitals by Ontario's government. Patients, seniors, hospital workers, nurses, health care professionals, doctors and concerned community members joined forces in a giant rally today to send a clear message to Ontario's Wynne government that the cuts to – and privatization of – public community hospitals must stop. Speakers talked about being charged extra user fees of hundreds or even thousands of dollars at private clinics for cataract surgeries, colonoscopies, endoscopies and other services. The clinics also bill OHIP, speakers noted, and charge extra user fees on top even though the Canada Health Act is supposed to prevent the direct billing of patients and ensure equal access to health care based on need not wealth. The coalition is demanding that the government stop their plans to cut diagnostics and surgeries from local hospitals and contract them out to regional private clinics forcing patients not only to pay the extra fees but also to travel out of their home towns for needed care and privatizing public health care.