Federal Health Minister Jean-Yves Duclos said on Friday that Ottawa was clawing back $82.5-million from health transfers to the provinces for allowing for-profit companies to charge for medically necessary health services, mostly diagnostic services such as MRIs and CT scans.
More importantly, the minister served notice that, going forward, there would also be a crackdown on private companies offering telehealth services.
“It is critical that access to medically necessary services, whether provided in person or virtually, remains based on medical need and free of charge,” Mr. Duclos told reporters.
The key word in that sentence is “access” and it was given far too little importance.
Roughly 6.5 million Canadians don’t have a primary care provider. Those who do can’t necessarily book a visit in a timely fashion, either in-person or online.
Companies that offer telemedicine services – such as Maple, Telus Health MyCare, Felix, Rocket Doctor and others – are doing a booming business. People are paying anywhere from $50 to $100 for a virtual visit (or signing up for monthly plans of $30 or so) because they can’t obtain care through the public system.
It’s all well and good for Ottawa to take a stand against private, for-profit health care, but it would be a lot more useful if they used their energies fixing the crisis in access to primary care. If you don’t like the private, for-profit Maples of the world, then offer the same or better service in the public system.
Don’t just pontificate – innovate.
Better yet, bring the innovators under the medicare umbrella. Maple already has contracts to provide virtual care services for “free” in Nova Scotia and Prince Edward Island. There’s no reason other provinces can’t strike similar deals with telemedicine providers.
You have to give these companies credit. They have used legislative loopholes to give consumers a service they want.
Under Canadian law – specifically, the Canada Health Act – “insured persons” cannot be charged for “medically necessary” services. (More precisely, if patients are charged, it is the province, not the provider, who can be punished, by having federal money clawed back.)
Each province has a fee schedule that sets out what is insured for its citizens. Generally, all hospital and physician services are deemed “medically necessary,” except they aren’t. Prescription drugs, home care, long-term care and dental care do not fall directly under the purview of the law, so they are sometimes covered by public health insurance and sometimes not.
What companies such as Maple do is offer a physician consult by text or secure messaging, or have a nurse practitioner take the call. Those are not billable acts on provincial formularies, so the person paying for the health service is not an “insured person.”
Patients who want to pay out-of-pocket for faster surgery can also skirt the “ban” on buying care by, for example, travelling to Quebec from Alberta for non-urgent surgery, such as hip replacement done in a private clinic. When a patient crosses a provincial border, they are no longer an “insured person.” (Under the portability clause of the Canada Health Act, out-of-province coverage only applies to “medically necessary” care.)
Wealthy patients can also join executive or boutique health clinics that offer “medically necessary” care for “free,” but charge hefty fees for non-essential care and annual memberships that ensure good access.
It’s a reminder that the term “medically necessary,” which is the cornerstone of medicare, is incredibly vague.
Private delivery of care is not banned in Canada – it’s actually flourishing on the margins of medicare.
There are two principal critiques of private health services: They don’t offer continuity of care and they are inequitable.
First of all, it’s hard to ensure continuity of care when you have millions of people without a primary care provider and many people are dependent on walk-in clinics. In much of the health system, electronic medical records leave a lot to be desired. Telehealth companies are the least of our worries on that front.
Equity is a fundamental issue. The philosophy of medicare is a sound one: No one should be denied essential care because of an inability to pay. But that grand principle falls apart when access to essential care simply isn’t there.
Canadians are forking over their hard-earned dollars to for-profit telemedicine companies because they want and need health care and can’t get it otherwise.
Does cracking down on services such as Maple actually improve access to care? Or will the Federal Health Minister’s tough talk simply perpetuate the health system’s allergy to convenience and addiction to queuing?
André Picard