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A Closer Look: Block Fees and Boutique Medicine

Posted: January 18, 2023

(January 18, 2023)

What is a Block Fee?

Doctors are allowed to charge patients for services that are not covered by OHIP either

  1.  Item by item as these services are provided or
  2. By a “Block Fee” to cover all uninsured (non-OHIP covered) services for a period of 3 -12 months

Usually Block Fees are charged once per year and reportedly range from $100 – $250.These uninsured services include things like telephone advice & prescriptions, completion of forms and documents for medical assessments and some interviews with professionals re. patients.

Why Oppose Block Fees & Boutique Medicine?

  •  They violate the spirit of the principles of the Canada Health Act which provides for access to medically necessary hospital and physician services based on need not wealth.
  •  They potentially set up a two-tier system in which those who pay a block fee or a fee for “enhanced” but medically unnecessary care get better, faster care while those who cannot pay face discrimination.
  • They are difficult to control and regulate — people are hesitant to complain about our doctors, especially when there are no options for getting another doctor due to the shortage. Already, the fees are going up and people are reporting that they do not feel they have a choice in paying them.
  • They are unnecessary — physicians can already charge item by item for these things.
  • They inevitably open the door to some degree of Boutique Medicine, whether in the form of the extreme example reported in the Globe and Mail, or in a more subtle form of two-tiering and discrimination.

How Are They Misused?

The Medical Reform Group reports that the College of Physicians an Surgeons has received

complaints including:

  • A psychiatrist charging patients to review their daily logs.
  • Patients from one town being told their physicians would drop them from their practices if they did not pay the Block Fee.
  •  Patients from one town being told that unless they paid a Block Fee their telephone messages would go unanswered.

“Boutique Medicine”

Recently a Globe and Mail story described two family doctors who are charging their patients an annual fee of $2,500 for a detailed medical work-up, customized health plans and 24/7 access. In this way, they plan to have a small caseload and make their money through the enhanced service package. It is suspected that these physicians have structured the charges to avoid breaking the Block Fee policy of the College.

What Is the Government Doing About This?

In Bill 8 – the so-called “Commitment to the Future of Medicare Act”, which has been introduced and is in consultations, the government has brought Block Fees into legislation and therefore out of self-regulation by the College of Physicians and Surgeons. This is an improvement. However, it leaves their regulation unspecified.

What Are We Asking For?

We are recommending that the government ban the use of Block Fees.

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