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Island Voices: Extra-billing crackdown long overdue

Posted: April 22, 2018

(April 22, 2018)

By: Edith Machattie And Rick Turner, Times Colonist

The B.C. government is taking decisive action on an illegal activity known as “extra-billing,” bucking a years-long trend of ignoring illegal health-care fees charged to patients in B.C.

On April 4, Health Minister Adrian Dix announced plans to enforce patient protections against extrabilling that have been on the books since 2003.

This move comes along with news the federal government is fining B.C. taxpayers nearly $16 million as a result of extra-billing by some of B.C.’s doctors and private clinics in 2015-2016, with possibly more fines to come (for every dollar of extra-billing, the federal government claws back funding to the provincial government for public health care).

Extra-billing refers to unlawful practices where doctors or private clinics charge a patient for a healthcare service that should be provided at no cost because it is publicly insured as necessary care. These services include medically necessary surgeries, diagnostic tests and visits to a doctor’s office.

The minister’s plan to deal with this problem, along with recent government announcements about comprehensive investment and action to drive down public surgical and diagnostic wait times, represents a welcome new provincial direction for B.C. patients.

In 2003, the former B.C. Liberal government passed legal measures intended to add teeth to the province’s ban on extra-billing to protect patients from illegal fees and protect the public purse from federal fines.

But despite passing these measures in 2003, the province backed down from bringing the protections into force, following lobbying by some private clinics and doctors.

Instead, the former government took a dramatically different approach: They effectively turned a blind eye to illegal extra-billing over the ensuing years.

During that same period, the province also oversaw a steep decline in per-person health-care funding that left B.C. at the bottom of the pack compared to other provinces – allowing public wait lists for some key surgeries to grow to some of the longest in the country.

With less public capacity to perform timely surgeries and MRI scans, and a government willing to ignore extra-billing, the private for-profit clinic sector in B.C. boomed to the second largest in Canada – charging patients unlawful fees for a range of medically necessary surgeries, MRI scans and other health services.

A 2017 B.C. and Ontario Health Coalition research report found that 30 of the 34 private clinics surveyed in B.C. appeared to be extra-billing patients. Fees charged were often up to five times the legal limit. The majority of patients surveyed reported experiencing financial hardship as a result of paying private fees for necessary care, including struggling to afford necessities such as rent and groceries.

Similarly, a June 2017 Globe and Mail investigation confirmed extra-billing is widespread in B.C.

On top of the fact that the province has an obvious responsibility to better protect patients from illegal fees, the evidence is clear that wait times have only grown under a government approach of allowing public wait times to fall behind while ignoring illegal private fees.

In addition, the federal government appears newly committed to enforcing health-care law via large fines to offending provinces.

Clearly, bringing the 2003 protections into force is the right thing to do for patients and the public healthcare system.

Specifically, the new protections will: make it an offence for doctors and private clinics to extra-bill patients privately for medically necessary care; ensure patients are not liable to pay extra-billing charged by private clinics or doctors; create a complaint process for patients who have been extra-billed; and fine doctors up to $20,000 if they extra-bill patients.

The changes will make it easier for patients who are extra-billed to recover the fees, give the province the tools it needs to enforce the law, and ensure B.C.’s laws are in line with those in Alberta and Ontario.

These problems won’t be fixed overnight. However, the government’s focus on completing thousands more surgeries and diagnostic tests in the public system while protecting patients from illegal billing puts our province on the path we should have been on 15 years ago. Edith MacHattie and Rick Turner are co-chairs of the B.C.¬†Health Coalition.

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