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Ontario Health Coalition report highlights deceptive practices and extra fees in private clinics

Posted: April 17, 2024

(April 16, 2024) By: Barbara Patrocinio, QP Briefing

A new report conducted by the Ontario Health Coalition (OHC) claims that many patients who underwent surgeries at private clinics were deceived into paying additional fees for supplementary services.

The procedures should be covered by public funding.

The report was based on interviews with 18 patients, and also included 231 responses from a patient survey about extra-billing and user fees.

Of the 231 patients, 120 reported one incident or more of extra-billing, user fees and/or manipulative upselling.

“The bottom line is that patients are being told at private clinics that wait lists are more than six months and they need surgery more urgently, or patients are being told that wait lists are years long. These claims are most likely false,” the report reads.

The OHC noted that it is illegal under the Canada Health Act to charge patients for medically-needed surgeries or diagnostic tests, including all of the needed elements of the surgery (eye drops, creams etc.), as well as to give preferential access to patients who pay over those who can’t afford the expenses.

The clinics claim they’re within the law because the Canada Health Act only prohibits charging for services covered by provincial medicare programs, and nurse practitioners in private clinics can’t bill OHIP.

Some patients reported that the clinics informed them of excessively long wait times at public facilities as a way to trick them into taking the for-profit service. Some said that even when they received their surgeries at the for-profit clinics, it was heavily implied that wait times would be longer if they opted for the OHIP-covered version of the surgery instead of paying for upgraded lenses out of pocket.

But the report showed that according to the province’s waiting average, individuals with emergency conditions are attended to immediately, with the least urgent cases typically seen within an average of 106 days.

Ontario has a wait times website that shows the real wait times across the province. The OHC report explained that patients are triaged based on medical need. The level of need is based on a clinical assessment and priorities are assigned from priority one to priority four with target wait times for each.

The report says that 78 per cent of patients in Ontario are receiving cataract surgeries within recommended wait time targets and 84 per cent get their appointment with a specialist within wait time targets.

As of January, almost 10,000 health-care operations had been moved into for-profit clinics.

In February, the government tabled a private health-care facility legislation to move more publicly funded procedures, like hip and knee surgeries, to private facilities, both for-profit and non-profit. At the time, the move raised concerns from the opposition parties and unions about diverting public funds and staff from patient care to profits.

According to the OHC report, one patient who needed cataract surgery was informed that the procedure would cost $2,440 (laser) or $2,190 (Keratome), plus a COVID-19 charge of $10. The report said that the clinic later tried to persuade him to buy eye drops to use after the surgery for $50, but he noted that “the same eye drops cost $13.39 at Loblaws.”

Another patient who needed laser cataract surgery in 2018 said she was referred to a specialist in a private clinic in Brampton by her optometrist. She was charged $554, presumably for eye measurements, but she didn’t receive a detailed invoice. The clinic told her that if she wanted to get the surgery at a hospital, the wait would be at least three years and quite possibly five years long.

She then asked about OHIP coverage, and the clinic told her that they did not provide it because she would be receiving surgery faster at the clinic and a hospital would not produce results as good as those in a for-profit clinic.

The survey conducted by OHC showed that the largest proportion of patients subjected to extra charges were charged for cataract surgery, followed by charges for primary care, lab tests, and diagnostic tests.

The province has plans to allow for-profit clinics to perform more OHIP-covered procedures like hip and knee replacements and MRI scans still in 2024.

Amidst the crisis, this Monday, Minister of Health Sylvia Jones wrote a letter to the Federal Minister of Health, Mark Holland, asking him to properly close the “loophole” that allows the private-pay health care clinics to operate.

The letter said that “Despite the progress we have made, our province and many other jurisdictions have seen a disturbing rise of clinics charging patients for access to primary care. As you are aware, the federal Canada Health Act (CHA) sets out what services are publicly funded in provincial health care systems. However, the CHA does not contain provisions with respect to the permissibility of non-physician providers, for example Nurse Practitioners, charging patients for care that would be covered under the CHA if performed by a physician.

“This lack of a prohibition has created a loophole that certain health care providers and their clinics are taking advantage of, knowing there is no legal consequence or risk of getting shut down.

“This unintended consequence created by the CHA requires a national solution that includes further intergovernmental engagement. To this extent, I am asking for your department and your government to consult and work with provinces and territories on a Canada-wide solution to close this loophole,” the letter wrote.

The letter also said that while provinces may have tools at their disposal to bring in some provisions to put this practice to an end, doing so would create another problem by leading non-physician providers, like nurse practitioners, to leave Ontario to work in another province.

“A national solution is necessary to ensure Ontarians, and Canadians, can connect to publicly funded health care services, including primary care, no matter where they live.”

Federal Health Minister Mark Holland on Tuesday responded to the report, saying his government will work on a “Canada Health Act interpretation letter” that will “help make sure that no matter where in the country they live or how they receive medically necessary care, Canadians be able to access these services without having to pay out of pocket.”

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