(February 1, 2023)<\/p>\n
By: Mark Gollom, CBC News<\/p>\n
Federal NDP\u00a0Leader Jagmeet Singh has been sounding the alarm\u00a0about\u00a0privatization creeping into the public health-care system.<\/p>\n
Recently,\u00a0Ontario Premier Doug Ford<\/span><\/a>\u00a0announced he wanted to give a greater role\u00a0to\u00a0privately run for-profit clinics. These\u00a0facilities are clinics operated by the private sector that receive public funding from the Ontario Health Insurance Plan (OHIP) to perform medically necessary procedures.<\/p>\n But Singh says he’s worried that trend of using public money to fund procedures in private clinics will\u00a0take resources from the public system.<\/p>\n He said the federal government needs to utilize the Canada Health Act (CHA), which he said has significant powers to challenge for-profit privatized care.<\/p>\n “And it should be used more regularly and more aggressively to protect public health care,” Singh said Monday, speaking to reporters on Parliament Hill.<\/p>\n But what exactly does the CHA do, how is it used and is it a tool that those who oppose health-care privatization can rely on to stop that trend? CBC News explains:<\/p>\n The Canada Health Act, enacted\u00a0in 1984 after being passed unanimously in the House of Commons,\u00a0laid out criteria to ensure “reasonable access to health services without financial or other barriers.”<\/p>\n That meant Canadians would have access to medically necessary services without being directly charged for those services. All such services would be covered through the province or territories’ health-care insurance plan, according to the act.<\/p>\n It also established a number of conditions related to health-care access that the provinces and territories had to fulfil in order to receive transfer payments from the federal\u00a0government, known as the Canada Health Transfer (CHT). One of those conditions stipulated that patients couldn’t be charged an extra fee for medically necessary services, also known as “extra-billing.”<\/p>\n Singh said he wants the government to use the CHA to challenge\u00a0for-profit care. But there are no restrictions on private delivery inside public health-care systems,\u00a0said Colleen Flood, director of the Centre for Health Law, Policy and Ethics and University Research Chair\u00a0at the University of Ottawa.<\/p>\n “So what Ford has proposed, with private for-profit clinics, is perfectly fine under the Canada Health Act,” she said.<\/p>\n The CHA does not\u00a0forbid the provision of health services by private companies, as long as residents are not charged for insured services, according to the federal government website.<\/p>\n “In fact, many aspects of health care in Canada are delivered privately. Family physicians mostly bill the provincial or territorial health-care plan as private contractors. Hospitals are often incorporated private foundations, and many aspects of hospital care (e.g., lab services, housekeeping, and linens) are carried out privately,” the website states.<\/p>\n “Lastly, in many provinces and territories, private facilities are contracted to provide services under the public health-care insurance plan.”<\/p>\n It’s the finance side of the CHA\u00a0 where restrictions are imposed that disallow patients to be charged out of pocket for medically necessary hospital and physician services, Flood\u00a0said.<\/p>\n “What is medically necessary and how those rules are fixed are determined province by province.”<\/p>\n No province or territory totally prevents a two-tier\u00a0system\u00a0\u2014\u00a0they just try to make it less\u00a0appetizing\u00a0for doctors, she said.<\/p>\n “Almost all provinces have this rule which says, ‘look, if you want to bill the\u00a0public system, then you have to only bill\u00a0the public system.\u00a0If you want to opt out, opt out.'”<\/em><\/p>\n Bacchus Barua,\u00a0director of health policy studies at The Fraser Institute, said one\u00a0problem with the CHA is that the conditions imposed are “remarkably vague,” which create a risk-averse environment in terms of health-care policy.<\/p>\n “Because of that risk aversion, a lot of provinces actually go beyond what’s\u00a0explicitly required by the CHA so that they don’t accidentally get hit by by the federal government’s interpretation of it,” he said.<\/p>\n “We don’t see the sort of experimentation with policies that are proven elsewhere, to work in most other universal health-care systems.”<\/p>\n As the\u00a0CHA states<\/a>,\u00a0if\u00a0hospitals and doctors charge fees for medically necessary services,\u00a0then the federal government is supposed to deduct $1 from the province or territories’\u00a0annual grant or CHT\u00a0for every dollar assessed of the so-called extra billing.<\/p>\n Prime Minister Justin Trudeau, responding to Singh’s concerns about the enforcement of the CHA, said Monday that his\u00a0government will continue to defend the Canada Health Act and can pull back money from provinces that violate it.<\/p>\n “In the past, this government has pulled back money from provinces that haven’t respected it. We will continue to do that.”<\/p>\n According to the 2020-2021 Canada Health Act Annual Report, for the most part, provincial and territorial health-care insurance plans met\u00a0the requirements of the Canada Health Act. But there were some instances when the federal government said it had to withhold funds.<\/p>\n A deduction of\u00a0 $4,521 was taken from the March 2021 CHT payments to Newfoundland and Labrador for charges at\u00a0 a private ophthalmological clinic. Both New Brunswick and Ontario were dinged around $65,000 and nearly $14,000 respectively for charges at private abortion clinics.<\/p>\n The biggest violator, according to the report, was British Columbia, which submitted a financial statement of extra billing and user charges for fiscal year 2018\u20132019, in the amount of nearly $14 million. A deduction in the same amount was taken from British Columbia’s March 2021 CHT payments. (The federal government has reimbursed the province in recognition for its Reimbursement Action Plan).<\/p>\n The province has been the centre of a\u00a0legal battle waged by\u00a0private health-care advocate Dr. Brian Day<\/a><\/span>, the owner of the Cambie Surgery Centre in Vancouver, who argues that\u00a0patients should have\u00a0a right to pay for services if wait times in the public system are too long.<\/p>\n But Dr. Michael Rachlis,\u00a0a public health physician and an adjunct professor at the University of Toronto Dalla Lana School of Public Health, says that for the most part the federal government has not gone after provinces or territories for contravening the ban on extra billing for medically necessary services.<\/p>\n “The way the act is enforced \u2014\u00a0it’s not like there’s federal inspectors,” he said.\u00a0“<\/em>The provinces are asked to investigate themselves. There is no real enforcement mechanism.”<\/p>\n Rachlis\u00a0says he also believes that there are lots of private\u00a0clinics across Canada charging for medicare-covered services or up-selling services, citing a\u00a0Globe and Mail 2017 investigation<\/a><\/span> and work done by the Ontario Health Coalition.<\/p>\n “And the feds aren’t doing anything.”<\/p>\n<\/div>\n<\/div>\nWhat is the Canada Health Act?<\/h2>\n
What restrictions are there on private health care?<\/h2>\n
What happens if a province or territory violates\u00a0the Act?<\/h2>\n
Has the federal government gone after provinces for\u00a0violations?<\/h2>\n