A government crackdown on user fees will make health care inaccessible to millions, private clinics and insurers warn.

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Private insurers and health companies are bemoaning the government’s promise to crack down on provinces that allow private entities to charge patients for essential medical care, saying the move could threaten access to recognized workplace benefits.

Federal Health Minister Mark Holland said last month that he would issue a “short order” document clarifying how the Canada Health Act works. in the necessary medical care provided almost exclusively by health professionals other than doctors, usually nurses.

His leader, Jean-Yves Duclos, has previously promised to issue a letter of explanation on the issue in March 2023, in response to the increase in private clinics and primary care companies that charge subscription, membership or user fees to patients. for the maintenance that would be available. it is free if it is given in person by doctors working in the public system.

Brett Belchetz, chief executive officer of primary care provider Maple Corp., said the bill would make it harder for the estimated 6.5 million Canadians without a family doctor to get primary care. Company the other part is owned by Loblaw Cos. Ltd.

“The whole point of this letter, which is supposed to ensure good access for Canadians, fair access for Canadians – it won’t do that,” said Dr. Belchetz, an emergency room physician. “What it’s going to do is take something that really, really works in health care and it’s going to take it away.”

The pending letter of interpretation resurfaced as an issue last month when the Canadian Medical Association released a policy document on balancing public and private care. Among the CMA’s 22 recommendations was a call for governments to “implement the Canada Health Act’s prohibition against user fees by cracking down on jurisdictions that allow charging of member fees, user fees or bundled payments.”

For-profit companies and private clinics are “putting doctors behind paywalls,” warns Danyaal Raza, a family physician at St. Michael, part of the hospital network Unity Health in Toronto, is the past president of Canadian Physicians for Medicare.

“I would argue, and I think a lot of people feel the same way, that that’s a serious moral lapse,” he said. “It’s not what Canadians expect from institutions.” in their health practices.”

The health minister says she will soon issue guidelines clarifying limits for out-of-pocket primary care charges

But many Canadians who rely on affordable primary care don’t pay the entire tab themselves. About 10 million Canadians already have some coverage for primary care through their workplace benefits packages, according to the Canadian Health and Life Insurance Corporation. CHIA and other advocacy groups say they are concerned that reinterpretation of the Canada Health Act could eliminate those benefits.

“Now people are going to have to start trying harder to find a family doctor,” said Carolyne Eagan, president of the Benefits Alliance, which represents insurance advisers who develop group benefit plans. Or they will have to wait a little longer and stop, perhaps, to solve other problems at the right time.

When The Globe and Mail asked Health Canada how the bill would affect primary care paid for through workplace plans, spokeswoman Anne Génier said in an email that health insurance is intended to to supplement services provided through Medicare.

He wrote: “It is not intended to allow Canadians with private insurance through an employer benefit plan to jump the queue for health insurance services or to get special or expedited access to care in than those waiting for civil action.”

In Canada, the primary care industry — which has grown exponentially during the pandemic — operates both inside and outside the public system. Maple, for example, has contracts with Nova Scotia, New Brunswick and Prince Edward Island to provide publicly funded primary care virtually, via telephone or video conferencing, free of charge to patients (who they already pay for health care with their taxes).

But in some parts of the country, Maple and other telemedicine companies are using legal methods to charge patients or their private insurers.

Under the Canada Health Act, passed in 1984, the federal government provides health transfer payments to the provinces and territories in exchange for maintaining Medicare policies, including guarantees that patients will not pay out of pocket for necessary medical services.

If provincial governments allow such charges, Ottawa can – and has – suspended its federal transfer until it passes and enforces legislation banning user fees.

But there are holes. The Canada Health Act only applies to services provided in hospitals or by doctors, which means that other health professionals, including nurses, are free to act outside the act and charge patients.

In addition, provincial governments designate services as medically necessary by establishing payment systems for physicians to receive payment through public health insurance. Services without charging codes are considered insecure and considered fair game for private providers.

Some telemedicine companies, such as Sun Life-owned Dialogue, offer their services through employer-sponsored plans and do not charge patients out-of-pocket.

Some, including Maple, do both. For a monthly subscription of $79.99, Maple connects patients and doctors via secure text message, which is not a public insurance service in many states, and provides access to nurses, as well as facilities other unpaid services, such as writing sick notes and prescribing.

Doctor Rocket, another virtual care company, charges Ontario $59 for a text chat with a doctor, and $65 for a video call with a physician assistant, another group of health professionals referred to in the Canada Health Act.

The company’s platform also enables funded community care, a service that founder and physician William Cherniak wishes to see more widely available, especially in rural Canada. In the interview, Dr. Cherniak emphasized his support for one of the CMA’s recommendations: That “appropriate virtual care services” be publicly paid for at the same rates as individual care.

The rub is what is considered appropriate. Lauren Lapointe-Shaw, an internal medicine physician and researcher at the University of Toronto, said studies have shown that virtual telemedicine works best when it is provided by family doctors who have known their patients for years and I checked them personally if necessary.

He led an Ontario study that found patients who visited a publicly funded “outside” doctor — perhaps from a direct-to-consumer telemedicine company — were more likely to visit the ER during seven days compared to those who had seen their doctor for approx.

But that ideal situation isn’t available to the millions of Canadians who don’t have access to a family doctor, said Dr. Belchetz of Maple.

“To be honest, what I would like is, if the government doesn’t like what we do, if the government doesn’t like the user fees we charge, why? [they] will win us over by making the social system so good that nobody has to pay a dollar?” he said. “That would be a dream.”