Provinces knew health transfers could be affected by user fees, expert says

Health Minister Jean-Yves Duclos announced federal health transfers to the provinces are being reduced by $82 million after the Ottawa learned Friday they were charging patients for services that should have been covered by the public funding.

Eight provinces will see reductions in their next health transfer from the federal government over fees charged to patients in 2020 and 2021.

Alberta's deduction amounts to $13.78 million, behind Quebec and British Columbia.

Most of the deductions are related to fees for diagnostic services such as MRIs (magnetic resonance imaging) and CT scans (computed tomography or CAT scan).

"Canadians should always be able to access medically necessary services without having to pay out of pocket, no matter where the lives in the country, or how care is delivered," said Duclos in a news conference on Friday.

Duclos says it’s meant to crack down on a pre-existing "loophole" that worsened over the course of the COVID-19 pandemic.

"Universal, accessible and publicly-funded health care is a point of a pride for Canadians and protecting it is a priority."

PROVINCES WERE WARNED

The federal Liberal government enacted a new policy on diagnostic services in 2020 ensuring fees for such tests were covered by the Canada Health Act's single-payer policy.

The Canada Health Act allows the federal government to reduce health transfers when provinces charge user fees for medically necessary health services.

Lorian Hardcastle, a health law policy specialist at the University of Calgary’s Cumming School of Medicine, said the provinces were warned the federal government could limit health transfers for this issue.

"The bigger concern is that withholding money from provincial health budgets might mean that various people lose out. And so it really is a calculus for the federal government. Do we allow breaches of the Canada Health Act to persist? Or do we withhold funds and try to incentivize provinces to avoid those breaches," said Hardcastle.

Hardcastle says that private purchases of scans may have people access surgeries faster than those who might be sicker.

She says that can lead to shortages of physicians and technologists.

"If they're spending their time doing diagnostics in facilities for private pay patients, then public wait times can be longer," she said.

MEDICALLY NECESSARY

Health Minister Jason Copping spoke publicly during a visit to Calgary saying there are ongoing conversations between the province and Ottawa, and adds "we're on the same page."

"When there is medically necessary diagnostic imaging, and other procedures that need to be done, that needs to be covered under the Alberta Health Insurance Act," he said.

Copping says he understands there is a lengthy waitlist for diagnostic imaging, and his government provided $45 million in total funds to address the backlog.

"There has been 23 per cent decrease in CT waitlist from March 2020, and an almost 20 per cent (reduction) in the MRI waitlist," he added.

Alberta Health Services administrator Dr. John Cowell says long waitlists have been a problem for many years that have been solved periodically.

"It's based on availability of equipment and technicians that run the equipment and organizing the scheduling," said Cowell before adding, "additional funds that can be directed at this problem is always welcome."

SUFFERED ENOUGH

Wayne Hume, 77, paid $450 for a private CT scan in October 2022 to expedite access to a surgeon after receiving a June diagnosis of vasculitis and complicated sinus issues.

"It was going to be four to six weeks before I could get in, so to speed up the process I decided to pay for it myself," said Hume.

"I'd suffered long enough. I was hurting. My body was starting to run down."

Prior to June 2022, the Calgary resident had played competitive tennis weekly, but his illness made almost all physical activity exhausting.

His surgery was booked in late November.

"I'm not a real fan of private health care but ... if I pay for it then the guy behind me jumps the queue by another day, so I think it helps people that are waiting, if you can afford to wait," said Hume.

Hardcastle also predicts Alberta’s UCP government will push back against the federal decision.

"There does seem to be some appetite within both currently elected officials, but also the party more generally, to allow for more individuals to pay to jump public sector queues," she said.

LETTER TO COME

Duclos has also written to every province and territory to warn them about an increase in private fees being charged for other services, including virtual patient visits.

Copping says he has yet to receive and review that letter.

With files from The Canadian Press first published March 10, 2023.