Time to update Canada Health Act
The mandate letter to new Federal Health Minister Patty Hajdu asked her to “continue to ensure compliance with the Canada Health Act on matters of private delivery and extra billing.” Ignored as usual were sections of the CHA regarding portability of benefits both within and outside of Canada, as well as a requirement that fee disputes with physicians be resolved by binding arbitration.
For over three decades, Quebec has paid only its own lower rates rather than host-province rates for medical care in other provinces – a violation of Section 11 of the CHA. Often it would reassess claims and arbitrarily take back money already paid. Hence, most Canadian MDs are reluctant to deal with the Quebec government and simply require direct payment from patients. No federal health minister has intervened.
Thanks to equalization payments, Quebec has a surplus of $4.8 billion. In recent years, Many Quebec fees have greatly increased. Thus there is no longer any excuse not to sign the reciprocal medical billing agreement, and Ms. Hajdu should urge Quebec Health and Social Services Minister Danielle McCann to do so.
Effective January 1, Ontario cancelled out-of-country OHIP coverage, which had been up to $400 per day for ICU care. The Canadian Snowbird Association is seeking a judicial review. Several provinces had been paying less but had not been penalized, e.g., $75 for BC and $100 for Alberta, Saskatchewan, Quebec, and New Brunswick. The CHA requires payment at the daily rate for each province which, for the ICU, is about $5,000; only PEI and the three territories comply.
Last summer, then Federal Health Minister Giette Petitpas Taylor did send a “letter of concern” to Ontario Health Minister Christine Elliott, but apparently this was ignored.
All levels of government have overlooked the fact that snowbirds and many younger persons with pre-existing diabetes, heart disease, etc. cannot qualify for affordable private travel insurance, often because of recent changes in medications due to the global drug shortage problem.
A partial solution would be a targeted one per cent increase in the Canada Health Transfer. This would allow all provinces to meet their obligations under the CHA. It would largely cover physician and hospital costs in most countries (except for a few such as the US) and permit many new Canadians to visit friends and relatives back home. Quebec should not be allowed to opt out.
How could we afford this? Consider that the federal deficit is already $7 billion greater that predicted, not allowing for pharmacare and other promises. Rather than attempting to ensure compliance with only certain parts of the CHA, while ignoring other parts, Ottawa should be willing to update and amend the entire Act.
Dr. Eric Hoskins, in his national pharmacare plan, proposed modest user fees. Also nine provincial governments have been permitted by Ottawa to suggest private insurance for those travelling outside of Canada. Yet any discussion of user fees or privatization for basic medical and surgical services within Canada is taboo.
Ms. Hajdu should meet early this year with her provincial and territorial counterparts. She should also seek input from physicians, other health professionals, and patients with first-hand knowledge of blended public/private health delivery systems with shorter wait times in Australia, New Zealand, Taiwan, and most of the European countries, and be open-minded about borrowing methods to improve the efficiency of our own program. Possibly she or provincial medical associations could organize a series of town hall meetings across the country. Topics would include how physicians are kept from abandoning the public system, relative wait times in both systems, how elderly and indigent patient are exempted from modest user fees, and how persons with preexisting illnesses are fully covered.
This will help to make our own medicare system more fiscally sustainable, and fairer to patients and physicians.
Charles S. Shaver, MD