Aug 17, 2011
The service was prompted by evidence that doctors and clinics are routinely flouting medicare rules with sometimes creative methods of generating extra income, Deb Matthews, the province’s Health Minister, said Tuesday.
The government has ordered 4,500 patients to be reimbursed out-of-pocket fees they had been levied by colonoscopy clinics in the last few years, while Ms. Matthews said she has heard of a surgeon charging $100 for a post-operative glass of orange juice.
“There’s no doubt in my mind that people are trying to get around (the law)…. I think it’s really important that we all protect our universal health-care system,” the Health Minister said in an interview. “It’s just important that we are ever-vigilant.”
Critics, however, call the initiative a politically motivated waste of money that could be better spent on improving actual medical services. In the lead-up to this fall’s provincial election, the Liberal government seems anxious to portray itself as a steadfast defender of public health care.
“How is this going to improve patient care for anybody?” Brett Skinner, president and health-care analyst at the conservative Fraser Institute think-tank, asked about the snitch line. “It’s not helping patients get better access. In fact, it’s designed to prevent patients from getting better access.”
The Canada Health Act generally forbids health-care providers from charging patients directly for services that are covered under medicare. Various private health services have cropped up in Quebec, B.C. and Alberta in recent years, however, with little interference by the federal government.
The Ontario Liberals, on the other hand, have presented themselves as strenuous foes of private health care.
Since the “extra-billing and queue-jumping report line” and email address were set up in June, the province has received 130 calls and 60 emails from patients who believe they were wrongly forced to pay for health care, Ms. Matthews said. Those have in turn led to 35 investigations, some dealing with cataract surgery clinics where patients were allegedly required to pay for tests or lenses as a condition for receiving the operation, the minister said.
She conceded that unlawful private health is not “rampant” in Ontario but said there are signs that it is occurring regularly. Since 2006, for instance, the Health Ministry has investigated 16 clinics offering colonoscopies — diagnostic procedures that check for symptoms of colorectal cancer — and found that four were charging illegal “block fees” directly to patients, in addition to the payments they received from medicare.
Those reviews resulted in 4,500 people having fees totalling $226,000 — or about $50 each — reimbursed by the clinics, said Ms. Matthews.
An aide to the minister said officials were unable to separate out the cost of the hot line, which is being funded out of the ministry budget.
One private clinic that offers colonoscopies to its clients — and says it follows all the appropriate rules — stressed that bolstering the public system is important, but questioned how seriously that system is being threatened.
“It’s hard to tell whether going to this length is worth it as the government has not indicated the extent of the problem,” said Bronwen Evans, a spokeswoman for Toronto-based Medcan. “We would hate to see precious health dollars and ministry staff time diverted away from other things, like reducing wait times.”
An official with the group representing registered nurses applauded the hot-line initiative, however, saying the incursions by private medicine are significant, and could be leading to a system where those who can afford to pay more will get better service. That in turn pushes up the total cost of health care, and draws doctors away from the public system, said Rhonda Seidman-Carlson, president-elect of the Registered Nurses Association of Ontario.
“That is a slippery slope,” she said “You start having a for-profit system.”