The Ontario Health Coalition has conducted a cross-Canada study that includes the results of surveys of 136 private hospitals, diagnostic and “boutique” physician clinics, and with almost 400 individual patients in Ontario. The results of the survey are found in a recently released report titled ‘Private Clinics and the Threat to Public Medicare in Canada’. The entire report, released at a press conference in Toronto on Monday, June 12, 2017, can be found here: www.ontariohealthcoalition.ca
From the autumn of 2016 to the spring of 2017, researchers at the Ontario Health Coalition called private clinics right across Canada. Included in the survey are private surgical clinics including cataract surgery clinics, MRI/CT, colonoscopy/endoscopy clinics and “boutique” physician clinics. In total, we surveyed a sample of 136 private clinics in 9 provinces. From our interviews, we found 88 clinics in six provinces that are charging patients extra user-fees and selling medically necessary services. In addition, we surveyed 400 individual patients about their experiences with user-fees.
In response, 250 patients detailed extra charges that they faced when trying to access needed medical care in private clinics. Patients described these medical fees as ‘a shock’ and ‘a hardship’. A substantial number of those who participated are seniors – into their 80’s and 90’s who share stories that include their monthly pensions being wiped out due to fees for medical services.
‘In Ontario, the most common complaint from patients regarding extra user-fees occurs in ophthalmology clinics. It is now common for seniors who need cataract surgery to be faced with charges of $150 – $2,000 or more. Patients, most of them seniors, report that these fees are a shock, a significant blow to their incomes, and result in hardship.’
“Such fees are unlawful under the Canada Health Act, which forbids extra-billing of patients and requires that all Canadians receive medical care based on need. Both clinics and patients were asked about extra user-charges for needed health care services. Under the Canada Health Act such user fees are forbidden. But we found evidence that at least 88 clinics in six provinces are charging extra user-fees. Two-hundred and fifty patients detailed instances in which they have been charged for care. Fees charged to patients were exorbitant, much higher than OHIP costs, ranging from hundreds to thousands of dollars per patient. Patients, many of them seniors, told us that the fees were a shock and caused them financial hardship.” stated Ontario Health Coalition’s Executive Director, Natalie Mehra.
Health Coalitions and public-interest advocates across Canada are warning that challenges to public health care posed by private clinics have come to a head, and unless governments act to protect patients, public health care is at risk.
Natalie Mehra is also the author of the substantive report, which outlines several examples of double-dipping by clinics, where the public medicare system is billed as well as the patient.
‘Under Canada’s Public Medicare system, provinces are responsible for meeting the conditions and criteria of the Canada Health Act, including the Act’s prohibitions on user fees and extra-billing of patients that protect equity in access to care. Provincial governments have a duty, therefore, under Canadian law, to ensure that residents are not faced with user charges when they visit a doctor, a hospital or a clinic.
The federal government has the power to investigate transgressions of these protections for patients, and should be penalizing provincial governments that fail to comply. Both levels of government also have an obligation to Canadians to engage in population health planning, to provide services to meet Canadians’ needs.’
Located almost exclusively in the most affluent neighbourhoods of Canada’s largest urban centres where there is a wealthy ‘market’ for their services, so-called ‘boutique’ clinics sell a variety of medically necessary tests and procedures co-mingled with medically unnecessary services in an attempt to sidestep the Canada Health Act’s prohibition on user fees.
‘As a rule, these clinics charge extremely high fees for access to their services, and, as per the Toronto Life story, are often marketed for their exclusivity. Some clinics require health cards and bill both the public health care system and patients. Other clinics do not require a health card and charge patients directly for all services.’ The report especially provides investigation into Private MRI Clinics, Private Surgical/Colonoscopy/Endoscopy Clinics, and Private Cataract Surgery Clinics.
Mehra states, “Over the two decades or more in which Canadian provinces have experimented with privatization, the attempt to regulate private clinics has failed. Illegal billing, double-billing and quality problems have been widely reported. Having broken Canadian laws and charged patients — many of them seniors — thousands of dollars on top of the taxes that they already pay for these services, now that they are caught, clinic owners want to advocate to legalize extra-billing. They say that government should let it happen and just regulate the prices. So far, the record is not good.”
Mehra further said, “The solution to private clinics is to open unused capacity in our public operating rooms and diagnostic suites, use sound population planning processes to plan public hospital capacity to meet our communities needs, and roll contracts back in to our local public hospitals. Privatization is a failure. Its time to rebuild capacity in our community hospitals that operate on a non-profit basis in the public interest and insist that our governments plan for and resource our public hospitals to provide the services we need.”
“It is imperative that governments catch up to and rein in the private clinic industry. Canadian laws at the national and provincial levels are being contravened, largely unhindered by governments.” Shared Mehra in the report. “Medical ethics are being violated as physicians in some clinics have become modern-day snake-oil salesmen in a bid to sell medically unnecessary add-ons at exorbitant prices. The ‘market’ of private clinics has expanded and large chain companies are emerging, spreading extra user-fees across the country.”
“Private clinics are using failures in public policy as cover for their unethical behaviour. But their critique of what is happening in our public system is not entirely wrong. The solution is not to throw out public medicare and the protections against user fees and financial hardship that it affords to patients. The solution is to open unused capacity in our public operating rooms and diagnostic suites, use sound population planning processes to plan public hospital capacity to meet our communities’ needs, adopt innovations in wait time management and the organization of services to improve access, and roll contracts back in to our local public hospitals.”
“Privatization is a failure. Its time to rebuild capacity in our community hospitals that operate on a non-profit basis in the public interest and insist that our governments plan for and resource our public hospitals to provide the services we need.” Stated Mehra.