The growing threat to Canadian Medicare
HSA REPORT MAGAZINE, JUNE 2018
How privately-funded health care hurts us
On May 1, the B.C. Health Coalition (BCHC) presented two B.C. private surgical clinics with an invoice for $15.9 million. It was a symbolic gesture seeking to highlight how unlawful extra-billing by private clinics across the province is costing the public health care system. Supporters gathered with placards and banners protesting the creeping development of a two-tiered health system in British Columbia.
The federal government clawed back $15.9 million in federal funding to B.C. because of unlawful extra-billing conducted by private clinics in the province from 2015-2016.
Extra-billing, as defined in the Canada Health Act, refers to the amount charged to an insured patient for a publicly insured medical service that exceeds the amount paid out by the public insurer. Over the past 16 years, B.C. is the only province the federal government has repeatedly fined for unlawful extra-billing by withholding transfer payments on a dollar-for-dollar basis.
While publicly funded health care services are administered by the provinces and territories, the actoutlines the criteria provincial bodies must adhere to in order to receive federal health transfer payments. In Canada, these totalled $36 billion in 2016-2017. It is these five criteria (public administration, comprehensiveness, universality, portability, and accessibility) that define the principles and parameters of Canadian Medicare.
Despite this, extra-billing is widespread in the province. Now the new provincial government is taking steps to prevent the practice. In April, it announced that it would bring sections of Bill 92, the Medicare Protection Amendment Act, into law. This act passed in the B.C. legislature in 2003 but sections of it were not brought into force as a result of relentless lobbying efforts from for-profit clinics and physicians across the province. The then BC government, led by Premier Gordon Campbell, decidedly turned a blind eye to illegal extra-billing.
The enforcement of Bill 92 means that it will be an offence for doctors and private clinics to extra-bill patients, for which doctors can be fined up to $20,000. The B.C. government has coupled its crackdown of extra-billing with a strategy to reduce diagnostic and surgical wait times, thereby addressing the public’s reliance on privately funded and delivered services.
This flurry of public policy developments has brought to light some of the tensions existing between privatization and public health care in Canada.