Colleen Flood, a University of Toronto law professor on sabbatical in New Zealand, said in an e-mail that the federal government is "very nervous (unduly nervous) about enforcing its vision of health care on the provinces."
That's because it is not always clear when the act has been breached. Health care is often thought of as a provincial responsibility and some cases (such as user fees for abortions) are "inherently dangerous political issues," she wrote.
But Ms. Saunders said that some provinces are penalized. Last year, $126,775 was deducted from British Columbia's transfer payments because it failed to submit a report to the federal government on extra billing and user fees in 2001-02. Health Canada estimated the amount of charges and deducted it from transfer payments, according to the same documents.
At issue is the definition of what constitutes a medically necessary service. As it stands now, a private patient payment for a medically necessary service would be seen as a violation of the Canada Health Act.
British Columbia is seeking clarification over what is medically necessary, according to Carol Carman, executive director of communications for B.C.'s Ministry of Health Services.
Albert Schumacher, president of the Canadian Medical Association, said: "We need the list of what is going to be publicly funded and what is medically necessary."
One particularly busy private clinic is False Creek Surgical Centre in Vancouver, where about 3,000 private operations are performed each year. One of its owners, Mark Godley, said patients can pay for operations so long as it is a "lifestyle choice" and, therefore, not medically necessary. In other words, if patients can safely wait for the publicly funded procedure but choose not to, then they can pay to have it done at his clinic.
"People are not prepared to wait any more," Dr. Godley said in a telephone interview from Vancouver. "People are calling us out of desperation; they need care and they're not getting it."
As for Ryan Oldford, his mother isn't planning to take him to a private clinic for an MRI just yet. She is hoping that he, and other children in the queue, will be able to have their MRIs soon. But, she added, "I'm not ruling it out. I don't know that I can wait 2½ years."
John Ottenheimer, Health and Community Services Minister for Newfoundland and Labrador, said in a telephone interview that he has not entertained the idea of sending patients out of province to private clinics as a way to whittle down the waiting list. He said the province will be getting another MRI in Corner Brook in a couple of weeks and he is hoping to get a third some time later.
