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A brain scan at Western University’s Centre for Functional and Metabolic Mapping at Robarts Research Institute in London, Ont., on July 14, 2022.Geoff Robins/The Globe and Mail

The federal government has issued a warning to provinces and territories that it intends to reduce the funding they receive through federal health transfers if they continue to allow private companies to charge patients for medically necessary health services, including virtual care.

And it is also moving forward with separate reductions in health transfers to provinces that permitted people to be charged for diagnostic services such as ultrasounds, MRIs and CT scans – services Ottawa says should be accessible at no cost to patients.

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In a letter sent Thursday to each of the country’s provincial and territorial health ministers, federal Health Minister Jean-Yves Duclos says he is “very concerned” about the emergence of new out-of-pocket fees for using virtual or telehealth platforms to access health services that, if provided in person, would be covered by provincial health care plans.

“The complexities of modern family health, virtual and surgical care, including its provision across jurisdictions, and expanding scopes of practice of health workers, should not be used to permit these charges,” he says in the letter, which The Globe and Mail obtained a copy of.

Provinces and territories will soon receive a separate letter that will make clear that the federal government interprets the Canada Health Act to mean that all Canadians must be able to access medically necessary health services without having to pay out of pocket, “no matter where in the country Canadians live or how they receive medically necessary care,” Mr. Duclos writes.

Federal health officials have been negotiating new health accords with the provinces and territories that will add $46.2-billion in federal funding for health care over the next decade. In the letter, Mr. Duclos says improvements to the medical system must be made in a way that strengthens public and universal health care. If provincial and territorial governments allow private companies to charge patients for medically necessary services, he warns, Ottawa will use its authority under the Canada Health Act to impose financial penalties.

“Where instances of patient charges for these services are present, I will pursue a reduction in federal health transfers by an equivalent amount, as authorized by the Act,” he writes.

“Canadians pay for their health care services through their tax dollars, and should not be asked to pay again by way of patient charges when they need to access those services.”

Virtual health care is not new in Canada, but new platforms have swept across the country since the onset of the COVID-19 pandemic. They allow patients to see medical professionals through mobile video applications, text-based chats and telephone conferencing.

In 2019, virtual care accounted for an average of 3.4 per cent of the health services delivered to patients in Ontario, Manitoba, Saskatchewan, Alberta and British Columbia, according to Canadian Institutes of Health Information data. A year later, the proportion in those provinces had grown to an average of 18 per cent.

While some provinces have introduced virtual care as an extension of their public health offerings, a number of private, for-profit companies have emerged. Some of them have been contracted by provincial governments to fill gaps in ailing health care systems. But these companies don’t always bill for their services through the public system. They can charge patients directly by connecting them with physicians or nurse practitioners from outside their home provinces, because provincial health plans do not cover out-of-province services.

This is the first time in five years that the federal government has updated its interpretation of the Canada Health Act to react to fees being charged to patients for medical services.

In 2018, Ottawa sent a similar warning to provinces and territories, raising concerns about Canadians paying out of pocket for diagnostic tests. Two years later, a policy was implemented banning these fees.

On Friday, Ottawa will announce it is enforcing this policy by reducing health transfers to seven provinces in the coming weeks by a total of $76.5-million, for charges levied on patients for diagnostic tests in the 2020-2021 fiscal year. The majority of this amount, $41.8-million, will be deducted from Quebec’s health transfers, according to figures obtained by The Globe.

Mr. Duclos said in a statement that these medically necessary scans should be accessible at no cost to patients. “This is not acceptable and will not be tolerated,” he said.

Provinces and territories that work with the federal government to eliminate these fees for diagnostics may be eligible for reimbursement of their deductions, Mr. Duclos added.

The federal New Democrats have raised concerns about the practices of private virtual care providers. They have pointed specifically to Maple, Canada’s largest virtual health app. NDP MP Don Davies tabled a motion in the House of Commons last month calling for Ottawa to close loopholes that allow for the growth of “two-tier health care” in Canada.

“Ontario has insured virtual visits under [the Ontario Health Insurance Plan], but Maple has found a way around the province’s rules by connecting patients with a nurse practitioner or physician outside of the province. This is another gaping loophole,” Mr. Davies said in the Commons on Feb. 16.

Mr. Duclos says in his letter that he believes it is “critical” that access to medical services, whether provided in-person or virtually, “remains based on medical need and free of charge.”

Maple did not respond to a request for comment.

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