British Columbia has put three private health clinics under audit amid long-standing concerns about the practice of double-dipping, looking at doctors who work in the public system and who also charge some patients extra fees for quicker access to medical care.
Federal Health Minister Jane Philpott and her newly appointed B.C. counterpart, Adrian Dix, say three of the province's several dozen clinics are being examined for billing patients extra for medically necessary care, a violation of the Canada Health Act.
"The audit will determine the extent to which extra billing and user fees have been a barrier to accessible care for people in British Columbia," Dr. Philpott said in a statement Thursday.
In June, a Globe and Mail investigation found significant, unlawful extra billing by physicians through private doctor-owned clinics, where patients increasingly pay out of pocket to access everything from medical appointments to surgery. Provincial laws forbid doctors who bill the public system from also charging patients to access any type of medically necessary service.
The Globe found that because extra billing is not supposed to be allowed, prices that clinics charge for various services are unadvertised, unregulated and all over the map. Not only is the government not reining in those private fees, but, in contrast to the situation in the United States, insurance companies aren't allowed to step in to negotiate and cover the costs, either. Canadian patients are barred from buying private insurance to cover necessary medical services, except in Quebec, where the law allows it for minor treatments.
Patients interviewed in The Globe investigation said they simply paid the asking price, without question – not necessarily because they had the money, but because they were desperate to get treatment. Some even took out bank loans, not unlike some Americans who have no health insurance.
Mr. Dix, a former B.C. NDP leader and health critic who became Health Minister last month, said he strongly supports the audit agreement, which was negotiated under the province's previous Liberal government.
"We have to act to ensure that access to medical care in B.C. is based on need and not on an individual's ability to pay," Mr. Dix said in an interview with The Canadian Press.
"That is the reason the law exists and that is something that has been fundamental to Canada's health-care system for a long time and is something we strongly support."
Mr. Dix was unavailable for further comment.
Late last year, Dr. Philpott wrote to her provincial counterparts about double-dipping, singling out ways each jurisdiction could tackle the issue.
Health Canada and B.C. decided to proceed with the audits in March, Mr. Dix said to CP, noting that a considerable amount of planning has flowed from that decision.
"The results of the audit may have consequences … but the audits haven't been completed yet so commenting on conclusions that haven't been drawn would be incorrect and unfair," he said. "We are not assuming the results of the audits."
The Canada Health Act, which imposes conditions on the provinces and territories in exchange for health-care funding, prohibits so-called extra billing or user charges for services that are deemed medically necessary. If extra billing or user charges are confirmed, a dollar-for-dollar deduction from that region's federal health transfer payment is required.
Ottawa has the power to fine provinces that don't put a stop to extra billing, but British Columbia is the only province it has penalized in the past five years, with fines totalling a million dollars.
And that is a drop in the bucket compared with the tens of millions of dollars that flow through private-billing facilities each year.
Ottawa gets its data from the provinces – on how much unlawful extra billing it should penalize them for – so the provinces have a vested interest in minimizing those figures.
Ross Outerbridge, a surgeon interviewed in The Globe investigation, said he doesn't know if the Kamloops Surgical Centre he founded is being audited, but he said these actions are pointless as long as an unresolved court challenge involving a Vancouver surgery clinic drags on.
"It's clearly in the courts so they should leave it in the courts and have them figure it out first before they start auditing clinics," Dr. Outerbridge said Thursday.
Brian Day, medical director of the Cambie Surgery Centre, a private Vancouver clinic, will return to B.C. Supreme Court this fall to continue his constitutional challenge of Canada's public health-care system.
The challenge was started a decade ago after the province told him that auditors were on their way.
On Thursday, Dr. Day said these three audits do not involve his centre, but he suspects the government might have begun them after he recently pointed out, in his court case, that other clinics have been allowed to continue charging the same fees.
"Since we started our lawsuit, they haven't targeted any other clinics [until now]," he said.
The federal government is also engaged in the Cambie case, which it believes could have important implications for public health care across Canada.
Mr. Dix said "some of the principles" being defended by the government in the case are similar to the questions at play in the audits.
"It is what the Medical Services Commission in B.C. and the [provincial] ministry of health are defending in that case," he said.
Dr. Philpott, meanwhile, has also warned other provincial counterparts about extra billing and user fees, noting Ottawa will not tolerate the practice.
She has applauded Quebec for its decision in January to ban user fees, and she has also been in discussions with Saskatchewan officials about upholding the Canada Health Act.
In addition, she has been pushing back against a Saskatchewan law that allows private MRI scans if they are ordered by a doctor and if the private clinic does a second scan to someone on the public waiting list at no charge.
Allowing people to pay for private scans contravenes the act, Dr. Philpott says.
The situation is particularly acute in B.C., where there are now dozens of private medical facilities.
With a report from The Canadian Press