Skip to main content

B.C. Health Minister Adrian Dix, seen in this file photo, says the billing practices of three private health clinics in his province are being audited.

Rafal Gerszak/The Globe and Mail

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.

Story continues below advertisement

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.

Related: Canadian patients, advocates speak out about illegal doctor double billing

Opinion: Double-dipping doctors defy the spirit of Canadian health-care

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.

Story continues below advertisement

"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.

Story continues below advertisement

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

Geneticist Stephen Scherer says that Canada's medical expertise should be focused on a moonshot to surmount mental health issues. With advances in our understanding of the brain, Scherer says now is the ideal time to stake a claim on the future to help the one-in-five Canadians who will be affected by mental health issues in their lifetimes.
Report an error Editorial code of conduct
Comments

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to letters@globeandmail.com. Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • All comments will be reviewed by one or more moderators before being posted to the site. This should only take a few moments.
  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

Comments that violate our community guidelines will be removed. Commenters who repeatedly violate community guidelines may be suspended, causing them to temporarily lose their ability to engage with comments.

Read our community guidelines here

Discussion loading ...

Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to feedback@globeandmail.com. If you want to write a letter to the editor, please forward to letters@globeandmail.com.
Cannabis pro newsletter