Question Period Note: Canada Health Act – Privatization and Compliance Issues

• Overview of federal action on key Canada Health Act compliance issues.

• Our Government is firmly committed to Canada’s publicly funded health care system and the principle that everyone deserves access to quality, accessible and universal health care.
• The Government of Canada will work with provinces and territories to ensure that its significant ten-year investment of close to $200 billion in health care funding to provinces and territories is used in ways that respect the principles of the Canada Health Act.
• The Canada Health Act ensures all Canadians have access to medically necessary health care services based on their health need, not their ability or willingness to pay.
• This Government has demonstrated that it will uphold the Canada Health Act to ensure that patients do not face barriers when accessing medically necessary care. Toward that end, Health Canada continues to work with provinces and territories to eliminate patient charges for medically necessary services. As a result of provincial and territorial action to address these patient charges, Health Canada reimbursed over $90 million.
IF PRESSED ON MEMBERSHIP FEES AT PRIVATE PRIMARY CARE CLINICS
• The Government of Canada does not support a two-tiered health care system where patients may choose, or be required, to pay membership fees to access insured primary care services at clinics, or to gain preferential access to those services. These fees are considered patient charges under the Canada Health Act and raise concerns under the accessibility criterion of the Act.
• Whenever Health Canada becomes aware of clinics charging such fees, the Department engages with their provincial or territorial counterparts, and works with them to eliminate these charges.
• Most recently, Health Canada officials reached out to their counterparts in Alberta after media reports suggested a clinic was charging membership fees as a condition of accessing insured services and confirmed the province would be auditing these clinics.
IF PRESSED CANADA HEALTH TRANSFER DEDUCTIONS LEVIED TO QUEBEC IN MARCH 2024

• In January 2024, Quebec acknowledged Health Canada’s estimate of patient charges for medically necessary diagnostic services which occurred in fiscal year 2021-2022. As such, in March 2024, Health Canada levied a Canada Health Transfer deduction in the same amount.
Due to efforts made by Quebec to improve access to publicly funded diagnostic services, Health Canada made a partial reimbursement of the province’s March 2023 and March 2024, deductions. Health Canada continues to work with the province to encourage them to eliminate patient charges for medically necessary services, which would allow the province to be fully reimbursed for this deduction

Patient Charges for Medically Necessary Services Delivered Virtually and/or by Non-Physician Health Care Providers
On March 9, 2023, former Minister of Health, Jean-Yves Duclos wrote to his PT counterparts to express concerns about reports of patient charges for medically necessary services delivered virtually and/or by non-physician health care providers that would be insured if delivered in-person by a physician. Health Canada continues to engage with PTs on these issues.

Diagnostic Services Policy
The Diagnostic Services Policy confirmed the federal position that all medically necessary services, including diagnostic MRI (Magnetic resonance imaging) and CT (computerized tomography scan) services, are insured services, regardless of the venue where the services are delivered. Six provinces currently allow patients to pay privately for diagnostic services.

Provinces and territories were required to report on patient charges for medically necessary diagnostic services in December 2023. As a result of patient charges for these services, in March 2024,Health Canada levied $72,408,956 in mandatory dollar-for-dollar deductions from the Canada Health Transfer payments of the implicated jurisdictions. As a result of provincial action to address these patient charges, Health Canada has made reimbursements to several of these jurisdiction, including full reimbursement to Manitoba which has eliminated patient charges. Breakdowns by province are as follows:
• British Columbia - $11,270,216 ($15,587,542 to be reimbursed);
• Alberta - $20,450,175 ($20,538,796 to be reimbursed);
• Saskatchewan - $1,084,513;
• Manitoba - $650 ($354,477 to be reimbursed);
• Quebec - $36,014,132 ($46,728,814 to be reimbursed);
• New Brunswick - $1,794,635; and
• Nova Scotia - $1,794,635.

Membership/enrollment fees and private primary care clinics
Health Canada is aware of private primary care clinics in several provinces and territories (PTs) that charge enrollment and annual membership fees of up to $7,200. These clinics offer members access to insured primary care services, uninsured services (e.g., massage therapy and nutritional services), as well as comprehensive health assessments, which combine insured and uninsured services. Enrollment and membership fees at clinics staffed by enrolled physicians are considered patient charges under the Canada Health Act and raise concerns under the accessibility criterion of the Act, if access to insured services is contingent or preferential on payment of these fees.

In December 2023, Health Canada reached out to Alberta officials after media reports flagged a clinic charging membership fees in relation to accessing insured health services. Alberta has confirmed that the province will be auditing all private clinics that have a membership component to their services.

Access to Abortion in Ontario
In summer 2019, evidence in Ontario confirmed that some private abortion clinics charged fees for uninsured services, while not consistently informing patients these fees were optional, with respect to accessing insured surgical abortion services. Since March 2021, deductions totaling $86,065 have been levied against ON’s CHT payments in respect of patient charges for surgical abortion services.

Under the Canada Health Act Reimbursement Policy provinces and territories that face mandatory deductions have the opportunity to be reimbursed if they work with Health Canada to develop a plan to eliminate patient charges for medically necessary services, and the circumstances that led to them within a specified timeframe. Ontario is in the process of implementing its Reimbursement Action Plan to eliminate patient charges for access to abortion services. Due to the province’s progress to date, including new legislation that prohibits patient charges for these services, in March 2024, Health Canada made a partial reimbursement of the province’s March 2022, 2023, and 2024 deductions totalling $43,296.

Access to Abortion in New Brunswick
In New Brunswick, Regulation 84-20 of the Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals. This means that individuals who received these services at the private clinic in Fredericton were required to pay out-of-pocket. New Brunswick was the only province with a private abortion clinic (Clinic 554) where the province did not provide coverage for services. Since March 2020, deductions totaling $444,041 have been levied against the NB’s Canada Health Transfer (CHT) payments in respect of patient charges for surgical abortion services. Clinic 554 closed in February 2024, but New Brunswick remains subject to Canada Health Transfer deductions for patient charges levied through fiscal 2023-2024, for failing to provide coverage for these services.

The Reimbursement Policy
Under the Canada Health Act (CHA) Reimbursement Policy, which came into effect in 2018, provinces and territories that face mandatory deductions have the opportunity to be reimbursed if they work with Health Canada to develop a plan to eliminate patient charges for medically necessary services, and the circumstances that led to them. The plan must be successfully implemented within a specified timeframe (under the Reimbursement Policy, and as outlined in Section 25.01 of the Federal-Provincial Fiscal Arrangements Act, a province has up to two years from the date of a deduction to be reimbursed).

• Mandatory Canada Health Transfer deductions, totaling over $79M in respect of deductions for medically-necessary services, were levied in March 2024.
• Mandatory deductions are eligible for reimbursement provided the implicated province takes steps to eliminate patient charges and the circumstances that led to them, within two years after the deduction was taken. In March 2024, Health Canada authorized over $90 million in reimbursements to provinces which had taken action to address the patient charges for which they were previously deducted.
• For provinces that received partial reimbursement of their deductions, additional reimbursement can occur as actions are taken to fully eliminate patient charges.