CANADA HEALTH ACT – Abortion Access

About

Reference number:
HC-2019-QP-00001
Date received:
2019-12-09
Organization:
Health Canada
Name of Minister:
Hajdu, Patty (Hon.)
Title of Minister:
Minister of Health

Issue/Question:

In New Brunswick, Regulation 84-20 of the NB Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals (three NB hospitals currently offer the service – two in Moncton and one in Bathurst). This means that women who receive these services at Clinic 554 in Fredericton are required to pay out of pocket.

Patient charges for abortion services received in private clinics are considered extra-billing and user charges under the Canada Health Act and raise concerns under the accessibility and comprehensiveness criteria of the Act. The NB Health Ministry has repeatedly stated publicly that the government has no intention of changing its position on the issue, most recently in its October 2019 response to a request to fund the services that came from the health authority (Horizon Health Network) responsible for the delivery of health services in Fredericton area.

Will the Minister enforce the Canada Health Act and penalise New Brunswick for not covering abortion services in the private clinic in Fredericton?

Suggested Response:

• Our Government firmly supports a woman’s right to choose, and believes that safe and legal abortion services should be available to all Canadian women.

• A woman should not face charges when seeking these insured services at Clinic 554.

• This issue has been raised with the New Brunswick government and we continue to work with them to ensure access without costs for women seeking abortion.

• While it is my strong preference to see New Brunswick insure abortion services in the private clinic, if it does not, I am prepared to take deductions to its health transfer payments as required by the Canada Health Act.

IF PRESSED ON THE POSSIBILITY OF PENALTIES TO NEW BRUNSWICK

• The Act is clear: where there is evidence of patient charges, a mandatory deduction to federal health transfer payments to the province or territory is made.

• I take my responsibilities under the Act seriously and I plan to uphold its requirements.

Background:

In New Brunswick, Regulation 84-20 of the NB Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals (three NB hospitals currently offer the service – two in Moncton and one in Bathurst). This means that women who receive these services at the private clinic in Fredericton are required to pay out of pocket. New Brunswick is the last province with a private abortion clinic that refuses to provide coverage for services delivered there. Patient charges for abortion services received in private clinics are considered extra-billing and user charges under the Canada Health Act and raise concerns under the accessibility and comprehensiveness criteria of the Act. The lack of coverage for abortions performed in private clinics has been discussed bilaterally with NB since 1995, without resolution.

The Morgentaler Clinic in Fredericton closed in July 2014. Clinic officials indicated New Brunswick regulations preventing coverage of abortion services provided in private clinics made the clinic financially unviable. A crowd-sourcing effort subsequently raised sufficient funds and in January 2015, it was reopened as Clinic 554. The clinic’s web-site indicates abortion services cost between $700 and $850, depending on the stage of pregnancy. It also indicates financial assistance may be available from the National Abortion Federation and provides contact information. The clinic also offers primary health care services and services to the LGBT community, all of which are covered under the provincial health insurance plan, according to the clinic director. It claims a roster of 3,000 patients.

Clinic 554, which is the only facility in the area providing surgical abortion services, may close due to the lack of public funding for these services. In early July 2019, former Minister Petitpas Taylor met with the NB Health Minister to discuss the accessibility and comprehensive concerns related to this issue, including the patient charges being levied by the clinic for the abortion services. These concerns were reiterated in the Minister’s follow-up letter sent on July 24, 2019. NB has not formally responded to the July letter. However, the NB Health Ministry has repeatedly stated publicly that the government has no intention of changing its position on the issue, most recently in its October 2019 response to a request to fund the services that came from the health authority (Horizon Health Network) responsible for the delivery of health services in Fredericton area.

Access to abortion services has improved in New Brunswick in recent years, under policies initiated by the previous provincial government. In 2015, the province increased the number of hospitals providing the service from two to three, reduced restrictions on referrals for the service, and eliminated the requirement that the service be provided by a specialist. In 2017, the province became the first province to provide universal coverage for Mifegymiso, under the provincial health insurance plan.

There are CHA concerns regarding abortion services in other provinces. In Summer 2019, media reports indicated that Ontario women are encountering patient charges for abortion services when they sought insured services in certain private clinics in the GTA. Health Canada officials met with their colleagues from Ontario, which committed to investigating and eliminating these patient charges.

Access to abortion services is challenging for women in a number of provinces, where the distance travelled to seek surgical abortions or referrals for medical abortions can be great.

On an annual basis, provinces and territories are required under the Canada Health Act to submit financial statements of patient charges to Health Canada. To date, New Brunswick has not included patient charges for abortion services received in the Fredericton clinic in its financial statements although they have been specifically asked to do so this year.

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