Question Period Note: CANADA HEALTH ACT COMPLIANCE ISSUES

• Will the Minister enforce the Canada Health Act to ensure Canadians are not forced to pay out-of-pocket for the medical services they need?

KEY MESSAGES
• 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.
• While the COVID-19 pandemic continues to disrupt the lives of Canadians at an unprecedented level, our universal health care system has been an enduring source of comfort.
• The Minister of Health takes her responsibility to defend the Canada Health Act seriously.
• This Government will uphold the Canada Health Act to help ensure that patients do not face barriers when accessing medically necessary health care.
IF PRESSED ON PATIENT CHARGES FOR ABORTION SERVICES IN NEW BRUNSWICK AND ONTARIO…
• Our Government believes that Canadians should have access to the full range of reproductive health services, including abortion services.
• Individuals should not face charges when seeking these insured services regardless of where the services are provided.
• The Act is clear: where there is evidence of patient charges, a mandatory deduction to federal health transfer payments to the province or territory must be taken.

BACKGROUND
Patient Charges for Abortion Services (NB and ON)
In New Brunswick (NB), 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 individuals who received these services at the private clinic in Fredericton were required to pay out-of-pocket. NB was the last province with a private abortion clinic where the province refused to provide coverage for services. Patient charges for abortion services received in private clinics are considered extra-billing and user charges under the Canada Health Act (CHA) 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.
When the Canada Health Act Annual Report 2019-2020 was tabled in Parliament in February 2021, some media reports indicated Health Canada planned to levy a penalty of approximately $140K in March 2021. In fact, that was the deduction, which was levied in March 2020. The penalty levied against New Brunswick in March 2021 was $64,850.

Evidence indicates that some private abortion clinics in Ontario (ON) charged patients facility fees when accessing insured surgical abortion services. While the Ontario Health Insurance Plan provides coverage for physicians' fees related to abortion services in all private clinics, the province only covers facility fees in the four private abortion clinics licensed as Independent Health Facilities (IHF). Health Canada has been clear with ON that patient charges being levied in non-IHF clinics are user charges under the CHA, and based on patient charges reported by ON to Health Canada, a deduction of $13,905 was levied against the province’s CHT payment in March 2021. Health Canada and ON are working together to ensure these barriers to access are eliminated.
Budget 2021, released in April 2021, acknowledged the need for greater access to sexual and reproductive health care information and services across the country. The Budget proposed $45 million over three years to fund community-based organizations that help make sexual and reproductive health care information and services more accessible for vulnerable populations.
Patient Charges for Cataract Services in Newfoundland and Labrador (NL)
Working collaboratively with Health Canada, NL developed and carried out a plan to eliminate patient charges for insured cataract surgery provided by an enrolled physician at a private clinic. While NL has faced ongoing deductions to its CHT payments in respect of these patient charges, including a deduction of $4521.29 in March 2021, these amounts have been reimbursed as the province has successfully eliminated the charges.
Charter Challenge in British Columbia (BC)
On September 10, 2020, the Supreme Court of BC released its decision in Cambie Surgeries Corp v. BC (Attorney General), which dismissed a constitutional challenge to provisions of BC’s Medicare Protection Act and upheld the province’s ban on patient charges and the purchase of private insurance for publicly insured health care services. The decision is being appealed and will be heard in the BC Court of Appeal June 14-18, 2021. Canada is participating in the appeal.
Patient Charges for Surgical Services in BC
While the elimination of patient charges in BC has been hindered by an injunction related to the Charter challenge, the province has continued to work collaboratively with Health Canada to address these charges. In March 2021, British Columbia's CHT payment was reduced by $13,949,979 for patient charges at private surgical clinics. To date, Health Canada has authorized a partial reimbursement of BC’s March 2019, March 2020, and March 2021, deductions for a total of $24,598,418 in recognition of efforts taken by the province to address and eliminate these charges.
Diagnostic Services Policy:
The Diagnostic Services Policy, which came into effect on April 1, 2020, is aimed at eliminating patient charges for medically necessary diagnostic services, such as MRI and CT scans. The policy confirms the long-standing federal position that medically necessary diagnostic services are insured services, regardless of the venue where the services are delivered.
Provinces and territories were given nearly two years’ notice that the Diagnostic Services Policy was coming into effect, to give them time to align their health care systems with its requirements. Under the Policy, provinces and territories will be expected to report on patient charges for medically necessary diagnostic services in December 2022. Patient charges for these services will result in mandatory dollar-for-dollar deductions from the Canada Health Transfer payments of the implicated province or territory beginning in March 2023. Seven provinces currently allow patients to pay privately for diagnostic services and Saskatchewan actively encourages the practice, through its 1-for-1 model.

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