Question Period Note: CANADA HEALTH ACT COMPLIANCE ISSUES

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

KEY MESSAGES

• Our Government takes its responsibility to defend the Canada Health Act seriously.

• 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.

• Our universal healthcare system has supported Canadians throughout the pandemic and provided the care to both prevent and treat COVID-19.

• 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 patient 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.

Patient Charges for Abortion Services (NB and ON)
In New Brunswick (NB), Regulation 84-20 of the 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 receive these services at the private clinic in Fredericton are required to pay out-of-pocket. NB is the only province with a private abortion clinic where the province does not provide coverage for services. Patient charges for abortion services received in private clinics are considered user charges under the Canada Health Act (CHA), and raise concerns under the accessibility and comprehensiveness criteria of the Act. In March 2020 and March 2021, deductions of $140,216 and $64,850 were levied against the province’s Canada Health Transfer (CHT) payments in respect of patient charges for surgical abortion services. The lack of coverage for abortions performed in private clinics has been discussed bilaterally with NB since 1995, without resolution.

Evidence indicates that some private abortion clinics in Ontario (ON) are charging patients to access 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 advised ON that patient charges being levied in non-IHF clinics are considered user charges under the CHA. 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.

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, all deducted 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). The Court 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. An appeal of the decision was heard by the BC Court of Appeal in June 2021. A decision from the Court of Appeal is expected in the next four months.

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. Since March 2018, BC’s CHT payments have been deducted $62,742,889 in respect of patient charges at private surgical clinics. To date, Health Canada has reimbursed $40,528,957 of these deductions in recognition of the province's efforts to 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 all medically necessary services, including diagnostic services, are insured services, regardless of the venue where the services are delivered. Seven provinces currently allow patients to pay privately for diagnostic services and Saskatchewan actively encourages the practice, through its 1-for-1 model.

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. Provinces and territories have an opportunity to receive an immediate reimbursement of any deduction if they eliminate these patient charges before March 2023.

None