Behind user fee crackdowns and threats of funding claw backs lies the question of what is ‘medically necessary’
The Canada Health Act stipulates that no user fees should be charged for “medically necessary” health services – broadly defined as hospital care and physician services. According to a piece written by the Globe and Mail’s public health reporter Andre Picard, “medically necessary” must be more clearly defined.
Provinces have been pushing the limits on services by allowing money to be charged for various medical procedures. Bill 20, a law passed in Quebec last year, explicitly allowed user fees for services from application of eye drops to insertion of intrauterine devices. Saskatchewan, on the other hand, announced a scheme that allows private clinics to charge clients for MRI scans, provided that the clinic does a second pro-bono scan for each paying client they accommodate.
“When times get tough… governments try to rein in health spending and one of their main targets is physician fees,” Picard said. That was presumably Federal Health Minister Jane Philpott’s motivation when she took the provinces to task last year. Philpott issued warnings that monies collected from patients would be clawed back from health transfers – a penalty allowed under the Canada Health Act whenever fees are charged for “medically necessary” services.
Quebec Health Minister Gaétan Barrette was initially defiant, but the prospect of losing an estimated $83 million in health funding was too risky; he eventually relented and quashed “accessory fees” in the province. Still, he argued that Quebec is not subject to the Canada Health Act, and has threatened to sue the federal government – all the while being unable to reach a new agreement with Ottawa on health transfers.
Saskatchewan has been more successful in its negotiations with the federal government. Not only has the province reached a health funding agreement with the feds (as have several other provinces and territories), but it has also convinced them to let the 2-for-1 MRI initiative continue for another year to determine if it improves public access.
“The real issue that needs to be tackled is not user fees – it’s finding a way to determine what is ‘medically necessary’ and covered by medicare and what is not,” Picard said, clarifying that universal health coverage does not mean covering everything for everyone at all times. “How do we draw those lines in the sand, all the while ensuring equitable access for all? That’s the public debate we really need to have.”
Related stories:
Quebec health minister’s user fee abolition to kick in on Jan. 26
Saskatchewan slammed over policy allowing private MRI queue-jumping
Provinces have been pushing the limits on services by allowing money to be charged for various medical procedures. Bill 20, a law passed in Quebec last year, explicitly allowed user fees for services from application of eye drops to insertion of intrauterine devices. Saskatchewan, on the other hand, announced a scheme that allows private clinics to charge clients for MRI scans, provided that the clinic does a second pro-bono scan for each paying client they accommodate.
“When times get tough… governments try to rein in health spending and one of their main targets is physician fees,” Picard said. That was presumably Federal Health Minister Jane Philpott’s motivation when she took the provinces to task last year. Philpott issued warnings that monies collected from patients would be clawed back from health transfers – a penalty allowed under the Canada Health Act whenever fees are charged for “medically necessary” services.
Quebec Health Minister Gaétan Barrette was initially defiant, but the prospect of losing an estimated $83 million in health funding was too risky; he eventually relented and quashed “accessory fees” in the province. Still, he argued that Quebec is not subject to the Canada Health Act, and has threatened to sue the federal government – all the while being unable to reach a new agreement with Ottawa on health transfers.
Saskatchewan has been more successful in its negotiations with the federal government. Not only has the province reached a health funding agreement with the feds (as have several other provinces and territories), but it has also convinced them to let the 2-for-1 MRI initiative continue for another year to determine if it improves public access.
“The real issue that needs to be tackled is not user fees – it’s finding a way to determine what is ‘medically necessary’ and covered by medicare and what is not,” Picard said, clarifying that universal health coverage does not mean covering everything for everyone at all times. “How do we draw those lines in the sand, all the while ensuring equitable access for all? That’s the public debate we really need to have.”
Related stories:
Quebec health minister’s user fee abolition to kick in on Jan. 26
Saskatchewan slammed over policy allowing private MRI queue-jumping
