Good afternoon, and thank you for inviting the Canadian Health Coalition to speak today.
Founded in 1979, the Canadian Health Coalition is a public advocacy organization dedicated to the preservation and improvement of public health care. Our membership is comprised of national organizations representing health care workers, seniors, churches, anti-poverty groups, trade unions, as well as affiliated coalitions in 10 provinces and one territory.
We would like to share our perspective specifically on part 6 of Bill C-74, which proposes amendments “to allow Canada Health Transfer deductions to be reimbursed when provinces and territories have taken the steps necessary to eliminate extra-billing and user fees in the delivery of public health care.”
The Canadian Health Coalition welcomes this amendment, but we also believe it is imperative that this action be taken alongside other activities to curb the increasing threat of private, for-profit health care in Canada.
At a time when private clinics and user fees are springing up across the country, the federal government needs to make use of all the tools at its disposal to protect the ethos of equitable care for all. This includes withholding health transfer payments to provinces and territories who fail to uphold the core principles of the Canada Health Act that health care should be publicly administered, comprehensive, universal, portable, and accessible. In addition to violating these fundamental principles, unlawful extra billing comes at the expense of patients in need and the public purse.
In research led by our provincial affiliate, the Ontario Health Coalition, 136 private surgery, diagnostic, and boutique physician clinics were surveyed across Canada, finding evidence that at least 65% are charging extra user fees. These put patients at impossible decisions to choose between their health and basic living costs, and patients at these clinics often feel they have no choice but to pay for medically unnecessary add-ons and upgrades.
Recent research by the Parkland Institute highlights the rise of private membership clinics in Alberta. Individuals pay a yearly fee to access both insured medical services alongside non-insured medical services such as dieticians and massage therapists. This has the effect of limiting access to those needed medical professionals to those who can pay rather than those who are in need.
While some of these activities operate within a grey area, others are explicitly allowed by provincial governments. Saskatchewan allows private MRls to operate under a one-for-one scheme where private clinics are supposed to provide a free MRI to someone on the public waiting list for every paid MRI they perform. The Manitoba government has also expressed an interest in private MRls, and two are currently under development.
Quebec has had longstanding issues with user fees. Following threats of a lawsuit by patient groups and health advocates, they recently passed legislation to curb these fees, but there are reports that some patients are still being charged illegal fees.
Finally, right now in British Columbia, there is a potentially precedent-setting case at the B.C. Supreme Court to determine whether a for-profit surgery clinic, which was found to engage in double billing, should be allowed to operate.
Despite all of these examples and others, the federal government has been reluctant to impose punitive action against provinces that are enabling the proliferation of extra billing. In the past 15 years, there have only been a few instances of payments being withheld for non-compliance. In at least one case, those payments were reimbursed following the introduction of new legislation.
The overwhelming majority of Canadians want the federal government to act in defence of public health care. A recent poll commissioned by the CHC found that 89% of respondents want the federal government to intervene in unlawful billing from private practices. While the federal government should penalize provinces that fail to comply, we also do not want Canadians and the health care system to bear the financial burden of these penalties.
This amendment provides a way to reward provinces and territories for taking positive action. However, this change is meaningless if the Minister of Health does not enforce the Canada Health Act in the first place or if the federal government is not making sufficient investments in our public health care system.
In closing, we urge the federal government to take a more proactive stance in protecting the ethos of equitable care for all through broader investments in public universal health care along with increased data collection and reporting.
If this amendment will encourage such action, then we most definitely welcome it.
Thank you.