Health Canada's response is as follows:
In response to (a), the Canada Health Act requires that all medically necessary insured health services be covered by provincial and territorial health insurance plans. Provincial governments are primarily responsible for the delivery of publicly funded health care services in accordance with the Canada Health Act and some of these services, such as physician services, are being delivered by private providers. However, the Canada Health Act applies to insured health services whether they are provided in public or private facilities. Insured persons may not be charged to jump the queue to obtain these services.
In response to (b), provinces and territories are responsible for the administration and delivery of health care services. Some provinces have contracted out medically necessary services to private providers, particularly in the area of elective surgical and diagnostic procedures. The Canada Health Act does not preclude provinces from contracting out insured services provided that insured residents are not charged for such services.
Private, for profit delivery of insured services raises concerns under the act when providers accept or require private payment for insured services and permit queue jumping by those able to pay for preferential access to these services. The federal government's preference is that the publicly funded health care system be strengthened. No province has been penalized by the federal government under the Canada Health Act for contracting with privately owned clinics for the delivery of publicly funded health care services.
Since the enactment of the Canada Health Act, covering the period of April 1984 to March 2004, deductions totalling $8,753,151 have been applied against provincial cash contributions in respect of the extra billing and user charges provisions. This includes deductions applied with respect to facility fees for medically necessary services in clinics and with respect to patient charges for insured health services in private surgical clinics.