Private-pay clinics and double-billing cause hardship and le

Private-pay clinics and double-billing cause hardship and le

Postby Oscar » Thu Jun 15, 2017 10:07 am

Private-pay clinics and double-billing cause hardship and lengthen wait-times

[ ... wait-times ]

June 12, 2017 - 5:41 am

The Globe and Mail has published this feature article [ ... e35260558/ ] that reveals that: 63 per cent of the 699 doctors who work at 71 private-pay clinics also work in the public system; it's routine for these doctors to direct patients to private-pay clinics where they have a stake in the profits; it's also routine for these doctors to bill both their patient and the government for different aspects of the same treatment; even though these practices are in violation of the Canada Health Act, the federal and provincial governments do not strictly enforce the rules; and the costs charged at private-pay clinics are exorbitant.

The newspaper reports:

- "In theory, doctors who bill the public health-care system aren’t allowed to charge patients a cent to get necessary medical treatment. It’s illegal. If they do, Ottawa and the provinces are supposed to stop them [but] regulators are doing little to stop doctor-owned clinics from quietly and increasingly making patients pay for quicker access – for everything from appointments to surgery."

- "The Globe compiled data on 71 [private-pay clinics], across the country, almost all owned by physicians. Those clinics sell what some call 'private options', for which most of them charge patients hundreds, even thousands, of dollars. The data show that at least 63 per cent of 699 doctors listed as owning or working at those 71 private-pay facilities also work in the public system – an indication the rules against extra-billing are widely ignored."

- "Patient records, court filings and government audits suggest that conflicts of interest by doctors (directing patients to clinics where they themselves have a stake in the profits) and double-dipping (billing both their patient and the government for different aspects of the same treatment) are routine."

- "A national survey [ ... report.pdf ] conducted by the Ontario Health Coalition, a public health-care advocacy group, canvassed 136 private clinics over the last two years, and found that 71 of them sell speedier access to medical services that are supposed to be covered by provincial health plans. An additional 17 clinics in Quebec were selling access to magnetic resonance imaging tests – MRIs – which are not fully covered by the provincial government."

- "Volunteers who called posing as would-be patients were quoted prices ranging from $575 to $995 for an MRI; from $3,600 to $10,000 for minor knee surgery; and from $1,000 to $5,000 for cataract surgery."

- "Because extra-billing is not supposed to be allowed, the prices that clinics charge for various services are unadvertised, unregulated, and all over the map. Not only is the government not reining in those private fees, but, in contrast to the situation in the U.S., insurance companies aren’t allowed to step in to negotiate and cover the costs, either. Canadian patients are barred from buying private insurance to cover necessary medical services, except in Quebec, where the law allows it for minor treatments."

- "B.C. is the only province that the federal government has fined every year of the past five – approximately $1-million in total – for allowing extra-billing, in violation of the Canada Health Act [but] that is a drop in the bucket compared to the tens of millions of dollars that flow through private-billing facilities each year."

- "[The federal government] gets its data from the provinces – on how much unlawful extra-billing it should penalize them for – so the provinces have a vested interest in minimizing those figures."

- "Even in Ontario, long considered tough on extra-billing, and where the government investigated 314 complaints in the last five years, none of the doctors involved was sanctioned. More than one-third were made to refund their patients, but were then able to bill the province for those treatments."

The Council of Canadians argues that this situation is causing great individual hardship and harming our public system.

We believe that private-pay clinics are a problem, not a solution, and that a two-tiered health care system means longer wait times for just about everyone. Private-pay clinics siphon medical professionals from the public system thus lengthening wait times. Instead of pooling our health care resources, they suggest the wealthy deserve care before others or that it's acceptable to go into debt to receive needed medical care. We also believe there are public solutions to wait times. Long wait times could be minimized under universal health care with political will to address this situation, better coordination and multi-level strategies that make better use of surgical infrastructure.

We join with health coalitions across the country to call on governments to take action to safeguard single-tier public health care for all.

To read the 66-page Ontario Health Coalition national survey on the threat private clinics pose to public health care, (June 2017) click here: [ ... report.pdf ]

To read the stories of individuals affected by this situation, please see The Globe and Mail news report here:
[ ... e35260558/ ]

You can read more about our campaign to defend and strengthen public health care here:
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