Health care clinics in Quebec now allowed to bill patients extra fees

A medical clinic.
A medical clinic. Stock photo from iStock/Getty Images.

There is little question that we have a health-care system that has its problems. Long wait times to see doctors and access to certain services and procedures are just one part of the problem.

While our system of universal healthcare has its problems, there are also benefits.

The main benefit is that if we have a medical problem, we have direct access to medical care.  Even if sometimes we’re charged a little extra for doctor’s services – but wait a minute! Aren’t medical services under provincial health insurance supposed to be free of charge?

The Canada Health Act of 1985 states in s. 18 of the Act:

“In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, no payments may be permitted by the province for that fiscal year under the health care insurance plan of the province in respect of insured health services that have been subject to extra-billing by medical practitioners or dentists.”

In other words, the federal government forbids the province from allowing extra billing where provincial health insurance is being charged. In fact there are four sections in the Act, s.18 to s.22, that deal with extra billing. If the province is found to have conducted extra billing, then the amounts that were charged will be deducted from federal transfer payments.

Though extra billing is against the Canada Health Act, some doctors and clinics have charged those fees regardless.

Now, to add insult to injury, Quebec Health Minister Gaetan Barrette wanted to do something about extra billing – but instead of getting rid of it altogether, he decided to regulate it in Quebec.

Extra billing is - for example - if your doctor or the clinic asks you to pay an additional fee for medication, treatments or examinations, even though you’re covered by your provincial health insurance.

Barrette seems to want to try to regulate it by going through the clinic only. So the clinic would charge additional costs for things already covered by provincial health insurance, not the doctor. The Canada Health Act doesn’t mention clinics, so this may be one way to bypass the law.

However, medical authorities all across the province have sounded an alarm about changes to Bill 20 – which is the bill that now regulates extra billing.

Writing for the Huffington, two doctors – Dr. Danielle Martin and Dr. Ryan Meilli – write:

“Charging patients at the point of care for medically necessary services strikes at the heart of the principle that access to health care should be based on need rather than ability to pay. It undermines equity, increases system costs and reduces commitment to the public health care system.”

The doctors furthermore make the important point that those who need healthcare the most are often unable to pay these fees. This means people who truly need medical care, but cannot afford it will not seek it out, and goes against what our medical system has come to symbolize.

We may have problems with long waiting times, but at least everyone is able to get treatment, and not only the ones that can pay for it.

Sadly, despite vocal protest from medical professionals and associations - and with no public debate, the Bill was quietly passed on October 7, 2015.

Now the question is: will these new regulations be challenged? It seems likely.

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