Dix taking political gamble on health fees

B.C. Health Minister Adrian Dix is planning to fine doctors and private clinics that extra-bill their patients. Extra-billing occurs when patients are charged by their physician for services already insured through the Medical Services Plan.

The Canada Health Act of 1984 was the first in a series of attempts to put an end of this practice. It authorized the federal government to withhold transfer payments from provinces that permitted it.

But the act had two serious deficiencies. It placed all of the responsibility on the provinces, some of which had no desire to be drawn into a fight with physicians.

And because the legislation was easily circumvented, successive federal governments failed to follow through on the threat to withhold transfer payments.

In 2003, Premier Gordon Campbell’s government introduced the Medicare Protection Amendment Act that made it an offence to extra-bill. But here, too, the legislation was never fully implemented.

Now, though, times have changed: A different federal government in Ottawa is determined to act.

Health Canada has audited three private clinics in B.C., and estimates patients have been illegally billed $15.9 million. Transfer funds to the province in that amount will be withheld.

So Dix has bitten the bullet. He says the B.C. government will fine physicians who extra-bill up to $10,000 for a first offence, and $20,000 for a second.

This is at once a courageous and politically dangerous decision. The primary reason patients in B.C. visit private clinics is that they cannot get timely care in the public system.

Long wait times for surgical operations, and for some diagnostic procedures such as MRIs, are endemic. Patients have become accustomed to using the private system as an escape hatch when faced with delays.

If Dix succeeds in ending extrabilling, and the fines he has in mind will likely do that, private clinics will have two choices. They can stop charging patients for insured services or their physicians can de-enrol from the Medical Services Plan, which means they may no longer work in public facilities.

Several health authorities contract with private clinics to deliver surgical or diagnostic procedures for an agreed cost. But in these cases, the patient is not billed. The province picks up the tab.

The problem is health authorities have never been given enough money to deliver all the procedures required.

Dix recently announced funding for an additional 9,400 surgeries and 37,000 more MRI scans by 2019.

It’s unclear how much impact on waitlists the additional surgeries and scans will have.

If the province is prepared to rebuild surgical and diagnostic capacity to the point where reasonable wait times are established, the debate will essentially be over. Why would anyone pay for a private procedure if there is timely access in the public system?

But Dix has not yet demonstrated the public system can pick up the slack and achieve wait times that are within acceptable guidelines.

There is also a legal matter to consider. The provincial government is suing a private clinic in Vancouver for extra-billing. The clinic’s defence (in part) is that patients wait too long in the public system.

It might have been safer for Dix to hold his hand until the elimination of over-long waitlists was either achieved, or at least in sight. Instead, he is betting voters (and the courts) will recognize the moral intent behind his decision, even if some patients suffer.

Whatever the case, we are about to experience the health-care system that its inventors dreamed of, but in practice has proved elusive. This is an enormous political gamble.