Gov’t right to act on extra-billing by doctors

In 2003, the B.C. government passed the Medical Protection Amendment Act (MPAA), designed, in part, to protect public medicare by punishing physicians or private clinics who unlawfully charge user fees. However, after significant backlash from private clinics in B.C., key provisions of the act were never brought into force and the legislation sat gathering dust — until now.

Starting Oct. 1, the B.C. government will take action against doctors and clinics who unlawfully charge patients fees. Doctors who extra-bill for services that are covered under the Medical Services Plan (MSP) — B.C.’s public-insurance plan — will be required to reimburse their patients. The government can fine them (up to $10,000 for a first offence and $20,000 for a second offence) and even delist them from MSP, meaning they would no longer be able to provide care to patients covered under MSP.

The government argues that enforcement of the MPAA is necessary to protect the health of British Columbians who rely on the publicly funded system, but the for-profit clinics are once again determined to stop it. Cambie Surgery Corporation and its Specialist Referral Clinic, both private, investor-owned facilities, have filed an injunction application in the Supreme Court of B.C. asking the court to suspend enforcement of the MPAA.

Patients seek care at for-profit facilities for several reasons, but wait times in the public system are often cited. Doctors working at these centres take advantage of people in pain by billing them more than the agreed-upon fees charged in the public system.

These facilities are free to charge whatever they see fit for medically unnecessary care, such as cosmetic plastic surgery. They’re also allowed to treat patients on wait lists in the public system for medically necessary services but must do so under contract with the government, at the negotiated MSP rates, which are mutually agreed to by doctors and the B.C. Ministry of Health. Such privately run, but publicly funded, facilities have been successfully running for many years, serving the public and their shareholders.

The MPAA was created because the Campbell government of the day saw it as a defence against the loss of transfer payments from the federal government. In reality — as explained in Campbell’s affidavit — they did so, but rather than adequately funding the health-care system, B.C.’s government had decided to allow surgeons to provide privately funded surgical services to those who could afford it, in contravention of both B.C.’s own law and the federal government’s Canada Health Act.

There are many ways for doctors to advocate for needed improvements to the system in which we work. If doctors in B.C. are concerned that current MSP rates don’t match the cost of quality care, they should join the doctors of B.C. in contract negotiations currently underway — not ask the courts to allow them to bill as much as they like.

Wait lists are a challenge in any health-care system and ours is no different. There are many areas for innovation and systems change that can improve access and quality of care.

As physicians we can push for these changes. B.C.’s new surgical strategy is a great example, implementing regionally managed, centralized intake and wait-list management, as well as interdisciplinary care teams.

Similarly, the recent expansion of MRI capacity within the public system will help speed up diagnosis and help patients get the care they need more quickly.

Just because previous governments chose to sit on key provisions of the MPAA for 15 years doesn’t mean it isn’t valid or necessary legislation. After all, what’s better for the people of B.C., quality health care for all or profits for doctors who choose to game the system?

Dr. Duncan Etches is a family physician in Vancouver and named intervener in the Cambie trial. Dr. Michael C. Klein is professor emeritus at the University of B.C. departments of Family Medicine and Pediatrics and a board member of Canadian Doctors for Medicare.