Glo­ri­ous & Free?

ZOOMER Magazine - - CON­TENTS - BY LIBBY ZNAIMER Libby Znaimer ( libby@zoomer.ca) is VP of news on AM740 and Clas­si­cal 96.3 FM (ZoomerMe­dia prop­er­ties).

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dOYOUKNOWANY urol­o­gists?” That was the email from my friend Har­riet. Her mother was hav­ing chronic blad­der pain, and the sim­ple pos­si­bil­i­ties, like an in­fec­tion, had been ruled out. It was go­ing to take months to see a spe­cial­ist. That didn’t sur­prise me, but the kicker did. “She will pay to go to a pri­vate clinic,” Har­riet told me.

It seems that more pa­tients are will­ing to do the same to get quicker ac­cess to ev­ery­thing from di­ag­nos­tic tests to surgery. While it’s il­le­gal for doc­tors who bill the pub­lic sys­tem to charge pa­tients for any med­i­cally nec­es­sary ser­vice, a re­port by health coali­tions across the coun­try found that 88 of 136 pri­vate hos­pi­tals and clin­ics in six provinces are charg­ing user fees. And they don’t have to break the law – some­times pa­tients are “up­sold” to pro­ce­dures not cov­ered by the pub­lic sys­tem or re­quired to get a ser­vice that is not cov­ered be­fore they can get ac­cess to one that is. “In some cases, they are ... charg­ing pa­tients for ser­vices for which they have al­ready paid in their taxes,” writes Natalie Mehra, au­thor of the re­port and ex­ec­u­tive di­rec­tor of the On­tario Health Coali­tion. “Pri­vate clin­ics have in­sti­tu­tion­al­ized the prac­tice of co-min­gling med­i­cally needed ser­vices with med­i­cally un­nec­es­sary pro­ce­dures to side­step laws that pro­hibit ex­tra fees.”

“I saw my oph­thal­mol­o­gist about my cataracts,” Donna told me when she called into my ra­dio show Fight Back with Libby Znaimer. “I had to pay $400 for the up­graded mea­sure­ment pro­gram that they say is way bet­ter than OHIP. Should I have?”

The an­swer to that, of course, is be­tween Donna and her doc­tor. She dug deep into her pen­sion to pay be­cause she didn’t want to take a chance. Ac­cord­ing to Mehra, $400 is about twice what is usu­ally charged for pre­mium mea­sure­ment, and that high­lights an­other prob­lem. Since these fees are un­reg­u­lated, they are all over the map, “up to five times more than those in the pub­lic sys­tem,” says Adam Lynes-Ford of the B.C. Health Coali­tion.

Donna was also told that when she fi­nally gets her pub­li­cally funded surgery af­ter a year-long wait, she should pay $70 per eye for up­graded lenses. Donna may have got­ten off easy on that one – clin­ics charge up to $1,700 an eye for pre­mium lenses.

Mehra as­sured Donna that “ev­ery­thing you ac­tu­ally need for a good out­come for cataract surgery is cov­ered by OHIP.” But not ev­ery­one agrees. A few days later, Dr. Na­dia Alam, pres­i­dent-elect of the On­tario Med­i­cal As­so­ci­a­tion, told me her own mother is hav­ing trou­ble with the govern­ment-cov­ered lenses she received with her cataract surgery. “The govern­ment is will­ing to cover cer­tain things, but that doesn’t mean those are the best things,” she said.

Vol­un­teers pos­ing as pa­tients can­vassed a group of pri­vate B.C. clin­ics about the cost of surgery on a torn ACL. Fees for the con­sul­ta­tion alone ranged­from$350to$700withthe­ac­tual pro­ce­dure rang­ing from $5,000 to $12,000. They all promised surgery within weeks in­stead of wait­ing up to two years. B.C. is ground zero for pri­vate health care with the high­est num­ber of clin­ics charg­ing ex­tra fees. One clinic owner, Dr. Brian Day, has brought a char­ter chal­lenge to strike down pro­hi­bi­tions on ex­tra billing and user fees. In the mean­time, the B.C. Health Coali­tion al­leges that his clin­ics il­le­gally billed half a mil­lion dol­lars in just 30 days.

Even in cases where il­le­gal billing has been proved, there are few con­se­quences. Ac­cord­ing to the Globe and Mail, roughly 1,000 doc­tors in Que­bec had to pay their pa­tients back but were not sanc­tioned. The same thing hap­pened to about 100 doc­tors in On­tario last year.

Beef­ing up en­force­ment is, in it­self, no so­lu­tion to long waits and lim­ited ac­cess. Some say the only way to fix our health-care sys­tem is with more pri­vate medicine. The health coali-

“A re­port found that 88 of 136 pri­vate hos­pi­tals and clin­ics charge user fees”

tions say pri­vate clin­ics are the prob­lem, and they have to be out­lawed. The an­swer may lie be­tween those two ex­tremes. But we need clear rules. In the mean­time, Har­riet will keep look­ing for a urol­o­gist who will al­low her mother to jump the queue in ex­change for cash, and Donna will never be sure if she re­ally had to pay ex­tra to clear her cataracts.

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