A welcome second chance for B.C. medicare

Extra-billing ban will save public services, write Colleen Fuller and Seth Klein.

It’s taken over 14 years, but British Columbians will finally be protected against unlawful charges for medical services — just like all other Canadians.

In 2003, the B.C. government brought in the Medicare Protection Amendment Act (Bill 92) to prevent unlawful extra billing as required by the federal Canada Health Act. These provincial and federal laws ban doctors and private clinics from charging patients for medically necessary surgeries and other procedures covered by our public health care system.

In a rare display of agreement, the B.C. legislature originally passed Bill 92 unanimously.

But owners of for-profit surgical clinics and the B.C. Medical Association (now Doctors of BC) mounted an aggressive opposition campaign. Three weeks after it passed, then-premier Gordon Campbell said the new Act would not be proclaimed and most of its provisions were never enforced. The ensuing years have seen a steady stream of extra billing by private clinics and doctors.

Under the Canada Health Act, Ottawa contributes funding for provincial health care. But for every dollar of extra billing, the federal government claws back an equal amount from its cash transfers. In 2003, Ottawa clawed back $127,000 from B.C. for violating extra billing provisions of the Canada Health Act.

In 2015-16, that amount mushroomed to $15.9 million, enough for 53,000 MRI scans.

Last week’s announcement by Health Minister Adrian Dix that Bill 92 will finally be proclaimed is welcome news.

Doctors found to have unlawfully billed patients can be fined up to $20,000 and multiple violations could mean de-enrolment from the public system, meaning no more public funding. Patients who believe they have been inappropriately billed can apply to the provincial government to recover those costs.

A 2012 audit of two private clinics discovered patients were required to sign a waiver pledging not to seek such reimbursement. Patients also had to agree “not to disclose any information to any government regarding the particulars of the beneficiary’s surgery,” including costs. If the patient did disclose, the waiver “require the beneficiaries to indemnify the Extra Billing Clinic for damages and costs arising from disclosure.” Bill 92 should end such practices.

While this government action is important, it cannot succeed without additional welcome plans unveiled last month to reduce waiting times for surgeries and diagnostic services across the province within the public system. This year, B.C. will fund 4,000 additional hip and knee surgeries, plus 5,400 more dental and other surgeries compared to last year. Additional funding will provide 37,000 more MRI exams, addressing a persistent bottleneck in the system.

Equally important are long overdue plans to centralize surgical waiting lists.

Currently in B.C., every surgeon manages their own list, which is extremely inefficient. One study of waiting times in Alberta found that as many as 43 per cent of patients on surgical waiting lists no longer needed to be there, mostly because they had already received the surgery — unbeknownst to the surgeon whose list they were on. Centralized queue management is vital for the efficient flow of services and procedures and allows patients to see the first available appropriate surgeon.

The response to Bill 92 from private surgical and diagnostic companies is no surprise. One physician predicted a mass exodus of surgeons from the province. But if they want to extra bill they likely will have to leave the country too. B.C. is the only province that Ottawa has repeatedly fined for unlawful extra billing. Bill 92 aligns us with the rest of the country.

Opponents also claim waiting times will increase because private companies will be forced to close. Bill 92, however, will allow private surgical and diagnostic clinics to receive contracts from health authorities to provide services, as they have done since the 1990s, as long as they follow the law. Doctors remain able to leave medicare entirely and charge patients who are able and willing to pay.

What will come to an end is the erosion of our universal right to timely medical care.

Equal access to hospital and physician services based on need, not ability to pay, is the fundamental principle underpinning our public health system. This move by the new B.C. government strengthens that principle and should save the province millions of dollars a year in federal fines — money that can now go into patient care.