Where is it? Coalition seeks Canada Health Act interpretation letter

Canadians desperate for health care have increasingly turned to virtual care and nurse practitioners as the way to find help.

But many are facing unexpected bills because Canada has a patchwork of rules governing whether these essential medical services are covered by provincial health plans.

Health Canada officials have described it as a game of “whack-a-mole,” as the private sector tries to pry open the gaps in legislation to pad their profit lines – especially through virtual care. We have seen this pattern before with patient charges being levied by private for-profit clinics and for diagnostic services. 

Federal government pledged to take action 18 months ago

In early 2023, the federal government promised to issue what is known as an Interpretation Letter of the Canada Health Act. Three letters of interpretation of the Canada Health Act have been issued by Health Ministers since 1984.

“The complexities of modern family health, virtual and surgical care, including its provision across jurisdictions, and expanding scopes of practice of health workers, should not be used to permit these charges,” said then Health Minister Jean-Yves Duclos.

“It is my intention to clarify in a separate Canada Health Act interpretation letter that, no matter where in the country Canadians live or how they receive medically necessary care, they must be able to access these services without having to pay out of pocket.” he added.

Health Coalition wants letter to be released

“So where is it,” I demanded to know at a press conference in Parliament with Canadian Doctors for Medicare and endorsed by the Canadian Federation of Nurses Unions.

“It’s been 18 months…. Why has the Prime Minister failed to work with Health Minister Mark Holland to protect patients from unfair charges by for-profit corporations delivering virtual care, and nurse practitioners who have been given additional scope to practice, but no public funding to do so?”

Steven Staples (L), Anne Lagacé Dowson and Dr. Melanie Bechard at a press conference in Ottawa on November 18, 2024. Watch on CPAC

Dr. Melanie Bechard, Chair of Canadian Doctors for Medicare, said, “In a country that highly values our universal health care system, there is no way to justify charging patients for what has become an essential mode of health care delivery.”

“Nurses and health care professionals have expanded their roles over the last 40 years to better serve Canadians. It’s time for the administrators of the Canada Health Act to follow suit and protect patients.” said Linda Silas, President of the Canadian Federation of Nurses Unions, in a joint statement.

Government’s response

Toronto Star business reporter Kenyon Wallace, covering the press conference, reported that the Prime Minister’s Office referred the Star’s inquiries to the federal health ministry.

Matthew Kronberg, press secretary for Health Minister Mark Holland, said the federal government is “committed to building a stronger public healthcare system so Canadians can get the care they need.”

He added that the interpretation letter process involves extensive consultation with provinces and territories, reports Wallace.

“As jurisdictions explore further integrating physician-equivalent services and virtual care into their public health care insurance systems, we will continue to engage with them to ensure our health care system is dynamic,” Kronberg said. “We hope to have more to say on the upcoming letter soon.”

Corporations have likely prevented action

I venture to guess the reason why the Liberal government is stalling is because big business, telecom giants and insurance organizations are lobbying to prevent the government from protecting patients. It’s the same situation as pharmacare when big insurance companies opposed the Pharmacare Act because they felt it was a threat to their massive profits. 

We can’t wait any longer – patients want action – and even the provinces are asking clarity, as we have seen in a letter from Ontario’s Health Minister to her federal counterpart.

Public health care can innovate, whether it is through virtual care or nurse practitioners, while respecting the crucial principles of the Canada Health Act. It’s time for the Prime Minister to take action and protect people from prohibited patient charges while accessing medically necessary health care.