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Ottawa warns provinces not to charge fees for medically necessary services



The federal health minister is warning provinces not to charge Canadians fees for “medically necessary” care, including telemedicine and some private services, in a new letter released Friday.

“There has been evidence of residents paying out of pocket to access diagnostic services such as ultrasounds, MRI and CT scans — services that should be accessible at no cost,” said Health Minister Jean-Yves Duclos in a statement.

“This is not acceptable and will not be tolerated.”


He also noted in the letter that he is “very concerned” about increasing reports of patients being charged for “medically necessary” services and that whether these are delivered virtually or in person, they must be available free of charge.


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Duclos said he plans to clarify the expectation in an interpretation letter attached to the Canada Health Act, which lays out the standards of care Canadians must be able to receive under the public health care system, no matter where they live.

He will also be deducting a total of $82 million in Canada Health Transfers from the provinces over “patient charges levied during 2020-2021, for medically necessary services that should be accessible to patients at no cost.”



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This includes over $76 million in deductions under the Diagnostic Services Policy, which states that patients should not be charged for medically necessary diagnostic services, such as MRI and CT scans.

Another $6 million will also be deducted for other insured services at private surgical clinics and for access to abortion.


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Duclos said the federal government was clamping down on out-of-pocket expenses for private care “with a focus on virtual care and other medically necessary services that Canadians are being asked to pay for.”

Duclos sent letters to all provinces and territories, expressing concerns about a recent increase in reports of patient charges for medically necessary services.

“It is critical that access to medically necessary services, whether provided in-person or virtually, remains based on medical need and free of charge,” Duclos said in the statement.



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Last month, Ottawa reached a $192-billion health-care funding deal with provinces and territories of which roughly $46 billion would be new money.

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While Ottawa’s offer was far less than the $28-billion annual increase to the Canada Health Transfer that provinces wanted, the premiers accepted the offer and have been inking bilateral side deals for additional province-specific funds.


In a news conference Friday, Duclos said over the next few weeks the federal government will continue to put the finishing touches on action plans covering the first three years of the agreements in principle.

With increasing pressure on Canada’s healthcare system, some provinces are turning to the private sector to address the strains on hospitals.

In January, Ontario announced it was expanding the private delivery of public health care by funding clinics to perform more cataract surgeries, MRI and CT scans, colonoscopies, hip and knee replacements and other procedures in an attempt to ease pressures on the hospital system.



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The COVID-19 pandemic has also shifted the way patients seek medical help in Canada with an increasing demand for virtual healthcare across the country.


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In Canada, roughly 18 per cent of healthcare is provided virtually — up from three per cent before the pandemic, Duclos said.

He added while telehealth has its advantages in improving efficiency and convenience for patients in providing care online, there are also risks of overbilling involved, which is why he will be issuing an interpretation letter to provinces in a few weeks.

“We are in uncharted territory,” he told reporters in French during a news conference in Ottawa Friday.

“Private interests are playing a role, and this could lead to overbilling for medically necessary care.”

— with files from The Canadian Press


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