Two Items: i) Montreal Gazetter article outlining what is a problem under new Bill. ii) Medical Reform Group statement about this new step. Hari _____________________________ Montreal Gazette (January 25, 2007)
I. Loophole allows clinic fees Private surgical care. Wealthier patients to jump queue under Bill 33, legal expert warns BY AARON DERFEL A new legal loophole in Quebec will allow private surgical clinics to bill patients and the government at the same time, in apparent violation of the Canada Health Act. Under Bill 33, adopted by the National Assembly last month, clinics will soon be able to charge patients "accessory fees" for the use of a private operating room, equipment and even some personnel. Such a loophole, a McGill University legal scholar warned yesterday, will lead to wealthier patients jumping the queue for "priority access" to surgery as long as they pay an accessory fee. Yet at the same time, taxpayers will be paying part of the salaries of the physicians in these private clinics, said Marie-Claude Premont, associate dean of graduate studies in McGill's law faculty. "This is highly problematic," Premont said, adding she believes the loophole violates the Canada Health Act and the Quebec Health Insurance Act. The CHA outlaws charging patients "a facility fee for receiving a (publicly) insured service at a ... clinic." The Quebec law prohibits doctors who run a private clinic and who are still in the public system from billing patients for anything other than anesthesia and medications. The government adopted Bill 33 in response to a ruling by the Supreme Court of Canada that overturned the Quebec prohibition on private surgical insurance. The legislation now makes it possible for private surgical clinics to open in Quebec. The doctors in those clinics would still remain in the public system, however, billing the provincial medicare board for surgery. That means patients could go to a private clinic and use their medicare card to pay for the surgery. However, Bill 33 also allows doctors in such clinics to "post in public view ... the rates for services, supplies and accessory fees." The implications of the loophole did not come to light until this week when a Montreal doctor and some partners opened a private surgical clinic on Rockland Rd. in Town of Mount Royal. Doctors at the clinic will perform knee arthroscopies, hernia repairs and other day surgeries, billing the Regie de l'assurance-maladie du Quebec for each procedure. At the same time, patients will be charged $1,300 for the use of the facilities, equipment and some personnel. Corporate records indicate that the president of the clinic is a physician, Fernand Taras. When asked whether such fees were legal, an aide to Health Minister Philippe Couillard responded that the new law will resolve the question. "Under Bill 33, accessory fees will be outlined in detail - what can be an accessory fee and what cannot," Isabelle Merizzi said. "There will be an obligation on the part of the clinics, if they decide to go that route, to post their accessory fees so that that there is never a misunderstanding for the patient." At no point in the interview did Merizzi explicitly rule out the kinds of fees that the Rockland Rd. clinic now charges. She added that the provincial government will sign agreements with the medical federations in the coming months to decide on the various fees. Although Bill 33 was adopted on Dec. 13, it will only come into effect by provincial government decree. Thus, technically, the Rockland Rd. clinic cannot legally charge patients accessory fees before the law is in effect. Still, other private surgical centres in Montreal have been charging patients facility fees for publicly insured health services for a number of years. The Gazette has reported that since the summer of 2005 the Westmount Square Surgical Centre has been billing patients at least $2,000 in "set-up" fees for certain elective procedures. "This type of practice has already been going on in Montreal, and in my opinion, it's clearly doubtful (legally)," Premont said. Taras emphasized in an interview that his clinic abides by Bill 33. "You want to write an article that raises issues?" Taras said. "Maybe you should think twice. "The professionals (here) will be covered under medicare and until things evolve, the patients will pay accessory fees," he added. "This has been in practice for some time now. It has been tolerated." Michael McBane, national co-ordinator of the Canadian Health Coalition, criticized the province for pushing through the loophole. "Oh, my! This is basically a Trojan horse being introduced into the public health-care system via Bill 33," McBane said. "It's setting up two-tier, American-style health care - a private parallel system for the rich. "It's doubly disturbing because the prime minister of Canada (Stephen Harper) has been saying that his model for health-care reform is the Quebec model," he added. "You have this collusion between the premier of Quebec (Jean Charest) and the prime minister of Canada, both of whom are misleading the citizens. "They're saying they're going to solve wait times, when in fact, what (the loophole is) going to do is establish a superior private system and access based on ability to pay." Officials with Health Canada said they were unable to respond to a request for an interview yesterday. When Couillard introduced Bill 33 to the public last spring, he talked about setting up wait-time guarantees for joint replacements and cataract removals. The Supreme Court had ruled that Quebecers were waiting dangerously long times for some types of surgery. Quebec now offers wait-time guarantees for hip and joint replacements as well as cataract removals. Taras said his surgeons have limited operating-room time in hospitals and his clinic gives them an opportunity to reduce their waiting lists. "It's not uncommon to have waiting lists of 18 months," Taras said. "Either we have the status quo or we try to follow the spirit of Bill 33 and set up a centre that ... goes by the rules and regulations for patient safety, infection control and quality control." But McBane countered that the private clinics will ultimately harm the public system, lengthening waiting lists for those who can't afford to jump the queue. ______________________________________________________________ January 26, 2007 - FOR IMMEDIATE RELEASE Medical Reform Group GOVERNMENTS MUST STOP OPEN TWO TIER CARE IN QUEBEC, SAYS MEDICAL REFORM GROUP The latest developments in Quebec represent open two tier health care, Medical Reform group spokesperson Ahmed Bayoumi said today. A new clinic in Quebec conducting arthroscopies, hernia repairs and other day surgeries will be charging patients $1,300 to jump the queue. If Stephen Harper is true to his word about enforcing the Canada Health Act and protecting Medicare, he must act now. Both federal Liberal and Conservative governments have tolerated violations of the Canada Health Act, largely in British Columbia and Quebec. Violations have been in areas of sophisticated diagnostic tests such as MRI, and day surgical procedures. Recently, Gordon Campbells British Columbia government drew the line at charging patients for emergency room care, and prevented a for-profit clinic from making such charges. Two things make the latest violation important, said another MRG spokesperson, Irfan Dhalla. First, it is being done openly and publicly, rather than quietly and covertly. Second, the Quebec government may interpret the clinics charges as consistent with their recent legislation. The Quebec government has claimed that their legislation would prevent doctors from working both within the publicly funded system and privately funded for-profit clinics at the same time. At this new clinic, public dollars are supporting patients who queue-jump and doctors who are setting up a two-tier system, said Dr. Bayoumi. This is a clear violation of all the principles of public health care. Now is the chance for Stephen Harper to show that he really has changed his stripes and believes in Medicare, Dr. Bayoumi concluded. If he fails to act, the public will see that his declarations of support for universal, equitable care are nothing more than political show. For more information: Dr. Ahmed Bayoumi Dr. Irfan Dhalla Janet Maher (416) 770-1311 ___________________________________________________
