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Are these private-pay clinics legal? Health minister won't say

Some new clinics are taking advantage of the family doctor shortage to charge patients
Ontario Premier Doug Ford and Ontario Health Minister Sylvia Jones attend an announcement at Seneca College, in King City, Ont., Friday, Feb. 9.

A new private medical clinic in Ancaster, Ont., is welcoming patients to come and see a nurse practitioner for issues they might accustomed to going to a doctor for — a cough, sore throat, ear infection, and so on.

But instead of showing their OHIP card and billing the Ontario government, those patients will need their credit card, or cash, to pay the $80 fee for an episodic visit, according to the clinic's website. Alternatively, they can pay a subscription fee of $400 plus tax per year for adults and $300 for kids, according to its website.

The clinic spells out why on its website: "Nurse Practitioners (NPs) are not covered by OHIP. It is legal for an NP to bill patients privately for health care services."

It's one of several new clinics operating under a similar business model — one that's made possible because so many Ontarians don't have a regular, government-funded primary care provider, so they're willing to pay.

The clinics say they're legal because the Canada Health Act only prohibits charging patients for services covered by provincial medicare programs, and nurse practitioners in private clinics cannot bill OHIP.

But advocates for public medicare argue that it is against the law — that nurse practitioners can't charge patients for medical services that would be covered by OHIP if provided by a physician. 

"There should be no user fees," said Doris Grinspun, CEO of the Registered Nurses' Association of Ontario (RNAO). "That's the piece that the RNAO opposes fervently because it will undermine the Canada Health Act — not only legally, but also the spirit. " 

Ontario's minister of health has repeatedly refused to spell out the government's view. 

Asked by The Trillium and other media outlets on multiple occasions about the clinics over the past week, Health Minister Sylvia Jones has said repeatedly that it's illegal to charge patients for OHIP-insured services, but would not say if the government believes that applies to the services being performed by nurses in private clinics, when those same services are OHIP-insured when performed by a family doctor.

However, Jones stressed that she was referring to only OHIP-funded services and that clinics can charge for services not covered by OHIP.

"The minister’s comments stands (sic)," said press secretary Hannah Jensen, when asked for clarification of the minister's statements, and later shut down media questioning of the minister when The Trillium asked about the issue again.  

Nor would Jones say anything about the government addressing the issue. 

Asked if her government would use its power to close the loophole that's allowed the clinics to open, Jones again said the government would shut down clinics charging for OHIP-insured services.

Patients who believe they've been charged for a medical service they shouldn't have been can complain to the government and be refunded, but she said it would depend on whether the clinics are providing OHIP-insured services, she said.

Some of the clinics are explicit about what they're doing.

Like the clinic in Ancaster, one that's set to open next week in Sudbury puts a clear price on visits to a nurse practitioner for traditional primary care services that are covered for family doctors under OHIP.

It puts it this way: "In the province of Ontario, nurse practitioners are unable to bill OHIP for their services like physicians do. As a result, private, independent nurse practitioners have to charge fees for their services. Patients can claim these costs on their 3rd party insurance ie. Canada Life, Sun Life, Manulife."

The nurse practitioner who is opening it, Lisa Parise, told the Sudbury Star she wanted to work at a publicly funded clinic, but it didn't have the funds to hire her on a permanent basis.

To the RNAO, that's the heart of the issue.

Grinspun said she's lobbying the government to provide a public funding stream to cover nurse practitioners setting up private practices to provide health-care services — the medically necessary kind, "not Botox" — without charging the public.

"It's not a business for us," she said. "It's a service to the public."

She also wants to see the government fund more primary health care teams that would provide more publicly-funded places for Ontario's nurse practitioners to work, saying the government's recent $110 million announcement to that effect falls short.

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Jessica Smith Cross

About the Author: Jessica Smith Cross

Reporting for Metro newspapers in five Canadian cities, as well as for CTV, the Guelph Mercury and the Turtle Island News. She made the leap to political journalism in 2016...
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