Duclos warns provinces to stop allowing clinics to charge patients for virtual health care

The federal government warned the provinces Fridaythat they could see their future federal funding clawed back if they continue to allow private clinics to charge patients directly for virtual health care.

In a letter sent on Thursday, Health Minister Jean-Yves Duclos warned his provincial and territorial counterparts that medically necessary services are covered by the Canada Health Act, even if they are provided online or by phone.

"There should be no fees for medically necessary health-care services, wherever people may live in this country," Duclos said at a news conference on Parliament Hill.

Duclos said health-care delivery is always evolving and virtual care has become much more prevalent since the onset of the pandemic. He said that is a good thing, but has come with the added risk that people who cannot afford to pay will be unable to access the service and that directly contravenes the spirit of the Canada Health Act.

Duclos intends to send another letter clarifying how virtual care will be treated under the act, which prohibits patient fees in a universal health-care system but isn't explicit about the relatively new phenomenon of virtual care.

This warning came as Duclos also informed some provinces their next transfers will be clawed back because of the last Canada Health Act clarification, which was issued in 2018.

That year, Ottawa told provinces and territories that diagnostic tests are covered by the act and gave them two years to address the problem of allowing patients to be charged fees for testing.

Quebec clawback accounts for more than half of total

But in 2020-21, fees were still being collected in seven provinces, totalling $76 million. The same amount is being taken from their health transfers this month.

Quebec's $41.9-million clawback accounts for more than half that amount, followed by British Columbia at $17 million and Alberta at $13.8 million.

Another $6 million was deducted from B.C., New Brunswick and Ontario for allowing patients to be charged for abortion services or surgery in private clinics.

However, because B.C. has implemented a plan to fix the problems leading to the extra-billing, most of that money will be returned.

Following the 2018 policy directive on diagnostic tests and the Canada Health Act, B.C. took a number of steps to expand access to MRIs and other tests in public hospitals and clinics, and in 2019 made it illegal for clinics to charge patients for diagnostic tests.

Duclos said other provinces can also see some or all of the funds restored if they take steps to end the practice.