Although the COVID-19 pandemic exposed faults in our health-care system, it also created opportunities for innovation, most notably through the expansion of virtual care and nurse practitioner care. Spurred by the pandemic, these types of care have become increasingly effective and accepted ways of providing care to Canadians.
But the speed at which virtual care and nurse practitioner care expanded has led to issues of inequitable access for patients with some providers charging patients to speak with a doctor online or by phone or to consult with a nurse practitioner.
Charging for medically necessary health care – whether by billing patients out of pocket or through their employer-funded private insurance – contravenes the spirit and intent of Canada Health Act (CHA). Yet, since virtual care and nurse practitioners are not yet explicitly mentioned in the CHA (because nobody imagined this in 1984), for-profit corporations, some physicians and some nurse practitioners are exploiting this unintended loophole.
This exploitation forms part of the basis for the widely anticipated, but much delayed, interpretation letter from the Government of Canada’s Ministry of Health. This letter was originally promised in March 2023 to clarify 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.”
Most would agree that patients should not be charged for necessary health care, but some business groups, policy advisors, insurance companies and physicians have taken issue with the government’s intent to clarify that out-of-pocket fees for virtual care and nurse practitioners are not allowed. They purport this clarification to eliminate creeping private pay would unintentionally impact access to virtual care. They falsely claim that 10 million Canadians who have access to virtual care through their workplace are at risk of losing it unless an exception is made to allow employer-funded private insurance to cover these services.
There are two intentional distortions with their self-interested claims.
First, those who are lucky enough to have private workplace insurance would not lose access to virtual care or nurse practitioner services. Instead, provincial and territorial governments, together with the federal government via the Canada Health Transfer payments, would pay for these services, just as they are required to publicly fund all other medically necessary care.
Second, these claims ignore the fact that the other 29 million Canadians who don’t have private workplace insurance would also be able to access virtual care and nurse practitioner care without having to pay out of pocket.
In other words, publicly funding medically necessary virtual care and nurse practitioner care will improve access for everyone, not just those fortunate enough to have a stable job with benefits.
The only ones who would benefit from exempting virtual care and nurse practitioner care from the provisions of the CHA would be for-profit virtual care corporations and insurance companies, not patients. The opportunity for corporate, physician, and nurse practitioner profit should never drive health policy decisions.
Canadians already pay for health-care services through tax dollars, and we must not ask patients to pay again when they need care. Clarifying that medically necessary virtual care and nurse practitioner care must be publicly funded would help to ensure that all Canadians have access to health care when they need it.
At a time when Canadians are struggling to make ends meet, we must not allow corporations and insurance companies to prevent fair access for everyone, including the many without employer-based private insurance.
The federal minister of health must do the right thing and release the long-awaited interpretation letter that will uphold the principles of the Canada Health Act in this modern age. Virtual care and nurse practitioner care are here to stay; let’s publicly fund this care so that it’s accessible to all Canadians.
What we need is a way for NPs to bill Ohio something which the CMA and other physician groups have fought against. However the government cannot afford to take over virtual or NP care due to the cost
I agree with Dr Ho that virtual care should be fully funded. It is the only way we can assure equitable access to primary care across the country. As virtual care expands and we measure its effectiveness, muti- modal care should become the norm for most patients and temper our expectations for brick-and -mortar team-based care.
While Dr Ho has chosen to frame the current situation as exploitation by insurers and for-profit providers, isn’t it governments doing the exploiting by not paying for these services for those of us without alternatives?