As Dr. Brian Day’s decade-long court battle over the right to pay for your own health care grinds on in Vancouver, this is the first week of B.C. Health Minister Adrian Dix’s strict enforcement of extra-billing laws.
As of Oct. 1, all procedures deemed “medically necessary” under the Canada Health Act are subject to fee repayment and heavy fines for extra billing. That mean some of the dozens of private clinics that have developed over the past 20 years in B.C. may be out of business, unless they can keep going under contract with a health authority that pays the full bill from the provincial treasury.
As of this month, patients who believe they have been extra-billed can apply to the B.C. Medical Services Commission, which can recover the billed amount and impose fines of $10,000 for a first offence, $20,000 for a second.
With long wait lists for a whole host of procedures and an aging and growing population, this is a critical time for B.C. A scan through the health ministry’s wait time database gives a sense of the pressure already on the system.
Here’s one of hundreds of examples: as of the end of August, there were 4,244 B.C. residents waiting for surgery to repair an abdominal hernia, a painful and debilitating rupture of the stomach muscles where the intestines push through.
At most hospitals in B.C., you’ll likely wait somewhere between eight and 30 weeks for that surgery, unless you’re hurt on a job covered by WorkSafeBC, which sends you to the front of the line. And that’s with grey-market private clinics taking some of the load from people willing to pay to end their suffering.
(Next time you hear a politician fret about over-prescription of opioid painkillers, consider why that might be.)
I caught up with Dix last week after he announced the province was taking over two private magnetic resonance imaging (MRI) clinics, in Surrey and Abbotsford. Diagnostic tests like MRI and CT scans have been exempted from federal and provincial laws banning extra billing, but Ottawa has now decided they will be included in our Cuban-style state monopoly of health care as of April 1.
That deadline was just extended by six months, giving B.C. time to add public capacity. Hence the purchase of private MRIs, along with extending operating hours and the addition of new machines, particularly in the Northern Health and Fraser Health regions.
“The federal government has decided, even though it’s always been illegal to do that under the Canada Health Act, that they’re not going to permit [privately paid MRIs] any longer,” Dix told me. “And of course I don’t personally like the two-tiered nature of it. If you can afford to pay, you get ahead of me on the next wait list when you come back in the public system, because you can afford to pay for your MRI.”
MRIs assess the need for things like hip and knee replacements, another chronic wait list that grows with an aging population. Dix expects the additional MRI capacity to also take some of the load off CT scanners, which have been used instead of MRI because the wait time is often shorter.
He downplays the impact of his crackdown on privately funded health care in B.C. He argues that private surgery is a small part of the picture here, once you account for large private clinics that run mostly on public-pay contracts with health regions. We’ll soon see.
Tom Fletcher is B.C. legislature reporter and columnist for Black Press. Email: firstname.lastname@example.org