CHARBONNEAU – Nurse practitioners should be brought into Health Care Act

A DRAFT POLICY from the Canadian Medical Association (CMA) has caused quite a stir in the medical community. The CMA has identified loopholes where a two-tiered health care system could operate.

One concern is the growing use of nurse practitioners and other health care professionals such as pharmacists.

Nurse practitioners and others operate in a grey area because they were never included in the Canada Health Act of 1984.

The act only applies to physicians. Since 1984, provinces have expanded the scope of practice of other health professionals.

Since nurse practitioners are not included in Health Act, they could extra-bill. With a shortage of doctors, other health care professionals are providing more care than ever.

As far as I can tell, nurse practitioners are not extra-billing patients; except where a patient has workplace insurance which requires that a patient pay upfront and be reimbursed later –not a violation of the Health Act.

Private health insurance is legal as long as does not duplicate services covered by provincial health insurance plans. Private insurance covers services not covered by the public system, such as dental care, vision care, or prescription drugs.

The CMA is concerned that private health insurance is offering services meant to be covered by public insurance. Their draft policy calls on governments to “enforce the Canada Health Act prohibition against user fees by clamping down on jurisdictions that allow the charging of membership fees, user fees or bundled payments.”

The Nurse Practitioner Association of Canada is a little defensive. Laura Housden, president of the association, warns against a prohibition of charging users fees by direct billing:

“If we start putting these safeguards in place against private user fees right now without publicly funded services,” she said, “is this going to result in a reduction in access for Canadians, which we do not want to see?”

She is concerned that some patients who can’t find a family doctor will lose the only access to health care they have if they can’t pay to see nurse practitioners

I find this statement puzzling. Surely nurse practitioners are not billing patients for health care services covered by the Canada Health Act.

The call from the CMA to prohibit what is already illegal under the Health Act is also perplexing, especially when the call from the CMA came after federal Health Minister Mark Holland said he would issue a letter clarifying the Canada Health Act.

Holland wants to make certain that the Health Act applies to medically necessary care delivered virtually and by health professionals other than doctors, often nurse practitioners.

Private insurers and virtual health companies are sounding the alarm over a federal promise to penalize provinces that allow private entities to charge patients for medically necessary primary care, saying the move could threaten access to a popular workplace benefit.

Private health care is a useful benefit for many Canadian workers but it cannot be used as way of providing access to primary health care that all Canadians don’t have.

There are simple solutions: bring nurse practitioners and other professionals under the Health Care Act and enforce the prohibition of extra-billing that already exists.

David Charbonneau is a retired TRU electronics instructor who hosts a blog at http://www.eyeviewkamloops.wordpress.com.