Health care warnings are not enough

There’s usually something powerful about letter writing in relationships. Personally written letters are both intimate and considered. They give stylish expression to a sender’s deepest thoughts, most ardent passions.

One of the few areas in which the charming practice apparently endures in an era of emojis, texts and app swiping is in the arena of intergovernmental relations.

And Canada’s leaders are at it again.

Health Minister Jean-Yves Duclos has dispatched a letter to all provincial and territorial health ministers expressing alarm about the creep of privatization into health care and warning that the federal government will withdraw funding if extra-billing is discovered.

Duclos stressed that Canadians should not be paying out of pocket for medically necessary care, including such things as virtual visits with doctors and fee-for-service surgeries performed outside their home province.

“I am very concerned with the recent increase in reports of patient charges for medically necessary services,” Duclos wrote. “This is not acceptable and will not be tolerated.”

On the one hand, the federal government should be encouraged to act on the threat if breaches to the Canada Health Act occur.

On the other, Duclos and colleagues need to be saying much more on what innovations it proposes that can help ease the strains evident in the country’s beleaguered health-care system.

Provinces and territories are struggling with increasing pressures on health-care budgets and Canadians face long waits for medical care in systems unable to meet demand. Emergency departments are overflowing while 20 per cent of Canadians don’t have access to a family doctor or nurse practitioner.

Duclos said he will clarify how virtual health services are delivered and set out new terms in a Canada Health Act interpretation letter to be sent to the provinces and territories in coming months. It will be the fourth such letter sent by a federal health minister since the act became law in 1984.

It’s vital, of course, that the federal government keep close watch on the expansion of for-profit care and use financial clawbacks as the stick to ensure provincial compliance. Vigilance is essential. But Duclos will need to deliver much more.

If nature abhors a vacuum, for-profit companies delight in such opportunities and they are jumping in to fill the health-care gap.

After Ontario’s move last year to lower the fees paid physicians for one-off virtual visits, some companies launched chat-based medical services, which are not covered by OHIP.

One company, Rocket Doctor, began charging $55 for a live chat. Others, such as VirtualDr.ca and Maple Corp., have also emerged to offer online medical care not covered by OHIP.

Some Ontario doctors, through a program called Kindercare365, have been offering parents availability for their kids with a nurse practitioner for a monthly fee of $30. Demand was reportedly overwhelming.

Duclos finds himself in a predicament created by the meeting of willing buyers and willing sellers happy to do business in the telehealth marketplace that has arisen from technological change and a frayed public system.

As one telehealth innovator told CBC, “we can continue to wait for the government to fix it. When’s that going to happen? Or we can do something. I’m doing something.”

The minister had best get to work crafting his letter on the Canada Health Act.

Threats will not answer the worsening crisis. Nor will pledges, however heartfelt, to protect a system that is not delivering.

Minister Duclos finds himself in a predicament created by the meeting of willing buyers and willing sellers happy to do business in the telehealth marketplace that has arisen from technological change and a frayed public system