The federal government is deducting a total of $82 million in Canada Health Transfers from provinces, including Alberta, over “patient charges levied during 2020-2021, for medically necessary services that should be accessible to patients at no cost.”
A summary posted online by the government of Canada shows Alberta’s deductions will be $13.8 million.
Federal health minister Jean-Yves Duclos sent letters to all provinces and territories, expressing concerns about a recent increase in reports of patient charges for medically necessary services, including telemedicine and some private services.
“There has been evidence of residents paying out of pocket to access diagnostic services such as ultrasounds, MRI and CT scans — services that should be accessible at no cost,” Duclos said in a statement.
“This is not acceptable and will not be tolerated.”
“It is critical that access to medically necessary services, whether provided in-person or virtually, remains based on medical need and free of charge.”
When asked about this Friday, Alberta Health Minister Jason Copping said he hadn’t seen the letter, hasn’t been fully briefed and didn’t know the amount Alberta would lose.
However, he said there has been an “ongoing dispute” about how the transfer system works — what’s allowed and not allowed.
“I understand there’s been ongoing conversations about the interpretation of ‘medically necessary’ and payment for medically necessary and how that works in the regulations,” Copping said Friday.
He said other provinces are having the same types of discussions with the federal government.
“I’m looking forward to actually reviewing the letter … and then discussing it directly with Minister Duclos.”
Copping acknowledged there are long waits for some services and the province continues to invest in the health-care system and add capacity.
“On diagnostic imaging, we understand that there’s been a wait-list and the wait-list is far too long.
“We’ve invested a significant amount of dollars over the last two years as well as part of Budget 2023, an additional $12 million, so that’s $45 million total to get caught up on the backlog.
“We’ve already had some success in regards to improving wait times,” he said, citing a 23 per cent decrease in waits for CT scans and 20 per cent decrease for MRI since March 2020.
On Friday afternoon, an Alberta Health spokesperson released a statement saying while the ministry take the issues seriously, it also believes having sound data to support any issues or concerns must be part of the process.
“The federal government can’t just assume there are issues and have the provinces and territories try to prove otherwise,” spokesperson Scott Johnston said.
“Alberta has in place a robust audit system to ensure there are no extra billing or user fee charge issues. This is why we don’t agree with the findings of the federal government.
“That said, there is an onus on all parties to work together to assess any issues and address them accordingly, based on the appropriate application of the legislation and policies in place.”
Johnston said to that end, the province has requested a formal legal opinion on the federal government’s position.
“The Government of Alberta will work with the federal government on addressing this issue and ensuring Alberta receives the full Canada Health Transfer payment that it is entitled to.”
John Cowell, head of Alberta Health Services, said wait times for diagnostic imaging has been a problem “for many years” which has “been solved periodically.”
“It’s based on the availability of the equipment and the technicians who can actually run the equipment and organizing the scheduling,” he said.
But this news should not have come as a surprise to the provinces, according to Lorian Hardcastle, an associate professor at the University of Calgary’s faculty of law.
“The federal government gave them notice many years ago that this was coming. They’ve known for years that the federal government found these private MRI and CT clinics to be a violation of the Canada Health Act and the provinces knew that the federal government’s intent was to withhold money.
“If the minister had a problem or question of interpretation, the time to bring it up isn’t now; the time to bring it up was years ago,” Hardcastle said.
She said what may have come as a surprise, however, was the feds following through on this enforcement and that it was across the country.
“Certainly, in the past, the federal government has threatened enforcement but not followed through or has turned a blind eye.”
Hardcastle said it will be interesting to see how the different provincial governments respond. She said they can chose to not comply with the Canada Health Act and forfeit the money or comply and receive the funds.
“I think this is going to be politicized in Alberta and it’s going to become part of that discourse around federal intrusion and Alberta pushing back,” she said.
She said legal precedent indicates the federal government isn’t acting outside its jurisdiction in this case.
“The federal government here isn’t regulating the delivery of health services; it’s merely saying: ‘If you regulate your health service delivery in a particular way, you can qualify for federal funds … if you wish, but you don’t have to.'”
Duclos said he plans to clarify the expectation associated with health transfer payments in an interpretation letter attached to the Canada Health Act, which lays out the standards of care Canadians must be able to receive under the public health-care system, no matter where they live.
As part of the $82 million being withdrawn from provinces in their health transfers, there will be $76 million in deductions under the Diagnostic Services Policy, which states that patients should not be charged for medically necessary diagnostic services, such as MRI and CT scans.
Another $6 million will be deducted for other insured services at private surgical clinics and for access to abortion.
The deductions are a legal requirement and mandatory, Duclos explained.
Health transfer deductions can be reimbursed if the province or territory carries out a reimbursement action plan to eliminate the charges to the patient — and the process that led to the charges — within two years.
B.C. went through the process and was reimbursed $15.6 million, the federal government said.
Last month, Ottawa reached a $192-billion health-care funding deal with provinces and territories of which roughly $46 billion would be new money.
While Ottawa’s offer was far less than the $28-billion annual increase to the Canada Health Transfer that provinces wanted, the premiers accepted the offer and have been inking bilateral side deals for additional province-specific funds.
Shannon Phillips, Alberta’s Opposition NDP critic for finance, said $13 million is a relatively small amount compared with the total funding that comes with the Canada Health Transfers.
Still, she says there’s undoubtedly been a trend towards Albertans paying more for health care.
“We know that over time, there have been successive UCP decisions that have raised expenses for health care for Albertans.
“In general, the best-case scenario is that Albertans are not paying out of pocket for medically necessary services. Certainly, we know that Danielle Smith has a plan to ensure that Albertans pay out of pocket for a family doctor,” Phillips said.
Read more: Alberta NDP calls on Premier Danielle Smith to come clean on pursuing health-care user fees
But Copping stressed Alberta’s support of covering costs for medically required services.
“As a government, we fully support that when there’s medically necessary diagnostic imaging and other procedures that need to be done, that needs to be covered under the Alberta Health Insurance Act. So, we’re on the same page. There is some dispute about how that’s actually being interpreted by the federal government.”
— with files from Saba Aziz and Morgan Black, Global News