Saturday, January 27, 2007

The wrong course of treatment

CanWest reports that the federal Department of Health is at least pretending to be taking a critical eye to Quebec's apparent Canada Health Act violations. But for the moment, the public posturing seems to be more an excuse not to take action than any reason to think the Cons will really fight for universality:
The federal government has concerns about private clinics in Quebec whose surgeons bill both medicare and patients at the same time, says an aide to federal Health Minister Tony Clement.

"If it is found that services that they are charging for are a violation of the (Canada) Health Act, we would be taking some action at that point," said Erik Waddell, Clement's spokesman...

Waddell said the federal government also has questions about Bill 33, the law adopted by Quebec's National Assembly last December that allows for the establishment of private surgical clinics.

Of particular interest to the federal government is a clause in the law that could let private clinics charge patients "accessory fees" while the doctors still bill medicare.
Now, it's understandable that Clement and company wouldn't want to jump to conclusions without a full analysis. But it's also hard to see how the case could be much more clear. From the Canada Health Act itself:
12. (1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province

(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons;...

19. (1) In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, user charges must not be permitted by the province for that fiscal year under the health care insurance plan of the province.

(2) Subsection (1) does not apply in respect of user charges for accommodation or meals provided to an in-patient who, in the opinion of the attending physician, requires chronic care and is more or less permanently resident in a hospital or other institution.
Needless to say, a scheme couldn't violate the above two provisions much more clearly than Quebec's appears to. If a "charge" can be considered to "preclude...reasonable access" (which must be the case for s. 12(1)(a) to make any sense), then the accessibility criterion must be violated by any facility fee large enough to affect access or even alter the uniformity of health-care availability. And s. 19 couldn't be much more clear in drawing a distinction between legitimate accommodation charges for hospitals, and costs strictly associated with delivery of an insured health service.

What's worse, the Cons have a readily available means for consultation under the Canada Health Act itself which is intended to provide for discussion. Indeed, any action against a province under the Canada Health Act is subject to a consultation and resolution process before funding is to be withdrawn - see s. 14(2) in particular. (Yes, that would be the same process which Clement put to an end in a few cases when the Cons first took power.)

Which means that if the Cons plan on jawing in public rather than invoking the rules under the CHA (when it's the Minister himself who's responsible to get the consultation process started), then it's all too clear that nothing's going to get done. And all the public statements in the world won't help to preserve a universal system if the Cons are more interested in going to the press alone than in taking even preliminary substantive steps.

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