Hey there, time traveller!

This article was published 3/4/2017 (1262 days ago), so information in it may no longer be current.

Opinion

With scarce funding and unrelenting demand, it is proving difficult to predict the future of Canada’s health-care system. However, there are some intriguing signs of what is yet to come.

Last week, we learned that Timely Care, a private clinic that uses nurse practitioners, had just opened in Winnipeg. For a fee, Timely Care will send a nurse practitioner to your home to perform a wide range of medical services. The clinic believes patients will be willing to pay a small fee to avoid the time and inconvenience of going to a jammed emergency room or waiting hours for a walk-in appointment with a family physician.

Phil Hossack / Winipeg Free Press Provincial governments are keeping an eye on the legality of businesses such as Timely Care

Timely Care fees range from $40 for a 10-minute virtual consultation with a nurse practitioner via video link, to $80 for a basic house call and $110 for a physical examination.

There is only one problem. No matter how you look at it, it appears likely Timely Care is operating contrary to the spirit, if not the letter, of the Canada Health Act.

The act prohibits the charging of medical fees "in addition to any amount paid... for that service by the health care insurance plan of a province." This legal provision is not airtight; there are many grey areas where practitioners sneak in fees for things such as filling out medical forms or signing notes for employers. But for the most part, ancillary fees are not charged for the provision of a medical service.

This law ensures every Canadian has access to the same level of health care by preventing the wealthy from buying faster or better service. However, while the principle remains sound, the interpretation of the act has always been up for debate.

Over the years, the federal government has gone to great lengths to enforce this principle, sometimes deducting money from federal health transfer payments to force a particular province to cease a particular practice that contravenes the act. That has not stopped people from challenging the definition of extra billing.

The Saskatchewan government has been given a year to cease a controversial program that allows people to purchase private MRI tests. Just last month, Quebec finally passed legislation prohibiting medical user fees after years of sparring with Ottawa.

So, in this complex and combative legal context, where does Timely Care fit in?

It did not take long for the Manitoba Nurses Union and the opposition NDP to declare Timely Care a violation of the Canada Health Act. In particular, both are concerned these private clinics are going to starve the public system of in-demand health-care practitioners, which would result in longer waits for those who could not afford to pay extra fees.

Looking at other Canada Health Act disputes, it is tough to see how Timely Care could not be in violation of federal law. Having said that, similar clinics in other parts of the country have so far avoided the contempt of the federal government.

Last year, a clinic called Caredrop opened in St. John’s, N.L., offering house calls by nurse practitioners to deliver basic medical services for a fee. The range of services and the fees charged are nearly identical to Timely Care. To date, neither the province nor the federal government has taken steps to shut it down.

In fact, the Newfoundland and Labrador government seems bullish on the concept. Steve Kent, the province’s health minister, said last April he is scrutinizing Caredrop to see if it falls within the federal law, but was supportive of its intent.

"I’m always interested when people are being innovative within health care," Kent said. "We just need to make sure we’re doing it right."

It seems clear a physician could not do what the nurse practitioners at Timely Care and Caredrop are doing without falling afoul of the federal law. Why are nurse practitioners being treated differently?

Physicians, for the most part, are paid on a fee-for-service basis. That is to say, the gross majority of doctors do not earn a salary, but rather get paid by the public system for each and every service they provide. Doctors Manitoba, which represents physicians in this province, negotiates the fee schedule with the province. Except in a few cases — such as filling out forms or providing notes — physicians are not allowed to charge extra fees to patients.

Nurse practitioners, on the other hand, are salaried employees of the province. They work for Timely Care as private contractors who are paid a portion of the fees charged by the clinic, which operates as a booking agent and dispatcher.

That means the nurse practitioners do not bill the province for the services they provide. Thus, the fees they charge are not technically "extra billing." For now, it appears the difference in the way doctors and nurse practitioners are paid is creating a loophole through which Timely Care has eagerly jumped.

Timely Care fits nicely into the arguments made by private health-care advocates, many of whom argue that allowing people to purchase medical services will ultimately reduce demand on the public system and shorten waiting lists. It’s a solid theory that holds up well in almost every regard.

The one big flaw is that — as the nurses and NDP pointed out — Canada does not suffer from an oversupply of health-care professionals. In most provinces, there are critical shortages in a broad range of medical professional disciplines. If doctors and nurses were also allowed to work in a private system, it would eventually erode staffing in the public system and mean fewer procedures and longer waits for those who could not afford the private option.

It is noteworthy the province recently admitted it closed one of its QuickCare Clinics and shortened hours in others due to a shortage of nurse practitioners. It’s hard to see how Timely Care alleviates that problem, no matter how many patients can afford to purchase services privately.

Innovations such as Timely Care should not be rejected out of hand. In fact, it’s not hard to see that the Timely Care model may be an improvement on the former NDP government’s QuickCare Clinic system, which never lived up to expectations.

If the province can figure out a way to allow health-care professionals to dabble in the private system without crippling the public system, it could make sense to allow a private, mobile nurse practitioner model. In lieu of that, there is an argument to be made this model should be adopted for the public system.

At a time when health care is threatening to bankrupt provincial treasuries, that care would most definitely be timely.

dan.lett@freepress.mb.ca