Open this photo in gallery When he introduced the legislation for debate, Colin Hansen said his proposed law was meant to bring B.C. in line with other provinces to ensure compliance with the Canada Health Act. Diana Nethercott/The Globe and Mail

The tough measures to crack down on extra billing by doctors announced this week by NDP Health Minister Adrian Dix were written 15 years ago by a Liberal health minister, Colin Hansen. But the Liberal government abandoned those measures after intense lobbying from proponents of private medical clinics.

Mr. Hansen said on Thursday he was persuaded that his legislation was flawed, and he warned that the changes made this week cannot be effectively implemented for the same reason.

In 2003, the B.C. legislature unanimously passed Bill 92 under the Liberal government. It was a response to annual penalties from the federal government on B.C. for violating the Canada Health Act by allowing extra billing.

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When he introduced the legislation for debate, Mr. Hansen said his proposed law was meant to bring B.C. in line with other provinces to ensure compliance with the Canada Health Act. “We expect these measures will help us to protect the financial and medical interests of our patients and B.C.’s health care system,” he told the Legislature in 2003, “while continuing to ensure equitable access to care by all British Columbians.”



After the law was passed, however, private clinic operators lobbied against it. “The phone started ringing off the hook,” Mr. Hansen recalled in an interview. “There was the reconsideration [in cabinet] based on information that was brought forward.” As a result, the law was not enacted. (Three years later, another Liberal health minister, George Abbott, proclaimed some sections of the act to provide greater auditing powers.)

Mr. Hansen said he was persuaded by the lobbying in 2003 that the law was not enforceable because there is no clear definition of what services are medically necessary and therefore subject to billing restrictions under the Canada Health Act.

“If the elements in the bill were to be proclaimed, in the absence of any proper definitions around those terms, how could it be effectively implemented,” he said.

Mr. Dix said in an interview on Thursday that he believes Mr. Hansen wrongly caved in to lobbying, and that the law that has been sitting on the books for 15 years will be a powerful tool to rein in illegal extra billing.

An investigation by The Globe and Mail last year found significant unlawful extra billing through private clinics – especially in British Columbia – where patients pay out of pocket for access to everything from medical appointments to surgery.

The newly enacted law provides new penalties for doctors who engage in illegal extra billing, and aims to end queue-jumping by patients who pay to fast-track access to publicly funded medical care.



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British Columbia leads the country in extra-billing practices, and Ottawa has levied penalties every year since 2001 for violations of the Canada Health Act.



In response to The Globe’s stories on extra billing, Ottawa vowed to increase pressure on the province to clamp down. Audits earlier this year led to the largest-ever federal penalty against B.C., almost $16-million.

A physician or clinic engages in extra billing when additional charges are made to patients for procedures that are otherwise paid for by the public system.



Mr. Dix said the Liberal government had turned a blind eye to extra billing and starved the public health care system for resources. “The government was engaged in a policy of ‘don‘t ask, don’t tell,’” he said.

He noted that other provinces have acted on extra billing without enforcement problems.

“Alberta isn't being fined, Ontario isn’t being fined, Manitoba isn’t being fined,” he said. “British Columbia is the only province to be fined under the Canada Health Act every year.” He said the scale of the problem demonstrates the need to rein in extra billing.

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“This was a failure by the previous Liberal government and we are paying the price now.”

