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Clinics with fees exploiting gaps in health system, Green MLA says

Adam Olsen says because nothing has been done to stop the fee-based systems, a gap has been created that’s being exploited

As another family-practice clinic that charges patients an annual fee begins taking on patients, Green Party MLA Adam Olsen is raising concerns that the province is allowing practices to exploit gaps in the public health-care system.

Beta Therapeutics on West Saanich Road in Royal Oak, set to start taking on patients Monday, is one of a growing number of practices in the south Island openly charging annual fees under different schemes.

The clinic is charging patients a monthly fee of $110 — based on an annual cost of $1,320 — for its “family medicine membership,” with care provided by a physician de-enrolled from the Medical Services Plan.

Olsen, representing Saanich North and the Islands, said this week that while Health Minister Adrian Dix has said he supports equal access to a universal primary health-care system, because nothing has been done to stop the fee-based systems, a gap has been created that’s being exploited.

“And we are seeing, and we will see, people who could be practising family medicine in this province moving their services outside of the MSP billing system and delivering those services to those who can afford to pay,” said Olsen. in Sidney charges a $2,400 annual fee for non-Medical Services Plan-covered services, while Dr. Perpetua Nkechi Nwosu of Perpetual Health Centre in Saanich plans to de-enroll from MSP as of next week to charge a $1,500 annual one-time membership fee to cover “all appointment and treatment” with the physician and her team. The service is free for children 10 and under.

Health Minister Adrian Dix says he has asked the independent Medical Services Commission, which oversees the Medical Services Plan, to investigate these clinics for possible contravention of the Medicare Protection Act or Canada Health Act. The commission includes three members from the Doctors of B.C., three from government and three from the public.

Dix has also asked the commission to review private fee-based services offered by Telus Health Care Centres to ensure there’s no queue-jumping for patients who pay the fee, which isn’t allowed under the Canada Health Act.

Care Centres’ LifePlus package — which includes around the clock access to a health-care practitioner and costs about $4,500 annually — and other fee-based services have drawn criticism that they’re creating a two-tier health care system.

In response to Olsen’s comments in the legislature this week, Dix said the Medical Services Commission consistently takes action on violations, “including cases in the member’s riding.”

“They have the authority, based on the act, to take action, including the power of injunctions. They take that role very seriously.”

On Saturday, Dix said in a statement that “a majority” of B.C.’s family physicians are receiving funding to help with overhead costs — part of $118 million in interim funding announced in August. The first $107 million for 3,164 eligible doctors is now being paid out, Dix said, with $11 million to be distributed in mid-November.

Beta Therapeutics clinic director Samantha Rocha said she and her partner were forced to charge fees because of prohibitive operating costs.

The clinic’s physician Dr. Dan Cutfeet, who formerly worked in Alert Bay, is expected to de-enrol from the Medical Services Plan.

De-enrolled physicians can charge patients directly, and patients can’t seek reimbursement from MSP. Another option for doctors is to “opt out” of MSP, which means they can directly charge patients, who can then seek reimbursement from MSP for the amount that’s covered under the plan.

Physicians who are not enrolled in MSP can order lab or diagnostic tests, but they are not payable by MSP and patients responsible for those costs are not eligible for reimbursement, according to MSP’s website concerning physician enrollment status.

Rocha said in early October that all but 20 per cent of the Cutfeet’s patient roster had been filled — a typical patient panel is about 1,200 — and the clinic plans to take on another doctor in six months.

“We have the space to accommodate additional providers,” said Rocha.

Asked about potential investigations by the Medical Services Commission, Rocha said the clinic has a positive relationship with the commission.

“They have been truly helpful in guiding us as we build a model that respects the parameters of the Medicare Protection Act and Canada Health Act.”

Rocha said she and her partner are doing their best to make the services as affordable as possible in hopes that negotiations between the province and Doctors of B.C. bring more solutions to light.

The province and doctors are currently negotiating a new Physician Master Agreement that is expected to provide more options for how and how much doctors are paid. Dix and Doctors of B.C. president Dr. Ramneek Dosanjh are scheduled to make an announcement about supports for doctors on Monday morning.

Rocha said based on what’s decided, the clinic would “evaluate potential changes to our model.”

“We think concerns about being able to afford to pay for health care are valid and we understand that this model won’t work for everyone.”

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