‘Clamping down’: CMA draft policy has strong words on charging user fees, dual practice and more

The Canadian Medical Association has published a draft policy on delivering healthcare to patients amid the crunch in resources found in virtually every corner of the country. Among the two key recommendations on primary care, one stands out, suggesting governments “enforce the Canada Health Act prohibition against user fees by clamping down on jurisdictions that allow the charging of membership fees, user fees or bundled payments for persons to access publicly insured primary care. This will ensure primary care remains universally accessible in keeping with Canada’s long-standing value of equitable access to care.”The other primary care recommendation is for governments to scale up team-based care, calling on the various jurisdictions to ensure 50% of Canadians are attached to a primary care team within the next five years and 80% within 10. “The shortage of family physicians and the underfunding of primary care models have led to the establishment of privately funded clinics led by a variety of health professionals,” the draft read. “In some cases, patients pay a fee to join a private clinic to then also gain access to a family physician. These private clinics are generally not integrated with the publicly funded system, resulting in siloing and fragmentation of care.” Looking to specialty care, the CMA wants to see the continued prohibition or severe restriction of duplicate insurance models “whereby people can purchase private insurance to access medically necessary services already covered under the Canada Health Act.” Regarding individual provinces and territories, the association is calling on them to implement and publicize clinically appropriate wait times and targets for medically needed procedures; strive to meet those targets, and if not possible in their own jurisdiction, pay for another province or even country to deliver the service. “The CMA supports the right of patients to seek care either within their jurisdiction or outside of their province or territory if they cannot receive care in a timely manner,” the draft read. The recommendations also noted governments should support and maintain specialist referral tools to keep things moving. And it underlined the need for interoperability between tools used to share patient information. The policy also had plenty to say on dual practice, defined as when physicians work both within the public system and for private enterprise such as third-party insurance programs. It noted that while this duality is long-standing, “the advent of services such as private-pay virtual care has further blurred the lines of providing medical services in both publicly and privately funded systems.” With that in mind, the recommendations note that jurisdictions need to ensure “appropriate virtual care services are funded as part of the publicly funded health care system and remunerated commensurately with in-person services; measures are put in place to ensure equitable access to virtual care; and dual practice for public insured services not be permitted except in situations where evidence indicates it will enhance system efficiency and equitable access to care.” Details on these and more than dozen further recommendations in the draft policy can be read, in full, here.“In our dialogue with thousands of health providers, patients and caregivers, we heard a strong call for solutions that focus on equity, access and quality of care,” said Dr. Joss Reimer and Dr. Kathleen Ross, CMA presidents, in a press release. “Given that the status quo is simply not an option, our health system must adapt and evolve with a commitment to creating accessible, cost-effective, high-quality, sustainable solutions.”The CMA noted that it intends to work to refine the recommendations in the draft with the goal of finalizing them in Fall 2024.

‘Clamping down’: CMA draft policy has strong words on charging user fees, dual practice and more

Register for free access or login.

Related Topics