Ontario faces calls to fund nurse practitioners as clinics charge patients a fee

Private vs. public healthcare There are many questions about is legal and what isn't when it comes to subscription-based healthcare and nurse practitioners.

Medical experts say the rise in subscription fees and paying to see nurse practitioners highlights a need for governments to invest more in publicly funded healthcare.

Nurse practitioners are not covered by OHIP, and it is legal for them to charge patients for their services.

Yin Yuan Chen is an associate professor in the faculty of law at the University of Ottawa and says some publicly funded nurse practitioner clinics exist but there are few.

"There is such a thing as a nurse practitioner led clinics here in Ontario, those are very specific kinds of clinics," Chen said. "They are led but also governed by nurse practitioners; in those situations those clinics are actually funded by Ontario. It is publicly funded services that people can see and they won’t be charged."

A nurse practitioner is similar to a family physician in that they can diagnose, treat minor ailments, write prescriptions and refer to specialists. However, the training between a doctor and a nurse practitioner vary and practitioners cannot specialize.

Chen says subscription-based, or paying for visit clinics, are "no surprise" given the healthcare crisis in Ontario.

"A clinic that provides access to nurse practitioners are not technically led or governed by nurse practitioners and therefore not covered under the public health care system here in Ontario," Chen says.

A visit to a nurse practitioner at a private health care clinic will cost patients a fee. For example, at an Appletree Medical Group Clinic in Ottawa, fees start at $49, but there are additional fees for services like injections or pap tests.

The fees can vary. One clinic is Toronto is charging up to $1,200 a year.

"There is no law prohibiting them, or suffer any penalty for charging fees to patients directly," Chen says.

"To the extent it fails outside of the public health system, it truly works based on the dynamic of the market, it will be up to the supply and demand."

Medical experts and politicians are sounding the alarm for the Ontario government to better fund nurse practitioners.

On Wednesday at Queen’s Park, Liberal health critic Adil Shamji said even if the letter of the law is not being violated, the spirit of comprehensive, universal and accessible health care is.

"The Canada Health Act says that health care is supposed to be comprehensive, universal, portable, publicly administered, and it's supposed to be accessible, and currently the rules are not allowing those five principles to be respected," he says.

If a clinic is functioning as primary care, it should be governed and funded as such, said Interim Liberal Leader John Fraser.

These questions come as the Ministry of Health is investigating a walk-in clinic in South Keys that is reportedly charging patients $400 a year for access.

The South Keys Health Center maintains the fee is legal.

With files from the Canadian Press