Ontario health advocates warn of 'manipulative upselling' at private clinics

New concerns for Ford's private health clinic plan The Ford government says it is adding 'guardrails' that require private health clinics to post uninsured charges upfront to patients.

Ontario health advocates say they will fight to stop the Doug Ford government from allowing more private clinics to conduct OHIP-covered surgeries, alleging the bill will result in further “manipulative upselling” of medically unnecessary services.

“The decision of the Ford government to privatize our public hospital services is a political choice,” Natalie Mehra, executive director of the Ontario Health Coalition, told reporters on Monday.

“It is not a necessity.”

The Ontario Health Coalition, which advocates for publicly-funded health care while representing more than 500 member organizations and individuals, released a compilation of testimonies from patients who say they were forced to pay out of pocket for procedures that should be covered under their insurance.

The examples provided include payments for cataract surgeries as well as MRIs and other prescribed diagnostic services.

In some instances, patients said they were urged to get upgraded lenses, told they had to incur the costs of eye measurements, and invoiced for contrast dye needed for imaging. In others, patients were reportedly told they would have to wait longer for services covered under the Ontario Health Insurance Plan (OHIP).

The costs, according to the coalition, were anywhere from a few hundred dollars to over $8,000.

“The Canada Health Act was meant to protect patients from exactly these types of fees and this kind of snake oil salesman,” Mehra said. “It should not be like going to a car mechanic when you go into your doctor's office, where you're told that there are a range of things that you need and the patient has no idea how to measure the veracity of these claims.”

Bill 60—also known as the Your Health Act—allows both for-profit and not-for-profit clinics to apply for a license in order to perform certain surgeries under OHIP, including cataract surgeries, MRI and CT scans, minimally invasive gynecological surgeries and, eventually, knee and hip replacements.

These new community surgical and diagnostic centres will need to prove in their application they have consulted with other health partners and will be integrated into the current health system. “Expert organizations” will work with Ontario Health and the Ministry of Health to ensure quality and safety standards are met, the government said. This includes inspections of clinics and a complaint system that will allow patients to report if they were overcharged or not provided the correct care.

The Ontario government has made it clear that patients will not have to pay out of pocket for these services and that clinics cannot accept payments to jump the queue.

The legislation doesn’t, however, prevent upselling.

Officials have said a clinic will need to provide information about uninsured services, including the costs, up front. “Prescribed documents”, which will likely include service fees, will be posted on the clinic’s website, the government added.

In response to a question in the legislature Monday, Parliamentary Assistant to the Minister of Health Robin Martin suggested the Your Health Act is “remedying a problem that has existed in public hospitals as well as clinics.”

"We are expanding oversight by bringing in this new legislation,” she said.

“Integrated health centres will now have to post any uninsured charges both online or in-person and every community surgical and diagnostic centre must have a process for receiving and responding to patient complaints"

However Mehra said she doesn’t believe the oversight measures will be enough.

“What we're saying is that privatizing the surgeries and diagnostics is a bad idea period,” she said, adding that private clinics should have the option to either only provide OHIP services or provide private care.

Mehra argues that if clinics don’t mix between privately offered services and OHIP services, those receiving publicly-funded procedures shouldn’t be subject to extra charges or manipulated to purchase “medically unnecessary stuff attached to the surgery.”

“Privatization has ballooned under the Ford government and this is the last stage in an ongoing move to privatize piece-by-piece-by-piece our public health system,” she said.

“The way to stop this is not to bring in more, it's to use the existing capacity we have everywhere across the province in our public hospitals in order to clear surgical backlogs and improve access.”

Ford has maintained that Ontarians will be able to pay for these services through OHIP and not their credit card, a statement he reiterated Monday when asked about privatization concerns.

“We have to start thinking outside the box we have to start thinking differently and make bold decisions,” he told reporters alongside Prime Minister Justin Trudeau at an announcement in Mississauga.

“we will always make sure the safety comes first….make sure there’s no different regulations and expedite the process. We’ve been doing this here in Ontario for a number of years.”

Trudeau, whose government has not been shy about the fact that they are watching to see how the new reforms play out, added that his role is to ensure the Canada Health Act is “respected”

“I can tell you over the past number of years, this government has clawed back or withheld money or penalized a number of provinces for not having lived up to the Canada Health Act and we will not hesitate to do so going forward,” he said.

“Canadians expect to continue to have a public health care system. They expect to be able to deliver the results they and their families need. That's exactly what we're working on together across the country right now.”

The Ministry of Health has that it's Commitment to the Future of Medicare Act (CFMA) prevents physicians from charging for OPHIP services.

"The ministry fulsomely reviews all known potential violations of the CFMA that come to its attention," a spokesperson for the minister of health said in a statement to CTV News Toronto.

"If a patient feels they have been charged for an OHIP-insured service, they can contact the CFMA program at1-888-662-6613or by [e-mail].”

The Your Health Act was introduced as a way to reduce the surgical backlog in Ontario, whose wait list stood at about 206,000 people as of last month.

However it was met with almost instant criticism from experts and advocates worried the province’s plan would result in a funnelling of money and resources such as staffing out of the public sector and into the private.

A survey conducted by Angus Reid showed that Canadians are split about how they feel about more privatization within the health-care system. About 39 per cent of respondents wanted little to no private-sector involvement in health care while 28 per cent said increasing privatization was necessary.

The last third of respondents were “curious, but hesitant.”

In Ontario specifically, just under half of respondents were most likely to support public care compared to privatized services.

When asked generally how they felt about increasing private delivery of care, the survey found about 53 per cent of Ontarians said it would worsen the health-care system.

More than half of Ontarians also said they would oppose allowing patients to pay for faster access.