How private is health care allowed to get?
For doctors unconnected to MSP, there’s no limit to what can be charged
Since The Westshore broke the news of a local doctor who’s planning to charge her patients a monthly fee to remain patients, we’ve heard one thing over and over: “I didn’t think this was allowed.”
Dr. Perpetua Nwosu’s proposed $125 fee was first presented as a “non-medical fee,” but was quickly withdrawn while it was under investigation. Finally, she decided to de-enrol from the Medical Services Plan (MSP) and go ahead with the monthly fee beginning in November.
Patients have expressed their alarm, but as the Saanich-based doctor has continued to roll out her plan, some have been surprised to learn that it’s completely legal, if discouraged by the authorities.
According to the Ministry of Health, there is no limit to what a practitioner can charge patients if the doctor is not part of MSP. If the doctor works in a publicly funded facility, like a hospital or care home, they have to charge MSP rates ($32 for a basic visit) at their clinic. But if they only work in a private clinic, such as Dr. Nwosu’s Perpetual Health Care, there is no cap.
“I was surprised when I read your article, to see that doctors can actually operate outside of the auspices of MSP—that that's actually allowed in Canada,” said a now-former patient of Dr. Nwosu, Sukhvir Virk from Langford. “That is not consistent with the Health Care Act. That makes no sense to me.”
Virk’s family were patients of Dr. Amarjit Nirwan, but were dropped when Dr. Nwosu took over the practice just before the pandemic hit. His mother has complicated health issues which require regular medical care, and he knows she’s not alone.
“We are going to need a lot more care for the aging population. The Health Care Act, I thought, actually ensured that these people who are now in need of this service would get it. They paid into the service through their taxes, and now they're just asking for it back,” he said.
“For the paradigm to shift on them now? We shouldn't allow this as easily as it seems to be happening.”
Is this how two-tier health care starts in BC?
Dr. Nwosu isn’t alone in looking for alternatives to working within BC’s medical system.
Beta Therapeutics in Saanich is starting a similar program, for $110 a month, on Nov. 1. The clinic currently offers services not covered under MSP—athletic therapy, massage therapy, physiotherapy, and more. A massage therapist who works there now told The Westshore they’d been trying to go the MSP route, but ran into a “bureaucratic wall, essentially.” They saw the need for primary care attachment, heard from doctors who were interested in a membership model, and have decided to run with it.
They have one doctor starting Nov. 1, and will add more based on demand and ability.
“We do understand that unfortunately, this does exclude a certain amount of the population because there is a monthly fee. And that's something that we were trying to mitigate as much as possible trying to keep that fee as low as possible. But I do understand that still excludes people. But we're going to be constantly monitoring that as well and making sure that we're serving the public the best we can, under the circumstances,” he said.
TELUS Health made waves during the pandemic as it bought a tele-health app (initially called Babylon Health), which syncs with MSP. Any BC resident with a health number could book an appointment for a video meeting with a BC-based physician, and any prescriptions would be sent to the patient’s chosen pharmacy. That part of TELUS Health is covered by MSP, free to users.
It’s like a walk-in clinic on your phone. There’s limited availability to choose what doctor you’ll see, and minimal continuity of care. For simple prescription renewals, or less complicated medical issues it’s a convenient system.
In May, 31 BC doctors were primarily seeing patients on TELUS Health, charging more than 80% of their total fees to MSP through the program. Another 131 doctors were using it some of the time—about 26% of their fees were through the app.
TELUS seems intent on growing its share of the healthcare industry. It has bought clinics, opened storefronts, it offers electronic medical record management and direct billing services for doctors. And, it offers a suite of health care services available for a fee—including an option to be attached to a particular family doctor.
TELUS’s LifePlus program costs between $3,600 and $4,650 a year, and gives access to a primary care physician, an on-site laboratory, and a multi-disciplinary team. There are four LifePlus locations in Vancouver, but none yet in Victoria. Patients of those Vancouver doctors who switched to Telus Health had to choose to pay, or lose access to their doctor.
The fee is lower at the two Victoria clinics, but the principle remains the same: pay for access you can’t currently get in the public system.
One of the few patients we’ve been interviewing since breaking the news in early August is worried about what costs come with accepting an uninsured doctor. She’s asked the Medical Services Commission, who told her any referrals from a non-MSP doctor won’t be covered.
“If I'm going to have to pay for every referral, and every bloodwork, and every x-ray on top of $1,500 annual fee, that's a lot,” said the woman we’ve been calling Hayley.
“You're taking this chance, I guess like any insurance. You pay a set fee for insurance and that covers everything, or you take a risk of not having insurance and you may get away with it. Or you may really regret it.”
Health Minister Adrian Dix said in a press conference that his department has tasked the Medical Services Commission with investigating Telus Health and Perpetual Health Clinic, but no answer from the commission has been given.
Virk hopes people pay attention and put pressure on politicians to do better.
“We as Canadians are actually very polite, and we allow the people who are making these legislative decisions without the masses really knowing the impacts to them. And it all gets sort of swept under the rug, in terms of the public not being aware of how they're going to be impacted.”
Each patient we’ve interviewed has shared a common fear that this is the beginning of private health care in BC.
“This is literally going to [be] privatization of health care for profit,” Virk said. “If we allow this particular person to do this, then it's a very slippery slope.”