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Nurse practitioner fees could ‘undermine’ Ontario public health investment: minister

Ontario’s health minister says a proliferation of fee-for-service nurse practitioner-led clinics will “undermine” taxpayer investment in the province’s health-care system as the province looks to crack down on the practice.

As part of an ongoing push for a solution, Sylvia Jones wrote to her federal counterpart, Mark Holland, on Monday, asking for Ottawa to close what the Ford government views as a key legal loophole.

“As you are aware, the federal Canada Health Act (CHA) sets out what services are publicly funded in provincial health care systems,” Jones wrote.

“However, the CHA does not contain provisions with respect to the permissibility of non-physician providers, for example Nurse Practitioners, charging patients for care that would be covered under the CHA if performed by a physician.”

In recent months, more than a dozen private health clinics across the province led by nurse practitioners have started offering a range of health-care services — from urgent appointments to treat minor ailments to more in-depth mental assessments — for fees that can average hundreds of dollars.

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While Ontario began funding 25 nurse practitioner-led clinics in 2011, the Ford government only recently expanded the program by including an additional seven clinics under the funding envelope.

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The Registered Nurses Association of Ontario (RNAO) has been pushing for the Ford government to speed up its process of green-lighting publicly integrated nurse practitioner clinics, claiming there is “frustration” among nurse practitioners stuck waiting on the sidelines.

“They are giving up on waiting for funding,” RNAO president Doris Grinspun said. “They’re saying the public wants us, we are going to set up shop and they’re charging patients.”

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In her letter, Jones asked the federal government to “work with provinces and territories on a Canada-wide solution to close this loophole, to guard against unintended consequences, and prohibit nonphysicians from charging for publicly funded services.”

In a statement to Global News, Health Minister Mark Holland’s office said the federal government is expected to issue an “interpretation letter” on the Canada Health Act “soon.”

“This letter will clarify the application of the Canada Health Act on the modernization and improvements in health care, including virtual care, telemedicine, and the expansion of the scopes of practice of health workers, such as nurse practitioners,” Holland’s office said.

A spokesperson for Holland added that the point of the interpretation is to ensure Ontario residents can access services “without having to pay out of pocket.”

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Both the Ontario NDP and Liberals have accused the government of skirting its responsibilities by turning to the federal government to address the issue.

“The government says they have a solution but they keep knocking this over to the feds and refuse to show leadership — the provincial government has solutions that they could be addressing right now, right here,” Ontario NDP Leader Marit Stiles said Monday.

Ontario Liberal MPP John Fraser agreed the province doesn’t need the federal government.

“That’s just a delaying tactic, it’s a waste of people’s time for them to say that,” he said.

Jones admitted she “may have the tools” to end nurse practitioner clinics charging patients but said she feared a patchwork system could lead to health-care workers leaving Ontario to work elsewhere.

“A national solution is necessary to ensure Ontarians, and Canadians, can connect to publicly funded health care services, including primary care, no matter where they live,” Jones wrote.

“This means provincial, territorial, and federal governments must be at the table to discuss a sustainable way to ensure our health care system remains publicly funded.”

In her letter, Ontario’s health minister suggested that if a national approach to the problem is not taken, taxpayer spending on other areas of health care could become less effective.

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“Continuing to allow non-physician providers to operate in fee-charging primary care clinics will undermine our public investment in these new teams and our expansion of publicly funded primary care across the province,” she wrote.

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