Provincial cuts to virtual care: The wrong move

Authored March 21, 2023

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At least one media outlet has reported that, at the end of March, the Ontario government will cut funding that allows ER doctors to provide virtual care. This decision, combined with the government’s recent reduction in OHIP fees for virtual care provided by family doctors, is the wrong move. Eliminating innovative pathways to provide care to the public is not the way to crack the case of our desperate health-care system.

The provision of our publicly funded health-care system is governed by both provincial and federal legislation, the purpose of which is to ensure that the government provides timely, accessible and effective medically necessary care to the public.

On a provincial level, the purpose of the Health Protection and Promotion Act is to “provide for the organization and delivery of public health programs and services, the prevention of the spread of disease and the promotion and protection of the health of the people of Ontario.”

The preamble of the Commitment to the Future of Medicare Act, another piece of provincial legislation, states that the “people of Ontario and their Government… [r]ecognize that access to community based health care, including primary health care … are cornerstones of an effective health care system.” [Emphasis added.]

The preamble also states that the “people of Ontario and their Government … [b]elieve in public accountability to demonstrate that the health system is governed and managed in a way that reflects the public interest and that promotes efficient delivery of high quality health services to all Ontarians.” [Emphasis added.]

Making it financially impossible for physicians to provide virtual care to reduce wait times in our severely strained ERs is, arguably, not promoting an effective health-care system.

In addition to being bound by the provincial legislation, our provincial government must also comply with the provisions of the federal Canada Health Act, in connection with the governance of our public health-care system.

Under s. 5 of the Canada Health Act, each province is eligible to receive a full cash contribution payable by the federal government, to the province, for each fiscal year. However, as outlined under s. 7, in order for the province to qualify for such a contribution, the province is legally required to provide “reasonable compensation for all insured health services rendered by medical practitioners.

The decision from the province to pay physicians, under OHIP, an insulting $15 for a phone consultation (or a whopping $20 for a virtual visit), or to cut fees for virtual ER care altogether, is arguably contrary not only to the provincial legislation but also to the provisions of the Canada Health Act, which requires the province to provide “reasonable compensation” to physicians.

Cutting OHIP fees for physicians to provide virtual care does not make sense for our public system. But the juxtaposition is undeniable when compared to the apparent support from the Ministry of Health for private arrangements between corporations and public hospitals to utilize operating rooms on weekends, in the name of reducing wait times (as has been recently reported in the media).

The apparent contradiction in support for our physicians starts to send the message that our provincial government will only value our physicians if they are able to buy into the system. This would be contrary to the explicit legislative directive to the provincial government that our public health-care system must be accessible and efficient.

Brooke Shekter is a lawyer with TTL Health Law. Her practice focuses on administrative law and professional discipline. Shekter earned her juris doctor from Western Law.

The opinions expressed are those of the author and do not reflect the views of the author’s firm, its clients, Law360 Canada, LexisNexis Canada, or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.

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