Ex-provincial health minister sees red

Ann Silversides

doi:10.1503/cmaj.081872

The rash is gone. The wrath, however, remains. Last fall, Jim Wilson, a former Ontario health minister, was asked to pay $125 to make an appointment with his dermatologist to deal with a persistent rash under his arm.

The Conservative MPP (Simcoe-Grey) bristled at the notion and told the dermatologist's receptionist that the charge was illegal. He asked her to remind the doctor “that I'm a former minister of health.”

That argument had no effect. Wilson, in turn, declined to pay the $125. Like millions of other Canadians, he doesn't have a family doctor. His retired about 4 years ago, and Wilson says he hasn't had time to line up for another.

Conservative MPP Jim Wilson. Image by: Office of Jim Wilson

When Wilson called the Ontario Ministry of Health about the charge, he was advised to obtain a referral letter from a walk-in clinic or emergency ward. He also called the College of Physicians and Surgeons of Ontario, though he didn't make a written complaint, which is necessary to trigger a formal investigation.

“I didn't want to embarrass the doctor,” Wilson explained. “I just don't want people paying fees that are illegal … I have elderly constituents who told me they would just pay the fee because they didn't know it was illegal.”

Extra charges are increasingly being introduced at private clinics that offer publicly insured services (CMAJ 2008;179[11]: 1112-3), while advocacy groups report that more and more patients report concerns about physician charges (CMAJ 2008;179[9]:888-9).

Wilson raised the issue in the Ontario legislature “on behalf of the 800 000 to 1 million Ontarians who don't have a family doctor and can't get a legitimate letter.” Health and Long-Term Care Minister David Caplan responded that “I find it remarkable that this member and his party, who advocated a $3 billion cut to health care, would even deem to ask this question.”

What does Wilson think ought to be done? “Physicians need to be reminded by the ministry … probably through the CPSO [College of Physicians and Surgeons of Ontario], that the rules are the rules and if you are this hard up for money, come and talk to us — don't break the Canada Health Act.”

The college declined to comment on Wilson's complaint, but a spokesperson says it will sometimes advise physicians if they are not in accord with college policy and will also refer information received about “aberrant billing” to the Ontario Health Insurance Plan. College policy (www.cpso.on.ca/policies/blockfees.htm) states that “fees for being available to render an insured service” may not be charged.

Canadian Dermatology Association spokesperson and Toronto-based dermatologist Dr. Charles Lynde has heard of such fees being charged, particularly by doctors who also perform uninsured cosmetic procedures. The fee may be refunded if the visit turns out to be for an insured service, he adds. “It is a grey area … every physician does what he thinks is right.” Lynde says Wilson was “ trying to queue jump” and should have “done what the rest of the world does and go see a walk-in clinic.” Specialists in Ontario are paid less for an initial visit (a “consultation”) if there is no referral letter, he added.

Under Ontario's 2005 Commitment to the Future of Medicare Act, the general manager of the health insurance plan is authorized to require doctors to submit information about extra charges to patients, including “unauthorized” payments. Violations have included charges for medical supplies, such as bandages and syringes, that are included as part of an insured physician service, and block fees that include some insured services.

The number of reported violations climbed to 320 in 2007/08 from 120 in 2004/05.