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Ford government promises to close fee-for-service health-care loophole

The Ford government is promising to close a loophole that allows nurse practitioners in Ontario to charge patients fees for services despite the province’s commitment to uphold the publicly funded health-care system.

More than a dozen 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 typically average hundreds of dollars.

A database of clinics, compiled by the Nurse Practitioners Association of Ontario, shows more than 30 locations in the province as of late 2023, many of which openly advertise their fees online and in publicly accessible locations such as the Toronto subway.

While the Canada Health Act lays the groundwork for how medically necessary services are paid for under the country’s single-payer model, nurse practitioners are treated as employees within the health-care system rather than independent operators.

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The Ford government calls it a federal loophole that has allowed nurse practitioners to operate outside the health legislation and charge patients fees that would be typically covered by the Ontario Health Insurance Plan (OHIP).

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On Monday, the Ford government suggested, for the first time, that it’s willing to crack down on the loophole.

“Our government will not tolerate clinics taking advantage of a loophole created by federal legislation,” said Nolan Quinn, the parliamentary assistant to the minister of health. “If the federal government doesn’t take action to ensure Ontarians and Canadians can access publicly funded health care, we will.”

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While it’s unclear what steps the Ford government would take to end the practice, ministry officials said the province is engaged in active talks with the federal government on the issue.

Critics, however, charge that the government is in “denial” over the situation and claim the province isn’t working fast enough to cauterize the problem.

“I have at least three clinics in my riding,” Liberal MPP John Fraser said. “They’re just turning a blind eye to what’s going on, it’s happening all across Ontario.”

The Ontario NDP also asked Monday for an investigation from the auditor general into the practice.

“We’re seeing ads popping up in Toronto subways and all over social media. People are desperate,” NDP Leader Marit Stiles said. “You’ve got 2.3 million Ontarians without access to primary care, absolutely people are very vulnerable and we’re hearing increasingly about these fees.”

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While the rules allowing nurse practitioner-led clinics to charge patients predate the Ford era, the government has introduced legislation — Bill 60 — that increases the role of private health clinics in Ontario.

Some critics believe those changes created the conditions for more private delivery of public health care.

In the 2024 budget, the Ford government also announced more than half-a-billion dollars to help 600,000 residents find a family doctor which, health-care advocates say, is key to reducing the burden on overloaded emergency rooms.

Still, the government is facing calls to include nurse practitioners as independent contractors under OHIP to avoid patient charges.

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