‘This is a form of 2-tier health care,’ says medicare advocate, while acknowledging it’s legal
Some doctors in Ontario are offering their patients the option of extra health care, at a price: seven-day a week rapid access to appointments with a nurse practitioner, for a fee of around $30 a month.
It's perfectly legal under both the federal and provincial medicare rules. But since it involves charging for health care, it adds fuel to a growing debate over two-tier health care in Canada.
Kindercare Pediatrics in Toronto launched its nurse-practitioner program in response to overwhelming demand from parents during the surge in respiratory illnesses among kids last fall, said the practice owner, Dr. Dan Flanders.
"We couldn't keep up," said Flanders in an interview. "Everybody was working their brains out and we were still turning away close to 100 patients a day."'
The program he developed is called Kindercare365 and it is pitched as "on-demand health care for kids." It relies on nurse practitioners, who are authorized in Ontario to provide many of the same services as family physicians, including diagnosing illnesses and prescribing medications.
The optional subscription costs $29 per month (plus HST) for one child or $59 per month for two to five children. It promises an immediate virtual appointment with a nurse practitioner from 8 a.m. to 9 p.m. any day of the week and, if necessary, an in-person appointment no later than the next day.
"This has opened up a door so that more young families can have access to healthcare," said Flanders. "It's not ideal that patients have to pay, but it's something that's going to help increase access."
Why it's legal
The Canada Health Act prohibits charging patients for medically necessary services that are covered under provincial health plans. Since nurse practitioner services are not covered by the Ontario Health Insurance Plan (OHIP), it's legal for doctors to charge.
But within Ontario's complex systems of compensating physicians, there's a disparity that means some patients can actually get health care from a nurse practitioner without paying anything:
Physicians who practice in the province's Family Health Team model receive annual funding that allows them to hire health professionals such as nurse practitioners, so they don't charge their patients for access.
Doctors who bill on the fee-for-service model, such as Flanders and his fellow pediatricians at Kindercare, don't get provincial funding for nurse practitioners.
Flanders says if nurse practitioners in family health teams improve patients' access to health care, the province should extend that funding to other primary care providers.