The Canadian Medical Association (CMA) is calling on the federal government to urgently review the Canada Health Act (CHA) — with respect to provincial compliance with the accessibility criterion as it relates to the provisions for reasonable compensation — in order to address the recent unilateral actions of the governments of Ontario and Nova Scotia.
Dr. Cindy Forbes, CMA President, shared the concerns of Ontario and Nova Scotia physicians in a letter to the federal Minister of Health, dated Apr. 26. Ontario physicians have been without a contract since March 31, 2014, and the province of Nova Scotia has given Royal Assent to, but not yet proclaimed, the Public Services Sustainability (2015) Act, which suspends the right of Doctors Nova Scotia to arbitration.
“The CMA is very concerned that the lack of effective oversight and enforcement of the accessibility criterion in the CHA as it relates to the provisions for reasonable compensation has the potential to undermine the Medicare program in the immediate and longer term,” said Dr. Forbes. “In short, it is simply unacceptable that physicians can be left in limbo when governments fail to come to agreement with their provincial or territorial medical association. It is an issue of fundamental fairness.”
In her letter, Dr. Forbes quotes from Justice Emmett Hall’s review of the Medicare program, which ultimately led to the CHA in 1984. Hall clearly recognized the power imbalance of the shift to an exclusive public payer for physician services, stating “I reject totally the idea that physicians must accept what any given Province may decide unilaterally to pay. I reject too, as I did in the report of the Royal Commission, the concept of extra-billing.”
Justice Hall’s recommended solution to this imbalance was provision for that “when negotiations fail and an impasse occurs, the issues in dispute must be sent to binding arbitration, to an arbitration board consisting of three persons, with an independent chairperson to be named by the chief justice of the relevant Province and one nominee from the profession and one from the Government”.
The amendments to the CHA put forth in the letter would make the provision for reasonable compensation clearer and would mandate jurisdictions to negotiate agreements that include dispute mechanisms with medical associations.
The CMA has been advocating for such an amendment since 2013, when the association expressed similar concerns in a letter to former Minister of Health Leona Aglukkaq. At that time, the government confirmed they had no plans to amend the CHA in light of the contract between the government and physicians of Alberta.