New Canada Health Act interpretation letter makes clear that health care providers cannot charge patients or employee insurance plans for medically necessary services, but is still unsettled on virtual care

Toronto, January 10, 2025 – Canadian Doctors for Medicare is glad to see that Minister Holland has finally released the long-awaited Canada Health Act Policy Interpretation Letter, but failing to include virtual care is a major oversight that requires immediate action.

Provinces and territories have failed to consistently pay for medically necessary services provided virtually by physicians, or by health care workers like nurse practitioners and pharmacists considered to be delivering “physician equivalent” services. This has occurred because of ambiguity on whether the Canada Health Act applies to these services. Consequently, a rapidly expanding network of private, for-profit clinics and other facilities across the country has been taking advantage of this ambiguity to charge patients or their employee benefit plans for services that Canadians are already entitled to under Medicare.

After today’s announcement, governments will be required to stop for-profit clinics and associated health care providers from charging patients for medically necessary in-person care, or face the withholding of federal funding for violating the Canada Health Act.

The Canada Health Act prohibits user fees and extra-billing for medically necessary services. Since health care providers like nurse practitioners and pharmacists play an increasingly important role in delivering health care, the federal government’s interpretation letter now clarifies that in addition to prohibiting physicians and hospitals from charging patients for medically necessary care, other professionals providing “physician equivalent” services may not charge patients either.

However, the letter did not offer any clarity to protect patients from charges for the same types of services if provided virtually. Instead, this has been left unresolved.

“We are deeply disappointed that the Minister omitted virtual care from the Canada Health Act Interpretation Letter” said Dr. Melanie Bechard, Chair of Canadian Doctors for Medicare and a pediatric emergency medicine physician based in Ottawa. “It’s great that our patients will be protected from being charged for care delivered by non-physician health care providers, but with a stroke of the pen, Minister Holland could also ensure patients don’t have to pay for care when it’s provided virtually, such as by phone, live video, or text message”.  

“Canadians must be able to access medically necessary care from health care professionals without having to pay out of pocket, regardless of whether that care is provided virtually or in-person”, said Dr. Danyaal Raza, Past-Chair of Canadian Doctors for Medicare and a family physician in Toronto. “Evidence from around the world is clear: charging patients for health care leads to poorer outcomes and higher costs to the health care system.”

Meanwhile, lobbyists for the private insurance industry and for-profit virtual care corporations have successfully pressured the federal government to exclude virtual care from the provisions of the Canada Health Act .

“Today’s announcement is lukewarm for patients, but a win for the insurance industry and for-profit virtual care corporations,” said Dr. Bernard Ho, Vice-Chair of Canadian Doctors for Medicare and an emergency and family physician in Toronto. “It’s frustrating that when push comes to shove, corporate interests have been prioritized over building a health care system that works for everyone.”

Canadian Doctors for Medicare offers evidence-based resources on the value of publicly-funded health care and the reality of alternative systems. The organization’s position statement on virtual care may be read here – https://www.canadiandoctorsformedicare.ca/virtual_care, and its policy brief on privatization is available at – https://www.canadiandoctorsformedicare.ca/myth_privatization.

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About Canadian Doctors for Medicare

Canadian Doctors for Medicare is a nationwide, evidence-based nonpartisan member organization dedicated to strengthening and preserving Canada’s publicly-funded health care system. We advocate for innovations in treatment and prevention services that are evidence-based and improve access, quality, equity and sustainability. 

For more information, please contact:

Zareef Ahmad
National Director
Canadian Doctors for Medicare
[email protected]