Federal Health Minister Mark Holland says provincial and territorial health plans will cover primary care provided by nurses, pharmacists and midwives.
Holland says regulated health professionals who are not doctors will be able to bill the government for medically necessary services that would otherwise be provided by a doctor.
The minister says the changes are part of a new interpretation of the Canada Health Act that will come into force on April 1, 2026.
He says the move is necessary because some patients are paying out of pocket for medically necessary care, even at some private nursing clinics.
Holland says that charging patients for those services is not consistent with universal health care and that nurse practitioners should be able to bill the health care system the same way doctors do.
He says the changes won’t come until next year because provincial and territorial governments need enough time to adjust their health insurance plans.
Holland issued the directive in an “interpretation letter,” reviewing which providers are included in Canada’s Medicare system, sent to health ministers on Thursday but released publicly on Friday morning.
In an interview Thursday night, Holland said he was “deeply concerned” about patients being charged for public health care services.
“That is certainly not in the spirit of the Canada Health Act, and this interpretation letter overrides it,” he said.
The new policy also “empowers” non-physician health professionals to provide the full spectrum of care for which they are qualified, Holland said.
Nurse practitioners in particular can help alleviate pressure on primary care physicians and the health care system as a whole, he said.
“There has been an expansion in the scope of practice of many regulated health professionals (e.g. nurse practitioners, pharmacists, midwives) to better utilize the full scope of their competencies, knowledge and skills to increase access to necessary care “Holland wrote. in the letter to their provincial and territorial counterparts.
The changes will be applied in provinces and territories through federal health transfer payments, which could be deducted if patients are charged for medically necessary care, he said.
The Netherlands’ directive comes nearly two years after his predecessor, Jean-Yves Duclos, expressed concern in a letter to health ministers about patients paying out of pocket for medically necessary treatment.
In that letter dated March 9, 2023, Duclos committed to issuing a revised interpretation of the Canada Health Act to prevent that from happening.
Last September, Canadian Doctors for Medicare wrote to the Prime Minister’s Office asking when that “long-awaited” interpretation would be released.
The group’s president, Dr. Melanie Bechard, said it would help “ensure that all Canadians continue to have access to necessary health care based on their needs, not their ability or willingness to pay.”
“The shift toward episodic care delivered virtually by physicians and longitudinal care delivered by nurse practitioners (and other types of providers) was not anticipated in 1984, when the Canada Health Act was passed,” Bechard wrote.
“Clarifying that medically required virtual care or professional nursing care must be publicly funded would be consistent with the spirit and intent of the Canada Health Act.”
Holland said the delay was due to ongoing consultations with provincial and territorial governments over the past two years to reach agreement on the new policy.
Duclos also identified virtual care and telemedicine as areas where some patients may be paying out of pocket inappropriately.
Holland said billing for virtual care is not addressed in his current directive, but remains a concern he is discussing with his provincial counterparts.
“If you go into a doctor’s office that is a physical doctor’s office or if you go into a virtual doctor’s office, both of those things should be covered by the Canada Health Act,” he said.
“Both of these things should ensure that a patient is not paying for their health care services.”
This report by The Canadian Press was first published Jan. 10, 2025.
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