Federal Health Minister Mark Holland speaks during a news conference, in Vancouver, on July 23, 2024.DARRYL DYCK/The Canadian Press
Nurse practitioners and other non-physician health professionals can bill the public health care system when providing primary care, Ottawa has told the provinces in a long-awaited new directive that is also meant to stop those professionals from charging private fees to patients.
The federal government’s new direction is outlined in an interpretation letter of the Canada Health Act sent from federal Health Minister Mark Holland to his provincial and territorial counterparts on Thursday.
But companies that provide health care through private insurance say the directive is not a good use of public money and that it provides no clarity on virtual care services.
Mr. Holland said he expects to discuss virtual care more at a meeting of health ministers later this month in Halifax, and that it will be dealt with in a separate letter in the future.
An estimated 6.5 million Canadians do not have a family doctor, and so in recent years provinces have expanded the roles of health care professionals such as nurse practitioners and pharmacists to provide more primary care.
But those professionals have operated in a grey area because the Canada Health Act, passed in 1984, only directly covered health services from physicians and hospitals. Some clinics have charged patients fees for services or membership in a way physicians would be barred from doing.
Mr. Holland’s letter said all medically necessary care should be covered by public health insurance, no matter who the provider is, and patients should not be charged fees.
In an interview on Thursday, he said provinces will still determine scope but the letter allows for providers such as pharmacists, nurse practitioners or midwives to be able to charge the health care system “the same way a doctor would.”
When asked why it took nearly two years to release the interpretation letter, Mr. Holland said it took time to get right.
“This is something that’s going to exist forever,” he said. “This is now how the Canada Health Act is going to be interpreted.”
The changes will come into effect April 1, 2026.
Groups representing medical professionals said they welcomed Ottawa’s clarification of the rules.
Joss Reimer, president of the Canadian Medical Association, said the letter was a “win” for patients and would ultimately give them more access to care.
Valerie Grdisa, chief executive officer of the Canadian Nurses Association, said it recognized the high value that nurses and nurse practitioners bring to the health care system.
The response from provinces varied. British Columbia said it welcomed the letter, while Ontario said it was still studying it.
Alberta said it considered the letter an overreach into provincial jurisdiction in deciding what services are covered by public insurance.
Health care in Canada is managed by provinces and largely paid for by the federal government through the Canada Health Transfer, which is $52-billion for the current fiscal year.
Health Canada spokesperson Tammy Jarbeau indicated Ottawa did not have a cost estimate for the new direction, and said provinces and territories have the next year to work out implementation.
Jessi Rampton, spokesperson for Alberta Health Minister Adriana LaGrange, said Alberta was uneasy about the financial implications. “We are concerned about the financial and operational impacts of this new approach, especially without any new federal funding to offset the costs,” she said.
Ottawa has yet to offer clarity around billing for virtual care.
Some provinces allow public billing for virtual health care services – including Prince Edward Island, Nova Scotia and New Brunswick, which all have contracts with Maple Corp. – but in other provinces, the services are paid by patients or through private insurance.
On virtual care, Mr. Holland said it is his view that building consensus in this area is essential. He said that he hoped that the virtual-care interpretation letter can be released as soon as possible.
Maple co-founder and chief executive officer Brett Belchetz, who is also a Toronto physician, said he was deeply concerned by the lack of detail in the letter. He said it did not come with a plan for how to pay for the new services and will cause a “financial burden” on the system.
“By moving millions of dollars of services that are currently privately funded into the public domain, this shift could overwhelm provincial budgets without a clear strategy for managing the additional costs,” Dr. Belchetz said in a statement.
He said he does not anticipate the letter will have a direct impact on the operations of Maple, which is partly owned by Loblaw Cos. Ltd., because of the lack of direction on virtual care.
Jean-Christophe de Le Rue, spokesperson for telemedicine provider Dialogue, which is owned by Sun Life Financial Inc., said the company fully agreed that Canadians should not have to pay out of pocket to access health care – and that employer-sponsored services, such as theirs, should be an alternative.
He also described the letter as “vague and unclear” and said Dialogue would seek clarity with the provinces.
Over all, Danyaal Raza, a physician and primary-care and health policy scholar at St. Michael’s Hospital, said the letter was a “mixed bag.”
“It’s going to make things easier and more people in Canada will be able to access care based on medical need and not ability to pay,” Dr. Raza said.
But he said the absence of clarity on virtual care was a “major missed opportunity.”