Nova Scotia recoups $3.7M in health-transfer clawbacks from Ottawa
Health Canada withheld payments because province has allowed patients to pay out of pocket for private imaging
Ottawa has paid Nova Scotia several million dollars in health transfers that were previously withheld because of people paying out of pocket for private MRIs and ultrasounds.
According to the federal government, no one in Canada should pay for medically necessary diagnostic imaging services, and it's been clawing back money from Nova Scotia and other provinces for allowing it to happen.
However, Nova Scotia and Ottawa have come to an agreement that recently resulted in a reimbursement of $3.79 million — the total amount clawed back over the past three years. The payment was finalized in March.
"It's been a long time coming," said Katherine Fierlbeck, a professor of political science at Dalhousie University who studies health policy. She noted many other provinces have already made arrangements to reduce or eliminate privately funded medical imaging to have their health transfers reimbursed.
Fierlbeck said she has a long list of questions about the details of the agreement, some of which she's hoping will be answered in Health Canada's annual report on transfer payments.
The report is typically tabled in Parliament each March, but the House wasn't sitting from the start of January to the end of May — the result of a prorogation and then the federal election. The report has yet to be tabled since the new session began last week.
Health Canada released the reimbursement numbers to CBC News on request, along with a brief explanation.
Contract with private clinic
A spokesperson for Health Canada said the key reason for the reimbursement is "efforts taken by Nova Scotia to eliminate patient charges at the private clinic."
The private clinic they refer to is Healthview, which offers MRIs and ultrasounds. Nova Scotia Health (NSH) signed a contract with the Halifax imaging clinic last May to send some patients there at the public expense.
A spokesperson for NSH said 2,278 MRIs and 585 ultrasounds were publicly funded at Healthview in the first year of the five-year, $7.6-million agreement. Patients who NSH sends to Healthview are triaged in the same way as patients who go to public clinics.
Privately funded imaging continues
But the contract with Healthview does not entirely eliminate cases of patients paying for medically necessary imaging.
Healthview still accepts patients who want to pay to jump the queue, and at least two other private clinics in Halifax do the same.
Wosler Diagnostics opened last summer, offering ultrasound only, and Why Wait Imaging opened earlier this year, offering ultrasounds and MRIs. NSH confirmed it does not have contracts with either of these clinics.
Fierlbeck said this is hard to reconcile with the fact the province received a full reimbursement of health transfer clawbacks.
"If it's only partial coverage, I would have thought that the ministry would say 'OK, partial coverage, we'll give you partial reimbursement,'" Fierlbeck said.
She said covering some services at private clinics — but not all — makes for a "thinly veiled two-tier system."
The Nova Scotia Department of Health and Wellness would not make anyone available for an interview.
Health authority working on imaging backlogs
The underlying issue that's pushing many Nova Scotians to seek private medical imaging is a backlog in the public health-care system, with some people waiting months or years for MRIs and ultrasounds.
Dr. Tim Mailman said the problem is complex and has been years in the making, but Nova Scotia Health is "laser-focused" on improvements.
Mailman, senior medical director of the diagnostics and therapeutic services network, said the main bottleneck is staffing; there's a shortage of imaging technologists.
"Let's use MRI as an example," he said in an interview earlier this year. "If we were able to run our current MRIs across the province [for] extended hours, we have enough MRIs to meet the demand."
Mailman said there's a "complex workforce strategy" in the works to address that issue.
Additionally, Mailman said the health authority is working on a central intake system to streamline booking. He said he expects it will reduce duplication and no-shows, and ultimately shorten wait times. The health authority is expecting the system to come online this summer.
Mailman said the health authority is also working on training and support for clinicians to make sure they're sending patients for the most appropriate type of imaging.
"As a provider myself, I can tell you it's not always easy … I still call my phone-a-friend radiologist to say, 'With this specific situation, should I be asking for a CT? Should I be asking for an MRI?'
"It's not policing the resources, it's working with providers," he said.
Mailman said the backlog is most pronounced in the Central Zone, which includes Halifax. He said other parts of the province are "getting very close to balancing capacity and demand."
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