Managing the interface between public and private healthcare in Canada is an ongoing debate. While charging for medically necessary services in doctors' offices and hospitals violates the Canada Health Act, the Act doesn't explicitly address virtual care provided by physicians or care delivered by nurse practitioners, both virtually and in-person. This ambiguity has led some doctors, nurse practitioners, and virtual care companies to charge patients or employer-funded insurance plans.
The Canadian Medical Association (CMA) advocates for governments to prohibit user fees for primary care services, including virtual ones, and prevent duplicate insurance where individuals can purchase private insurance to access medically necessary services already covered by the Canada Health Act. The federal government is poised to issue a policy interpretation letter clarifying that access to medically necessary services, whether in-person or virtual, remains based on medical need and free of charge. This implies that private payment for virtual care services, whether directly by patients or employer-funded insurance, is not permissible. This stance raises concerns for virtual care corporations that have capitalized on the ambiguity in the CHA by charging patients or employer-funded insurance for virtual consultations via video, phone, or text message, or for in-person appointments with nurse practitioners. Some companies oppose the CMA's recommendations, arguing that these measures could jeopardize existing workplace virtual care coverage and other access methods Canadians utilize for care not currently funded by provincial plans