Paid virtual care under threat of being shut down by feds

Employer-paid virtual care, made popular during the COVID-19 pandemic, is under threat of being shut down entirely by a yet unreleased Canada Health Act interpretation letter from the federal Minister of Health, likely attacking any care where patients pay out of pocket. 

Multiple industry and business leaders around the country are increasingly alarmed by the language used by successive ministers of health and the language contained in a draft interpretation letter circulated to provinces and stakeholders.

Parts of this draft letter, obtained by the Insurance Portal, illuminate their cause for concern.

In short, the government is concerned with any patients being charged for services that would normally be covered if the care were being provided in-person, by a physician.

The government says that between May and September 2023, provinces and territories had the opportunity to suggest changes to the interpretation policy. The draft of the yet unpublished letter said implementation was pushed back a year to come into effect as of April 2026.

Some advocates had hoped that the interpretation letter would stipulate the nurse practitioner care and virtual care should be publicly funded, according to Canadian Doctors for Medicare. The letter, however, explicitly says the new interpretation is not to expand the services insured under the Canada Health Act.

In discussing the modernization and improvements in healthcare, the memo attached to the draft specifically discusses private, virtual clinics that are charging patients for services that would normally be insured if the services were provided in person, by a physician. The memo’s language notes that if a provider is legally entitled to practice virtually in a jurisdiction, any medically necessary services should be covered by the province or territory within which the patient resides.

“There has been evidence of residents paying out of pocket to access diagnostic services such as ultrasounds, MRI and CT scans – services that should be accessible at no cost. This is not acceptable and will not be tolerated,” Health Canada and the Minister of Health at the time, Jean-Yves Duclos said in a statement issued in March 2023.

In his letter to the provinces and territories issued the same day, the minister threatens provinces, saying “where instances of patient charges for these services are present, I will pursue a reduction in federal health transfers by an equivalent amount, as authorized by the (Canada Health) Act. My officials are always ready to work with yours to discuss patient charge issues.” 

In response to this and the interpretation draft released to provinces, territories and stakeholders, doctors, chambers of commerce across the country and the industry itself have all sounded the alarm that this interpretation will have significant unintended consequences for millions of Canadians, many of whom do not have access to primary care physicians at all.

Today, 10-million Canadians have access to virtual healthcare that is paid for by their employer according to the Canadian Life & Health Insurance Association (CLHIA). The association says over 500,000 employer-paid virtual healthcare consultations occurred in 2023, through group health benefits. The Calgary Chamber of Commerce says more than 50 per cent of virtual healthcare users in general do not have access to primary care. Canadian Doctors for Medicare also notes that this restricted access further restricts Canadian’s access to specialist care, as well.

“Since primary care is the foundation of our health care system, patients without a primary care provider often find the referral gateway closed to other specialist care,” they write.

Among the responses to this narrative, the industry has its supporters.

“On behalf of the Calgary business community, the Calgary Chamber of Commerce expresses our concerns regarding the unintended repercussions of the Government of Canada’s proposed interpretation of the Canada Health Act. The proposed change to ban employer-funded virtual care would be extremely disruptive to the existing care system, which is currently backfilling a significant shortage of family doctors. Critically, this change would also limit the provision of health care services in Canada without sizably increasing government expenditures to fill the gap created by this limitation,” the chamber stated in a letter to the Minister of Health and the Minister of Public Safety, Democratic Institutions and Intergovernmental Affairs earlier this year. “Businesses deeply value their ability to support employee health and well-being, including access to virtual care through employer benefit plans.” 

Earlier this year the Business Council of Canada and the Canadian Chamber of Commerce together expressed similar concerns and sentiments, saying there is a solution: That is, to include an explicit allowance for employer-paid care in any interpretation to provinces from the federal government. “By accommodating employer-paid care in the interpretation letter, the government can ensure that access to supplemental care is preserved for millions of Canadians while ensuring that no Canadian is forced to pay out-of-pocket to see a healthcare professional,” they write.

As for the industry itself, the CLHIA’s president and CEO, Stephen Frank in November 2024 came out with a statement saying employer-paid virtual care has been available in Canada since 2017, improving access to timely, quality health care services.

An important and necessary solution 

“Since then, employer investment has improved the innovative and secure technologies that make these services possible,” he points out. “Employer-paid virtual care should be supported by all governments as an important and necessary solution to the current healthcare crisis. Policy and decision makers should be focused on the real problem of Canadians paying out of pocket for care. We support the government’s efforts to eliminate this practice. We are calling on government to address out of pocket payments for care without removing virtual care options for 10 million Canadians who already have access to it through their workplace benefits.” 

Although the association hopes that the delay in issuing the interpretation letter means that the minister’s office is working on wording, the CLHIA’s representatives say thus far the government has not been receptive to their efforts, the prevailing sentiment being that anyone obtaining care that hasn’t been paid for by the country’s governments is in a way, “jumping the queue.” 

As for the interpretation letter’s final publication and release, the Minister of Health, Mark Holland has reportedly said that he will table it at a health minister’s meeting – one which was supposed to occur this month. Having been postponed with no new date yet, the minister’s meeting is now expected by some to convene in January 2025.