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Plan for user fee at St. Mary's put on hold
October 31, 2003


By Ann Lukits

Friday, October 31, 2003 - 07:00

Local News - Providence Continuing Care Centre has put on hold a controversial plan to charge outpatient rehabilitation patients a $50 user fee.

Barbara Theman, director of communications, said “because of the uncertainty that’s come to light about this fee, we are not moving forward until we get clear direction” from the Ministry of Health and Long-Term Care.

Government officials advised Providence late Wednesday that they want to review the fee before it’s introduced at St. Mary’s of the Lake Hospital in Kingston and St. Vincent de Paul Hospital in Brockville.

Depending on the results of that review, “we may not be moving forward,” Theman told The Whig yesterday.

“We in no way want to do anything that is against what is allowable or against any regulations. And from our perspective the good news is that if this is a problem, we want to know before we implement it.”

Providence had planned to introduce a one-time assessment charge of $50 for OHIP-funded physiotherapy, occupational therapy and speech and language pathology at St. Mary’s and St. Vincent de Paul on Monday.

The purpose of the fee was to generate additional operating revenue to help offset significant year-end deficits projected at both sites. Providence staff would not be required to pay the $50.

After the hospital’s plan was revealed in a Whig story Wednesday, it came under attack by the Kingston Health Coalition for its potential to discourage some people from seeking care.

Dr. Sam Shortt, director of the Centre for Health Services and Policy Research at Queen’s University, was also critical of the new charge. Short said that user fees historically hurt people who can least afford them.

The Ontario Physiotherapy Association termed the fee “alarming,” and part of a growing trend by chronically underfunded hospitals.

Despite an internal memo from the director of rehabilitation services at Providence stating the ministry was aware of the fee and considered it “allowable,” Theman said Providence officials didn’t have a written directive from the ministry or a legal opinion backing that claim.

The decision to begin charging patients was based on “discussions with other hospitals” that have introduced similar fees, she said.

“It was our understanding that [charging an assessment fee] was an allowable practice,” Theman said.

The Peterborough Regional Health Centre began charging $45 for outpatient rehabilitation assessments in 1995. All subsequent sessions are covered by the Ontario Health Insurance Plan.

Theman acknowledged the public discussion generated by the fee and stressed that “it’s important to get it right.” A decision by the ministry is expected as early as today.

“We would rather have this clarified now so that we do not in any way go forward with something that is not

allowable,” Theman said.

Djamel Lounis, a former senior policy adviser with the Health Ministry who’s now self-employed as a Kingston health insurance consultant, applauded the decision to review the hospital’s plan.

Lounis, who was the province’s first policy adviser on physiotherapy, became knowledgeable about federal and provincial health legislation through his work with the government and owners of private physiotherapy clinics.

He said the proposed $50 assessment fee contravenes three statutes: the Canada Health Act, the Ontario Health Insurance Act and the Ontario Health Care Accessibility Act.

“It’s very important that the public be made aware of their rights,” Lounis said in an interview.

Lounis provided The Whig-Standard with relevant sections of the three health acts showing that outpatient physiotherapy, occupational therapy and speech therapy are insured hospital services protected by legislation.

• The Canada Health Act lists physiotherapy and “services provided by persons who receive remuneration” from a hospital under a definition of hospital services. The act also outlaws extra billing for insured health services.

• The Ontario Health Insurance Act lists occupational therapy, physiotherapy and speech therapy under a section that sets out the hospital services which are insured by the province. The act does not make an exception for first visits or assessments.

• The Ontario Health Care Accessibility Act states that hospitals cannot accept extra payments for insured services. Hospitals that violate the act can be penalized up to $50,000 for the first offence and up to $200,000 for subsequent offences.

Lounis believes Providence Continuing Care Centre would contravene two principles of the Canada Health Act if it proceeds with the $50 user fee: comprehensiveness and accessibility.

He praised the fee review, adding that he hopes the ministry will take a close look at what other hospitals in Ontario are doing.

“I think it is absolutely great,” he said of Providence’s decision to suspend the fee. “I am glad they stopped because they know they would have been stopped in any case.”