Thursday, March 19, 2020

Is fee-based telemedicine even legal? It seems so un-Canadian

Apparently, demand is burgeoning for Canada's new telemedicine services during the current COVID-19 outbreak. I don't mean government-sponsored serices like Telehealth Ontario (for whom demand is definitely spiking, but not in a good way,with long wait times). I mean private enterprises like Maple, Dialogue, Babylon and Akira.
Never heard of them? Me neither until today, but they are seeing exponential growth in the current climate of social distancing and self-isolation. The deal is you get to consult with experienced qualified Canadian doctors from the comfort of your own home at the click of a button. Consultations can be by text, audio or video, and the doctors can make full diagnoses of a large variety of conditions, write sick notes, referrals and prescriptions and even have them sent direct to your home. These new services have been described as "the Uber for doctors and patients".
But it comes at a cost. Most provincial health insurances in Canada specifically only cover in-person doctor's visits. So, you pay (using Maple as an example) $49 per virtual "visit" on weekdays, $79 at weekends, and $99 overnight, or there are also convenient monthly plans. It is in fact private healthcare, which Canada's public health system is not supposed to allow, and a step towards a two-tier healthcare system that has long been anathema in Canada.
You can why interest has been piqued during the restrictions of COVID-19. And you can see how it would be very useful for some of Canada's remote communities. Maple is even offering COVID-19 assessments for free at the moment, although don't kid yourself that this is entirely out of the goodness of their hearts.
Sound too good to be true? Well, maybe not if you can afford it.
Companies like Maple and Akira have been around since 2016, but haven't really gained that much traction until recently. But as they become more popular, the issue of whether such private medicine is even legal in Canada's universal public healthcare system will undoubtedly come to the fore. British Columbia was the first province to allow this kind of private online service, and now, using the smokescreen of the COVID-19 pandemic, Ontario has just followed suit.
Not everyone is happy with it. A vice-president at Women's College Hospital comments, "It has the potential to undermine the universal healthcare system". According to a University of Alberta professor of health policy, "In my opinion, it's operating outside the Canada Health Act". And the principle of universality based on need not means that is enshrined in the Canadian health system does indeed seem to be breached by the development. It's not clear to me how such operations are legally allowed to persist.
Questions have also been asked about the quality of care when a doctor does not have access to a patient's medical records, and about folllow-up and continuity of care. Another worry is that, while good, experienced doctors are answering online queries, they are not attending clinics in their own community.
It may (or may not) be the way of the future, but it is by no means a problem-free concept. Having said that, opposition has been pretty muted. I guess people have other things on their minds right now.

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