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New Study finds that “extra billing” is back.

February 10, 2011

Private clinics charge patients for medically necessary services, provide excessive care.

Toronto - A study published in the current issue of the Canadian Journal of Gastroenterology finds that 31.7% of patients in private clinics are being charged for access to colonoscopy services,

The study, which was funded by Cancer Care Ontario and carried out by researchers at Women’s College Hospital, surveyed 2000 patients aged 50 to 70 years about their experience of colonoscopy services.

“Charging for medically necessary services is a violation of the Canada Health Act, as well as provincial law,” said Dr. Danielle Martin, one of the study’s authors and Chair of Canadian Doctors for Medicare. “It is unacceptable to extra-bill for insured services, or to charge for uninsured services as a condition of accessing insured services.”

The study also found that private clinics instructed patients to return for repeat follow-up testing more frequently than is recommended. Critics of for-profit clinics have often expressed concern that the profit motive may lead to over-treating patients, providing more care, for a fee, than is needed.

“Given the small but potentially serious risks of colonoscopy, as well as the expense, it is neither safe nor efficient to recall patients more frequently than needed. The benefits simply do not outweigh the harms,” said Dr. Irfan Dhalla, a physician at St. Michael’s Hospital and Board member of Canadian Doctors for Medicare.

Doctors at private clinics also appear to be engaged in the questionable practice of “self-referral” seeing patients initially in a hospital but referring the patient to see them separately in their private clinic. 10% of private clinic patients said the doctor who delivered the care at the private clinic was the same one who initially referred them there from the hospital. The risk of conflict of interest involved in referring patients to private, fee-charging clinics in which the referring doctor has an interest has been raised in the growing discussion about private clinics in Canada.


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