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      The Nova Scotia Citizens Health Care                                   Network

Medicare.. Need NOT Greed!


 June 24, 2004                                                                                       BY FACSIMILE



Hon. Angus MacIsaac

Minister of Health

P.O. Box 488

Halifax, N.S.  B3J 2R8


Dear Mr. MacIsaac:


Re:  Proposed Health Care Co-operative in New Glasgow


We understand from media reports that your Department is investigating the possible setting up of a health care co-operative in New Glasgow by Dr. Cathy Felderhof and the Nova Scotia Co-operative Council.


As someone who was involved in helping to achieve the Canada Health Act and a ban on extra-billing by Nova Scotian doctors in the early 1980’s, and who has also been involved in community health centres in Nova Scotia and Saskatchewan since the 1970’s, I am very concerned about this proposal.  I attended the public meeting held by Dr. Felderhof on June 15 about her proposal and frankly left with more questions and concerns than when I entered it.


One of the main reasons that I and the Health Network are concerned is that many of Dr. Felderhof’s patients are already paying $8 a visit and $160 a year for so-called uninsured services which she indicates in her recent letter to patients includes administrative costs, telephones, practice assistants such as nurses and information technology. In the first place, such services are not on the list of uninsured services outlined by Doctors Nova Scotia and secondly, the payment of such fees is outrageous and contrary to the Canada Health Act and the Health Services Insurance Act of Nova Scotia.  For the thousands of Nova Scotians who worked to get rid of extra-billing twenty years ago, we certainly did not want to see one set of patient charges for insured services replaced by a new and increasing set of fees for so-called uninsured services.   It is our understanding that the negotiated fee schedule is supposed to help cover overhead costs of physicians.  What other health professional can negotiate a fee schedule to receive payment and then, also bill patients directly for additional revenue?


We believe it is important to remember that when Bill 106 was passed in 1984 to take effect on July 1st of that year, it was with the clear understanding that doctors would stop charging patients directly and instead negotiate with the government for what they feel they need in terms of remuneration and coverage of their costs. “It is the intention of this government, Mr. Speaker, to make sure that balance billing is not any longer an option of the Medical Society”(Hansard, June 5, 1984, p. 3313).  In fact, Bill 106 provided a final offer arbitration process to help resolve all outstanding issues in negotiations between the Medical Society and the government. 


At the public meeting on June 15, Dr. Felderhof suggested that a move to a co-op for her practice was a move away from privatization. I suggest the opposite is actually the case because the co-op would provide an organizational structure to entrench these fees so that they are no longer at the discretion of a physician directly with her/his patient but actually established by the co-op in consultation with the doctor.  In other words, what has been established by a doctor on her/his own now becomes part of an organization acting on behalf of the doctor, that is, a private clinic.


Follow-up media coverage suggests that most patients are receptive to Dr. Felderhof’s proposal, I beg to differ.  Only a small proportion of her patients were in attendance. There was no vote taken at this meeting and I heard several very clear expressions of concern during and after the meeting about the costs to patients under this proposal.  In addition, concerns about what would happen to patients who could not afford the fees were not answered either.  This is exactly what happens under a system or an organization that permits user fees: a complex, costly set of administrative arrangements to collect fees and financial barriers to people who can’t afford to pay.


Perhaps what was most disturbing was the strong possibility as expressed by Dr. Felderhof that if patients did not accept her proposal within two weeks, she would have to seriously re-consider whether she would continue her practice.  I also find this unacceptable and completely contrary to co-op principles.  A true co-operative is established by a group of concerned people for a common purpose not at the request of one powerful person, namely, a doctor to deal with concerns about her/his practice.   I am not aware of any other community health centre or co-operative health centre in Canada that has been set up at the request of a doctor to provide a new way to collect payments for uninsured services.


I tried to point out to the meeting that there is another alternative to this so-called co-op proposal which is to establish a community health centre with a global budget negotiated with the Department of Health and the District Health Authority so that patients do not have to pay any charges for uninsured services.  This is already the case with at least two community health centres in Nova Scotia and certainly elsewhere in Canada. I have urged the Co-op Council to work with the Nova Scotia Federation of Community Health Centres.


We therefore strongly feel your Department cannot sit by idly and let Dr. Felderhof’s patients continue to face excessive user charges.  We urge you to take the following actions:


        Investigate and publicly report on the growth of patient charges for so-called uninsured medical services across the province.  Prior to 1984, the former Health Services and Insurance Commission used to release annual figures on the number of physicians who were billing above tariff or extra-billing by county and the percentage of billings represented by extra-billing in each county.

        Ensure no patient is prevented from receiving necessary services by such charges especially with the amount and range of fees being charged by Dr. Felderhof currently or under a proposed co-op involving her and her patients.

        Recognize most if not all the current so-called uninsured medical services as insured services as is possible under Section 17(2)(b) of the Health Services and Insurance Act.

        Stop doctors such as Dr. Felderhof or any organization employing them from receiving payment from M.S.I. if they want to also bill patients directly for some services as is possible under Section 17(2)(d) of this Act.


         Work with the Nova Scotia Federation of Community Health Centres to establish a combination of legislative, funding, technical and other needed measures to support the establishment of a network of non-profit community health centres across the province with global budgets, interdisciplinary teams and no user fees.


The Nova Scotia Citizens’ Health Care Network finds the current situation for Dr. Felderhof’s patients to be deplorable and anticipates it could well become even worse under a co-operative. We strongly urge you not to take a wait and see attitude but to step in immediately and not to allow this unacceptable situation to continue, especially for her patients on low and fixed incomes. 


We would like to meet with you as soon as possible to elaborate on our concerns and suggestions.  Please contact our Chairperson, Debbie Kelly, at 455-9164 as soon as possible as this situation has significant implications for the whole province.


Yours sincerely,



Ian Johnson


Nova Scotia Citizens Health Care Network



c.          Debbie Kelly, Chairperson, Nova Scotia Citizens Health Care Network

            Dianne Kelderman, CEO, Nova Scotia Co-operative Council

Heather McCleave, Chair, Nova Scotia Federation of Community Health Centres

Ronald Skibbens, Inspector of Co-operatives, Service Nova Scotia and Municipal Relations

            Maureen MacDonald, NDP Health Critic

            Dave Wilson, Liberal Health Critic