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 (Medicare need NOT greed)

November 23, 2004

Hon.  Angus MacIsaac

Minister of Health

Dear Hon. Minister:

RE:    CO-OP

We would like to refer to our letter of June 24th, 2004 to the Honourable Angus MacIsaac regarding the establishment of a health care co-op by Dr. Cathy Felderhof.    Despite the many valid points made in this letter, and  the reassurance from the A/Deputy Health Minister at our August 2004 meeting to look at the charges Dr. Felderhof was charging patients,  the Government of Nova Scotia has apparently decided to support the establishment of North Nova Co-op.

We were informed by the A/Deputy in August that we would be informed of the findings on the "investigation" of patients being charged fees per visit and annually.   This is in violation of the Canada Health Act and the Health Services and Insurance Act, and we charge you with the responsibility of policing these Acts.  We will in no way accept the government's decision to support this health co-op and request you take responsible action to charge Dr. Felderhof under these Acts.  We also look forward to the report which was supposed to look into the allegations of charging patients.

We are extremely disappointed by this decision and find it difficult to understand.  It is also surprising that the Physician responsible for Primary Care in Nova Scotia would support this initiative.  It does not fit what we believe to be the model for Community Health Centres, far from it.   It is also disappointing that Doctors Nova Scotia appear to be supporting the Co-op.  As the body responsible for negotiating payment levels for physicians in Nova Scotia, it should have behaved more responsibly.  Our organization is a strong supporter of the Community Health Centre concept but this co-op fails to meet what we believe to be the appropriate criteria.  The government has also failed to provided leadership and support for the development of community health centres in this province.

The payment level negotiated for physicians by Doctors Nova Scotia provided for administrative costs of providing physicians’ services and should be adequate for Dr. Felderhof.  If it is not, she has the option of accepting other reimbursement systems as many of her colleagues do.  Under the co-op arrangement, it would appear the DoH will pay the Co-op for physicians and administrative services.  Is this permissible under the Health Services and Insurance Act?   Such organizations are not listed under the description of "provider" in the Act.   Will the DoH pay the co-op more than Dr. Felderhof’s present   rate?  If not, will the co-op not face the same situation as that faced by Dr. Felderhof?   We would suggest that an alternative would be to pay Dr. Felderhof an amount less than that paid to other physicians by deducting administrative charges from fees paid to her.

These funds could be used to employ a receptionist and pay the office rent and hire a nurse to "allow  Dr. Felderhof to practice her profession".  This would likely cost less than supporting a co-op as is presently being implemented. 

Perhaps the DoH should re-examine how it pays physicians by paying them only for their services and the DoH paying administrative costs separately.   It should also examine how much patients are paying for services not covered by MSI.  For all these reasons, the DoH should not approve payments for any additional co-ops like this one until these important questions and concerns are answered.

We would like the opportunity to meet with you to discuss this subject further including the legal aspects of paying a co-op for physicians’ services.  As well, we would appreciate a response to our letter of June 24th 2004.

We look forward to hearing from you in the near future about a meeting.


Debbie L. Kelly, Chairperson

Nova Scotia Citizens' Health Care Network 

cc:   NDP Health Critic, Liberal Health Critic and Network Organizations