Ontario will miss federal deadline to publicly fund nurse practitioners
Ontario will no longer publicly finance all medically necessary services from nurse practitioners as of April 1, as ordered by the federal government, leaving some patients to pay out-of-pocket for primary care.
Health Minister Sylvia Jones years ago pressured the federal government to close a loophole in the Canada Health Act that allowed some nurse practitioner clinics in the province to charge patients for primary care.
The government has done this by clarifying that nurse practitioner services provided by physicians fall within the Act’s requirement that medically necessary services be publicly funded. It has given provinces and territories an April 1 deadline — but Ontario won’t be ready.
“The Ministry of Health is actively reviewing and engaged in ongoing discussions with provincial and territorial partners and the federal government regarding the implementation expectations of the federal government’s directive,” spokeswoman Emma Popovic wrote in a statement.
Provinces will not begin imposing fines for non-compliance until April 2027. Critics and nurse practitioners say Ontario should not wait.
Owners of private clinics say they have no choice but to charge patients because nurse practitioners can’t bill OHIP
“(The federal government’s) letter really underscores the importance of the provincial government’s immediate implementation of a strong, sustainable funding mechanism to support nurse practitioners as key members of the health-care workforce,” said Michelle Acorn, CEO of the Nurse Practitioners Association of Ontario.
“The lack of easily accessible funding models has historically limited the number of public positions and practice settings for nurse practitioners in Ontario,” she said.
“The flexible funding mechanism will help nurse practitioners provide the timely, high-quality, accessible care that Ontarians deserve when and where they need it.”
Nurse practitioners in Ontario can evaluate patients, order and interpret tests, and prescribe medications and treatments. They work in a variety of settings, including family health teams and community health teams, hospitals and long-term care homes, as well as more than two dozen publicly funded nurse practitioner-led clinics.
Health minister’s delay ‘hypocritical’: Liberal critic
two years agoThe proliferation of private subscription fee-based nurse practitioner clinics made headlines. Jones, answering questions from the opposition and media, placed the onus on the federal government to close the “loophole” that allowed him to operate.
“If there is a barrier that is allowing these clinics to happen, perhaps the member opposite can pick up the phone and phone their federal counterparts, because that’s what I’m doing,” she said in Question Time in March 2024.
“I’m making the case that if the Canada Health Act allows these for-profits, we will shut them down with a change to the Canada Health Act and the involvement of the federal government.”
Ontario Liberal health critic Dr. Adil Shamji said it is “hypocritical” for Jones to delay the implementation of something he urged two years ago.
He said, “To me it suggests that it has always been more convenient for this government to allow patients to pay out of pocket rather than for our public medical care.”
“We know that nurse practitioners can provide exceptional primary care, and there is no reason why, if they are providing a service that would otherwise be covered if provided by a physician, there is no reason why it should not also be covered under our public health care system.”
Clinics want funding, but some have no choice: nurses
Nurse practitioner MaryAnn Green, along with two nurse practitioner colleagues, operate one of the membership-based clinics that Jones threatened to close.
He applied to run a publicly funded clinic in 2023, when the government issued an expression of interest for new primary care teams, but was rejected. Green, seeing the great need for primary care in his community of Kingston, Ontario, decided to open a clinic anyway.
“It’s disappointing,” Green said. “I’m not in charge because I want to. It’s because it’s the only way to move forward.”
“From where I made that offer and accepting that OK, I’m not going to get the funding, the option is to sit back and wait until I get the (Ontario Health Insurance Plan), continue to try for funding or move forward with a personal business plan.”
Green’s clinic has urgent care services, as well as an $1,800 annual membership for primary care. She hopes that when Ontario comes up with its own plan for funding nurse practitioners, it will be at an adequate level.
“I definitely want public funding, and want to be able to provide patients with free access to health care,” she said.
“I’m concerned that we won’t get enough money to properly run such a clinic. We know there are some inherent problems with the current model, where you’ve already heard family physicians complain that they’re not making enough money from the OHIP billing process, and they feel that their administrative burden is too high.”
A new report shows Ontario hospitals spent $9.2 billion on private, for-profit nursing and staffing agencies over the past decade, a figure that is expected to double between 2013 and 2023. Critics of private agencies urged Ontario to phase them out, calling them a ‘band-aid on a sore wound’.
Currently in most settings, nurse practitioners are paid salaries, although rates are higher in hospitals, for example, which can make it challenging to recruit and retain nurse practitioners in existing publicly funded primary care settings, Acorn said.
In addition to seeing better compensation for nurse practitioner positions, which are already publicly funded, the association wants to see flexible funding models, such as for family doctors, who can bill OHIP on a fee-for-service basis or who are paid per patient enrolled.
NDP primary care critic Dr. Robin Lennox said the government must work to fully integrate nurse practitioners into the primary care system as it works toward its goal of connecting all Ontarians to primary care by 2029.
“I would like to see enough flexibility in the funding model to allow our nurse practitioners to be trained and able to function as independent primary care providers, particularly, you know, in our rural and remote areas where access to primary care is more limited,” she said.
“This is a really great opportunity to prevent nurse practitioners from essentially having to enter a private-payer system to be able to provide the primary care that they have been trained for.”
