Queue Jumping Fee Negotiations

Supporters of the False Creek Urgent Care Centre may have gotten more than they thought possible when the Campbell government reached a last minute deal that allows a CareCard to be accepted as full payment at the Centre. The showdown between the government and the clinic was billed as a test of will with Health Minister George Abbott proclaiming: "I want to reiterate the Province's firm position that no facility in British Columbia will be permitted to operate outside the bounds of provincial legislation." Cynics might suspect that a deal was reached months ago and that the theatre leading up to the last minute announcement was nothing but careful conditioning of the public to accept a major change to Medicare.

Consider the circumstances that lend credibility to the cynical point of view. Dr. Mark Godley, the Centre's director, notified the Ministry of Health of his intentions to open the Centre almost a year in advance, but the Minister maintains he was taken by surprise. The February 14, 2006, Speech from the Throne, which marked the opening of the legislature with a statement of direction from the government, asked: "Why are we so afraid to look at mixed health care delivery models, when other states in Europe and around the world have used them to produce better results for patients at lower costs to taxpayers?". In other words, the welcome mat for an expansion of private care and private payment was out. The Centre's financial backers invested millions to build and equip the new facility, supposedly without knowing whether or not the government would apply for an injunction to shut it down until its legality was tested in the Supreme Court of Canada. On the eve of opening, the Clinic's price list included $199 just to get in the door for an evaluation, and additional fees after that, such as $50 for a blood test or $70 to set an arm cast. After a deal was announced with the government, Abbott claimed that the Centre will now operate like any other walk-in-clinic. If you believe that, I have some Florida swamp land to sell you.

How can the Centre break even, let alone make a profit, if one day it wanted to charge $199 just to examine a patient, and the next it accepts the MSP payment schedule, which pays a physician $88.02 for the first half hour of emergency care, but defines it as treating critically ill patients, so most of the procedures offered at the Centre would not quality. A routine office visit, that a drop-in-centre might charge, is paid $36.27 for someone over age 80 and less for everyone else. Even if the fee schedule for emergency medicine applied to the Centre, which is unlikely, it is hard to see how it could come anywhere close to the same level of billings as was indicated in its original price list. In other words, the government deal, the details of which are still secret, likely involves a special fee arrangement to cover the enormous investment that has been made in what the Centre advertises as "advanced diagnostics". Incidentally, most physicians who hung a sign outside their office proclaiming advanced diagnostics would probably find themselves in hot water with the College of Physicians and Surgeons for unethical advertising.

If the Campbell government had issued tender calls or Requests for Proposals for private medical centres to supplement the work of the VGH and St. Paul's emergency departments, it would no doubt have been controversial, but it would have been legal and consistent with Treasury Board requirements. The secret deal announced with respect to the False Creek Urgent Care Centre amounts to issuing a contract without going to tender. Does that mean that any group of physicians can threaten to accept private payments for queue jumping and be rewarded with a special contract that avoids the unpleasantness of having to go through negotiations between the British Columbia Medical Association and the Medical Services Commission?

If it is true that the Centre is now operating like any drop-in-clinic, then it's staff will always be busy and its beds full. That kind of jump start with no direct charge to the consumer overcomes a lot of resistance that the $199 door fee might have posed. No wonder Finance Minister Carole Taylor is claiming that health spending pressures are enough to break the bank. If the government is that incompetent in managing public money, there could never be enough tax revenue to pay all the health bills. This entire situation calls for full disclosure, and if it is anything like it has been presented, it urgently calls for a fix.