MSP Enrollment a Secret

August 10, 2007

Inconsistent Estimates of MSP Enrollment

The Ministry of Health doesn't agree with the Ministry of Finance with respect to the number of people covered by MSP. Documents released as a result of a freedom of information request are not complete, but what has been released so far raises more questions than answers. Figures from Finance indicate that there are more people covered by MSP than there are people in BC, but figures from Health indicate that approximately 73,000 British Columbians are not covered by MSP.

Just two days after an appeal was filed with the Freedom of Information and Protection of Privacy Commissioner an envelope postmarked August 8th, containing a letter dated August 3rd, arrived with what the Ministry said should close the file. Finding the response inadequate, I requested that my appeal to the Commissioner be continued, but the partial answer warrants discussion.

On February 7, 2002 the Campbell government announced a 50% increase in Medical Service Plan (MSP) premiums. That was the first, and most significant, of several tax increases that clawed back the income tax cut from many low and medium income families. At the time of the announcement the Ministry of Finance provided some reports with a background document that showed the number of families that received premium assistance as of December 31, 2001. A copy of that document fell into my hands when I was asked by a reporter to comment on the announcement. I filed the document but came across it again in December 2006, whereupon I submitted a freedom of information request asking for updated information. I've documented my quest for an answer to that FOI on these pages.

My initial interest in MSP data by level of premium subsidy was to compare it against claims made by the Minister Responsible for Housing, Rich Coleman, when he announced the rental assistance program. In October 2006 he said that the program would immediately benefit 15,000 low-income working families and homeless individuals. On March 1st the eligibility criteria were expanded so that families with incomes less than $28,000 per year could qualify. As of March 31, 2007 only 1,300 were receiving the benefit with another 600 applications being processed. The 2006 MSP records by level of premium subsidy show 172,000 families who meet the income criteria; a subset of those families would meet the other criteria and qualify for rental assistance. Using the MSP records to reach out to those families would probably offer a greater health benefit than paying for more visits to the doctor made necessary by unacceptable living conditions. Nevertheless, government's outreach to potentially eligible families consists of running ads on a few bus shelters. I still can't understand why my request for simple statistics met with months of delay. The table I requested should be routinely published on the Ministry of Health's website. The delays sparked my interest in pursuing the matter beyond how the data relate to eligibility for rental assistance.

In its August 3rd response the Ministry of Health provided an email and a table. The email said: "There are significant discrepencies (sic) between the numbers supplied by Finance for 2001 and for MSP through the RAPCPM3-1 Report." "Significant" is an understatement! For the category of no premium assistance in 2001, the Ministry of Finance document showed 1,332,944 contracts (families and unattached individuals) while the MSP report showed 1,480,317, for an understatement by the Ministry of Finance of 147,373. Finance also made understatements in the categories that received 100% premium subsidy, for a total understatement of 170,818. Notwithstanding its understatement of the number of contracts, Finance went on to overstate the number of people covered. When contracts are translated into individuals, Finance's February 2002 document showed 4,096,677 people covered, but the document produced by the Ministry of Health showed 3,981,617 people covered. According to BC Stats the population of BC was estimated as 4,055,195 on January 1, 2002 (the day after the date given for the Finance and Health figures). In other words, the table released as background by the Ministry of Finance when premiums were increased by 50%, showed 41,482 more people than the province's estimated population; the Ministry of Health figures made available this week indicated that there were 73,578 fewer people covered by MSP than the estimated population of the province. The premium increase announced in February 2002 didn't take effect until May 1, 2002. Public Accounts for the fiscal year ending March 31, 2003 (starting April 1, 2002) showed that MSP premium revenue rose from $955 million in 2001-02 to $1.358 billion in 2002-03, but it was estimated to be $1.299 billion for 2002-03.

Moving forward 5 years to December 31, 2006, the Ministry of Health's email shows that Finance switched to underestimating the number of contracts relative to figures from MSP; in particular, the table Finance provided to me in its April 2007 response to my request showed 2,019,175 contracts as of December 31, 2006, but MSP figures indicate 2,189,993. The Ministry's response did not break down the number of contracts by premium level (single, couple, family or unit 1, 2, 3) but it indicated that according to MSP, 4,265,419 people were covered as of December 31, 2006. Statistics Canada estimated the population as 4,338,106 as of January 1, 2007. That suggests 72,687 residents of BC were not covered by MSP as of December 31, 2006, only 891 fewer than the MSP shortfall in 2001. New arrivals who have been in the province for less than three months are not eligible for coverage, but British Columbians who leave the province are eligible to maintain their coverage for three months. The net difference is less than the unexplained 73,000; during the last three months of 2006, 13,951 people moved to BC from other provinces and 9,349 moved to BC from outside Canada (11,227 moved out of BC to other provinces and 1,454 moved from BC out of Canada).

In summary, the data provided by the Ministry of Finance indicate that more people are covered by MSP than there are people in the province, but the data provided by the Ministry of Health indicate that about 73,000 British Columbians are not covered by MSP. It is hard to believe that someone in the Ministry of Finance or Ministry of Health isn't aware of these problems. It is hard to believe that the two Ministries don't reconcile their differing estimates. It is possible that they take the view that for statistical purposes a potential error of 1.5% of the population is not significant, but the data aren't used just for statistical purposes. Yet another Ministry, the Ministry of Small Business and Revenue, is involved in collecting MSP premiums. It takes the view that premiums are a debt owing and must be paid like any other tax whether someone wants MSP coverage or not. If no one else cares about a possible 73,000 person under-coverage for MSP, it would, and if the MSP records contain people who are no longer eligible, then the revenue folks are wasting their time chasing them with debt collectors. A little more light might be cast on these problems if the Office of the Freedom of Information and Protection of Privacy Commissioner is successful in persuading (or ordering) the Ministry of Health to provide a more comprehensive answer to my information requests.

August 9, 2007

MSP Enrollment a Secret

Why can't the Campbell government say how many people are enrolled with BC's Medical Services Plan (MSP)?

Just before Christmas 2006 I submitted a freedom of information request asking the Ministry of Finance to update a table it produced in February 2002 showing the number of families, by level of premium assistance, that were covered by MSP in 2001. It took until early April 2007 to get a response, and when it came it looked as if more people were enrolled than the number of people in the province. In a series of articles, I provided alternative ways of interpreting the data the Ministry provided. Calculations were necessary because the updated table showed the number of contracts (families and unattached individuals) covered as of December 31, 2006, but not the total number of individuals or the number of individuals in each category of premium assistance. That made a further information request necessary asking for the number of individuals covered as well as for any documents that discussed the apparent problems with enrollment.

It has been four months since the second request was submitted, eight months since the original request, and I still don't have a simple answer to how many people are enrolled with BC's Medical Service Plan. An appeal was filed this week with the Freedom of Information and Protection of Privacy Commissioner on the Campbell government's apparent refusal to provide the requested information.

In his 2006-07 Annual Report Commissioner Loukidelis noted that: "Government ministries have sought to use MSP name and address data to locate individuals for a variety of reasons, but the unifying feature of their efforts is that they would like to use MSP as a citizen registry for many purposes." On June 20, 20007, the Commissioner issued an investigation report with respect to the improper use of MSP records by an employee of the contractor employed to collect premium payments. It was alleged that the employee helped a friend find the address of his former wife, a threat to her safety. Procedures were improved following the investigation by the Commissioner, but thanks to the Campbell government, the company suffered no penalty. Aware of how personal information, including addresses, can be abused, the Commissioner cautioned that if the government decides to implement a citizen registry, something it appears to want to use MSP for on an ad hoc basis, it should engage in careful scrutiny and meaningful public consultation. Such scrutiny and consultation would be better informed if the public were aware of the extent of inaccuracies in the current MSP enrollment system. If they can't protect privacy or accurately count heads with the limited purpose, premium-driven, MSP system, what makes them think that a full blown citizen registry as the core of a government data bank would be workable or safe?