Nfld. & Labrador

Paying a private nurse practitioner is completely legitimate: prof

A Memorial University political scientist says having people pay nurse practitioners for primary care does not violate any current legislation or health policies.

Political scientist Steve Tomblin: 'The fact that she's doing this is a good thing'

Nurse practitioners are increasingly setting up private clinics in Newfoundland and Labrador, where people pay to receive primary health services. (CBC)

A Memorial University political scientist says having people pay nurse practitioners for primary care does not violate any current legislation or health policies.

MUN professor Steve Tomblin said the notion that Canadians don't pay for health services is a myth. (CBC)

Corner Brook nurse practitioner Ellisa Sinnicks-House has opened a private clinic that provides prescriptions and referrals to specialists, albeit at a fee to the consumer. She claims she is filling in gaps in the health care system, although the clinic has stirred up debate on the whole idea of people paying for primary services.

Memorial University professor Stephen Tomblin is throwing his support behind those kinds of private clinics, saying they represent an attempt to provide relief to an overburdened health system.

"It's good for the patients, and it's more effective at driving change in the health-care system — which is really in a state of crisis," he said.

"It's not a policy approach, which I think would be a preference, but I think the fact that she's doing this is a good thing."

Tomblin said that any efforts to significantly reform the health-care system on a national level have come up short.

In light of that, he said it is not surprising that such private health-care services would pop up, particularly to serve those who would prefer to not spend long hours waiting in a hospital emergency department.

"It's unfortunate she isn't working in the public system, but the reason she's working where she is is because the system is so hard to change from the inside," he said.

"This is an attempt, at least in the short-term basis, to provide some kind of relief."

Not a violation of Canada Health Act

With regard to whether charging people for health services violates the Canada Health Act, Tomblin said that's not necessarily the case.

Nurse practitioners in Newfoundland and Labrador perform a variety of health services including referrals, care for accute chronic diseases, ordering and interpreting tests and diagnoses. (Eliseo Fernandez/Reuters)

"The Canada Health Act is more symbolic than real," he said.

"Everyone talks about the significance and importance of it but if you trace it is had absolutely no impact on what's happening within the health-care system."

He said there are already many examples across the country where people are paying for health services.

"There is a certain myth about our health-care system — health care does not cover everything. Over 31 per cent of it is already private," he said.

"We don't really have these strong national powers or oversight, so there's a lot of opportunity for people to do things in different ways."

Gap in the health system

Meanwhile, Newfoundland and Labrador Nurses' Union President Debbie Forward said the message she's getting about this specific practice is that there's an visible gap in the province's health care system and how nurse practitioners fit into it.

"Right now they're hired by the regional health authorities, the minister referenced that as well, but when a nurse practitioner wants to practice outside a regional health authority the question becomes, who pays?" said Forward.

Ellisa Sinnicks-House says some people are happy to pay a nurse practitioner to get medical service faster 2:10

According to Forward, physician clinics can hire a nurse practitioner, but patients wouldn't foot the bill for visiting the nurse. Instead, the salary would be paid by the clinic.

She added there needs to be a way for the public to utilize nurse practitioners within the public system.

"It doesn't make sense that if in a practice you can see a physician and it's covered under MCP, you can see a nurse practitioner for the exact same issue and a fee be charged," said Forward.

"We've certainly gone on record that one of our identified areas of need for this government as we headed into the budget was a greater capacity for hiring of nurse practitioners."

Forward said the union has spoken to the premier and the health minister about expanding the role of nurse practitioners in the province.

Response from minister of health

Steve Kent, Newfoundland and Labrador's minister of health and community services, said he is seeking advice from his staff on the legal status of the new clinic in Corner Brook.

Health Minister Steve Kent says there is a growing demand for nurse practitioners in Newfoundland and Labrador. (CBC)

"We support the principles of the Canada Health Act, but we need to recognize there are elements of private expenditure and delivery that are part of the health-care system today," he told CBC's St. John's Morning Show.

"The population of nurse practitioners in the province is actually growing and I think that's a good thing." 

Kent said during recent health summits that the provincial government has held, there seemed to be some support for more fully drawing on the skills of nurse practitioners. 

Kent said he thinks it's good to think outside the box and come up with news ways to solve health-care problems, but he hopes that it can be done correctly.

"Frankly, we haven't looked at a fee for service model, private or publicly for nurse practitioners," he said.

"I'm always interested when people are being innovative within healthcare, we just need to make sure we're doing it right."


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