Review of Standard Health Insurance Fees Released

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Government will not increase standard health insurance fees at this time but is willing to review the fees again next year with cooperation from healthcare providers.

Standard health insurance fees are the list of fees approved by the Health Insurance Commission that an approved insurer is liable to pay under the Standard Health Insurance Contract for a healthcare benefit provided to a compulsorily insured person.

Under the law, every healthcare facility and registered practitioner must file with the Health Insurance Commission, annually, the maximum fee charged for each health benefit provided by the facility and the registered practitioner.

In May 2015, Morneau Shepell was contracted to carry out a survey, engaging all healthcare providers and approved health insurers. This was to determine the costs associated with operating a medical practice and to assess physician billing practices, thereby giving the government the required information to determine whether the fees for medical services and treatments should be increased.

Based on a benchmarking analysis, the consultants recommended different levels of increase in the various categories of services, which would result in a 12.3 per cent increase to costs across the healthcare system. However, Cabinet decided to postpone any increase in fees at this time, with the hope that a future review will see the response rate from the physicians and other healthcare providers improved to a level where meaningful conclusions can be drawn based on local data.

Out of the 139 physicians and 67 health practices contacted, only 50 responded, and not all completed the survey. Less than 10 of those 50 who responded provided financial information to the consultants to give an understanding of the cost structure for operating a medical practice.

“This made it extremely difficult for the consultants to have a high degree of confidence in determining a reasonable level of cost of operating the medical practices,” said Ministerial Councillor for Health, Roy McTaggart. “As a result, it was very difficult to establish a fair level of fees for services provided by the healthcare provider. We commend those healthcare providers who did respond to the survey but unfortunately it was not sufficient.”

As the Standard Health Insurance Fees have not been increased for many years, government is willing to review the fees again in 2017 and is encouraging all providers to fully participate in the survey at that time.

“We need the healthcare providers’ cooperation to do this as we can only determine a fair level for the fees based on the information they provide us with,” said Ministry of Health Chief Officer Jennifer Ahearn. “We urge the healthcare providers to be forthright in providing this information, which is held in strict confidence by the actuaries conducting the survey, so that we can work with them to ensure that a fair level of fees is implemented.”