Employer-paid virtual care may find itself in the hot seat after the federal government releases long-awaited clarifications of what is and is not permitted under the Canada Health Act (CHA).
“It comes down to who’s paying the bill,” says Amr Galal, Consultant at Bridgewell Financial and member of the advocacy committee for Benefits Alliance.
“Within our industry we know that corporations are paying the bill for their employees for virtual care, but we don’t know if governments will take that into account,” Galal explains. “If they simply divide things up as publicly or privately funded, we’re concerned that employer-funded virtual care will be lumped into what’s prohibited under the Canada Health Act.”
The back story
The CHA was enacted in 1984 and requires provinces and territories to cover medically necessary care provided by physicians and in hospitals. Since then, scopes of practice for other healthcare providers, such as nurse practitioners and pharmacists, have expanded to include some of the medically necessary services provided by physicians.
However, not all provinces and territories subsequently put funding in place to enable these non-physician providers to bill the public healthcare system. As a result, these providers bill patients directly, which is contrary to the CHA, or they must swallow the cost, which is unsustainable.
Parallel to these developments, virtual care for non-urgent medically necessary services began to attract the interest of private group health insurance providers and employers about 15 years ago—and its inclusion in benefits plans exploded during the COVID pandemic. Approximately 10 million Canadians, including working adults’ spouses and children, now have access to employer-paid virtual care, estimates the Canadian Life and Health Insurance Association. There is no cost to the employee and physicians, nurses, nurse practitioners and other regulated practitioners provide the services.
What’s going on now
In March 2023, then federal Health Minister Jean-Yves Duclos announced he would release an “interpretation letter” to clarify to the provinces and territories that “access to medically necessary services, whether provided in-person or virtually, remains based on medical need and free of charge.” And where there is evidence of Canadians paying out of pocket in a province or territory, the federal government “will pursue a reduction in federal health transfers by an equivalent amount.”
While Duclos acknowledged the benefits of virtual care, telemedicine and expanded scopes of practice for health workers, he wrote that “they have also resulted in the emergence of new patient charges to access medically necessary care that would otherwise be covered if provided in-person by a physician.” For example, charges for services provided by nurse practitioners and for employer-funded virtual care provided by physicians and nurses (although Duclos does not specifically reference employer-paid virtual care).
Public payers still await the interpretation letter and current Health Minister Mark Holland has been vague on a timeline, recently telling media that he wants to ensure the letter is not “injurious to federal, provincial and territorial relations.”
Meanwhile, business advocates such as Benefits Alliance, the Canadian Chamber of Commerce and the Business Council of Canada warn against the possible unintended consequences of an interpretation letter that inadvertently shuts down employer-paid virtual care. In their joint letter submitted to Health Minister Holland, the Chamber and Council requested that “an explicit allowance for employer-paid care is included in any interpretation to provinces from the federal government.”
The bigger picture
The hope is for the federal government to step back and recognize the role being played by employers, says Galal. “The biggest question that needs to be answered is, ‘Is virtual health care good or bad for Canadians?’ That’s the crux of the matter. And we believe it’s good for Canadians because it expands access to doctors and other healthcare providers, and it makes that access easier.”
Galal adds that employer-paid virtual care is an example of innovation that can proliferate in the private sector because it has the capital, the acumen and the resources to move quickly. “If governments were saying they have our own solutions that will operate just as well, then okay we won’t need employer-paid virtual care anymore. But that’s not happening and there is no way that the federal government can now say that removing employer-paid virtual care would improve access to healthcare. And in my opinion, that would contradict the Canada Health Act in its truest form.”
To that point, Galal notes that, according to the CHA, the main objective of Canadian health policy is to facilitate access to health services “without financial or other barriers.” Unfortunately, too many other barriers have come to exist within the public system. “Long wait times, closed ER departments and outdated technologies are frankly causing harm. Employer-paid virtual care needs to be recognized as part of the solution,” says Galal.
Liam MacDonald, Director of Policy and Government Relations, Canadian Chamber of Commerce, agrees. In a recent opinion piece in The Globe and Mail, he noted the growth of employer-paid virtual care is “more an indictment of our public system than anything else,” and called out “the misguided and outdated ideology that holds that the private sector has no role in the delivery of medical care under any circumstance, simply on account of it being the private sector.”
The value of virtual care
Dr. Marc Robin, a family physician for more than 20 years, describes employer-paid virtual care as a “win-win-win” for governments, patients and employers. “Employer-funded virtual care is accessible to 10 million Canadians today, for which no equivalent exists in the public system. This model represents a new source of healthcare funding, where employers actively contribute to the health and well-being of their employees and their families,” he says.
Robin became Medical Director of Dialogue, a provider of employer-paid virtual care and division of Sun Life, in 2020. “For me it is always about putting patients first and trying to make a difference. What we are doing here is making a difference.”
For example, half of the people using Dialogue’s virtual services do not have a family physician. “Without employer-paid virtual care, their go-to would have been the emergency room. We are a good complement to the public healthcare system. We’re not competing here,” says Robin.
He adds that, should an updated interpretation of the CHA result in the discontinuation of employer-paid virtual care, even inadvertently, “the volume of patients that we are reaching today cannot just be switched over to the public system. We urge the federal government to encourage and allow employer-funded virtual care to continue because failing to do so risks further exacerbating accessibility issues and hindering our healthcare system’s ability to properly care for Canadians.”
Dialogue has sponsored third-party research studies to further demonstrate the value of employer-paid virtual care. An economic analysis in 2022 found that each virtual consultation saves the Canadian healthcare system $52 on average due to reduced public payments to physician and emergency departments. And a survey of 1,027 employed Canadians and 86 HR professionals, conducted by Environics Research in February 2024, found:
- 82 per cent of Canadians agree employers should provide virtual health and wellness options, more so than well-being programs (54 per cent) and employee assistance programs (46 per cent).
- A strong majority of Canadians and HR leaders believe that virtual care enables faster access to care (84 per cent), prevents work absences (82 per cent), allows proactivity for individual and family health (79 per cent) and increases productivity (75 per cent).
Established in 2016, Dialogue is the virtual-care provider for more than 50,000 employers across Canada today. Retention rates are high for both employer and employee, with proven returns on investment and high satisfaction scores.
“I take the 8:00 am shift typically and I often see parents who wake up with a sick kid and wonder, ‘Can I go to work? Can they go to daycare?’ They are often stressed,” says Robin. “You’re able to sort everything out before 8:30 and it’s hard to describe their gratitude. It’s a really good feeling.”