For $30/month, Ontario doctors offer rapid access to nurse practitioners

Some doctors in Ontario are offering their patients the option of extra health care, at a price: seven-day a week rapid access to appointments with a nurse practitioner, for a fee of around $30 a month.

It's perfectly legal under both the federal and provincial medicare rules. But since it involves charging for health care, it adds fuel to a growing debate over two-tier health care in Canada. 

Kindercare Pediatrics in Toronto launched its nurse-practitioner program in response to overwhelming demand from parents during the surge in respiratory illnesses among kids last fall, said the practice owner, Dr. Dan Flanders. 

"We couldn't keep up," said Flanders in an interview. "Everybody was working their brains out and we were still turning away close to 100 patients a day."'

The program he developed is called Kindercare365 and it is pitched as "on-demand health care for kids."  It relies on nurse practitioners, who are authorized in Ontario to provide many of the same services as family physicians, including diagnosing illnesses and prescribing medications. 

The optional subscription costs $29 per month (plus HST) for one child or $59 per month for two to five children. It promises an immediate virtual appointment with a nurse practitioner from 8 a.m. to 9 p.m. any day of the week and, if necessary, an in-person appointment no later than the next day.

"This has opened up a door so that more young families can have access to healthcare," said Flanders. "It's not ideal that patients have to pay, but it's something that's going to help increase access." 

The Canada Health Act prohibits charging patients for medically necessary services that are covered under provincial health plans. Since nurse practitioner services are not covered by the Ontario Health Insurance Plan (OHIP), it's legal for doctors to charge. 

But within Ontario's complex systems of compensating physicians, there's a disparity that means some patients can actually get health care from a nurse practitioner without paying anything: 

Flanders says if nurse practitioners in family health teams improve patients' access to health care, the province should extend that funding to other primary care providers. 

"For those people who say this should be publicly funded, I say I 100 per cent agree," he said. "If the government paid for this, it would be a very efficient use of health care dollars." 

Dr. Danielle Martin, chair of the University of Toronto's department of family and community medicine, says this disparity is inequitable and unfair, particularly since less affluent patients tend to be less likely to be enrolled in Family Health Teams. 

"Why aren't we funding team-based care for all Ontarians when we know that this is the most effective way to provide healthcare services?" Martin said in an interview with CBC News. 

While Martin acknowledges it's perfectly legal for Kindercare365 to charge for the option of rapid appointments with a nurse practitioner, she has concerns.