Whether it’s because we can’t get time off work or we’re stuck at home with young kids, many of us are missing doctors’ appointments: a recent Ipsos poll found that 68 per cent of Canadians have missed at least one due to long wait times or a lack of after-hours availability. A new Uber-like service, recently launched in Ontario, is looking to change that with virtual care.
But like Uber, it’s controversial: Maple, the new 24/7 virtual walk-in clinic, has to work around existing health-care legislation, because the services it offers are not covered by provincial insurance. And, like Uber, it’s disrupting a traditional service model through technology. “We are not a health-care provider," says Maple’s chief executive, Brett Belchetz. “We’re a technology platform.”
While Canada already has some virtual walk-in clinics (like Akira, launched in spring 2016), Maple is the first to offer 24/7 access to family physicians for virtual appointments — to those prepared to pay for it. A single appointment costs $49 on weekdays, $79 on weekends, and $99 from midnight to 8 a.m. The physicians are able to answer questions, diagnose conditions, and write prescriptions and doctors’ notes.
Since its launch in late January, about 3,000 patients have signed up in Ontario. Maple plans to offer services nationally by the end of the year.
Under the Canada Health Act, provinces and territories are responsible for covering medically necessary care, including most hospital visits and doctors’ appointments. But about 30 per cent of health care in Canada is private — think prescription drugs, and vision and dental care. While the Act prohibits private payment for physician and hospital services, doctors can still charge for services not covered according to the legislation.
The telemedicine services that Maple provides aren’t covered by the Ontario Health Insurance Plan, because current legislation doesn’t allow for the idea of virtual care. “There’s a very clear requirement in provincial health plans that for [the province] to reimburse a medical visit, the patient and the doctor have to be physically in the same place,” Belchetz says, “which excludes anything that we would do virtually.”
That means virtual walk-in visits are not covered, and are available only to those that can afford them.
Still, Belchetz says many patients who use his service have low incomes. They earn hourly wages and often struggle to make ends meet, he explains, so by using Maple’s services instead of taking a half-day off work, they actually come out ahead, financially.
“My hope is that one day virtual care is reimbursed exactly the same way as in-person care,” Belchetz says. “This clearly is the future of the way care should be provided.”
So far, it’s unclear how the Ontario government will address telemedicine practices. “At this time, the Ministry is exploring options related to the funding of virtual physician consultations and assessments,” David Jensen, spokesperson for the Ontario Ministry of Health and Long-Term Care, wrote in an email.
Canada has lagged behind other countries in providing virtual care, due to a lack of integrated electronic health records, the fee-for-service model, and outdated privacy laws that make adopting new technologies tough. “If we look around at the United States, the United Kingdom, most of Europe, and Australia,” Belchetz says, “virtual care is taking off as a more efficient and more well-liked way of care being provided.”
(Kaiser Permanente, the largest health system in the U.S., announced late last year that more than half of its patients now receive care through video conferencing, phone calls, and other technologies.)
“Until recently there has been limited to no discussion of this kind of virtual visit” in Canada, says Sacha Bhatia, director of the Women’s College Hospital Institute for Health System Solutions and Virtual Care, in Toronto.
Even so, Ontario boasts one of the largest telemedicine programs in the world, the Ontario Telemedicine Network, which is funded by the provincial government. It offers more critical care services, rather than the family doctor care companies like Maple and Akira provide. In northern communities, for example, where specialist doctors are often not available, patients can receive care by video conference. Use of OTN services has increased an average of 32 per cent each of the last three years, Jensen says, with more than half a million patient visits in 2015–16.
“The OTN has done some limited pilots in this area using telemedicine technology to let people up north see their doctor remotely,” says Bhatia, but he adds that it’s tightly controlled: patients still must go to a clinic or hospital to receive care, and OTN requires specific technology to connect patient and doctor.
Maple’s doctors, like those at walk-in clinics, don’t have access to patients’ medical records. As well, patients can’t request specific doctors, nor are they guaranteed to see the same one every appointment. This has caused some health professionals to raise concerns about continuity of care.
“We need to ensure that all people have access to good primary care,” says Bhatia. “Virtual tools should be an enabler of good primary care. There should be no reason why your family doctor isn’t able to communicate with you virtually, or why your comprehensive family health team isn’t able to offer services that look similar to what Maple does.”