Federal health policy changes could expand primary care in Canada

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Nurse practitioners and other non-physicians could be able to bill OHIP directly under federal policy changes that represent a sea-change in the delivery of primary care across Canada.

On Friday, federal Health Minister Mark Holland released a long-awaited Canada Health Act interpretation letter and announced a new Canada Health Act Services Policy. The policy, he said, confirms that, if a service is considered medically necessary, it should be covered by a patient’s provincial or territorial health care plan “whether the service is provided by a physician or a physician-equivalent.”

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That means nurse practitioners, midwives and pharmacists could be paid directly through OHIP and other provincial and territorial health care plans, something that, until now, has been reserved for physicians.

The federal interpretation letter does not make the change, but puts pressure on provinces and territories to do so. The new policy, Holland said, will come into effect April 1, 2026, to give provincial and territorial health care plans “time to adjust.”

“At that time, any medically necessary physician-equivalent services provided by regulated health professionals, such as nurse practitioners, are to be paid for by PT (provincial and territorial) health care plans.”

Once it comes into effect, any charges to Canadians for such services will be considered extra billing and user charges, under the Canada Health Act.

“This means every dollar wrongfully taken out of the pockets of Canadians will be deducted from the (provincial and territorial) health transfers.” Provinces and territories will be eligible for reimbursement once patient charges and the circumstances which led to them are eliminated, Holland said.

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Last April, Ontario Health Minister Sylvia Jones called on the federal government to take action to stop the “disturbing rise of clinics charging patients for access to primary care” in Ontario and elsewhere.

In the letter to federal health minister Holland, Jones said at the time that continuing to allow nurse practitioners and other “non-physician providers” to operate fee-charging primary clinics would undermine the expansion of publicly funded primary care across the province.

Ema Popovic, spokesperson for Jones, said Friday the province was reviewing the interpretation letter “to understand how it will impact the delivery of high-quality, publicly funded care in Ontario and across the country and look forward to further conversations and this approach at the federal provincial territorial meeting of health ministers later this month.”

The letter clears the way for Ontario, which has almost half of the nurse practitioners in Canada, to begin negotiations to find different ways to pay nurse practitioners for delivery of medically necessary care, said Michelle Acorn, chief executive officer for the Nurse Practitioners’ Association of Ontario, that could include the ability for a nurse practitioner to be paid under a fee-for-service model, as some physicians are, or under expanded salary models.

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The nurse practitioners’ association calls the inclusion of health providers who are not physicians in provincial plans a win for patients and providers.

The letter underscores the importance of the provincial government’s immediate implementation of robust, sustainable funding mechanisms to support NPs as key members of the healthcare workforce, the association said in a statement.

“The lack of easily accessible funding models has historically limited the number of public positions and practice settings for NPs in Ontario, where nearly half of NPs in Canada practice.”

Doris Grinspun, CEO of the Registered Nurses Association of Ontario, says there are many nurse practitioners ready to set up clinics as soon as changes are put in place by the Ontario government. She called the potential changes to which health professions can bill directly under OHIP “huge” and said the improvement in access to health care would be immediate. The association has long called for such changes and is pressing the province to act quickly to set up a model to fund nurse practitioners.

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“More than 2.5 million Ontarians lack access to a regular primary care provider with a projected increase to 4.4 million by 2026. Many nurse practitioners currently provide care through fee-for-service clinics across Ontario due to a lack of funding for their services from the Ontario government. Closure of these clinics could exacerbate the crisis if Ontario does not act swiftly to support an innovative public funding model,” Grinspun said.

The policy change comes during a crisis in access to primary care across the country. In Ontario, more than 2.5 million residents were without family doctors as of 2024, according to the Ontario College of Family Physicians. Recently, some Ottawa residents who have lost their family physicians have been forced to enter lotteries in an attempt to get new doctors.

Against that backdrop, some nurse practitioners have set up stand-alone clinics to offer primary care services. But, because they have been unable to charge under OHIP, they charge patients directly for the care.

Nurse practitioners work in a growing number of areas within the health system, including in clinics, hospitals and long-term care, for which they are paid directly by the province. Ontario has increased the number of nurse-practitioner-led clinics in recent years to 28, but there are calls for more. There have also been calls for more clinics which include physicians and a number of other health professionals. Other regulated health practitioners providing medically necessary care could also charge OHIP and other health plans under the announced changes.

In Ottawa, one woman was charged $110 for a pap test — a routine cancer screening test that is recommended by the province. She underwent the test at a clinic, but, because it was done by a nurse practitioner, the clinic charged her.

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