Preserving equity in a patient pay model within Canada’s public healthcare system is indeed challenging, but several strategies could be considered to mitigate potential inequities:

1. Income-based sliding scale fees:
– Implement a sliding scale fee structure based on income levels
– Lower-income individuals would pay less or nothing, while higher-income individuals would pay more
– This ensures that financial burden is proportional to ability to pay

2. Annual out-of-pocket maximums:
– Set annual caps on total patient contributions
– Once the cap is reached, all further care would be fully covered
– Caps could also be income-adjusted to further protect lower-income individuals

3. Exemptions for vulnerable populations:
– Provide full exemptions for certain groups, such as:
– Children and seniors
– People with chronic illnesses or disabilities
– Low-income individuals and families
– Indigenous populations

4. Essential vs. non-essential services differentiation:
– Maintain universal free access for essential and emergency services
– Apply patient pay models only to elective or non-essential services

5. Health savings accounts with government contributions:
– Establish health savings accounts for all citizens
– Government could provide base contributions, with additional amounts for lower-income individuals
– These accounts could be used to cover patient pay expenses

6. Refundable tax credits:
– Implement a system where individuals can claim healthcare expenses as refundable tax credits
– This would effectively reimburse people for their out-of-pocket costs, with potentially higher reimbursement rates for lower-income individuals

7. Community health insurance pools:
– Create local or regional insurance pools to spread the cost of care across communities
– This could help manage costs in areas with higher healthcare needs or lower average incomes

8. Transparent pricing and cost education:
– Ensure all costs are clearly communicated upfront
– Provide financial counseling and education to help patients understand their options and potential costs

9. Robust appeals process:
– Establish a clear and accessible process for patients to appeal charges or seek financial assistance
– This would provide a safety net for those facing unexpected or unmanageable healthcare costs

10. Continuous monitoring and adjustment:
– Implement ongoing analysis of the system’s impact on different demographic groups
– Regularly adjust policies to address any emerging inequities

11. Reinvestment of generated funds:
– Ensure that any additional revenue from patient payments is reinvested into the healthcare system
– Focus reinvestment on improving access and quality of care for underserved populations

12. Preserve universal coverage:
– Maintain the fundamental principle of universal coverage for all Canadians
– Patient pay models should supplement, not replace, the existing public funding model

These various measures could help preserve equity, and pilot programs would be necessary to assess the full impact on healthcare equity and access for patients. Healtheon is an example of a pilot program with subscriptions in place to fund services that are not currently funded by the provinces.  Healtheon is a hybrid model that introduces patient pay programmes for services that are not funded by the provinces.