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Duclos warns provinces to stop letting patients be charged for virtual health care

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Provinces that continue to allow private clinics to charge patients directly for virtual health care could see their future federal funding clawed back, as the government moved Friday to put an end to a proliferation of for-profit virtual care in Canada.

Health Minister Jean-Yves Duclos said he intends to clarify that virtual care is covered by the Canada Health Act, the same way the federal government clarified in 2018 that it applied to all medically necessary diagnostic tests.

That latter point led Duclos Friday to claw back health transfers to seven provinces for allowing private clinics to charge patients directly for MRIs, CT scans and other tests.

He said the move is mandatory under the Canada Health Act. And he warned the same thing could happen in the future if provinces don’t tackle fee-for-service in virtual care for services that would be paid for through the public health system if they were provided in person by a doctor.

“It is critical that access to medically necessary services, whether provided in person or virtually, remains based on medical need and free of charge,” said Duclos.

Duclos said virtual care grew from about three per cent of health services in Canada before COVID-19 to about 18 per cent now. He called that a positive development, but said it cannot be used to allow more user fees in the health care system.

Dr. Brett Belchetz, the CEO of Maple, an online medical clinic, said he thinks the federal government is opening a legal can of worms.

He said Canadian law has been clear that fees can be charged for services that aren’t medically necessary and that provinces get to determine what that applies to. If provinces won’t start paying for virtual visits, he said he doesn’t think Ottawa can prevent patients from paying for it themselves.

“I’m very confused about what the announcement actually means,” he said.

“Because I cannot see any legal rule in which the government can now say that they will have services that they do not cover, but yet Canadians do not have the right to pay for themselves.”

Clawbacks to federal transfers over private billing are not new. Between 2015 and 2022, an average of $15 million a year was clawed back from provinces for user fees charged by private surgical clinics, or for abortion services.

This year, eight provinces are losing $82.5 million, of which only $6 million is not related to diagnostic tests.

When the clarification that all medically necessary diagnostic tests must be covered was made in 2018, Ottawa gave provinces and territories two years to address the problem of patients being charged fees.

But in 2020-21, fees were still being collected in seven provinces, adding up to a total of $76 million. The same amounts are being taken from their health transfers this month.

Quebec’s $41.9-million clawback accounts for more than half that amount, followed by British Columbia at $17 million and Alberta at $13.8 million.

In total, the clawbacks account for just 0.2 per cent of the transfers Canada issued provinces and territories in 2020-21.

Quebec Health Minister Christian Dubé criticized the clawbacks and urged Ottawa to offer more money to the provinces, not less.

Dubé also argued that the private sector should be used to complement the public sector, to allow for better care for the population.

Duclos said provinces that change policies or fix issues that allowed for inappropriate private billing within the next two years can get the money returned.

B.C. took a number of steps since 2018 to expand access to MRIs and other tests in public hospitals and clinics, and in 2019 made it illegal for clinics to charge patients for diagnostic tests. As a result, $15 million that was clawed back in the last two years is now being returned.

B.C. Health Minister Adrian Dix said no government in Canada, provincial or federal, has taken as much action as his to make the public system work and bring people back into it, citing a significant increase in MRI tests conducted in public settings. He accused Ottawa of taking an uneven approach.

“Since 2017, we’ve taken action again and again. This is particularly true in diagnostic care,” he said.

“And British Columbia takes the process seriously. We report seriously on the results here. And the federal government enforces the Canada Health Act intermittently across the country.”

Saskatchewan is losing $742,447 from this clawback, related to its seven-year-old policy to allow private clinics to charge directly for MRIs and CT scans as long as they provide an equal number of scans for free to people on the public waiting list.

The province’s Health Minister Paul Merriman said the move added capacity to the system to do more tests for no extra cost, and Saskatchewan has been trying to get Ottawa to discuss the matter for more than six years.

“To date, there has been a complete unwillingness on the part of the federal government to approach the issue with an open mind,” Merriman said.

Alberta Health Minister Jason Copping said the province fully supports public health insurance covering medically necessary diagnostic imaging. But he said there is a dispute between many provinces and the federal government about how Ottawa is interpreting the term “medically necessary.”

“I understand there have been ongoing conversations about the interpretation of medically necessary and payment for medically necessary, and how it works in the regulations and what’s allowed and what’s not allowed,” said Copping.

His office said the province has requested a formal legal opinion on Ottawa’s position.

This report by The Canadian Press was first published March 10, 2023.

— With files from Colette Derworiz in Calgary, Brittany Hobson in Winnipeg and La Presse Canadienne.

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STD epidemic slows as new syphilis and gonorrhea cases fall in US

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NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.

The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.

Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.

“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”

More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.

Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.

The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.

Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.

Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.

Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.

Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.

Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)

There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.

“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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World’s largest active volcano Mauna Loa showed telltale warning signs before erupting in 2022

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WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.

That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.

Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.

“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.

Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.

When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.

The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.

The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.

Worldwide, around 585 volcanoes are considered active.

Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.

Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.

(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Waymo’s robotaxis now open to anyone who wants a driverless ride in Los Angeles

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Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.

The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.

After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.

Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.

Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.

“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.

Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.

But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.

Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.

Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.

Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.

That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.

Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.

Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.

The Canadian Press. All rights reserved.

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