After hinting at it for weeks, the Progressive Conservative government has strongly signalled subsidies for chiropractic services are about to be reduced.
Health Minister Kelvin Goertzen said Thursday he met this week with representatives of the Manitoba Chiropractors Association about future funding, and he expects the talks to conclude in the next week or so.
"We are not opening their contract without their consent, but we’ve had a number of discussions about what that might look like," Goertzen said. "There are different things that we could do in-contract and out of contract. But I think the approach that we’ve taken is that we want to do this in a co-operative way."
To reduce costs, the province could subsidize fewer patient visits each year or lower the value of the subsidy on the 12 that are now covered. It could also introduce a means test, only subsidizing patients with lower incomes. Or it could limit coverage to certain groups, such as seniors, as some provinces have done.
The previous NDP government signed a five-year funding agreement with chiropractors that runs until March 31, 2020.
Under the contract, chiropractors currently bill Manitoba Health $12.30 per patient visit. A maximum of 12 visits per patient are subsidized each year. No other province provides such broad coverage for chiropractic services.
The subsidies cost the province nearly $12 million last year.
Goertzen refused to state categorically whether the current contract was being renegotiated, but he didn't deny it was.
"I think we’re having good discussions with them regarding their contract and what it might look like going forward. They’ve been very good in terms of those discussions," he said of the association.
Goertzen noted the government has asked for broad buy-in from the health sector to get spending under control, and chiropractors understand that.
"It is fair to say the premier has indicated that this is an 'all hands on deck effort' to ensure that we have sustainability in the health-care system today, tomorrow and into the future," he said.
An official with the Manitoba Chiropractors Association would only confirm discussions are taking place with the government.
"At this time, it would be inappropriate for me to comment on our discussions as they are ongoing," he said earlier this week.
Meanwhile, the minister said he's spoken to the profession about reports some chiropractors discourage vaccination.
"I’ve indicated to them that we want to ensure that individuals who are working in the health-care system are providing information that is consistent with information that is being provided by health-care practitioners generally," Goertzen said. "I think they understand that. I think they took that seriously… and are taking serious actions about that."
Some chiropractic procedures, such as those involving the neck, are controversial. A local media outlet this week obtained an uncensored copy of a 13-year-old provincially commissioned report that said funding for chiropractic services should be strictly limited, and that procedures not be subsidized for minors.
The 2004 report of the Chiropractic Health Care Commission had previously been available only in a heavily redacted form. The CBC reported the uncensored version of the report recommended the Health Department should limit chiropractic subsidies to treatment of acute lower back pain. It questioned the efficacy of chiropractic treatment for neck pain as "ambiguous or at best weakly supportive."
Goertzen said he has not read the entire document, which he referred to as "an old report." He said he's received other information, for example, that says treatments for kids are appropriate.
He said some studies also show chiropractic services can prevent patients from having to go to hospital.