His experience with the program went downhill from there. Within a month he was told the $460, 18×18-cm cushions on the chair were giving his mom pressure sores and had to be replaced — also at $460. The final straw came a day after his mother died in October when he received a letter from the health ministry informing him his mother was not approved for the program and wouldn’t be funded for anything through ADP.
“They went ahead and made the wheelchair before they had the okay to do it, charged full price for it … yet the government never gave them the okay to do it,” he said.
“I think it’s a ripoff.”
Auditors that recently reviewed the U.S. Medicare system have also concluded that taxpayers and patients there are getting ripped off — yet the numbers reveal they’re getting a far better deal than Ontarians.
The Office of Inspector General for the U.S. Department of Health and Human Resources released a report in September that found Medicare was allowing $4,018 US for a standard power wheelchair that cost suppliers an average of $1,048 US.
While the information used dated back to 2007, Ontario is paying these prices for manual wheelchairs.
The Inspector General advised Medicare officials to ensure their prices reflect and respond to the downward trend in pricing on these items or use its authority to “set payment limits when payments are grossly higher than acquisition costs.”
The American Association for Homecare, which represents durable medical equipment providers and manufacturers, called the report misleading because it did not account for federally mandated supplier standards for Medicare.
Susan Eng, spokesman for the dignified aging advocate group CARP, said all this is particularly galling when the most common complaint from users is so much gets turned down, often for reasons the patient does not understand.
“If they are going to waste money in one area then of course they’re not going to have money left over for the other things,” Eng said.
“It is a serious problem for our people because what we get are, ‘This thing is not covered and that not.’
“People are prepared to pay for part of this themselves but if the prices are being inflated then of course their user portion is also inflated.”
The health ministry has had success lately using its purchasing power to squeeze lower prices from generic drug makers and should be doing the same thing with the ADP, Eng said.
“There is a need for competitive pricing for all of these kinds of things to have the bundle of public dollars available and used more efficiently so that more people are covered for what they need,” she said.
“From our standpoint of consumers, we’re stuck. There’s only so many options we have — take it or leave it are the two options that come up the most.”
Health Minister Deb Matthews said she has enormous respect for the auditor’s work and the ministry is currently in the middle of its regular two-year price review of assistive devices.
