Why aren’t registered dietitians’ services covered by one of Canada’s biggest health-insurance plans?

Yoni Freedhoff, MD, Special to the Globe and Mail

Diet and weight-related illnesses combined are thought to represent Canada’s No. 1 preventable cause of death, and many worry the financial costs of these diseases will cripple Canadian health care as we know it.

In tackling these issues, our government does not give the impression it’s springing into action. Over the past few years we’ve seen the federal government ignore the recommendations of Canada’s Trans Fat Task Force, disband its sodium working group and continue to burden us with a Food Guide that, simply put, doesn’t reflect science’s current understanding of the impact of diet on chronic disease.

Given all that, perhaps I shouldn’t have been surprised to learn that despite registered dietitians (RDs) being one of Canada’s few regulated health professions, RDs are not currently covered by Canada’s Public Service Health Care Plan (PSHCP) – the extended insurance plan enjoyed by over 600,000 of Canada’s public servants and their dependents.

Given the PSHCP’s government sponsorship, it seems safe to say that the plan covers those services that our government identifies as helpful in managing, protecting and improving health. And given the plan’s size, stature and source, it may also be safe to say that its recommendations serve as a role model for coverage for many of Canada’s smaller private health-care insurance plans.

Before getting into the specifics of the PSHCP, let’s briefly look at what a regulated health profession is. This is where a health profession’s college has been given the legal responsibility and authority to protect the public by setting and enforcing guidelines of practice, ensuring members meet both training and educational standards and being available in the case of a complaint. It is the Regulated Health Professions Act that protects titles such as pharmacist, nurse, physician, massage therapist, chiropractor and registered dietitian. Unlike their regulated counterparts, unregulated health-care providers have no mandatory mechanisms to ensure quality of care, and consequently, though there will no doubt be some exemplary providers, it’s buyer beware with them.

Now back to what the PHSCP covers. Well, it covers the obvious stuff – prescription medications, dental care and vision care. It also covers visits to registered health professionals including massage therapists, physiotherapists, chiropractors, physiotherapists, psychologists, speech language pathologists and chiropodists. And it doesn’t stop there. Also included are the unregulated health professions of osteopathy and naturopathy, and if there’s deemed to be a medical need, it even covers the electrolysis of excessive facial hair. But if you’re a federal public servant and you’d like one of Canada’s formally regulated health professionals, a registered dietitian, to provide you with guidance and advice on how you might better your health by improving your diet, you’ll have to pay for that advice out of pocket.

Why our government’s public service health-care plan is covering services that in some cases are delivered by unregulated health professionals and in others may even be services medical science has conclusively deemed no better than placebo, and not the services of one of Canada’s regulated health professions, is a question I can’t answer. It’s an especially confusing question when considering that diet and weight-related illnesses – illnesses that registered dietitians’ regulated training and education leave them well-equipped to help manage – are tremendous burdens on both individuals and on Canada’s health-care expenditures.

What I can say however is that unless our government starts taking food seriously – where food refers both to nutrition as well as to our food environment – Canadians, and our health-care system, will suffer.

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Dr. Yoni Freedhoff is an assistant professor of family medicine at the University of Ottawa and the founder and medical director of the Bariatric Medical Institute – dedicated to non-surgical weight management since 2004. Freedhoff sounds off daily on his award-winning blog, Weighty Matters, and you can follow him @YoniFreedhoff. His latest book, The Diet Fix: Why Diets Fail and How to Make Yours Work, is a national bestseller