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Newsletter – November, 1999 Vol.6, No.3

IN THIS ISSUE

Skies Wide Shut: Airline Competition on Standby
No Prescription For Privacy: Druggist Misdiagnose Bill C-6
New Report: Utility Shopping – Are Consumers Ready?
Summer Follies: CRTC’s 411 Caper

Skies Wide Shut: Airline Competition on Standby

This fall, while the media was pre-occupied with the storyline of which airline was going to triumph in the takeover wars, PIAC together with Transport 2000 Canada, The Air Passenger Safety Group, The Council of Canadians and Options Consommateurs formed a coalition, The Canadian Association of Airline Passengers (CAAP). The purpose of CAAP is to represent the interests of ordinary airline customers in whatever environment came about as a result of the corporate power struggles.

CAAP noted that the consumer unfriendly conditions that are all too frequent in the North American air market would become exacerbated in a monopoly domestic market without proper consumer protection measures being implemented. To that end, an Airline Passenger Bill of Rights was prepared by the original founding members setting out key standards for safety, quality of service, and pricing. The founding organizations were later joined by the Manitoba Society of Seniors, Canadian Federation of Students, Rural Dignity of Canada, Ontario Coalition of Senior Citizens’ Organizations, lending support to the efforts to secure a customer rather than a industry centered airline market in Canada.

CAAP believes that all passengers in Canada are entitled to reasonable standards of comfort, quality and safety on board any flight. In addition, the price of that flight and the calibre of passenger service either should be the product of a genuinely competitive market or a regulatory regime setting fares on reasonable costs and mandating compliance with reasonable quality of service indicators.

PIAC and CAAP have brought their message to parliamentarians in the House and Senate, Transport Canada, the Competition Bureau, and the Cabinet. We would further like to see the establishment of an Air Transport Users Council that would help speak for consumers concerning the establishment of consumer friendly policies for airlines.

For further information concerning CAAP and the Airline Passenger Bill of Rights see the PIAC web site at www.piac.ca.

No Prescription for Privacy: Druggists Misdiagnose Bill C-6

Last year, the federal government came though on a promise to introduce legislation to protect the personal information of Canadians from abuse in the private sector. Bill C-54, “The Protection of Personal Information and Electronic Documents Act”, combines two separate legislative initiatives. In its reincarnation as Bill C-6, the Act has passed the House of Commons and is now before the Senate.

While very much a compromise from our perspective, the Bill is worthy of support because of the protections that it would give to Canadians who are increasingly concerned about the unauthorized uses of their personal information for commercial gain. The Act would finally give Canadians some degree of privacy protection and control over their personal information that is collected, used and traded in the private sector. (continued pg.2)

However, some special interests—including the Canadian Pharmacists Association, the Ontario Association of Medical Laboratories, and the Ontario Ministry of Health—are lobbying the House and the Senate to have personal health information exempted from the Act. They claim that it is unnecessary to protect health information in the same way as other personal information and that it will be too great a cost for the health care system.

Twenty-five organizations from across the country recently sent a letter to the Prime Minister, the Minister of Health, and all members of the Senate urging them to pass the Bill and to resist the pressure from the health sector to exempt health information from protection under the Act. A copy of the letter together with the names of the supporting organizations is on the PIAC website. www.piac.ca

FACTS ABOUT BILL C-6 AND HEALTH INFORMATION

1. What is the purpose of Bill C-6?

The Bill establishes in law a set of fundamental, widely accepted principles of fair information practice centered around the individual’s right to know and control what is being done with his or her personal information. It is an effort to bring our laws into line with our social expectations, now that technology has transformed the landscape such that we can no longer take our privacy for granted.

Several years in development, Bill C-6 is a finely crafted compromise between the public’s growing demand for privacy protection and business’s demand for minimal regulatory restrictions. The Bill is accepted by a wide range of industry and public interest groups as a reasonable set of rules for protecting informational privacy in the changing marketplace.

2. To whom does Bill C-6 apply?

Bill C-6 applies to private organizations, but only when they collect, use or disclose personal information in the course of commercial activities. It does not apply to governmental bodies. Nor does it cover anonymous information (e.g., for epidemiology studies or monitoring of general health care costs).

Bill C-6 would not apply to provincially regulated entities such as pharmacies, medical clinics and laboratories, until three years after it comes into force. In the meantime, it is expected that provinces will develop similar legislation, which would likely take precedence over Bill C-6.

3. What does Bill C-6 require?

The Bill requires, among other things, that companies obtain the informed consent of individuals to the collection, use and disclosure of their personal information, except in specific instances. The Bill says that this consent should be explicit in the case of personal health information, given the fundamentally private nature of it and the potentially prejudicial uses to which it can be put. However, for uses and disclosures that are reasonably expected by the individual in the context of the transaction (e.g., delivery of the service requested; communication of test results back to the ordering physician), consent can be implied.

Consent need not be obtained at the time of each and every transaction. As long as the individual has been properly informed of the purposes and has consented to them, the consent to those purposes is valid until it is withdrawn.

Bill C-6 does not require consent to disclosures of personal information where “required by law”, or where “requested [by a government institution] for the purpose of administering any law of Canada or a province”.

4. Why should health information be included in this regime?

Health information is among the most sensitive information about individuals. It deserves at least as much protection as other types of information. As noted by the Minister’s Advisory Council on Health Infostructure, patient privacy is an essential component of a successful health care system: “informed consent should be the basis for sharing [personal health] information” (p.11), and “patients should be able to exercise control over what portion of their electronic record is seen by other professionals and providers” (p.3-6).

Bill C-6 provides baseline protection for health information. Health-specific legislation is also needed to address the special sensitivity of medical records and to achieve the goal of effective health care. But under no circumstances should the health sector be exempt from the fundamental principles set out in Bill C-6: people deserve to know what is being done with their personal health information, and to control the subsequent use or disclosure of this very sensitive information.

5. Why not let the provinces take care of this?

First, not all personal health information falls under provincial jurisdiction; some is in the federal sphere. Second, it is unlikely that all ten provinces will legislate to protect health information privacy – yet all Canadians deserve to be protected. Third, the track record of those provinces that have tried to legislate in this area does not bode well for privacy. For example, Ontario’s last proposed Bill on health information was characterized by many as an access bill, not a privacy bill.

6. Won’t Bill C-6 compromise our ability to deliver effective health care?

Patient privacy and effective health care do not conflict; rather, they go hand-in-hand. If patients feel that their personal information may be used for purposes against their wishes, they may refrain from providing full or accurate information, thus compromising the integrity of the health care system. Canadians value their privacy, as well as their health care system. Both are “public goods”.

7. Won’t Bill C-6 lead to higher health care costs?

Bill C-6 requires commercial health care providers to obtain the explicit informed consent of patients to uses of their personal information beyond those necessary to render the service in question. Explicit consent is not needed for uses and disclosures that are clearly expected by the patient as part of service delivery (e.g., communications with insurers or prescribing physicians). Thus, the cost of delivering of primary health care would not be significantly affected.

It is only in respect of other non-necessary purposes, such as drug marketing and medical research, that explicit consent is required. Individuals should have a right to control such secondary uses of their personal information.

New information technologies offer opportunities for tremendous gains in the efficiency and effectiveness of health care through the sharing of patient information among health care providers. Requiring patient consent to such sharing may add to the cost of the “health infoway”, but it is essential if patients are to have control over the uses to which their personal health information is put. New technologies will still offer net savings and improvements in health care.

8. Won’t Bill C-6 limit our ability to conduct medical research?

No medical research using personal information should be permitted without the individual research subject’s knowledge and consent. This is a basic tenet of ethical research. In any case, most research can and should be conducted using anonymous information.

New PIAC Report Utility Shopping: Are Consumers Ready?

Deregulation has taken place in Canadian utilities such as transportation, telephone, natural gas, and is imminent in electricity. Once the market has been deregulated, consumers can switch from the former monopolist to another company. But are residential consumers are actually ready for the utility shopping that is brought by deregulation of utility services?

This report provides an overview of the deregulation debate, which shows that residential consumers have reason to be wary of deregulation. Residential consumers do not automatically benefit from deregulation of a utility market. In some cases, consumer choice is slow to emerge, and when it does emerge choice is limited. Deregulation can lead to price increases and quality decreases in practice, even though competition theory stipulates that the opposite should be true. Some or all of these factors can compromise social values, such as affordability and accessibility.

The report evaluates the level of consumer sovereignty that actually exists in Canadian deregulated markets, by examining the results of a national survey on consumer knowledge and attitudes towards the long distance, natural gas, and future electricity markets.

Key findings of the study include:

  • Where natural gas deregulation has taken place, consumers’ ability to understand and make choices about natural gas prices and contracts is so low that real competition is not possible in a large segment of the market;
  • In the long distance market, consumer knowledge and confidence has developed since competition was introduced, though there are still significant gaps;
  • Abusive practices are rampant in the natural gas market.

The report concludes with recommendations for decision-makers in implementing future deregulation of utility markets, aimed at ensuring that real consumer sovereignty in these markets materializes, and is established early on. The recommendations are:

  • “Workable” competition should work for residential consumers as well as business customers;
  • Advertising needs provide more information;
  • There should be sources of independent information for consumers;
  • Just because it is deregulated doesn’t mean it never needs to be monitored.

The report will be available in December 1999.

Please call (613) 562-4002 ext. 60 or fax to (613) 562-0007 Coilbound 78 pages $15.

Summer Follies: Bell Canada’s 411 Caper

In August of this year, consumers in Ontario and Quebec were startled by the news that they would have to start paying for Bell’s Directory Assistance (at 75 per call) even when the operator can’t find the number requested.

The CRTC had accepted arguments from Bell Canada that directory assistance calls for numbers that the operator can’t find are particularly expensive for the company, and that since the company has to bear these costs, it should be permitted to recover them through the regular 75¢ charge.

On behalf of a coalition of consumer groups, PIAC opposed the Bell application and, buoyed by the public outcry, launched an appeal to the CRTC to review and vary the decision. Backing PIAC’s appeal were the results of an informal survey of 100 directory assistance calls conducted by PIAC with a view to testing the accuracy of Bell’s 411 service.

Of the 100 numbers requested, we found an error rate of 24%: Nine of the existing, listed numbers were not found by the Bell operators; nine of the numbers provided were incorrect; in four cases a central switchboard number was provided rather than the specific department requested; in one case an old number was provided; and in one case the number was provided in French even though it was requested in English.

The CRTC decision means that Bell is equally reimbursed for failure and success, such that there is no financial incentive for it to improve its directory assistance service. Moreover, charging for a service even when it isn’t rendered seems contrary to normal business practice.

The CRTC is still considering our appeal.

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