The CMA recently warned a House of Commons subcommittee that the disability tax credit (DTC) process is driving a wedge into the physician–patient relationship by making doctors appear to be villains who deny their patients the credit.

"In the current structure of the DTC program, physicians evaluate the patient, provide this evaluation back to the patient and then ask for remuneration," Dr. Henry Haddad, the CMA president, told the Commons Subcommittee on the Status of Persons with Disabilities. "This process is problematic since the patient gets the form back immediately and might blame the physician for denying the patient the tax credit when it is the program that dictates the standards."

Haddad said a further issue is that most physicians feel uncomfortable asking for payment from someone they know will not qualify for the credit. "It's being paid to say no," said Haddad.

The CMA wants the subcommittee — chaired by Toronto MP (and MD) Carolyn Bennett — to follow the lead of the Canada Pension Plan (CPP) Disability Program, which collects forms from physicians and pays them directly.

The CMA also explained that the DTC program does not use the same criteria to define disability as programs such as the CPP and Veterans Affairs Canada.

"This is confusing for physicians, patients and others involved in the application process," said Haddad. "The CMA would like to see some consistency in definitions across the various government programs. They don’t have to be identical — just not completely different."

The DTC program gained the public’s attention because the Canada Customs and Revenue Agency that oversees the program sent letters to 106 000 people currently receiving the credit indicating that they need to be re-examined to ensure they qualify.

"If we had been advised we would have highlighted the financial and time implications of sending 100 000 individuals to their family physician for recertification," said Haddad. "Physicians are the key point of contact for applicants of the DTC, and given the way the program is structured we're vital participants in its administration."

In addition to the basic concerns relating to the DTC program, the CMA also reiterated its call for a national task force to look at how tax policy can be better used to support health policy.

"In our pre-budget submission to the Standing Committee on Finance, we recommended the federal government establish a national task force to study innovative ways to synchronize tax policy with health policy," said Haddad. "A study of this nature would look at all aspects of the taxation system, including the personal income tax system, in which the DTC is a component."

Subcommittee member Wendy Lill, the NDP MP for Dartmouth, NS, agreed that the different definitions of disability are likely causing confusion and recommended that they be addressed as soon as possible.

"I must say that what you (the CMA) have contributed has been really important," said Lill. "We could move on that model in the short term, but like you say, the important issue is to actually look at the broader issue of integrating a better tax policy with the health and social policy.

"That’s a really exciting concept."