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By Astrid Brousselle
Université de Sherbrooke
and Damien Contandriopoulos
University of Montreal
MONTREAL, Que. Nov 13, 2015/ Troy Media/ – The people of Quebec will only benefit from a universal, free and comprehensive health-care system if there is strong and swift intervention by the federal government.
Otherwise, Quebec will likely be the first province to slip out of the Canadian health care scheme. In fact, Quebec’s current health-care laws and practices do not respect the principles set out in the Canada Health Act.
During the past decade, the core principle of health care — that medically necessary care should be universally covered and paid through public funds — has gradually eroded in Quebec. The process has been a slow but steady sum of small legislative changes that have benefited practitioners over patients. The result has been governmental tolerance for grey-zone billing practices and impressive fee-charging creativity from medical entrepreneurs.
The turning point was probably the Supreme Court of Canada Chaoulli ruling in 2005. The decision said that prohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms, particularly in light of long wait times for some health services. The ruling has fed steady development and acceptance of a two-tier health-care system in Quebec.
The expectation that medically necessary care will be free in Quebec is less and less warranted. Some specialists in public hospitals propose faster access to their patients – for a fee — or less invasive interventions through their for-profit clinics. In such clinics, doctors are still paid by Quebec’s public health insurance, but patients are often billed for the rental of the surgery room, for local anesthetics or for access to more advanced technologies.
While officially illegal, such practices are widespread. Stories abound about eye drops or anesthetics that cost the clinics cents being billed to patients for hundreds of dollars.
This clearly puts the doctors involved in a conflict of interest.
More to the story: Quebec introduces health care user fees through back door by Ryan Meili and Danielle Martin
In a health system experiencing a significant shortage of practitioners, medical resources are drained from public hospital-based “free” care and into private purses. It also ties health-care quality and accessibility to a patient’s wealth — precisely what the Canada Health Act tries to prevent.
For example, Montreal Children’s Hospital — one of Montreal’s two pediatric university hospitals — has decided to stop offering many medically necessary services. Instead, it will direct some patients to a new outpatient clinic. There, parents may be billed for such services as dermatology, endocrinology, general pediatrics and other important specialized care.
This steady disintegration of the principles of health care could soon be irreversible. Premier Philippe Couillard’s new Bill 20 will legalize direct patient billing for medically necessary services provided outside of hospitals. The provincial government is confident that Ottawa won’t intervene to enforce the Canada Health Act in Quebec (the federal government hasn’t intervened in the past decade).
Bill 20 makes legal practices that were grey-zone breaches in the universal public health system. This is creates a parallel, legal private health-care system subsidized by public health insurance. This could be the final blow to health care in Quebec.
An unhealthy coalition — the Couillard government, private clinic owners, medical federations, private insurers and even some hospital administrators — is irresistibly pushing to decrease the care offered in public institutions and to increase the market share of direct payment and privately insured services.
The only chance to save health care in Quebec is direct intervention by the federal government. Prime Minister Justin Trudeau and federal Health Minister Jane Philpott must enforce the Canadian Health Act in Quebec, even cutting federal health transfers until the province conforms.
Doing anything less will mean access to care according to a Quebec patient’s wealth, rather than their needs.
Astrid Brousselle is a professor in the Community Health Department, and researcher at the Centre de recherche de l’Hôpital Charles-LeMoyne, Université de Sherbrooke and Canada Research Chair in Evaluation and Health System Improvement. Damien Contandriopoulos is a professor in Nursing and a researcher at the Public Health Research Institute at University of Montreal (IRSPUM). CIHR Research Chair in Applied Public Health. Brouselle and Contandriopoulos are included in Troy Media’s Unlimited Access subscription plan.
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