CHARBONNEAU – Quebec leads Canada in private health care

MORE QUEBEC DOCTORS are moving into private practice than anywhere else in Canada. They are doing so because Quebec laws allow it, and because strict requirements that are driving them away from public practice.

A survey of 9,000 Canadians found that 31 per cent of Quebecers didn’t have a family doctor or nurse practitioner compared with 22 per cent nationally.

Of those without a regular primary-care provider, 37 per cent of Quebecers said they have had to pay a fee for non-urgent care compared with 21 per cent across Canada.

Unlike the rest of Canada, Quebec allows doctors to bill patients for procedures covered under their Health Insurance Act.

This makes Quebec significantly different from other provinces.

B.C. doesn’t allow non-participating doctors to charge more than the public insurance rate. Ontario has made it illegal to bill patients for services already covered by their Health Insurance Act.

Where all of Canada has only a few non-participating doctors, Quebec has more than 600. British Columbia has nine non-participating doctors and Alberta has three according to an investigative report by the Globe and Mail (August 8, 2023).

Non-participation is not the same as opting out. Doctors who opt out can bill patients directly at the medicare rates. Non-participating doctors work completely outside medicare.

Quebec is also different because the government has imposed several requirements on doctors that aren’t compulsory elsewhere in Canada.

One of those requirements is called PREM, which attempts to spread doctors out to less populated areas. If doctors insist on practicing where they are not supposed to, their medicare billings are cut by 30 per cent.

Another requirement is called AMP which forces doctors to work compulsory shifts in short-staffed hospitals and other public facilities. For the first 15 years of their practice, family doctors are required to contribute 12 hours weekly.

While these two requirements are well-intentioned, they impose conditions that some Quebec doctors find unacceptable. Doctors are lured to private clinics because of the prospect of lighter caseloads and not having to deal with PREM or AMP.

Too bad that the Quebec government didn’t ask doctors what they thought before implementing them.

The number of non-participating doctors wasn’t always as high as now. It all changed in 1996 when six family physicians, including Dr. Jacques Chaoulli, pulled out of medicare.

In a court case, similar to Dr. Brian Day’s in B.C., Chaoulli challenged Quebec’s ban on private insurance for health care services already covered by medicare.

While the case made its way through the courts, three Montreal doctors opened one of the first fully private clinics in 2004.

The following year, the Supreme Court ruled that the ban on private insurance violated the Quebec Charter of Rights.

That opened the door to private health care. The law allowed doctors to control their practice.

One string of Quebec clinics offers an annual health plan from $799 to $4,999, or you pay “à la carte,” from $249 for a family medicine consultation, to hip replacements that start at $24,699.

Quebec is a distinct society in Canada with a unique culture. The growth of private health care is not a distinction that Quebecers can be proud of.

David Charbonneau is a retired TRU electronics instructor who hosts a blog at http://www.eyeviewkamloops.wordpress.com.