More Quebec MDs opting out of medicare, report shows
Nearly a year and a half after Quebec banned medical accessory fees in the public system, the number of doctors opting out of medicare continues to rise, the latest provincial statistics show.
The cumulative total number of doctors who no longer practise in the public system — and who have the legal right to bill patients directly for medical services — stood at 413 in April, up from 377 during the same month last year. That’s an increase of 9.5 per cent — and a dramatic 159 per cent since 2008, according to a review of data compiled by the Régie de l’assurancemaladie du Québec (RAMQ), which administers medicare.
Experts suggest that the ban on accessory fees — which was a source of additional income for doctors — might have had the unintended consequence of pushing some physicians toward going fully private. When doctors become “non-participants” of the public system, they can bill patients for any medical service.
This year’s increase is almost triple that of the 3-per-cent hike in April 2017.
“There’s a slow but clear trend (of doctors) opting out,” said patientrights advocate Paul G. Brunet, of the Conseil pour la protection des malades. “Doctors are seeing a business opportunity or they’re fed up with the bureaucracy ” of the public system.
Brunet added that the prohibition on accessory fees — which took effect in January 2017 — has made the public system “not financially interesting anymore” for some physicians.
After years of tolerating exorbitant fees for everything from eye drops and allergy tests to ultrasounds and vasectomies, the provincial government ended them after Ottawa threatened to cut transfer payments to Quebec.
Amanda Wilson, national director of the Canadian Health Coalition, said the opting-out trend in Quebec is “very concerning” because the lack of access to family doctors and medical specialists remains a problem in the province.
Wilson contended that this year’s increase “is a reaction by doctors to Quebec passing that new legislation to cut back on user fees.”
“We need doctors in the public system to meet patients’ needs, based on their needs and not the ability to pay,” Wilson said.
SPECIALISTS QUIT
A total of 298 general practitioners and 115 specialists were considered non-participants last month, according to RAMQ.
Among the specialists who have quit the public system are orthopedic surgeons, ophthalmologists, cardiologists, dermatologists and anesthesiologists.
Two gastroenterologists opted out in February last year, one month after the ban on colonoscopy fees in private clinics took effect. Most other provinces have imposed restrictions on doctors who seek to practise outside the public system.
Ontario, for example, allows doctors to withdraw from the medicare regime, but then automatically caps the fees they can bill patients to exactly what they would earn under medicare — a restriction that has discouraged all but a few doctors from going private. No such restriction exists in Quebec.
In 2006, the Conseil pour la protection des malades urged then health minister Philippe Couillard to impose a compulsory delay of two years for any doctor wanting to opt out of the public system, but that recommendation was not followed.
Still, the law does give the minister the power to intervene if the government judges that access to the public system is being undermined. Wilson, of the Health Coalition in Ottawa, urged Quebec Health Minister Gaétan Barrette to intervene.
That’s not something he will do, Barrette’s press attaché told the Montreal Gazette this week. “As of today, the proportion of doctors in the system who have gone private is still very marginal, representing 2.04 per cent of all doctors eligible to bill (RAMQ), compared with 1.9 per cent last year,” Catherine W. Audet said by email. “We consider the situation to be stable.”
What’s more, Audet added, the abolition of accessory fees has “allowed people to obtain services only with their medicare card and not with their credit card.”