Quebec patients ‘falling through cracks’

Province’s ban on accessory fees taking effect

MONTREAL • First, it was Quebec’s gastroenterologists who warned they would no longer perform colonoscopies in their private clinics.

Then came radiologists, who started cancelling appointments last week for ultrasounds in their private practice.

And now Quebec’s commercial pharmacists have serviced notice that they won’t vaccinate for the flu or carry out certain blood tests as of Jan. 26.

Since Quebec’s ban on so-called medical accessory fees took effect this month, patients have complained that they’ve been turned away from some private clinics, while hospitals have not been given additional resources.

“Patients are falling through the cracks,” said Paul Brunet, executive director of the Conseil pour la protection des malades.

“It’s urgent. Something must be done. Can you imagine all the patients who now have no choice but to go to the emergency room because they don’t have access to these services?”

On Friday, Brunet’s group threatened to launch a class action against radiologists for discontinuing ultrasounds in their clinics. That same day, the Association québécoise des pharmaciens propriétaires (AQPP) announced that its members will likely discontinue services for which they were able to charge patients in the past.

Among those services are vaccinations and blood tests for those who take anticoagulant medication (blood thinners). Pharmacists used to charge patients about $20 for the test, which is used to evaluate the ideal dose for a patient.

Jean Bourcier, executive director of the AQPP, estimated that the province’s pharmacists carry out 135,000 such blood tests each year. “Now that they risk losing money on each and every test, the pharmacists are going to refer patients to hospitals and CLSC clinics,” Bourcier said.

“This is a major problem. We don’t see how the public sector, how the CLSCs, can absorb this overflow of patients.”

Brunet agreed, criticizing Health Minister Gaétan Barrette for banning accessory fees without allocating additional resources to hospitals and reaching agreements with doctors and pharmacists. In fact, the government has cut funding to Montrealarea hospitals like the McGill University Health Centre and the Jewish General.

Barrette has dismissed the potential impact, saying that his government is actually improving access to health care by banning the fees.

And on Friday, Barrette pledged that next month the anticoagulant tests in pharmacies will be added to the province’s medicare formulary, allowing pharmacists to be paid for them by the Régie de l’assurance-maladie du Québec.

Barrette’s pledge was news to Bourcier, who accused the minister of negotiating in bad faith with pharmacists.

“We’re a bit skeptical of what Barrette is promising,” he added. “The minister is improvising as he goes along.”

Indeed, Barrette initially proposed to legalize accessory fees. But his position changed dramatically last year after meetings with federal Health Minister Jane Philpott. Ottawa has repeatedly reprimanded Quebec for allowing accessory fees to flourish, arguing that they constitute user fees in violation of the Canada Health Act.

Patient-rights groups in Quebec were also gearing up to file class actions against the provincial government, and some cases are already pending in the courts.

“The minister seems to be stuck between Mrs. Philpott, who advised him of the illegality of the fees charged to patients, and the province’s health professionals, who have been charging fees since 1970 as medicine and techniques have evolved,” Brunet said.

Still, Brunet slammed Barrette for rushing through the ban and for a lack of clarity on the subject. Unlike for some public-awareness campaigns, the health ministry has chosen not to take out advertisements spelling out what fees can still be charged and what services are now covered under medicare.

A list is available on the ministry’s website, informing the public that doctors in private practice can no longer charge fees for eye drops, vasectomies, colonoscopies, mammography, childhood vaccinations, among other services. Doctors, however, can still charge for MRIs, cosmetic surgery and laser eye surgery, among a smaller list of exceptions. Quebec’s commercial pharmacists have serviced notice that they won’t vaccinate for the flu or carry out certain blood tests as of Jan. 26.