Health issues in the Quebec election

“One of the great mistakes is to judge policies and programs by their intentions rather than their results.” – Milton Friedman

In the Quebec election campaign, there is a perceived desire for change. However, is this best accomplished by replacing the Liberal government with the CAQ?

According to a recent Vote Compass poll, healthcare was the number one issue by 32% overall and 40% of persons aged 55 years and older.

One key proposal of the CAQ is to reopen the signed contract with Quebec specialists and slash each MDS income by roughly $80,000. FMSQ President Dr. Diane Francoeur warned, “We didn’t want to fight, we are much better when we collaborate. She claimed that patients now have improved access to anesthesiologists in Quebec’s regions and doctors plan to extend operating hours for medical imaging in hospitals.

Gertrude Bourdon recently demanded that the plan to reopen negotiations with specialists be shelved; when this was refused, she spurned the CAQ and is now likely to become health minister if the Liberals win the election.

The stance of the CAQ is reminiscent of the Toronto Star, which had been attempting in the name of “transparency” for several years to obtain and publish the names of the top 100 billing MDS in Ontario. Yet as former Ontario Medical Association President Dr. Shawn Whatley wrote, “When government sets a low price on a medical service, it does not follow that patients can get the same medical service that they might have had the price been different.. If doctors cannot afford to provide all the care they would like for X, then doctors will adjust. They will shorten visits and refer more often, or choose to see different patients.”

Admittedly, the gross incomes Quebec physicians have finally risen to slightly above the average of their counterparts in other provinces. Recall, however, that until recently, they were the lowest in Canada. There were several predictable effects. Large border areas in West Quebec have had difficulty attracting sufficient numbers of specialists and family physicians. This was partly due to fees much lower than those in Ontario, as well as inadequate funding of health facilities. This has caused many patients to seek care in Ottawa, Pembroke, and Hawkesbury.

Yet because of the low fees paid by the Quebec government, few physicians in the Ottawa valley or in the rest of Canada would accept a Quebec health card as payment in full. Patients treated electively, or those who developed an unexpected illness while on business or vacation would be forced to pay out-of-pocket and then await partial reimbursement.

Quebec has refused to sign the Reciprocal Medical Billing agreement and the federal government has ignored its violation of the Canada Health Act. For years I had felt that the only solution was for Ottawa to pay physicians directly for treating all out-of-province patients, much as it does for federal prisoners, does through the IFHP for refugees, and did until several years ago for members of the RCMP.

Now that Quebec physicians have achieved fee parity, a simpler solution would be for Quebec to finally sign the RMB agreement. This would certainly satisfy those who felt that health care delivery should remain within provincial jurisdiction.

If the CAQ does win the election and implements its fee cuts for Quebec physicians, this retrogressive move would lessen the chances of Quebec ever signing the RMB agreement. Its impact would not be confined to West Quebec. All Quebecers would remain secondclass citizens when they sought medical treatment in other parts of Canada.

Hopefully, Premier Couillard will promise that - if he is re-elected - he will sign the RMB agreement and leave as his legacy fully portable health care throughout Canada for all his fellow Quebecers.

CHARLES S. SHAVER, MD OTTAWA, ONTARIO

Ottawa physician Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine, and returned to Canada in 1970. He is Chair of the Section on General Internal Medicine of the Ontario Medical Association.