Give Quebecers fully portable medical benefits
Ottawa must step in if Quebec won’t abide by act, says Dr. Charles S. Shaver.
“Why is the federal government letting Quebec get away with this violation, when it was so inflexible in the issue of extra-billing?” – then Liberal federal health critic David Dingwall, May 1989
Once Dingwall became Liberal health minister, he failed to act. Quebec residents are therefore still denied the fully portable medical benefits of all other Canadians.
Hospital care is fully portable across Canada. Section 11 of the Canada Health Act (CHA) states that physicians are to be paid at the rate in their province — not that of a visiting patient. Quebec is the only province that has refused to sign a reciprocal billing agreement. It pays only its own rates which, until recently, were the lowest in Canada. Hence few MDs elsewhere in Canada will accept a Quebec medicare card.
For nearly 30 years, all politicians have ignored the problem. Saskatchewan was the birthplace of medicare. How symbolic it would be that Conservative leader Andrew Scheer could introduce legislation that would at last give Quebecers full medicare portability.
Impaired access to medical care affects three major groups of people in Quebec:
Quebecers may travel to other Canadian cities on business or vacation. Those with pre-existing conditions may fear that they might develop an unexpected complication and face major out-of-pocket medical charges.
Quebecers who move permanently to another province are “covered” for the first three months by Quebec insurance — yet very few MDs will accept their medicare card. This may affect those who retire, move to another province — perhaps to be near relatives — and require routine lab work, prescription renewals, etc. soon after arriving.
There is a major shortage of physicians in West Quebec. Therefore, residents of this region often choose to seek care from MDs in Ottawa and other border cities. Lack of fully portable medical benefits is not merely an issue of financial inconvenience; it may cause serious hardship and adversely affect outcomes. An article by Caroline Alphonso in the Globe and Mail in November 2010 described a man across the river from Ottawa with colon carcinoma. The Ottawa Hospital anesthetist refused to accept his Quebec insurance. He therefore waited several months until he had the surgery done in Montreal. Perhaps in part as a result, by then he had extensive metastases. He developed multiple complications and eventually died several years later. This case is likely not isolated.
Meanwhile, federal and Quebec politicians continue to ignore the problems of ordinary Quebecers. By enforcing only part of the CHA, Ottawa prohibits out-of-pocket payments by Quebecers to MDs within Quebec, but turns a blind eye when they occur elsewhere in Canada.
Quebec maintains that health-care delivery is a strictly provincial matter. However, for patients treated in another province, is the relevant province that of the patient or of the treating physician? Surely Ottawa has a duty to ensure that Quebec patients are fully covered throughout Canada.
If it cannot or will not force Quebec to comply with Section 11 of the CHA, a good solution would be for the federal government to pay physicians directly for outof-province patients. Most MDs would likely utilize this voluntary method of receiving payment. Ottawa does so for federal prisoners, for refugees (through the Interim Federal Health Program) and did so until recently for members of the RCMP. I estimate that this would cost ( just for Quebec residents) about $175 million — an affordable sum.
Hopefully Andrew Scheer and health critic Marilyn Gladu will introduce legislation setting up this mechanism so as to finally give Quebecers the portable benefits enjoyed by their fellow Canadians. It is difficult to imagine why Liberal or NDP politicians would oppose this.
A recent Forum Research poll revealed 43 per cent support for the Conservative Party and 38 per cent for the Liberals. Health care is a major priority for all Canadians. By ensuring that Quebecers were accorded full medical portability, Scheer might even further improve the chances of a victory in 2019.