French university issue highlights health-care inequities
Prime Minister Trudeau and the premiers will be in Montreal, December 7, for a First Ministers’ Meeting. They need to provide portable medical benefits for Quebecers and overall reform.
According to the fall economic statement, Minister Morneau announced this year’s deficit would be $18.1 billion – three times what was promised. By 2023-24, the debt would be $765 billion. Quebec’s debt is $187 billion. Health consumes nearly half of provincial budgets; Ottawa contributes about 20%. The provinces must look for new revenues.
One potential is medical tourism, and at the Meeting, one topic is how to diversify international trade. Canada can deliver health care less expensively than the US. A knee or hip replacement costs US $60-80,000 in Boston, but CAD $20,000 at a Montreal private clinic.
Encouraging expansion of hospitals with ORs devoted to elective surgery such as joint replacements on American, Chinese, and other foreign patients, would bring in the needed revenue, and provide employment for orthopedic surgeons and other professionals.
More controversial is whether to amend the Canada Health Act to permit a limited amount of privatization for residents of Canada. Ottawa remains intransigent. Federal Health Minister Petitpas-Taylor has criticized Quebec for allowing patients to pay out-of-pocket for (private) care. Yet Quebec residents requiring care in another province are often required to pay directly -- and await partial reimbursement.
Premier Ford cancelled an $83.5-million French university in Toronto. Trudeau, Elizabeth May, and Jagmeet Singh were critical, and MPP Amanda Simard quit the PC party. Representatives of the 600,000 Franco-Ontarians protested in 40 cities. Yet Ontario already provides French-language instruction at the University of Ottawa, Laurentian, Hearst, and Glendon College of York University, and cannot fill these institutions with Franco-Ontarians, replying on out-of-province students.
Premier Legault expressed “disappointment” at Ford’s decision, but overlooked one chronic problem that his own province has created: such a university would attract students from Quebec. While in Ontario, they lack complete medical coverage thanks to Quebec’s refusal to sign the Reciprocal Medical Billing Agreement (RMBA). Quebec students already pay extra non-refundable fees at the University of Ottawa Health Services.
At the December 7 meeting, Legault should stop criticizing Ford on this issue unless he is willing to sign the RMBA. If he refuses, Ottawa should pay physicians directly for treating out-of-province patients.
Trudeau and the premiers must encourage Legault to sign the RMBA. They should launch a study of amending the CHA with a view to eventually permitting private health-care. While continuing to ensure universal coverage, such reforms could provide fiscal sustainability via medical tourism.
Charles S. Shaver, MD,