Paying for health care
“The federal government is not going to start telling us how to manage it,” replied Premier François Legault to Federal Health Minister Ginette Petitpas Taylor, who warned that Ottawa would cut healthcare transfer payments if Quebec continued to allow patients to pay out-of-pocket.
Quebecers treated out-of-province already do pay MDs directly and await partial reimbursement. Even Justin Trudeau - now a legal resident of Ontario - voted in Ottawa in late May, and almost certainly has an OHIP card, which entitles him – unlike his constituents in his riding – to fully portable medical coverage throughout Canada. Although he is now defending French language rights, in his mandate letter to Taylor, he stressed only cracking down on user fees and extra-billing, and completely failed to mention portability of medical benefits outside Quebec (Section 11 of the Canada Health Act) and fair dispute resolution for physicians (Section 12, CHA).
2018-19’s federal health transfer, $6.2 billion, was only 16.1% of Quebec’s health (and social services) budget. Ottawa contributes about 20% of health funding to most provinces. However, the federal deficit is $19.4 billion and total debt is about 1 trillion! All provinces need new sources of revenue, especially if their physicians and health professionals are to be fairly treated.
Despite their contract, Quebec has frozen agreed increases of specialists’ fees. While Ottawa refuses to amend the CHA to permit the provinces to find new revenue sources via limited privatization.
Provinces need new sources of revenue. One is medical tourism. This would not contravene the CHA. There are 165 residents and fellows in orthopedics seeking employment in Canada and 73 working outside the country. A knee or hip replacement costs US $60-80,000 in USA, but only about CAD $20,000 at a private clinic near Montreal. Encouraging expansion of hospitals across Canada with ORs devoted to elective surgery such as joint replacements on American, Chinese, and other foreign patients, would bring in this revenue, and provide employment for surgeons, nurses, and other professionals, who would remain to service their fellow Canadians, and shorten wait lists.
More controversial is to amend the CHA to permit limited privatization for Canadians. I suggest that each provincial medical association recruit members who bring patients in, or who worked in nations with blended public/private systems. Those with first-hand knowledge of such systems would be invited to town-hall meetings across each province. They would educate health professionals, politicians, the media, and the public as to such systems.
They could answer several questions:
1) How are physicians prevented from entirely leaving the public system for the private? Are they required to work several hours per week in the public system?
2) What assurance is there that persons with pre-existing problems are not excluded?
3) What are the incomes of MDs (including benefits) compared with other professionals and the public in that country, and also MDs in other parts of the world?
We should be open-minded and learn from other countries with efficient systems, shorter wait-times, and high rates of patient and physician satisfaction. A blended public/private system could make our healthcare system more sustainable, and yet still provide universal coverage.
Charles S. Shaver, MD, Ottawa