While a record 780 doctors have withdrawn from the public system in Quebec, only 14 in the rest of the country have opted out of medicare, according to the latest report on the state of the Canada Health Act.
What’s more, in March 2023 Ottawa fined Quebec nearly $42 million — by far the highest of any province — for allowing patients to be charged illegally out of pocket for “medically necessary diagnostic services” that should be covered under medicare.
The annual report provides the strongest evidence to date of the extent to which health care has been moving more and more toward the private sector under the Coalition Avenir Québec government.
“In March 2023, Quebec was subject to a deduction (in funding health transfers) of $41,867,224 under the Diagnostic Service Policy, based on estimates made by Health Canada,” the report observed. “The deduction was the result of patient charges for medically necessary diagnostic services that occurred in 2020-2021.”
Quebec refused to provide Health Canada with its figures on the number of doctors who have opted out of the public system, but the latest update by the Régie de l’assurance maladie du Québec reveals that 780 general practitioners and medical specialists were “non-participants” in the public system as of July 12, up by nearly 22 per cent from 641 the year before.
Not only does Quebec have the highest number of fully private physicians in Canada, the province is the only one in the country to maintain a loophole that lets doctors opt in and out of the public system regularly. Although La Presse reported in February that Quebec was considering closing that loophole, Health Minister Christian Dubé’s office has declined to respond to queries by The Gazette about whether it intends to do so.
In contrast, Ontario permits its doctors to withdraw from the medicare regime, but then automatically caps the fees they can bill patients to exactly what they would earn under medicare — a restriction that has discouraged all but a few doctors from going private. No such restriction exists in Quebec.
In fact, only a dozen out of 35,340 doctors in Ontario opted out of the public system in 2022-23, down from 17 five years earlier.
The only other province where doctors have opted out of medicare is British Columbia, where two surgeons operate privately. That’s the same number as for the five previous years.
Unlike most other provinces, Quebec has also balked at sharing with Health Canada its statistics on the number of private-for-profit health facilities. Under the CAQ government, Quebec has maintained that health care is its exclusive jurisdiction and has often accused Ottawa of meddling.
Federal Health Minister Mark Holland’s office declined to respond to queries by The Gazette on the rising number of doctors opting out of medicare in Quebec. Meanwhile, a Health Canada spokesperson suggested it’s Quebec’s sole responsibility to deal with the issue.
“Provisions in Quebec’s health-care legislation give the Quebec health minister the authority to allow, suspend or revoke the ability of physicians to practise outside the publicly funded system, based on the supply of medical professionals needed,” Anne Génier said.
She added: “The government of Canada is committed to preserving and improving our publicly funded health-care system, which values equity and fairness over profit and preferred access in the provision of medically necessary health care.
“The government of Canada does not support a two-tiered health-care system where patients may choose, or be required, to pay for quicker access to medically necessary services.”
Julie Drolet, Dubé’s press attaché, also declined to comment on Quebec doctors opting out and the government’s in-and-out loophole, referring a reporter instead to the public affairs department of the Health Ministry.
Marie-Claude Lacasse, a spokesperson for the ministry, sidestepped the question of the loophole and appeared to downplay the significance of the spike in the number of doctors quitting the public system.
“Around 97 per cent of physicians in Quebec are participants (in the public system),” Lacasse said. “So, despite an upward trend in non-participating physicians, it remains a marginal practice.”
Still, Lacasse added that “we are closely monitoring the evolution of the medical workforce.”
“For several years now,” she continued, “the Ministère de la santé et des services sociaux has been working hard to increase the number of positions in family medicine and, consequently, to make the field more attractive to medical students.”
Dubé has said he supports a robust public system, announcing last July a boost in medical school enrolment of 660 spots within four years. In the meantime, Dubé has created Santé Québec, recruiting “top guns” from the private sector with the goal of running the health system more efficiently.
But critics have accused Dubé of further opening the door to private care by appointing Geneviève Biron, whose family runs the Biron Health Group of private medical laboratories, as chief executive officer of Santé Québec.
“The private sector is now in control of our health network,” Québec solidaire health critic Vincent Marissal said at the time of Biron’s appointment in April.
The trend toward opting out of medicare comes amid Quebec doctors’ mounting frustration with what they view as costly red tape in the public system and a severe lack of resources. But as GPs and specialists have quit the public system, wait times for surgery and first-time consultations have soared.
At present, more than 50,000 Quebecers are waiting for a consultation with an orthopedic surgeon — another dubious record. Nearly 33,000 of them have already waited beyond the medically acceptable delay, in some cases for over a year, causing some individuals to become wheelchair-bound.