Last year, the Supreme Court of Canada ruled the Quebec government could not prevent people from paying for private insurance for procedures covered under medicare – if the public health care system could not deliver the service quickly enough.
That decision sparked a storm of speculation that Quebec was about to create a two-tiered health system, and introduce a wave of privatization of the publicly-funded provincial health system, something critics say Quebec seemed inclined to do in the past.
In February, Health and Social Services Minister Philippe Couillard seemed to signal as much in a policy paper that spoke of the need to reduce hospital wait times and raised the possibility of provincial support for private clinics to accomplish this.
Hundreds of submissions and weeks of hearings later, Couillard backed away from anything so drastic. Instead, Couillard said the Quebec government would introduce ‘limited’ privatization only.
Under Couillard’s plan, Quebec would allow an individual’s private health insurance to cover a limited list of procedures now covered by medicare. The list would include hip and knee replacements and cataract surgery. The Quebec government could expand this list anytime in the future.
These procedures could be delivered by private clinics, but these clinics would be “affiliated” with, or contracted by, public hospitals. Doctors and health care workers from public hospitals would staff these private clinics with the costs covered by medicare.
Couillard called his plan a compromise “between those who would like us to not touch the health care system at all, leave it as it is, and those who would like us to open it completely to the free market, which we will not do.”
“In the long run, there’s a great risk that it will hurt us,” said Marcel Girard, president of the health and social services sector in Quebec. “Of course, for now it’s only a limited opening for the private sector. But the door is definitely open and we don’t know where it will end. The immediate danger is the transfer of resources from the public sector to the clinics run by these companies. They will need surgeons, doctors and nurses. Where will they find them? In the public system, of course. So, when you look at it in a global perspective, the challenges we’re facing will remain and there’s no real solution on the table right now.”
Couillard plans to table a bill to amend Quebec’s Health Insurance Act likely by mid-June, before the National Assembly recesses for the summer. The bill cannot be passed until the fall.