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Montreal Gazette Fri Apr 17 2015

The number of Quebecers filing complaints about excessive fees charged by doctors in private practice has soared by 374 per cent during the past five years, according to newly-released figures by the Quebec College of Physicians. In some cases, ophthalmologists have charged hundreds of dollars for eye drops that should cost as little as $20. Increasingly, physicians who perform vasectomies outside of hospital are invoicing patients "accessory" fees that are not permitted under the law. In one flagrant example, the disciplinary board of the College of Physicians suspended a Westmount physician for three months and fined him $10,000 in 2013 after ruling that he charged patients "excessive and unjustified" fees.

Dr. Charles Bernard, president and executive director of the College, acknowledged that some physicians have "exaggerated" in the amounts they bill patients. But he blamed the problem on the provincial government for not updating the list of fees that are allowed in private practice since 1970. "The College is receiving more and more complaints about fees charged by doctors," Bernard said Thursday, citing statistics that the number of such grievances has jumped from 31 in 2010-11 to 147 in 2014-15. About 80 per cent of the complaints were resolved after mediation between the physician and patient. But nearly 30 complaints in 2014-15 were not settled to the patients' satisfaction. "What we believe is that the accessory fees should be clear," Bernard told reporters following a news conference. "We don't want (doctors) to exaggerate and that's why we want detailed invoices. "Although the College has taken steps to modify its Code of Ethics, the problem is not entirely resolved," he added.

However, Quebec radiologists are against universal coverage for the tests.

Four health associations representing Quebec doctors and medical students are demanding the province cover medical imaging done in private clinics.

the wait times for ultrasounds, magnetic resonance imaging (MRI) and CT scans can be as long as two years in hospitals, while the same services are available in less than 24 hours in private clinics. For patients without private insurance, MRIs done outside of a hospital can cost between $700 and $1,000.

Premier Pauline Marois announced plans for a new hospital, scrapping a Liberal plan to refurbish Quebec City’s Hôtel-Dieu, the oldest hospital in Canada.

The previous Liberal government was committed to a $1-billion refurbishing of the Hôtel-Dieu Hospital in Old Quebec, at first considering, then abandoning, the idea of building it as a public-private partnership, as is the case for the Montreal’s two new teaching hospitals, affiliated with McGill University and the Université de Montréal.

the hospital’s administrators have asked the government to consider a new hospital on vacant land adjacent to the city’s Enfant Jésus hospital.

Depuis 2008, le ministère de la Santé a versé plus de 18 millions de dollars à la clinique de chirurgie Rockland MD pour opérer près de 9000 patients de l’hôpital du Sacré-Coeur. En plus, la RAMQ a dû rembourser 263 000 dollars à des patients à qui la clinique avait facturé des « forfaits santé » jugés illégaux.

« Je peux vous dire que cette entente a cours jusqu’en septembre et qu’elle ne sera pas renouvelée », a tranché le ministre

Quebec will ban medicare user charges; 'There won't be any fees, period' for necessary care: Barrette Montreal Gazette Thu Sep 15 2016 Page: A1 / Front Section: News Byline: CAROLINE PLANTE Dateline: QUEBEC Source: The Gazette

Patients in Quebec will no longer have to pay user fees for medically required procedures covered by medicare, Health Minister Gaétan Barrette has announced. The minister told reporters Wednesday the measure was approved by cabinet and will come into effect in January 2017. For example, it will be illegal for doctors to charge patients $200 for eye drops before they undergo exams or treatments, or $150 to open their file, Barrette said. "When a medical service is covered by RAMQ, there are sometimes fees added to that. It's overbilling. Those fees will be illegal, totally illegal," he told reporters. "There won't be fees of $50, $70, $25 or $10, there won't be any fees, period ... No more over-billing."

"We made a huge effort as a society to go back to a balanced budget. Now we need to go on and put measures in place which will improve our health-care system," Barrette said. The change will not apply to medical procedures that are not covered by medicare, such as laser eye or cosmetic surgery, the government said, and Quebecers will still have to pay for doctors' notes because it is considered an administrative fee. Moreover, it will be possible for doctors to charge up to $15 for the transportation of blood samples to and from laboratories, and $5 for samples that do not contain blood. Barrette said he is abolishing add-on fees by rolling them into doctors' salaries. He estimated it would cost doctors between $10 million and $13 million a year. "When you have a total envelope of $7 billion, I think it's fair to ask that they incorporate those fees. The specialists have said that they will incorporate those costs for those services ... and as for general practitioners, there are no surgeries, so there is no reason for them not to incorporate those costs into their envelope," Barrette said.

Updated: May 25, 2016 5:

Primary care is at a crossroads in Quebec. Over the past 15 years, there has been a major paradigm shift, with primary care and family medicine delivered through the GMFs (groupes de médicine de famille) being recognized as the foundation of our health-care system.

As speakers and organizers, we were actively involved in the recent symposium Toward a Common Vision for Primary Care in Quebec. Organized by McGill University’s Department of Family Medicine and Institute for Health and Social Policy, the symposium assembled a capacity-crowd of 300 clinicians, administrators, patients, students, family medicine and other specialty residents, policy-makers and academics eager to engage in respectful public policy discussion and to claim a real stake in the design and improvement of the health-care system. Participants and speakers from Quebec, Ontario and the United Kingdom all emphasized that successful policy requires developing and promoting a shared vision in the population and among front-line workers. Effective implementation also requires iterative improvement through public consultation, accountability and clinician engagement.

What does an annual visit prevent? Nothing,' says Quebec Health Minister Gaétan Barrette

May 30, 2016

Annual medical checkups for healthy Quebecers over the age of five are being scrapped under new medical fee guidelines being implemented by Quebec's government starting in June. Healthy Quebecers will still be able to see the doctor once a year, but under a different category of visit called a "follow-up visit." 

Last night, prominent Montreal lawyer Jean-Pierre Ménard filed a petition on behalf of the Réseau FADOQ asking the Federal Court to issue a writ of mandamus to compel the Minister of Health to enforce the Canada Health Act in Quebec. The Government of Quebec instituted two-tier medicine last November when it voted in favour of Bill 20, which allows doctors to add accessory fees to their patient services. This is the first time to our knowledge that a citizens' group has asked the Federal Court to compel the government to apply the Canada Health Act.  CDM, along with our colleagues in the Canada Health Coalition, began working with public health care advocates including Monsieur Menard when we learned of Minister Barrette’s disturbing proposal to amend Bill 20, and legalize extra billing.

MONTREAL (MAY 3, 2016) – At a press conference today in Montreal, Canadian Doctors for Medicare (CDM) and Quebec health care advocates joined the Réseau FADOQ, Marc Ferland, and Liette Hacala Meunier in their bid to compel the federal government to enforce the Canada Health Act (CHA).

Posted on June 28, 2016 in Fight for 15, FTQ, Quebec

By Sonia Singh

Thousands of Quebec nursing home workers have walked off the job in their first-ever series of coordinated strikes. They’re demanding that all workers get a starting hourly wage of $15.

The Globe and Mail Tue Dec 17 2013

Just before the Quebec National Assembly adjourned for the holidays, Health Minister Réjean Hébert tabled Bill 67, the proposed "autonomy insurance" law. On the surface, the legislation would provide an additional $100-million a year for home care and home support services for seniors. Given that Quebec already spends $4.3-billion annually on long-term care for seniors, the new monies are modest, not nearly enough to keep pace with burgeoning demand. But the move is important - and will be watched closely by other provinces - because, more than anything, it represents a philosophical shift.

The proposed legislation, while popular with consumer groups and patients, has nonetheless had more than its share of controversy, most of it revolving around financing. The current plan is to create a large capital pool to fund future needs of the aging population - essentially a parallel public insurance program for home care.

Quebec Liberal Party unveils its economic platform, says it's time to return to path of prosperity

Mar 18, 2014

Quebec Liberal Leader Philippe Couillard says his government would put Quebec back on track by using the budget surplus projected for 2015-2016 to reduce the provincial debt and cut taxes.

Montreal Gazette Wed Jul 29 2015

The Quebec government is ordering hospitals and other health facilities to slash $150 million from their budgets for medical tests, imaging scans and procedures to patients that it has judged are not "pertinent to care," the Montreal Gazette has learned. In total, the Health Department is aiming to chop $583 million in spending through so-called optimization measures. And in a bizarre twist, the government has decided that it won't provide hospitals funding for next year's leap year day, Feb. 29, which will fall on a Monday, saving it $64 million.

t's up to hospitals to cover the shortfall on that day out of their own already diminished budgets. One of the biggest cutbacks will take place at the McGill University Health Centre, which last year was forced to cut $50 million from its budget. It must now reduce its spending by an extra $21 million. Of all the "optimization measures," the most controversial is compelling doctors to stop ordering tests the government now considers "unnecessary" in the context of austerity. Patient-rights advocates and managers in the health system are warning that this sets a dangerous precedent, opening the door to ageism and the prospect of clinicians no longer performing tests for people above a certain age. Reducing the number of tests in the public system could also result in an increase in the number of tests in private clinics. Health minister Gaétan Barrette has said he plans to propose legislation in August that would permit private clinics to start charging patients fees for some tests and procedures that would otherwise be covered under medicare in the public system.

Quebec nurses' union pleased with new powers

Oct 07, 2015

The Quebec government is giving nurses more powers in an effort to speed up treatment for patients.

National Post Fri Mar 13 2015

Gaetan Barrette, Quebec's Minister of Health, recently announced proposed legislation that would change how the province funds in vitro fertilization (IVF) for women unable to conceive without medical assistance. Women would have to sign a declaration stating that they had been sexually active for a sustained period, and were still unable to become pregnant. Women over the age of 42 would not be eligible for IVF at all. Minister Barrette, I would like to introduce you to Mikey, my little boy. I had him when I was 43 and I am not alone. The trend toward later motherhood is significant in most Western countries today. The proportion of Canadian women giving birth in their early forties has doubled since 1988, and in the U.S., it has quadrupled. The decision when to have a child is very personal. It is also widely acknowledged that women today are under tremendous social pressures to "be responsible," complete their education and establish financial and relationship stability prior to starting a family. Having a child later in life is not always a mere preference; often it is the result of how our current social structure limits the choices open to women. But by the time it is "socially responsible" to have a child, it may become biologically challenging. Our fertility declines and we are racing against our biological clocks. This is precisely when some need the assistance of IVF to conceive.

I am not certain why you chose 42 as a threshold (perhaps you are relying on policy advice from Douglas Adams' Hitch Hiker's Guide to the Galaxy, that suggested "42" is the answer to the meaning life). But this age threshold discriminates between women who are lucky enough to conceive spontaneously in their forties, and those who need assistance. It also discriminates between me and my husband, for whom there is no age limit in your Bill. Is it medically riskier to have a baby after 40? Yes, it is. Does the risk justify not having a baby? In most cases, it does not. And in almost all cases, this is a decision that a woman should have the liberty to make for herself. Women are making much riskier decisions without government intrusion, such as undergoing plastic surgery. They are making them for more trivial reasons than the desire to bring a child into the world.

March 19, 2015

Quebec must act soon to control the runaway costs of prescription drugs, Quebec’s health and welfare commissioner warned on Thursday. In a 140-page report tabled at the National Assembly, commissioner Robert Salois recommended an overhaul of Quebec’s prescription medication policy, which was released during Philippe Couillard’s term as health minister.

The costs are running so high, he said, they threaten the future of the province’s 18-year-old drug insurance plan. Quebec spent $7.7 billion on prescription drugs in 2014, $200 million more than the year before, he said.

Montreal Gazette Mon Nov 16 2015

When François Richard worried about an infection in his mouth, his doctor suggested he might have throat cancer. Richard said his physician outlined two choices: pay $250 up front for a quick test on the spot at the clinic or wait three months for a hospital appointment. Scared for his life, the Montrealer paid for the laboratory test immediately. Richard is one of 527 Quebec patients who responded to the Pointe-Saint-Charles community health clinic's registry documenting hidden charges billed for care, medication and services - $600 for eye drops, $30 for filling out a form, $25 for a five-minute phone consultation or renewing a prescription, and $135 for an ultrasound at a clinic that served as an overflow for a hospital.

It's Quebec's first public registry of its kind of fees billed for medical services, and it confirms extra or shady billing threatens access to medical services and care. The Pointe-Saint-Charles clinic launched the registry last year after it became clear that billing patients directly isn't a marginal practice. It's widespread among family physicians and specialists.

Montreal Gazette Wed Dec 16 2015

The Quebec College of Physicians is defending itself against charges by two researchers that the professional order has been lax on the growing use of accessory fees in private clinics. The researchers, Guillaume Hébert and Jennie-Laure Sully, accused the College of failing to crack down on abusive fees that some physicians in private practice are billing patients.

"Over the years, doctors have gradually inflated the amounts they charge to the point of demanding significant sums from their patients for unjustified reasons," they wrote in a research paper published by the Institut de recherche et d'informations socio-économiques (IRIS). "After years of procrastination, the College of Physicians clarified its code of ethics by reminding Quebec physicians that they cannot place themselves above the law. Despite this directive, doctors have continued to impose accessory fees and the College did not choose to enforce its own code of ethics, preferring instead to negotiate reimbursements for patients who have made complaints."

According to a new study from the Fraser Institute, and using 2010 data that looked at 46 indicators, the institute concluded that Quebec's healthcare system, followed by Ontario's, provided the best "value for money." Alberta scored a dismal seventh, Saskatchewan was eighth, and Newfoundland was dead last.

Quebec uses far more private delivery of publicly funded health care in comparison with the rest of the country.

maybe Alberta's government should take a close look at the private options being served up in Quebec

Our members on the provinicial social services council (Conseil provincial des affaires sociales - CPAS) launched  a TV advertising campaign on Monday, February 18. The campaign will run across Quebec for four weeks.

See the TV ad on YouTube (French only)

The Globe and Mail Tue Sep 20 2016

The government of Quebec is taking the eminently sensible - and legally mandated - step of abolishing extra-billing for publicly insured medical services. Good news! But there's a problem: the changes won't take effect until early next year, and nobody really knows how much in extraneous fees is being charged in the province. How is that possible? Overbilling has been a hot-button issue for the better part of four decades. Depending on whom you talk to, Quebec's doctors are charging patients $50-million to $90-million a year in added fees.

Earlier this year, the provincial auditor-general said the Quebec government's own estimates ($83-million) don't seem to be based in verifiable fact. One Montreal-based lawyer is suing the province over extra fees. He says Quebec is Canada's worst offender; he may be right, but who really knows? The Canada Health Act forbids extra-billing, but successive federal governments have mostly treated it with impunity. At least Dr. Gaetan Barrette opted to ban fees outright rather than apply his initial prescription - to pay practitioners an equivalent additional amount out of provincial coffers. Two years ago, he leaped into politics, and has brought about a series of deep reforms. (His many critics think he's a bully and a demagogue.) Probably his hand has been forced by ongoing litigation and federal Health Minister Jane Philpott.