Guest Editorial:

Out-of-province health-care fees?

 

Trump has imposed tariffs on steel and aluminum, and threatens automobiles and uranium. Up to 30% of Quebec’s products will be affected. There will be no winners, yet there could be one exception: resolution of Quebec’s lack of full participation in the portable Canadian health system.

Many Canadians have reacted by boycotting US products in stores. Some have cancelled visits to American tourist destinations and have urged friends to visit another part of Canada. Yet this poses problems for those from Quebec, especially if they have pre-existing conditions and do not qualify for unrestricted travel health insurance.

Quebec does provide portable hospital benefits. However, it has refused to sign the Reciprocal Medical Billing Agreement. Quebec alone has refused to sign. It pays only its own fees, until recently the lowest in Canada.

Most Quebec patients when receiving outside medical care feel like second-class citizens. They are billed personally, forced to pay out-of-pocket at the time of service, and later receive only partial reimbursement from Quebec. Other Canadians visiting Quebec must also pay the treating physician directly, which may deter some from travelling there.

Non-portable medical benefits affect Quebecers who become unexpectedly ill in another province or territory, those who move to another part of Canada and for the first three months are “covered” by a Quebec health card, and those in border areas such as Gatineau who require emergency or specialty services in Ottawa.

Over 30 years, Quebec has refused to obey the portability provision of the Canada Health Act, partially because of the previous disparity between fees paid by Quebec and those of  other provinces. No federal politician has attempted to enforce this portion of the CHA.

Premier Couillard could easily resolve this problem. Recently, his family physicians and specialists received significant fee increases. Gross incomes of Quebec family physicians are roughly 112% that of the average across Canada; it is 123% for medical specialists, 110% for surgical specialists, and 98% for cardiologists. Quebec has been fearful of antagonizing its own physicians if it was paying them less. Now, there is no excuse for the Quebec government to refuse to pay other Canadian MDs at host-province rates.

If the Quebec government still refused, another option would be for Ottawa to pay Canadian doctors directly for all persons treated out-of-province. Doctors do receive direct payment for federal prisoners and, until a few years ago, for members of the RCMP. MDs are paid at rates in their own province through the IFHP for refugees.
   
Premier Couillard has no excuse for not signing the RMB agreement. He would leave a permanent legacy by ensuring Quebecers received the fully portable health benefits enjoyed everywhere by other Canadians. It might increase tourism to Quebec -- and enhance his chances of winning the October 1 provincial election.

A year ago, Couillard stated that Quebec desired to “participate in an even stronger way in the Canadian federation.”  It’s time to translate those words into action.

Charles S. Shaver,
MD
Ottawa