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Quebec proposes health care user-fees

This week Premier Jean Charest’s government proposed two new fees for health care services in Quebec.

The Montreal Gazette reports that, “Quebec’s ‘health contribution’ would be phased in over three years, starting with a $25 charge on July 1, rising to $100 a year later and reaching $200 in 2012. It would raise $945 million a year, and a $25 charge for each doctor’s visit would generate $500 million a year. The $1.45 billion total would fund Quebec’s health care system.”

Adults will be required to pay the ‘flat tax’ of $25 (which increases to $200 in 2012) on their 2010 income tax returns this spring. This measure is expected to pass as part of the budget.

The $25 per visit to the doctor stands as a proposal for now, but would also be collected at tax time, not at the doctor’s office.

The Globe and Mail reports that, “By avoiding collecting a fee during each doctor’s visit, the government believes its proposal cannot be considered a breach of the Canada Health Act. However the Act, which was adopted in 1984, clearly states that when user fees are charged and collected they can be deducted from the federal funding a province receives from Ottawa.”

“The day after Quebec’s decision to introduce user fees for public health-care services, a broad coalition has emerged to stop the measure in its tracks (including Canadian Doctors for Medicare and Médecins québécois pour le régime public).”

“A number of Canadian academics, unions and social activists are also coming together to challenge Quebec’s plan, as is the Quebec Federation of General Practitioners.”

“Leading the political charge this time in Quebec is Amir Khadir, the sole Member of the National Assembly for the left-wing Quebec Solidaire party.”

And thousands have already marched against the budget, which includes the health care fee, but also an increase in the provincial sales tax and the fuel tax, and an increase to tuition fees in 2012.

The Canadian Press reports that the Quebec’s government’s action is, “a move that could have a ripple effect across the country…”

The provincial budget even stated, “Such a health deductible might also interest other provinces faced with major challenges in respect of funding health-care services.”

The Montreal Gazette notes though that, “contributions of this kind are already required in Ontario and British Columbia, where they are known as health care ‘premiums’.”

Ottawa Citizen columnist Susan Riley writes, “Such health ‘premiums’ or ‘contributions’ are not new, of course, and in Ontario they are higher. (Someone earning $36,500 in Ontario pays a $300 premium; at $200,000 plus, the charge increases to $900.)”

What would be new is the $25 charge per visit to the doctor.

Another Canadian Press report states, “A potential precedent-setting plan by one province to start charging patients $25 for a doctor’s visit is not being blocked by the federal government — at least not for now. The Quebec move, which could trigger a ripple effect across the country, is being met with a wait-and-see response from Ottawa. The federal government (only) said Wednesday that it expects provinces to respect the Canada Health Act, but had little else to say when asked whether it considered the move legal under federal law.”

That report adds, “Liberal Leader Michael Ignatieff (has already) signalled his support (for Charest’s plan). ‘In our opinion, what counts is maintaining universality of access to the system. We believe, and it’s a question of detail, that Quebec’s propositions conform to the Canada Health Act.'”

And Susan Riley notes, “The NDP have been curiously mute as well. Assessing they say. Waiting for the fine print, we’re told. Taking great care not to be seen to be ‘intervening’ in provincial matters. Except that many Quebecers, and other Canadians, want someone in Ottawa to stand up and fight for this cherished program.”

The Toronto Star editorial board writes, “The Quebec government, Ottawa and the federal Liberals are all being too clever by half. The Quebec proposals are a political sleight of hand, a medical mistake and a social policy blunder. They will do nothing to prevent rising health-care costs, which are more a function of growing pharmaceutical expenses and persistent inefficiencies in the system. The idea that patients are somehow driving demand has long ago been discredited by health economists, who point to physicians as the gatekeepers of the system. We have already had this debate in Canada. The Americans have just recently had their own debate. But it now appears this is a fight that must be waged again so that politicians can be reminded of the principle of universality that Canadians don’t want to see compromised.”