The role of the private sector is growing in Quebec's health care system

    MONTREAL, Aug. 9 /CNW Telbec/ - Although private financing of health care
may be controversial, Quebec has experienced continuous growth in private
health spending over the last 25 years. In 2006, it amounted to $8.6 billion.
This represents 28.4% of overall health care spending (up from 20.3% in 1981).
In an Economic Note published by the Montreal Economic Institute, vice
president and chief economist Marcel Boyer and economist Mathieu Laberge
review the costs paid by users of health care services.
    Mr. Laberge states that "the presence of out-of-pocket payments is not
bad in itself, but taking advantage of grey areas in the law damages citizens'
confidence in the health care system, whether public or private." Mr. Boyer
concludes that "a private sector presence in the health care sector should not
be feared since it has always made a significant contribution. The government
should consider rational, coherent solutions allowing for an increase in the
supply of health care services by carving out an intelligent and flexible
space for the private sector."

    Many patients must get around the Canada Health Act

    Unlike the situation prevailing in most OECD countries, the imposition of
user fees on health care services that are insured within the public system is
deterred by the Canada Health Act and by legal measures in each province.
There exist many instances, however, where patients can pay from their own
pockets to obtain certain health care services, including some services
insured under the public system. They can thereby get faster access to care or
higher-quality care and services.
    This growth in private spending goes along with changes in public
opinion. A Léger Marketing poll ordered in September 2006 by the Montreal
Economic Institute showed that 60% of people in Quebec would agree to the
government allowing those who so desire to pay more to obtain faster access to
health care services. A committee headed by Claude Castonguay, created in the
latest budget, is looking into this and other matters, with its report due in
the fall.

    An asymmetric public system

    Bill 33, adopted by the National Assembly in response to the Supreme
Court of Canada ruling in the Chaoulli case, will soon permit private
insurance for hip, knee or cataract surgery performed by a doctor working
outside the public system. It should be remembered that someone wealthy enough
to pay all fees charged by doctors outside the public system has always been
able to get faster care. Prohibiting private insurance has simply had the
effect of preventing people of more modest means from being able to do the
same. Bill 33 also sets out an obligation to display accessory fees. This
gives reason to believe that such fees will assume greater importance in the
near future.
    The Economic Note points out that the range of services insured by the
public system has changed over the years in response to a number of
considerations, including budgetary constraints, pressure from various
interest groups and the views of decision-makers as to what should or should
not be covered. From the beginning, the government did not hesitate to exclude
coverage of certain types of services viewed as too costly for the public
health insurance system.
    In some instances, the government authorizes public bodies such as the
SAAQ and the CSST to send beneficiaries to be cared for more quickly in the
private sector. The aim here is to save on income replacement costs. The
government thus denies to citizens what it allows for itself.

    Categories of health care services where payments may be requested

    Total private health care spending in Quebec was estimated at
$8.6 billion in 2006. This amount includes drugs (41%) and spending on
administration, capital and research. The Note focuses on services which are
paid for by users, including:

    - services not insured within the public system, such as dental care;
    - care provided by a doctor working outside the public system;
    - care offered by an employer, body or association to its employees or
    - services covered only in hospitals;
    - appointment search services;
    - accessory fees that a doctor may demand;
    - fees for greater quality or comfort.

    The Economic Note, titled The role of the private sector in the Quebec
health care system: a glimpse at existing fees, was prepared by Marcel Boyer,
vice president and chief economist of the Montreal Economic Institute, and
Mathieu Laberge, an economist at the Institute and holder of a master's degree
in international economics and econometrics from the University of Nottingham.
    The Note is available at

    The Montreal Economic Institute is an independent, non-partisan,
non-profit body that takes part in public policy debate in Quebec and across
Canada, offering wealth creation solutions on matters of taxation, regulation,
and reform of health and education systems. Its publications since 2000 have
included the Report Card on Quebec's Secondary Schools. In 2004 it won a
Templeton Freedom Award for Institute Excellence for the quality of its
management and public relations.

For further information:

For further information: and interview requests: André Valiquette,
Director of Communications, Montreal Economic Institute, (514) 273-0969 ext.
2225, Cell: (514) 574-0969,

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