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

Montreal, August 9, 2007 – 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 members;
– 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.

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For further information and interview requests: André Valiquette, Director of Communications, Montreal Economic Institute, Phone: 514 273-0969, ext. 2225 / Cell: 514 574-0969 / Email: avaliquette@iedm.org