Over the past several months, Quebec Health Minister Réjean Hébert has made one alarmist statement after another about private medicine.
In May, he spoke of the “hemorrhaging” of doctors to private clinics and said that this was making the shortage of doctors in the public system even worse. In September, he reiterated his determination to “plug the holes” and put an end to this “shift toward the private sector.” But what are the facts of the matter?
While their number has increased since the start of the 2000s, physicians who do not participate in the public health plan still account for just 1.38 per cent of all doctors in Quebec (263 out of a total of 18,990). Of this number, 186 were general practitioners, and 77 were specialists.
As for the number of doctors working in the public system, far from decreasing because of departures to the private sector, it is on the rise. From 2004 to 2012, there was a net increase of 1,129 general practitioners, while the number of specialists climbed by 1,716.
Furthermore, Quebec has more doctors per capita than the Canadian average, and more than seven other provinces.
It is therefore hard to maintain that the limited development of private medicine is responsible for any of the public system’s problems.
The official data on clinics is very clear. Our cross-checking allowed us to determine that non-participating physicians are affiliated with 185 medical clinics.
Most of these (58 per cent) either work alone, or are the only non-participating physician in clinics where participating physicians also work. It is interesting to note that “large” medical clinics are not representative of the private-medicine ecosystem, accounting for just 13 per cent of these doctors.
We tried to get a better sense of the nature of the clientele of private clinics, about which no data had been collected before now, by carrying out our own field study of the patients of private clinics.
First of all, the financial profile of clients does not correspond to the caricature of a wealthy elite pampering itself in luxurious clinics; instead, it looks more like the profile of the general population.
The reasons given for visiting a private clinic are directly related to the existence of problems accessing front-line care in the public system.
Nearly all visits were motivated either by an emergency or by pain or other medical concerns. Half of respondents also said they had tried to go to a hospital or public clinic for the same reason, before making their private appointments.
Finally, the reason mentioned as being very important by practically all patients polled (96 per cent) was the ability to get an appointment quickly.
Some of the other reasons considered most important were the ability to get treatment or surgery quickly; good patient follow-up; the fact that medical personnel provided good explanations of diagnoses or treatments; and the professionalism of the medical personnel.
While the supply of private medical services remains relatively limited, it nonetheless benefits many Quebecers. Far from constituting a “drain,” private medicine actually contributes to increasing the total supply of health services — and to relieving the pressure on the overloaded public system.
Its development should not serve as an excuse for avoiding the reforms needed to improve the efficiency of the public system, but should instead be encouraged.
Jasmin Guénette est vice-président de l’Institut économique de Montréal. Julie Frappier est économiste de la santé et titulaire d’une maîtrise en économie de l’Université de Montréal. Ils signent ce texte à titre personnel.