Restricting private practice would reduce access to care for Quebec patients, notes the MEI

Montreal, April 8, 2025 – By recommending the prohibition of private medical practice, Quebec’s order of physicians, the Collège des médecins du Québec (CMQ), is going against best international practices, states the MEI in a Viewpoint published this morning.

“When we look at healthcare systems that work better than ours, it’s clear that private medical practice does not reduce access to care,” says Emmanuelle B. Faubert, economist at the MEI and author of the publication. “Whether in France, Sweden, or the Netherlands, patients have better access to care than here, even though doctors have the option of practising in the private sector if they want to.”

In February, the Collège des médecins du Québec submitted a brief on Bill 83, in which the organization notably recommended prohibiting the status of non-participating physician.

Since Quebec does not authorize mixed practice, this would have the effect of requiring all Quebec doctors to work exclusively for the governmental health insurance plan, putting an end to all independent practice.

Such an approach is in sharp contrast with the one adopted by the majority of OECD countries with universal healthcare systems, and in particular with those that obtain better results than Quebec in terms of access to care, explains the MEI.

In the oft-cited Commonwealth Fund ranking on access to care, Canada comes in seventh out of the 10 countries studied.

Each of the six countries ahead of Canada in the ranking have universal health care, while also allowing fully private medical practice.

“In the Dutch healthcare system, recognized as the most accessible in the world, only one per cent of citizens lack access to a primary care provider, such as a family doctor,” explains Ms. Faubert. “The Netherlands achieves these results thanks to a universal system that relies on a multitude of independent insurance and medical organizations, including independent doctors.”

In Quebec, a little over 16 per cent of the population are waiting for a primary care provider, such as a family doctor.

The researcher points out that authorizing mixed practice, as Denmark does for instance, would be a better way to restore access to care. This more flexible model allows doctors to work in both the public and private sectors.

A study looking at this practice found that there is no significant difference in the number of hours worked in public hospitals between doctors in mixed practice and those who work exclusively in the public system. Rather, doctors in mixed practice add some hours in the private sector, without reducing their commitment to the public system.

“What the example of Denmark shows us is that when doctors are given more flexibility, they are ready to do more and to see more patients,” explains Ms. Faubert. “In the end, more patients are able to be treated each year and wait times are reduced, which should be the goal of any healthcare system worthy of the name.”

In Quebec, doctors list the lack of flexibility, the administrative burden, and the desire for a better quality of life as the main reasons pushing them to leave the public system.

The researcher says that, if the government wants to encourage these doctors to rejoin the public system, it should address the reasons for their departure, rather than forcing them to return through the use of coercive measures.

The MEI study is available here.

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The MEI is an independent public policy think tank with offices in Montreal, Ottawa, and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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