The Quebec government is opening the door to private health insurance for some medical procedures. A policy document was released Thursday by Premier Jean Charest and Health Minister Philippe Couillard.

Charest is touting the plan as the beginning of a "new era for health care in Quebec."

The Quebec government plans to introduce guaranteed access wait times for several procedures including some radiation treatments and cardiac surgery as well as knee and hip replacements and cataract operations.

Guaranteed wait times

Calling it a new level of health care, Charest told reporters his government wants to guarantee all Quebecers in the public system that they won't have to wait more than six months for a knee or hip replacement or a cataract operation.

If any Quebecer were forced to wait more than six months, the province would help them get faster service. For example, if the waiting list is three months longer than the six-month waiting list, Quebec would cover the cost of the procedure in an out-patient clinic.

If the wait were beyond nine months, the province would pay for the operation to be carried out either outside of the province or even outside of the country.

Should the plan be accepted once the public consultation process is complete, Quebecers would also be able to take out private insurance policies to cover such procedures as knee or hip replacements, where the operation could be carried out in a private clinic.

Guaranteed wait times would cost the province about $20 million per year. Charest says he is looking at creating a public health fund that Quebecers would pay into to make the system work.

The plan would forbid doctors from working in both the public and private systems. Doctors could bill either the public system or private health insurance policies.

The policy paper is a response to the June 2005 ruling that a ban on obtaining private health insurance was unconstitutional.

When the ruling was handed down, the Charest government asked for time to implement new rules.

The decision was supposed to strike down the province's public monopoly on basic health coverage.

On Wednesday, Couillard revealed his plans to the opposition, including PQ health critic Jean-Pierre Charbonneau.

Charbonneau said one thing is certain: the government won't go as far as it had promised.

"The government changed its mind if you compare last fall to what they say now," Charbonneau said upon reading the Liberal plan.

ADQ Leader Mario Dumont says Couillard has abandoned any plan to make room for private health insurance in the province, and calls the plan "disappointing."

"My expectation would be for a major reform of health care. I think we need it," Dumont told reporters Wednesday.

Dumont says he has an even bigger concern: that the Charest government will delay taking any action until after the next provincial election, which could take another year, or more.

Jacques Chaoulli, the physician who challenged Quebec's monopoly on health insurance, expressed dissatisfaction with the limitations on private care, saying "patients will continue to suffer and die" because of waiting lists.

Chaoulli also took issue with the ban on doctors working in both systems. He said neither the Canada Health Act nor the Supreme Court decision prevents doctors who work in the public system from also working one day a week, for example, in a private clinic.

All that is forbidden, he said, is billing both the public system and private insurance at the same time for a procedure.

Chaoulli had expressed hope that the province would endorse a broad mix of public and private health care.

Under his vision, any patient with the money to buy extra insurance would be fast-tracked through a private network of clinics.

But Marie-Claude Premont, an expert in health-care law, says there is no proof Chaoulli's plan would free up the waiting lists in public hospitals.

Premont also believes that Chaoulli is misinterpreting the court ruling.

"The decision of the Supreme Court of Canada is not a carte blanche for private insurance in health care in Quebec," said Premont.

The McGill University professor, who has studied the ruling for months, says it allows doctors who have opted out of the public system to be paid through private insurance schemes. In Quebec, that is 100 physicians out of more than 18,000.

If Couillard goes beyond that, she says, he's in dangerous political territory.