Quebec won't shelve Castonguay health report

The Castonguay report on health care financing has some merit even though the Quebec Liberal government is rejecting most of its recommendations, Finance Minister Monique Jérôme-Forget says.

Former health minister Claude Castonguay tabled his task force report on Quebec's health care system on Tuesday, concluding the province should raise its sales tax and create new user fees for doctors' visits to keep up with the rising cost of medical care.

Quebec Health Minister Philippe Couillard quickly dismissed the suggested Quebec sales tax (TVQ) increase and said Tuesday there is no way the province will charge user fees.

But other recommendations will be useful, especially those calling for structural changes to the health care system, Jérôme-Forget said.

"That's the part that I find very interesting, progressive," she said Wednesday. "I do believe that decentralizing, financing based on [patient and procedure volume] is a good approach — making people responsible for what they are doing, and accountable, is a good approach."

Jérôme-Forget said there is no plan to increase the sales tax and Castonguay knew that from the start.

"We always said: the TVQ? Forget it! We're not going to raise it, OK? We're not taxing people to get more money. Believe me, it's very easy for the minister of finance to do that. OK? It takes just about a few seconds," she said.

There is a lot that can be improved in the health care bureaucracy to make it more efficient and productive, which will go a long way to cutting health care costs, Jérôme-Forget said.

Castonguay "proposed that in five years, we can reduce [health care costs] from 6 per cent to 4 per cent [of Quebec's annual budget]. I would say that it's more like seven to eight years," she said in French.

The government could replace annual block funding of hospitals with a new budgeting system based on the number of patients treated, she said.

Health laws work fine, health minister says

There's no need to amend the Canada Health Act, as Castonguay concluded, to allow physicians to bill public and private insurers for services rendered, Couillard said.

"The law is vague enough that it could be interpreted in a much more flexible way," he said.

Allowing physicians to practice in the public and private sector would have "no impact on the funding of the public health system, and no impact on access for the general public," Couillard said.

"It's only a question, I would say, of opportunity for physicians, and choice for citizens, which is good. But it does not address the entire problem of access and funding."

Members of the Opposition Action Démocratique du Québec, which supports most of the report's recommendations, say they are going to pressure the Liberal government to adopt the task force's conclusions.

Quebecers who are able and willing to pay to get faster treatment should be allowed to do so, and the ADQ will fight for that right, said Opposition health critic Éric Caire.

Castonguay disappointed

During a lunch-hour speech at Montreal's Chamber of Commerce on Wednesday, Claude Castonguay told his audience he was disconcerted by how poorly his recommendations were received, but admitted he's not surprised.

He took issue with how media reports interpreted his recommendations and said they were misrepresented as a road map to privatization.

Castonguay said the overall reaction to his report underscores a deep resistance to change and innovation in Quebec.

He predicted that once the dust settles, people will be able to examine his proposals in a more rational and less emotional way.

About 100 unionized health care workers protested outside the hotel where the chamber of commerce met on Wednesday.