Task force urges more private health care in Quebec

A provincial task force is recommending health-care user fees and greater privatization to guarantee the viability of medical care in Quebec.

The task force, headed by former Liberal cabinet minister Claude Castonguay, calls for a shakeup of principles guiding medical care in Quebec to control spiralling costs.

The Canada Health Act "hampers the evolution of the provincial public health systems" and needs to change to reflect new realities and challenges taxing health care, the report concludes.

Castonguay, who was Quebec's health minister when the province joined Canadian medicare, said the current system will not last if major changes aren't made soon.

"If nothing is done, at some point we will reach a crisis point," he said after tabling the task force report in Quebec City on Tuesday. "Decisions made in that kind of context are usually not very good decisions. That is why we say it is urgent to act."

Medicare costs make up a growing percentage of Quebec's annual budget and are increasing by 5.8 per cent a year, surpassing annual government spending increases by 3.9 per cent.

The task force report recommends Quebec cap health-care spending at 3.9 per cent of its total budget and cover additional costs through a health care fund financed partly by doctor visit charges and a provincial sales tax increase.

It also suggests Quebec residents pay user fees as high as $100/year to belong to a medical clinic, and physicians be allowed to practise in both the public and private sectors to increase access to services.

The Castonguay report's major recommendations include:

• An end to the province's monopoly over hospital management.
• A greater role for private health insurance to cover procedures currently paid for by medicare.
• An increase of one-half to one per cent of Quebec's sales tax to finance health care.
• The creation of more health clinics to ensure every Quebecer has access to a family doctor.
• Massive investment for home care and for people living with a loss of autonomy.

The task force did not present unanimous recommendations, with Parti Québécois representative Michel Venne submitting a minority report that opposes further privatization of medical care.

Lukewarm reception

Quebec Health Minister Philippe Couillard dismissed many of the report's recommendations, welcoming "all good ideas" but flatly rejecting any tax increase.

"We don't intend to raise the TVQ," he said, referring to the French acronym for Quebec's provincial tax.

The Liberal government is ready to discuss some of the report's recommendations, including the suggestion that hospital management be opened to private companies, but Couillard said there are many questions about how that kind of arrangement would work.

But the minority government is keen on changing the health-care system culture including their autonomy and how hospitals are funded, he said.

The Action Démocratique du Québec called the task force report a "lucid and hard" look at the state of health care in the province, said health critic Éric Caire.

A mixed public-private system would give people more choice about medical care, he said. But the ADQ does not support any sales tax increase because Quebecers already pay too much tax, he said.

Parti Québécois health critic Bernard Drainville said the government should focus on making health care more efficient before opening it up to private services.

The PQ supports Castonguay's recommendation to increase the sales tax to fund a health care fund, preferring that over charging people an annual fee for medical care,  Drainville said.

Unions pan recommendations

Health worker unions and opposition parties panned the task force recommendations, warning the report's conclusions will lead to American-style medical care and a two-tiered system. But Quebec's doctors' association welcomed the report's findings.

The Quebec Medical Association endorsed the task force recommendations with president Dr. Jean-Bernard Trudeau agreeing it's time to review the public health care system.

But Quebec's largest labour federation urged the government to reject the Castonguay report altogether, warning its recommendations would clear the way for two-tiered care.

"Our research department went around, and in every country where you have a two-tiered health-care system, the rich people are served first, a lot better, and the poor people or middle-class people are waiting a lot more to get services," said Michel Arsenault, president of the Féderation des Travailleurs du Québec.

Overall, the solutions proposed in the report won't really fix what is ailing Quebec's health care system, said Antonia Maioni, director of the McGill Institute for the Study of Canada.

"I think the real problem with this report is the obsession with trying to say how can we reduce public spending in health care and not taking into consideration that it's the total spending in health care that counts," she said in an interview with CBC News.

"So the same person is paying whether they pay through the public system or the private system. The same person is paying, the taxpayer."

Maioni said the task force also stepped beyond its mandate of recommending ways to improve health care financing, because the report criticizes organizational problems in the system.