Quebec Opens Door to more private health care

Instead of tackling problems of waiting times and staff shortages the "reformers" want to shift costs to individuals and let doctors earn more but through private practice. Interesting the Castonguay report is by a former insurance company executive. Of course there is no conflict of interest there!
The less publicly insured services and the worse the system the more private insurers will profit. The whole so-called socialised health care system is for the most part not socialised at all but for-profit from drugs, to contracted out services, to equipment and now to hospitals. Some of the costs are socialised but within the context of making profit.
The choice analogy of people buying houses and cars etc. is interesting. This denies that health care is a right but sees it as a consumer choice. One can choose a Cadillac heatlh system and live in a mansion or choose to shuffle about the city on foot and sleep in the streets.

Quebec opens door to more private health care
RHÉAL SÉGUIN and GLORIA GALLOWAY
February 20, 2008
QUEBEC CITY, OTTAWA -- Quebec Health Minister Philippe Couillard left the door open yesterday to physicians practising in both the public and the private systems under strict conditions in his response to a task force report on the province's health-care system that proposed "profound" changes.
Among the proposals in the report, entitled Getting Our Money's Worth, was the possibility of physicians having "duo" practices as well as allowing private insurance companies to cover services currently covered under the public-health program.
However, Mr. Couillard rejected a proposal to increase the sales tax and opposed the introduction of a tax deductible to help finance the health-care system.
Regarding the groundbreaking proposal to allow "duo" practice, Mr. Couillard said that doctors would be allowed to work in both the public and the private systems only under the strictest conditions, and only if there would be no shortage of doctors. The private sector must support the public system, Mr. Couillard insisted.

"The duo-practice model could be considered, but it won't be applicable for many years," he said.
"If we allow duo practice, it must have no impact on the public health care system and no impact on access to care by the general public."
Mr. Couillard also supported the recommendation that the government should allow private firms to manage hospitals through pilot projects that could eventually lead to "productive new options."
The head of the government task force, former Liberal minister and insurance company executive Claude Castonguay, said people are demanding changes to an "incoherent and rigid" system and should be given the freedom to choose the kind of health-care services they want.
"People can choose what car they want to buy, what suit they want to wear, what house they want to live in, but when it comes to their health, they don't have a choice. That's what I'm against," Mr. Castonguay said in an interview yesterday. "We are proposing to give a greater role to the private sector so that people can exercise a freedom of choice."
University of Toronto law professor Colleen Flood, who is Scientific Director at the Canadian Institute of Health Research and an expert on public-private health-care financing, said she was surprised the task force would go so far as to recommend that doctors be allowed to practise in both the public and private systems.
"In my view, that is the sort of irrevocable step towards a two-tier health-care system," Ms. Flood said in an interview yesterday. "Once physicians are able to work in the private system then you will start to see the real flourishing of that private system. Doctors will have a financial incentive to spend more time in the privately financed system ... and there is already a concern that there aren't enough doctors in the public system to allow this."
The task force insisted that the recommendations complied with the spirit of the Canada Health Act, but urged the federal government to change the law, which "hampers the evolution of the provincial health systems."
Federal Health Minister Tony Clement said yesterday that he is reviewing the report.
"Our government is committed to the principles that ensure that Canadians have universal access to medically necessary, timely and quality care based on need and not on an ability to pay," Mr. Clement said in a statement. "We are respectful of provincial jurisdiction in the delivery of health care."
The task force also proposed the creation of a "health stabilization fund" financed by an up to a 1-per-cent increase in the provincial sales tax.
Funding would also come from a maximum 1-per-cent to 2-per-cent deductible based on income and the number of times a person uses the health-care system. Lower-income earners and chronic care patients would be exempt.
"This is not a user fee," Mr. Castonguay stressed. "We reject user fees."
However, Action Démocratique du Québec health critic Eric Caire, who supports the task force's bold proposals for greater privatization, said the deductible was a good thing and that it amounted to nothing less than a user fee. "If it walks like a horse and looks like a horse, then no doubt that's what it is," Mr. Caire said yesterday.
The new funding scheme would collect slightly more than $2-billion and would be used to slow the projected 5.8- per-cent growth in government spending for health care to 3.9 per cent. Health and social services costs currently make up 44 per cent of the total provincial budget or $24-billion, which includes $5-billion for social services.
Another cost for patients would involve an annual access fee of a maximum $100 to become part of a health clinic and obtain access to a family doctor and other services. Statistics show that one in four Quebec residents does not have access to a family doctor. It would involve a "voluntary" contribution and act as an incentive for doctors to take in new patients and give all Quebeckers access to a family doctor within five years.
Hospital budgets should also be set differently and the report proposed that funding be determined by the services provided to patients. "The money would follow the patients," Mr. Castonguay explained. "Patients would no longer be viewed as an expense, but rather as a source of revenue for hospitals." Mr. Couillard said this was a proposal he intends to implement soon.
The report also responded to the needs of the province's aging population. It recommends that the government focus on improving home-care services and eventually move to privatize long-term-care facilities.
A spokesman for the Bloc Québécois said that, as long as the principles of free and universal health care are upheld, his party recognizes the need for a debate about the future of province's health system.