Not-so-universal healthcare

When it comes to so-called “universal” Medicare under the Canada Health Act, as the Globe and Mail reports, Quebecers are truly second-class citizens:

Under the portability requirement, every Canadian is entitled to full medical coverage, no matter where he or she lives, and provincial health insurance plans are supposed to be good anywhere in the country.

But that tenet is showing cracks at the Quebec-Ontario boundary. Quebec patients are turned away or pay out-of-pocket for medical services outside their home province, essentially denied portability.

[ . . . ]

And physicians inside Quebec have their own issues to contend with. Louis Godin, head of the Fédération des médecins omnipraticiens du Québec, says the government needs to resolve the problems in its home province before appeasing doctors elsewhere. Two million Quebeckers don’t have a family physician. Meanwhile, in the four faculties of medicine, 250 family-medical spots remained vacant over the past four years because doctors are paid roughly 30 per cent less than their counterparts elsewhere in the country. There’s a lack of medical infrastructure, especially along the boundary, which has resulted in a number of doctors moving to private clinics or simply picking up and leaving for other provinces.

Basically, what this means is that there are much longer waiting lists for elective procedures inside Quebec, due to a severe shortage of doctors and resources. So people go to Ontario to get health services. If they pay up-front and ask to get reimbursed by RAMQ, they’ll only get part of their money back — if they’re lucky. And many doctors in other provinces will refuse to see Quebec patients, because they’re strained enough meeting the demand from the local populace, and because of the bureaucratic roadblocks that get thrown up when they themselves try to bill RAMQ for their services.

This is an inevitable consequence of a system that makes federal promises but relies on provincial jurisdictions to carry them out. Quebec’s healthcare is a mess, and understandably, the rest of Canada doesn’t particularly want to enable or subsidize the mess.

If the Quebec government were truly serious about fixing healthcare, it would pay doctors as much as they’re getting paid in other provinces, make more spots available, and commit funds for infrastructure and services, to stem the steady tide of doctors across provincial borders. Canada already has a hard enough time hanging onto doctors who are seduced by the private salaries and perks south of the border in the US. But this inter-province competition needs to stop.

Of course, it won’t happen. Quebec will point a finger at Ottawa, at once demanding more funding, and then loudly decrying it when it’s offered as “interference” in a provincial matter. Biting the hand that feeds — nothing new for La Belle Province.

So if you’re living in Quebec and are one of the rare few with a family doc, consider yourself lucky. And if not, well, best hope you don’t get sick anytime soon.