SHAVER: Charest needs to challenge medical barriers

Gillian Steward in The Toronto Star asked whether Jean Charest can harness Alberta’s anger. He proposes more provincial powers, so that Alberta would manage its share of the Canada Pension Plan, have its own police force, and choose immigrants based on its needs, much like Quebec.

However, he must reverse his earlier position and agree to a health care system that is fully portable between all provinces and territories, including Quebec. Let me explain.

COVID restrictions are lessening. As a result, Canadians are increasingly travelling to other parts of their country on vacation or business. They take for granted that all costs will be covered should they face the need for unexpected medical or surgical care. Yet this still does not apply to residents of Quebec, nor to Canadians who require medical care in Quebec.

Consider an example that underscores the problem: Patrick Belanger, an economics student at Bishop’s University, fell accidentally on June 10 while vacationing in Sun Peaks, British Columbia. He was taken that evening to the Royal Inland Hospital in Kamloops and was found to have mandibular and facial fractures. No surgeon was available, so he was sent home on Percocet. He returned the next morning, but the first surgeon refused to admit him and operate because he had Quebec insurance. He was advised to simply fly back to Quebec for the required treatment.

He remained in severe pain until a second surgeon eventually operated a week later. However, his family eventually paid $2,563 out-of-pocket. It remains to be seen how much they will be reimbursed by the Quebec government.

As many Quebecers have discovered, when seeking health care in other parts of Canada, they may be treated as “second class citizens.”

I have written numerous articles about this problem since the late 1980s, but sadly all Quebec and federal health ministers have ignored it. This includes Jean Charest, who was Quebec Premier from 2003-2012,

Section 11 of the Canada Health Act clearly states that a physician treating a patient from another province is to be paid at the host province rate, not the rate of the home province of the patients. All provinces and territories have signed the “Reciprocal Medical Billing Agreement’ which permits an MD to bill his/her home provincial ministry of health and receive host-province rates; the physician’s province then collects from the province of the patient. However, Quebec has refused to sign.

In the late 1980s, Quebec fees were the lowest in Canada; now they are among the highest, as Quebec MDs enjoy the 3rd highest gross incomes of any province. Yet if a physician in the rest of Canada bills Quebec, or Quebec reimburses a patient who has paid the physician directly, often Quebec uses an older, much lower fee schedule!

Mr. Charest can now redeem himself. I call upon him to lobby federal health minister Jean-Yves Duclos and his Quebec counterpart Christian Dube and also pledge that if he becomes Conservative Party leader, and perhaps Canadian Prime Minister, that he will resolve this problem.

At the Council of the Federation meeting in Victoria, on July 12, Francois Legault indicated that he and the other premiers supported increased trade between provinces. However, this requires fully portable medical as well as hospital benefits.

Quebec residents should no longer face financial impediments to obtaining medical care wherever they are in Canada. Residents of Alberta and other provinces and territories should not be deterred from visiting Quebec for fear of unexpected out-of-pocket medical expenses.

Canadian Medical Association President Dr. Katharine Smart recently wrote, “We strongly encourage provincial and territorial governments to work together to ensure Canadians receive the care they need, when and where they need it, and the federal government to enforce the principles of the Canada Health Act uniformly across the country.”

Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.