Private medicine is thriving in Quebec (and elsewhere)

There was an eye-opening article in today's Globe and Mail about the worsening problem of private medicine in Quebec.

Quebec already has the worst primary healthcare indicators in the country, with 21.6% of people aged 12 and over having no access to a family doctor in 2021 (compared to 10.3% in Ontario, and 14.5% countrywide). Because of some quirks in Quebec healthcare laws, family doctors are leaving the public health system in droves, and setting up either as "opt-out" doctors (who charge patients directly but still follow the province's medicare fee schedule, so that patients can be reimbursed fully through public insurance), or, increasingly, as "non-participating" doctors (who work completely outside the medicare system, and charge market rates).

As of this spring, there were 642 non-participating Quebec physicians of which 423 were primary care family doctors (4.13% of all licensed GPs in the province). But that number is rising inexorably: in 2012, the equivalent figures were 280, 195 and 2.1%. This has created a situation unmatched anywhere else in Canada; the only other provinces with anything even similar are British Columbia (9 private clinics) and Alberta (3).

And, increasingly, doctors are turning to this alternative system earlier in their careers, some of them straight from med school. Why? Because money.

These doctors typically charge $250-$300 a visit for a basic checkup, a sum easily affordable by the wealthy, but beyond the means of the poor, and certainly beyond the means of the unhoused and most of those suffering from mental health challenges and chronic diseases. Many private clinics charge an amnual fee of several thousand dollars, and carry out batteries of tests, many of them unnecessary, even dangerous. But if there are not enough doctors in the public service to service these people - and we know there are not - what are impoverished Quebeckers to do?

Even after reading the article, I still don't really understand how such a situation is legal here in Canada, where free healthcare is supposed to be enshrined in our Constitution. Yes, healthcare is a provincial responsibility, but there is still a federal law (the Canada Health Act) saying that provinces and territories can be penalized if doctors who work under medicare engage in extra billing. I guess, though, this does not cover doctors who do NOT work under medicare. That is a gigantic loophole.

In Ontario, there is specific legislation banning doctors from charging for services that are already publicly insured. There appears to be no equivalent law in Quebec, though. And even in Ontario, there seem to be private clinics operating anyway - I have rich friends who swear by MedCan, for example, and I know there are several others like Cleveland Cl8nic, Medisys, Regal, etc - which seem to be able to stay in business notwithstanding said law. I don't really understand why.

Quebec seems to be a prime example of the hollowing out of the public healthcare system by private healthcare. This is exactly what public health proponents have been warning us about for decades. And yet it is happening anyway.