Quebec health minister rejects Castonguay's financing scheme

Community Action, March 20, 2008

Quebec Minister of Health and Social Services Philippe Couillard, rejected key recommendations of the Casonguay task force on the financing of the province's health care system.

The Castonguay report expresses a serious concern of public health care expenditures, that is growing faster than government revenues.

The controversial proposals include:

* the introduction of a health tax;

* greater freedom for physicians to bill privately;

* the freedom to operate a mixed medical practice within certain limits;

* allow to purchase private health insurance that would enable them to seek speedy treatment for the full range of services covered by medicare.

Task force member Michel Venne expressed dissent with these proposals in a separate statement. The most controversial is that of allowing physicians to work in both the private and public pay systems.

The task force would limit this to two conditions:

* the physician would have the approval of his or her health care institution; and

* the health care region has an adequate number of physicians for the public system.

Minister Couillard, who is also a physician, said that he does not share the apocalyptic view that the task force presents. He points out that a number of European countries have tried this approach, but because of exemptions and exceptions, the public cost continued to be high.

Among the specific financing proposal, the task force proposes a number of initiatives which they claim will improve access to care.

To help pay for the health care system, the task force recommends that Quebecers:

* pay a "deductible" based on one's income and number of visits to the doctor;

* patients pay an annual fee of up to $100 to belong to primary-care clinics that would guarantee 24-hour care; and

* pay an increase in the provincial sales tax of either one-half to one percentage point, with the new revenue going into a dedicated health fund.

Among the less controversial recommendations are these:

* review the services provided on a cost benefit basis to end a system considered incoherent and rigid;

* an Institut national d'excellence en sante to determine performance indicators and review the list of insured drugs;

* development of clinics, and priority to home care;

* reduction in the number of regional health agencies from 18 to six;

* increase the autonomy of producers of services--the CSSS, health clinics and other institutions, while making them more responsible for their management;

* physicians, institutions and clinics enter into contractual agreements; and

* independent members of the hospital board be remunerated.

The task force was headed by Claude Castonguay, a former health minister in the provincial Liberal government. Other members were: Joanne Marcotte, named by the official opposition Action Democratique du Quabec; and Michel Venne, named by the Parti Quebecois. Venne signed the report, but dissented from the recommendations involving a greater private-sector role.

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