Dr. Ryan Meili on the dangers of the proposed Bill 20 amendment in Quebec

September 15, 2015 | QUEBEC CITY

Medicare defense groups go after Quebec amendment to legalize outlawed fees,

Written by Mark Cardwell for Canadian Healthcare Network on September 15, 2015: http://www.canadianhealthcarenetwork.ca/physicians/news/government/medicare-defense-groups-go-after-quebec-amendment-to-legalize-outlawed-fees

A coalition of Canadian groups dedicated to defending Canada’s publicly-funded health care system is sounding the alarm over a proposed amendment in Quebec that would give private medical clinics the right to bill patients fees that are now illegal.

“(It) will create a two-tier health-care system that limits care for people who can’t afford extra fees,” Dr. Ryan Meili, acting Chair of Canadian Doctors for Medicare, said about the proposed amendment to Quebec’s Bill 20, a highly controversial act that ironically aims to promote access to family medicine and specialized medical services.

Once you open the door to this, who knows. There are no firewalls, so it could drift into family medicine, where we’re already seeing things like membership fees.

Under the amendment, which is currently being studied by the committee on health and social services at the National Assembly in Quebec City, certain add-on and ancillary fees that are routinely charged by physicians in private clinics would be permitted.

“Accessory fees need to be regulated, as some situations are even greater barriers (to access to health care), due to exaggerated fees, than our proposed solution,” Joanne Beavais, spokesperson for Quebec Health Minister Gaétan Barrette, told The Medical Post today.

She added that the committee “will study the fees that are actually invoiced to patients, and regulate the maximal fee which will be accepted.”

In many ways, the amendment is a response to pressure from the Quebec College of Physicians, which has been calling on the province to address what has become a troublesome regulatory issue in recent years.

That pressure reached the boiling point earlier this year, when the Association des cliniques médicales du Québec (ACMQ) warned that some private clinics could close after July 7, when an updated code of ethics that obliges doctors to produce detailed patient billings came into effect.

The change was intended to prevent a practice under which many doctors, specialists in particular, charged hidden fees to patients under the invoice heading “medication.”

The use of add-on fees in Quebec began years ago, when the province and its two union-like doctors’ federations negotiated a list of permitted charges.

For example, Quebec doctors are allowed to charge $10 to cover the cost of liquid nitrogen for mole removal, and topical anesthetics for minor eye wounds.

Quebec radiologists, too, have long been permitted to bill patients for MRIs and other medical-imaging scans.

Health minister Barrette and his wife, fellow radiologist Dr. Marie-Josée Berthiaume, used to run a private radiology clinic in Montreal.

In recent years, however, a widening array of physicians in private practice have been billing for a growing list of additional items and services to cover costs of specialized equipment and services.

Patients who have colonoscopies in private clinics in Quebec, for example, now pay a $600 fee on top of the fee paid to the specialist by the province’s health insurance board, the Régie d’assurance maladie du Québec – or RAMQ.

“Our clinics are here to support the public system,” Isabelle Girard, executive director of the ACMQ, told The Montreal Gazette in a story on the issue in June.

She refuted the idea that expanding the list of accessory fees would undermine medicare.

But that is exactly the argument being made by CDM, which represents hundreds of doctors across Canada.

“The Quebec government is trying to normalize, permit and regulate add-on fees, which are illegal under the Canada Health Act,” Dr. Meili told The Medical Post today from Saskatoon, where he is a family doctor.

“Their logic is backward.  They should instead be regulating and stopping these illegal activities.”

According to Dr. Meili, Quebec “could be on the hook” for the add-on fees it permits if Ottawa decides to subtract them from health care transfers.

Worse, such practices could become more widespread, further weakening Canada’s vaunted public health care system.

“Once you open the door to this, who knows,” said Dr. Meili.  “There are no firewalls, so it could drift into family medicine, where we’re already seeing things like membership fees.

“What if people started charging say $5 to make an appointment? Many studies show that even $5 can have an impact on people’s decisions in regards to their health.

“The bottom line with all of this,” added Dr. Meili, “is that fees limit access to people who have money.”