No to extra billing for health services - Letter to the Editor from Dr. Yun Jen
Thursday 24 September 2015
In a few days, or even a few hours, the Québec government will hastily and unilaterally adopt a set of amendments to Bill 20 to legalize the fees charged to patients in clinics for insured services, commonly called “incidental charges”. These amendments will modify Québec’s health insurance.
The discussion being proposed by the Québec Medical Association (QMA) is not about questioning the government’s right to determine what is and is not covered by the Québec health insurance plan. This action falls under its competence and it can decide at any time whether a fee will be covered or not. What the QMA is highlighting is the concept introduced by the Health Minister’s proposals that challenges universal access to medically necessary health care, regardless of the ability to pay, thereby eroding health care coverage. This new approach being proposed by the Minister seems dangerously close to an introduction of user fees, or extra billing, which is in total opposition to the principle of a universal health insurance system.
As set out in the Chicoine report in 2007, the QMA considers that extra billing for incidental charges points to the underfunding of private practices. But it is unacceptable for patients to be billed for incidental charges to make up for underfunding of the technical support centre and office expenses. The QMA suggests that compensation for the technical component should be increased in order to cover the real operating costs.
There seems to be some confusion in this debate – which lacks transparency and has failed to consult the individuals affected by the fees, that is, the patients themselves – and it is distancing the main stakeholders from the real problem linked to incidental charges. With the amendments it plans to introduce, the government is setting up a two-tier system and piecemeal privatization of the health care system, to the detriment of the patients who are supposed to be covered by their health insurance.
The issue is cause for concern because it undermines one of the pillars of Québec society: free access to medically required health care. And for this reason, the QMA feels it must be discussed in a public, open debate.