Dual-track system could wreck havoc with health care

Montreal doctor Jacques Chaoulli is billing himself as the “middle man” between patients and doctors with his medical brokering system, the first of its kind in Quebec. This system will allow patients speedier access to doctor consultations and therapeutic, surgical and diagnostic procedures, both in the public and private sectors. The Chaoulli Group will allow patients to access a physician within a week – without having to go on a waiting list – at a cost of $150 a year, plus $20 per consultation.
Right now, it is illegal for physicians working in the public system to directly charge patients for medical services that are already provided under Medicare. Chaoulli contends that, by acting as a middle man, his group would still be acting according to the law.
“What the Canada Health Act says is that when the service is provided on behalf of a third party, then it is not covered under the public regime,” he said. “So a public doctor might provide the care under a private regime.”
In this case, the third organization would be Chaoulli’s company.
It’s already happening, according to Chaouilli, and cites the Société de l’assurance automobile du Québec (SAAQ), which sometimes covers the medical costs of patients injured in car accidents.
Maria Peluso, a Public Policy professor at Concordia University, said she worries this will give priority health care access to those who can afford it, at the expense of those who can’t. “This goes against the public interest by creating divisions in society. It is an erosion of the health care system,” she said. “I find it is morally reprehensible to profit on health care.”
She thinks Chaoulli’s case will probably end up in court. “We do need a decision on this because this will direct government policy because such a decision is in the public interest.”
It is not the first time Chaoulli has challenged the Quebec health care system. In 2005, after trying and failing to set up a private hospital in Quebec, he called on the Supreme Court to lift Quebec’s ban on private medical insurance. Chaoulli won when the Supreme Court ruled that the Quebec government cannot prevent people from paying for private insurance for certain health care procedures covered under Medicare.
This could create an unjust parallel health system said Denise Boucher, Vice President of the CSN (Confederation of National Unions) which represents almost all Quebec unions. She explains that this won’t fix the real problem that the health system is facing: access. “We need to work on our health system and regroup activities where there are long waiting lists in clinics and specialized public centres, but we have to keep the system public and with universal access, instead of implanting a group like Chaoulli’s,” she said. “This group will probably entice doctors in the public system to work in the private one,” she fears.
Maude Barlow, author of several books on Medicare, agrees. “What [his group] will do is take the limited number of technicians, doctors and health care officials that we have in the public system and [move] them to the public one,” she said.
Chaolli counters this by saying he is setting up parameters to ensure that doctors do not abandon the public system to work in his organization. “I have a commitment from the public doctors. Only those who are not overbooked can participate with the Chaoulli group. The group would monitor the doctors to ensure the public system is not damaged.”
He hasn’t explained how he will do this.
Boucher said it is impossible to tell how much a group like Chaoulli’s rates will rise in the long term. “In the spring [Chaoulli] said he would charge $40 per year. Now he wants $150, plus people will have to pay $20 every time they get an appointment, plus if it is a doctor that is in the private health system the patient will have to pay even more,” she said.
“People will pay a lot, while creating a parallel system that will make health care even more inaccessible. This is a very bad choice.”
Sean Starksmen, a political science student at Concordia, said that this project will probably marginalize the poorest members in Quebec’s society. He also thinks health services should be provided by the province.
“I personally wouldn’t pay and I don’t see why the Quebec government can’t organize itself so that we don’t have to pay, since we already pay the highest taxes in Canada.”
Barlow said the government should not only work to improve the public health care system, but also protect it. “We need strong regulations to guard our public health care system. Anybody trying to manipulate the system should be penalized.”