Quebec’s refusal to sign medical agreement leaves Quebeckers at risk

Opinion: Most Canadians take for granted that should they require urgent medical care in another province, that all costs will be covered. Unfortunately, this still does not apply to residents of Quebec, nor to Canadians from other provinces who need physician care in Quebec

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“I was kind of in shock. Normally you’d do the surgery and figure out the billing afterward. I would wake up in the middle of the night screaming in pain.” – patient Patrick Belanger

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As COVID restrictions lessen, Canadians are now beginning to travel to other parts of their country. Most take for granted that should they require unexpected, urgent medical or surgical care in another province, that all costs will be covered. Unfortunately, this still does not apply to residents of Quebec nor to Canadians who need physician care in Quebec.

Consider the recent case of Patrick Belanger, an economics student at Bishop’s University, who fell on June 10 at Sun Peaks. He struck his face on a boulder, was taken to the Royal Inland Hospital in Kamloops, and was found to have mandibular and facial fractures. He was sent home on Percocet, but returned the next morning.

The first surgeon refused to operate because Belanger has Quebec medicare. He was advised to fly back to Quebec for the required treatment.

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Belanger’s parents flew to B.C. to assist him. His father stated, “We were baffled about his basic rights as a Canadian.” His mother added, “It’s gross incompetence on the part of the hospital and a failure on the part of the Canadian health-care system.”

He remained in severe pain until a second surgeon, Bob Rishiraj, operated a week later. He stated: “I think a patient is a patient and it doesn’t matter if they’re from Quebec, Ontario, or wherever.”

As thousands of Quebecers have discovered, when seeking health care in other parts of Canada, they may be treated as second-class citizens.

Prime Minister Justin Trudeau in recent mandate letters to incoming health ministers stressed the need to enforce the prohibition on “extra-billing” but failed to mention enforcing the portability provision of the Canada Health Act. Sadly, over the years all Quebec and federal health ministers and Canadian prime ministers of different political stripes have ignored this issue.

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Section 11 of the Canada Health Act clearly states that a physician treating a patient from another province is to be paid at the host province rate not the rate of the home province of the patients. All provinces and territories except Quebec have signed the Reciprocal Medical Billing Agreement which permits a physician to bill their own province’s Ministry of Health. The physician’s province then collects from the province of the patient.

However, Quebec has refused to sign.

Belanger paid Rishiraj $2,563 out-of-pocket. It remains to be seen how much he is reimbursed by the Quebec government.

In the late 1980s, Quebec fees were the lowest in Canada. Now they are among the highest, as Quebec MDs enjoy the third-highest gross incomes of any province.

Quebec residents should no longer face financial impediments to obtaining medical care wherever they are in Canada. Residents of British Columbia and other provinces should also be assured that they will not face out-of-pocket costs if they become ill while vacationing in Quebec.

Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is past chair of the section on general internal medicine of the Ontario Medical Association. The views here are his own.

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