A plea for federal action on portable health benefits

“There should be no fees for medically necessary healthcare services wherever people may live in this country.” —Federal Health Minister Jean-Yves Duclos, March 10, 2023 Minister Duclos indicated that he was clawing back $82 million in federal health transfers to eight provinces over fees charged to patients in 2020 and 2021, mainly for diagnostic procedures. He also warned about future clawbacks over private clinics charging patients for virtual care. I find this ironic, in that he—and all of his predecessors—continue to ignore the fact that Quebec residents lack portable medical care in all other provinces and territories. The Canada Health Act was passed unanimously in 1984 (i.e., all Quebec MPs voted for it). Section 11 clearly stipulates that when patients are treated in another province or territory, the “host-province” rate of the physician applies, not the “home-province” rate of the patient. All provinces and territories have signed the Reciprocal Medical Billing Agreement (RMBA) to facilitate payment. However, Quebec has refused to sign, and pays only its own rates. Few MDs in other parts of Canada will accept a Quebec health card. Some even refuse to see non-urgent Quebec patients. Read: Federal-provincial funding agreement needs to support doctors Quebec patients in hospitals must be seen and treated, lest the college of physicians and surgeons accuse a physician of “professional misconduct.” Yet after they leave for home, many of these patients never pay the treating surgeon or internist, even though the Quebec government is not on most doctors’ list of preferred charities! Most office-based doctors therefore demand upfront payment and leave the patient to obtain partial reimbursement from the Quebec government. This may take months. This occurs in three situations: Patients from West Quebec who see a physician in Ottawa, Pembroke, Hawkesbury, etc. Quebec patients who need urgent medical or surgical treatment in another part of Canada Quebec patients who move permanently to another province or territory, and for the first three months are covered only by a Quebec health card that few MDs will accept. For many decades, this problem has been ignored by prime ministers and federal health ministers of all political stripes. Read: A solution for Canada’s healthcare shortage Note that Prime Minister Justin Trudeau and Health Minister Duclos both represent Quebec ridings. I find it surprising that they remain so unconcerned about the major gap in the public health coverage of other Quebecers when they venture outside their province to another part of Canada. Of interest is that Trudeau for several years has actually been a legal resident of Ontario. He voted in Ottawa, and almost certainly has a portable OHIP card. He obviously has no concerns around medical coverage in Ontario and most of Canada (except possibly Quebec) for himself and his family. Quebec has always maintained that healthcare delivery was under provincial jurisdiction. Yet if a patient is treated in another province, which province now has jurisdiction: that of the patient or that of the treating physician? If the Quebec government remains intransigent and refuses to sign the RMBA, plan B would be for Ottawa to pay non-Quebec physicians directly, as it does for refugee and federal prisoners. The summer travel season is coming. Some Quebecers may visit another part of Canada. West Quebec residents may be unable to find a family physician close to home or wish to see a specialist in Ottawa. A Quebecer may move to another province and in the first three months need to have prescriptions refilled or diagnostic tests done. In addition, fully portable medical benefits would give Quebecers more to lose should there be another referendum. If the Parti Quebecois (now 18% in the polls) should win over the QS party of Francois Legault, they are committed to holding a referendum in its first mandate. Last month, a Leger poll put sovereignty at 38%—up 6% from a year ago. (See Peter Black's column, Sherbrooke Record, March 20, 2023.) It is time for Duclos to translate his words into prompt, concrete action. I urge him to demonstrate political will on behalf of his constituents and meet with his counterpart, Quebec Health Minister Christian Dube, so that their medical benefits are fully portable. This will be fair to Quebec patients, who will no longer feel like “second-class citizens” in their own country. It will also assure fair, prompt payment to MDs in the rest of Canada who may be asked to treat them. 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 expressed here are his own.

A plea for federal action on portable health benefits

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