Here’s to healthy user fees
Canadians interested in greater health-care choice should thank the Quebec government for introducing a “health contribution” in last week’s provincial budget. Only Quebec could get away with a user fee without provoking Ottawa’s wrath over a potential violation of the Canada Health Act. But since user fees are necessary to break the government monopoly on health-care delivery and permit more private options, patients eager for faster treatment and better uptake of new medical technologies should welcome the move.
Many provinces charged user fees or permitted doctors to charge them for office visits until 1984 when the last Trudeau government banned the practice in the name of universal coverage. The result was an almost immediate rise in health-care consumption. In some provinces, the increase was as much as 15% in the first two years after fees were outlawed. Undoubtedly, some of this increase represented poor patients who had previously found user fees a barrier to seeking needed treatments, but the bulk of added visits were simply patients taking advantage of the new “free” care. They no longer had to decide whether they really needed to go see a doctor because not even nominal charges of $10 or $25 were permitted.
Quebec is already home to the greatest number of private clinics in the country, so perhaps it shouldn’t be surprising that it is the first province to reintroduce user fees. By degrees, Quebec is advancing the evolution of private care and rationalization of the public system in ways no other province could get away with.
By itself, the new “health contribution” — a one-time annual charge of $25 this year, rising to $200 by 2012 — will not reduce overuse of the public system. To truly tackle the problem of unnecessary office visits, Quebec will have to move quickly to its proposed per-visit charge of $25, to a maximum of $250 for 10 visits in the same calendar year.
Only a fee that patients must confront at the time of each visit will spark them to ask themselves whether seeing the doctor is necessary. And only when they are forced to face the prospect of paying for some of their care directly, will they begin to demand more private delivery choices to ensure value for their dollars.
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