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Quebec abandons health care reform

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The Quebec government had the opportunity to be the first province to enact meaningful reform in health care, but instead it got cold feet.

By cancelling its planned $25 user fee for seeing a doctor, Quebec caved in to special interest groups that refuse to acknowledge the necessity of changing how we pay for health care in this country.

Quebec Finance Minister Raymond Bachand, acknowledging in his budget speech earlier this year that Quebec's health care system is in serious financial trouble, proposed two new measures: the $25 user fee for seeing a doctor, and a new health tax applied to all Quebec taxpayers.

User fees are common in the health insurance systems of virtually all other industrialized nations that have universal access to medical services. In fact, Canada is one of only five OECD countries that does not require some form of patient cost-sharing for health care services.

Since Quebecers -- and all Canadians -- pay for health care through their taxes, there is no incentive to control the amount (and type) of health care services they consume. And the lack of that "price at the point of service" inevitably leads to excessive demands for medical services.

But as government health care spending continues to consume a larger amount of its revenues, the provincial government will eventually be forced to either increase current taxes, introduce new taxes, or cut back the medical services it currently provides, none of which is good for patients and taxpayers generally. Quebec must put a stop to relying on this paying-more-and-getting-less-in-return' approach to funding health care.

As to Bachand's second item, according to news reports, the government is moving ahead with the proposed health tax, which will do nothing to tame health care spending, as it is not linked to the cost of care or a person's past or potential use of medical services. It is also not connected to health care demand and, consequently, will have no effect on current or future costs.

Ontario introduced a similar tax in 2004 called the Ontario Health Premium, which is also not linked to health care consumption and which has done nothing to improve the sustainability of government health care spending. Research shows that health care in Ontario is projected to consume 50 per cent of provincial revenues by 2014.

The real solution to Quebec's health care woes is to make people responsible for a portion of the health care services they use and the proposed user fee does just that. Its introduction would both create the necessary incentives for individuals to make reasonable choices when using medical services and reduce demand for unnecessary care. In addition, it would improve the allocation of medical resources because the supply of medical services would be determined by consumer demand.

The idea of requiring patients to pay a small user fee at the point of service until a determined deductible limit has been reached is not exclusive to Quebec. In fact, most European countries have some form of cost-sharing at the point of service, and many of those countries' citizens have superior access to a higher quality of care than do Canadians.

The primary resistance to cost sharing for medically necessary services in Canada is the belief that low-income individuals would be deterred from using health care services to the detriment of their health. The underlying assumption is that the rich would have access to high-quality health care while the poor would not, and the health of low-income families would suffer as a result.

The results, however, of the RAND Health Insurance Experiment -- a seminal study on the effects of cost sharing for medical services on health care utilization and health outcomes -- indicates that such criticisms are mostly groundless. Moreover, in many European countries that have cost- sharing mechanisms, low-income individuals are exempt from paying user fees. There is no reason that Quebec, and ultimately other Canadian provinces, could not introduce a health deductible from which low-income individuals or families (determined by means-testing) would be exempt. Likewise, patients with chronic health conditions such as high blood pressure and diabetes could be excused from paying a user fee.

A health tax is a step backward for Quebec. Real reform and improvement in health care delivery will result from the rational proposal to introduce health user fees. Now is not the time for Quebec's government to get cold feet.

Mark Rovere is associate director, Health Policy Research Centre, Fraser Institute.

Republished from the Winnipeg Free Press print edition September 27, 2010 A14

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