News  Quebec budget implements new health care fees

Activists critical of Ministry of Finance's proposed "user fee"

The provincial budget presented two weeks ago by the governing Parti Libéral du Québec (PLQ) is being criticized by proponents of public health care for the new fees it proposes.

The budget calls for two new fees to cover the increasing costs of the province’s health care system: a “health deductible,” criticized for resembling a user fee, and a “health contribution,” – a flat-rate fee that will be added to Quebeckers’ annual income tax bills and take effect on July 1.

The budget projects a $4.5-billion deficit for the 2010–2011 fiscal year, making Quebec the most debt-ridden province in Canada.  
The health sector accounts for over 12 per cent of Quebec’s GDP. It is the most important sector of the economy and, with 80 per cent of the population receiving health care each year, the most widely used provincial service.

Considering the debt crisis facing Quebec, and the large role of health care, minister of finance Raymond Bachand’s announcement of the Liberal government’s intention to balance the province’s budget by 2013-14 has big implications for the health care system.

First proposed in 2008, health deductibles have a dual purpose: to finance institutional growth, productivity, and efficiency within health care initiatives, and to reorient public behaviour regarding health care.

The deductibles would charge a fee for health services consumed over the course of a year. The cost would be determined based on the number of visits made to a health care provider, the monetary value of services consumed, and the income of the patient.

The deductible would be capped at one per cent of household income.

“Everybody benefits from health care; everybody should pay,” Bachand said to the Globe and Mail.

Françoise David, a member of left-wing provincial party Québec solidaire, questions that reasoning on her blog: “How can you can talk seriously about equality and justice while developing a two-tiered health-care system?”

Marie-Claude Goulet, president of Médecins Québécois pour le régime public, agreed, saying, “[One cannot] apply this principle of services. [It is] completely against all thinking of public health care.”

Bachand and others in the PLQ have asserted that the health deductible will encourage Quebeckers to make fewer unnecessary visits to their doctors – a notion Goulet rejects.

“There is a false idea that people are seeing doctors too often, as if they have a choice,” said Goulet. “[Sick] people have no choice to come; they need to come.”

Goulet’s stance reflects the view of many that the future health contribution and health deductible policies are not socially just and are in violation of the Canada Health Act of 1984.

Goulet stated that the health contribution and deductible are “forbidden under the Canada Health Act, and we hope that they will continue to be forbidden.” 
The federal government has yet to comment on the new fees. If the policies are deemed incompatible with the act, however, the revenue generated from the policies will be deducted from Quebec’s federal funding.

“Charging user fees in any way, shape, or form, no matter how you dress them up, accounts to a levy placed on people who are ill,” said Irfan Dhalla, co-chair of the Canadian Doctors for Medicare, to the Globe and Mail. “There’s no doubt that user fees violate the spirit of the Canada Health Act.”

The PLQ maintains, however, that due to the deductible nature of the new fees, as well as exemptions for low-income households, Quebec’s health system will remain progressive, public, and in accordance to the Canada Health Act.  
“Maybe it’s time Canadians sit down and examine that legislation,” Bachand said to the Globe and Mail. “The goal here is to serve our citizens and to have health services for all our citizens.”

The health contribution, much like health premiums that exist in British Columbia and Ontario, is a gradually increasing flat-rate tax that will be added into annual income taxes: $25 in 2010, $100 in 2011, and $200 in 2012.

Québec solidaire has criticized health contributions in addition to the health deductible, saying that it is a regressive policy that will result in an increased financial burden for middle-income households.

Though health contributions are fixed, the government is emphasizing the policy’s deductible nature by stating that the new fee will not be borne by lower-income households.

Responses in the media to the implementation of health contributions have been varied.

Jaques Menard, writing for the Montreal Gazette, called the budget provisions “a crucial turning point in our modern history.” He also pointed out that the new health care funding is in line with a slew of reports on the matter written over the past decade.

Sophie Cousineau, a blogger for La Presse, wrote, “The Liberal government has finally decided to act. Bravo.”

But she continued to note, “That doesn’t mean that the long-awaited decisions are the most just ones.”

While Cousineau indicates that the new health contributions are projected to generate much-needed revenue for Quebec in the amount of $945 million by 2012-13, she casts doubt on the likelihood that the policy will succeed.

“Even if the increase is ‘gradual,’ adult Quebeckers will quickly be paying $200 a year,” she commented. “Just to maintain their health care at their current, very unequal, level.”