January 26, 2017
Charlie Fidelman, Montreal Gazette
Quebec Health Minister Gaétan Barrette announced Wednesday that he’s carved out an 11th-hour deal with doctors, dental surgeons and pharmacists over the ban on medical accessory fees that comes into effect Thursday.
The province’s two main physicians federations cautioned that there’s still no global agreement on out-of-pocket fees that patients once paid, and there will be negative consequences for services.
Nonetheless, Barrette warned that doctors who contravene the ban could face sanctions.
Under the ban, extra medical fees will be illegal for services covered by the Régie de l’assurance maladie du Québec, which administers the public health and prescription drug insurance plans and remunerates health professionals. That includes, for example, fees related to eye examinations, vasectomies, colonoscopies, mammograms and childhood vaccinations.
Talking to reporters in Quebec City, Barrette said he has secured deals on a wide range of services, including surgeons doing pediatric dental surgery, and doctors performing vasectomies.
“For optometrists, dentists and pharmacists, things are resolved. There will be no problem regarding access,” he said. Certain problems that led to cuts in services have been fixed “for all intents and purposes.”
Ultrasounds were never considered extra fees, he noted. Previously, the diagnostic scans were not insured services covered by RAMQ, and now they are included, he said.
For the rest, “there are still technical discussions on certain elements at the table, but things are going well,” Barrette said.
Barrette has come under heavy criticism for abolishing fees in January without first reaching agreements with doctors and allocating more resources to hospitals to pick up the patient load as private clinics stop providing certain tests and services.
Last month gastroenterologists stopped performing colonoscopies in their private clinics, radiologists cancelled ultrasound appointments, and pharmacists discontinued blood tests. Recently, children’s clinics in Montreal stopped vaccinating kids over the fee dispute — about $10 a shot for vaccinations — causing a back up of two months at some local health clinics.
An injection of $21 million into 18 hospital operating rooms in the public system should make up for the shortfall of services in the private sector, Barrette said.
But the debacle of parents getting turned away from doctors’ clinics when seeking timely vaccines for their children, well, “that’s a side effect from the bill, which people wanted,” Barrette said. “Because of pressure to implement this bill prohibiting user fees, parents will have to go a CLSC to get a vaccine.”
The issue might be revisited in the future to allow vaccines in a physician’s office, he said. “Today it is not possible.”
But Parti Québécois health critic Diane Lamarre said she’s stunned by a situation brought on by Barrette’s “indifference” that she said, “is bordering on negligence.” The Health Minister didn’t want to end extra medical fees, she noted, but had to act because of pressure from Ottawa.
Barrette had ample time since summer to secure agreements with the province’s doctors, yet patients are now scrambling for appointments for diagnostic tests for major ailments, she said, including colon and breast cancer.
“It’s inconceivable this is happening,” she said. “It’s scandalous.”
But Lamarre also blamed physicians. The battle over remuneration and subsequent delays in medical services — that is a fight of the “privilégiés” or elites, she said.
“We have professionals who are very well paid in our system and at a certain point you have to ensure essential services,” she said. Depriving children of vaccines over a $10 fee is unethical, she said. “That service is a priority, it should be offered and it’s non-negotiable.”
Lamarre also said she’s extremely worried that Barrette is still negotiating compensation with the medical professionals.
“Will he again give (doctors) raises on top of raises? It’s hard to understand,” Lamarre said. “What’s certain is that there’s enough money in the doctors’ remuneration, with average annual increases of nine per cent since 2007.”
While the doctors and the government fight over fees, patients continue to be pawns and hostages, said Maurice Dupont, director of the seniors’ group Réseau FADOQ.
“While they are negotiating in public, patients aren’t getting — or are threatened with not getting — services to which they are entitled, and their health is at risk,” he said.
The province’s two main physicians federations remained largely silent following Barrette’s announcement.
Quebec’s medical specialists’ federation had warned last week that without fee agreements, private clinics will be hamstrung once the ban on medical accessory fees comes into effect. On Wednesday a federation official said nothing has changed — there is no agreement.
Jean-Pierre Dion, director of communications for the Fédération des médecins omnipraticiens du Québec, said the issue is too complicated to call it an agreement, when asked about the deal announced by Barrette.
“Given the elements we have on hand right now, there will be a negative impact on the accessibility of many services tomorrow (Thursday),” he said.
The family physicians are expected to clarify their position at a press conference early Thursday.
Caroline Plante of the Montreal Gazette contributed to this report