Government meddling contributes to doctor exodus in Quebec

They have not left Quebec’s health-care system but rather have opted out of the province’s publicly-financed framework to provide care to their patients privately.

Quebec’s health minister recently came under fire after reports revealed a record number of physicians left the province’s public system to practise privately. Less discussed are the reasons why physicians made this choice.

Indeed, it turns out that ill-conceived attempts to protect publicly-funded health care by the Trudeau government and successive provincial governments may have contributed to the increasing numbers of physicians opting-out.

To be clear, the 780 physicians in question account for about four per cent of physicians in the province. However, this represents a 22 per cent increase in the number of physicians leaving the public system compared to the previous year—and is part of a growing trend. More importantly, they have not left Quebec’s health-care system but rather have opted out of the province’s publicly-financed framework to provide care to their patients privately.

Why?

One reason, is because governments have forced them to do so.

Until recently, physicians in Quebec (including those who practiced in the public sector) were allowed to charge patients so-called “accessory-fees” in certain instances—for example, if the service was either not covered or insufficiently reimbursed by the government’s fee schedule.

However, the federal Canada Health Act (CHA) clearly states that “extra-billing” of this nature, when charged by physicians who also bill the public system, must result in dollar-for-dollar deductions in federal health-care transfer payments to the province. In other words, the CHA encourages provincial efforts to effectively force doctors to choose between the public and private system if any out-of-pocket expenses are involved.

And so, under financial threat by the Trudeau government, Quebec eventually clamped down on such fees charged by physicians who worked in the public system.

Consequently, physicians who relied on these payments to cover a portion of their operating costs faced an unfortunate choice—stay in the public system at the risk of financial ruin or opt-out entirely and practise exclusively in the private sector.

For many, the choice was obvious. One study found that by 2019 “an additional 69 specialist physicians opted out after the 2017 clampdown on double billing [sic] than previous trends would have predicted.” Several clinics offering endoscopy and colonoscopy services simply closed their doors. Quebecers also ended up with a less convenient health-care experience following this clamp down, as evidenced by the reduction in clinic-provided services that followed.

This attitude to extra-billing stands in stark contrast to the situation in other universal health-care countries such as Australia where consultations with specialists are usually only partially (85 per cent) covered by the universal plan. In fact, physicians (family doctors and specialists) can generally set fees above the government’s fee schedule so long as they forgo the convenience of directly billing the government (i.e. patients claim reimbursement after the fact). Notably, Australia’s health-care system costs less than Canada’s in total (including these private payments) yet delivers more rapid access to health-care services with a greater availability of medical professionals, hospital beds, and diagnostic and surgical technologies.

More generally, a recent study found 22 of 28 universal health-care countries require patients to share a portion of the cost of treatment (with generous protections for vulnerable groups). These include deductibles (an amount individuals must pay before insurance coverage kicks in), co-insurance payments (the patient pays a certain percentage of treatment cost) and copayments (the patient pays a fixed amount per treatment). Crucially, many of these countries including Australia, Germany, the Netherlands and Switzerland also have shorter wait times than we endure.

In these countries, physicians are also generally allowed to practise both in publicly-funded universal settings and private settings (a policy known as “dual practice”) rather than having their activities restricted to one setting only. In other words, Canada’s federal restrictions on cost-sharing and extra-billing (such as Quebec’s accessory fees) and provincial barriers to dual-practice place our universal system in the minority of a small cohort of countries that are not particularly known for stellar performance.

The looming threat of further reductions in federal cash transfers, under the CHA, has led to provinces such as Quebec imposing increasingly restrictive conditions on physicians in the public system. And in response, physicians—by opting-out—are indicating that they’ve had enough.

It’s ironic that the very groups intent on supposedly “protecting public health care” by forcing physicians to choose between the public and private systems have enforced policies that may very well lead to the public system’s continued demise.

Authors:

Bacchus Barua and Yanick Labrie

Related Topics:#BacchusBarua #FraserInstitute #YanickLabrie PublicVSPrivateHealthCare QuebecDoctorExodus QuebecHealthCare

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Carney government should privatize airports—then open airline industry to competition

Published on December 3, 2025

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From the Fraser Institute

By Alex Whalen and Jake Fuss

This holiday season, many Canadians will fly to spend time to with family and friends. But air travellers in Canada consistently report frustration with service, cost and choice. In its recent budget, the Carney government announced it will consider “options for the privatization of airports.” What does this mean for Canadians?

Up until the 1990s, the federal government served as both the owner and operator of Canada’s major airports. The Chrétien government partially privatized and transferred the operation of major airports to not-for-profit airport authorities, while the federal government remained the owner of the land. Since then, the federal government has effectively been the landlord for Canada’s airports, collecting rent each year from the not-for-profit operating authorities.

What would full privatization of airports look like?

If the government allows private for-profit businesses to own Canada’s major airports, their incentives would be to operate as efficiently as possible, serve customers and generate profits. Currently, there’s little incentive to compete as the operating authorities are largely unaccountable because they only report to government officials in a limited form, rather than reporting directly to shareholders as they would under privatization. Private for-profit airports exist in many other countries, and research has shown they are often less costly for passengers and more innovative.

Yet, privatization of airports should be only the first step in a broader package of reforms to improve air travel in Canada. The federal government should also open up competition by creating the conditions for new airports, new airlines and new investment. Currently, Canada restricts foreign ownership of Canadian airlines, while also restricting foreign airlines from flying within Canada. Consequently, Canadians are left with little choice when booking air travel. Opening up the industry by reversing these policies would force incumbent airlines to compete with a greater number of airlines, generating greater choice and likely lower costs for consumers.

Moreover, the federal government should reduce the taxes and fees on air travel that contribute to the cost of airline tickets. Indeed, according to our recent research, among peer countries, Canada has among the most expensive air travel taxes and fees. These costs get passed on to consumers, so it’s no surprise that Canada consistently ranks as a very expensive country for air travel.

If the Carney government actually privatizes Canada’s airports, this would be a good first step to introducing greater competition in an industry where it’s badly needed. But to truly deliver for Canadians, the government must go much further and overhaul the numerous policies, taxes and fees that limit competition and drive up costs.

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Ottawa’s gun ‘buyback’ program will cost billions—and for no good reason

Published on December 2, 2025

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From the Fraser Institute

By Gary Mauser

The government told Cape Bretoners they had two weeks to surrender their firearms to qualify for reimbursement or “buyback.” The pilot project netted a grand total of 22 firearms.

Five years after then-prime minister Justin Trudeau banned more than 100,000 types of so-called “assault-style firearms,” the federal government recently made the first attempt to force Canadians to surrender these firearms.

It didn’t go well.

The police chief in Cape Breton, Nova Scotia, volunteered to run a pilot “buyback” project, which began last month. The government told Cape Bretoners they had two weeks to surrender their firearms to qualify for reimbursement or “buyback.” The pilot project netted a grand total of 22 firearms.

This failure should surprise no one. Back in 2018, a survey of “stakeholders” warned the government that firearms owners wouldn’t support such a gun ban. According to Prime Minister Carney’s own Privy Council Office the “program faces a risk of non-compliance.” And federal Public Safety Minister Gary Anandasangaree was recently recorded admitting that the “buyback” is a partisan maneuver, and if it were up to him, he’d scrap it. What’s surprising is Ottawa’s persistence, particularly given the change in the government and the opportunity to discard ineffective policies.

So what’s really going on here?

One thing is for certain—this program is not, and never has been, about public safety. According to a report from the federal Department of Justice, almost all guns used in crimes in Canada, including in big cities such as Toronto, are possessed illegally by criminals, with many smuggled in from the United States. And according to Ontario’s solicitor general, more than 90 per cent of guns used in crimes in the province are illegally imported from the U.S. Obviously, the “buyback” program will have no effect on these guns possessed illegally by criminals.

Moreover, Canadian firearms owners are exceptionally law-abiding and less likely to commit murder than other Canadians. That also should not be surprising. To own a firearm in Canada, you must obtain a Possession and Acquisition Licence (PAL) from the RCMP after initial vetting and daily monitoring for possible criminal activity. Between 2000 and 2020, an average of 12 PAL-holders per year were accused of homicide, out of approximately two million PAL-holders. During that same 10-year period, the PAL-holder firearms homicide rate was 0.63 (per 100,000 PAL-holders) compared to 0.72 (per 100,000 adult Canadians)—that’s 14 per cent higher than the rate for PAL-holders.

In other words, neither the so-called “assault-style firearms” nor their owners pose a threat to the public.

And the government’s own actions belie its claims. If these firearms are such a threat to Canadians, why slow-roll the “buyback” program? If inaction increased the likelihood of criminality by law-abiding firearms owners, why wait five years before launching a pilot program in a small community such as Cape Breton? And why continue to extend the amnesty period for another year, which the government did last month at the same time its pilot project netted a mere 22 firearms?

To ask those questions is to answer them.

Another question—how much will the “buyback” program cost taxpayers?

The government continues to block any attempt to disclose the full financial costs (although the Canadian Taxpayers Federation has launched a lawsuit to try to force the government to honour its Access to Information Act request). But back in 2020 the Trudeau government said it would cost $200 million to compensate firearms owners (although the Parliamentary Budget Officer said compensation costs could reach $756 million). By 2024, the program had spent $67.2 million—remember, that’s before it collected a single gun. The government recently said the program’s administrative costs (safe storage, destruction of hundreds of thousands of firearms, etc.) would reach an estimated $1.8 billion. And according to Carney’s first budget released in November, his government will spend $364 million on the program this fiscal year—at a time of massive federal deficits and debt.

This is reminiscent of the Chretien government’s gun registry fiasco, which wound up costing more than $2 billion even after then-justice minister Allan Rock promised the registry program would “almost break even” after an $85 million initial cost. The Harper government finally scrapped the registry in 2012.

As the Carney government clings to the policies of its predecessor, Canadians should understand the true nature of Ottawa’s gun “buyback” program and its costs.