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Fraser Institute

Government meddling contributes to doctor exodus in Quebec

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From the Fraser Institute

By Bacchus Barua and Yanick Labrie

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.

Business

Lower taxes will help increase living standards for Canadian families

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From the Fraser Institute

By Jake Fuss and Grady Munro

According to a new poll from RBC, nearly half (48 per cent) of Canadians can’t maintain their standard of living due to rising costs. These polling results should come as no surprise; recent research has shown that Canadian living standards are in a historic decline.

Governments across the country should take note, and immediately cut the largest expense for families—taxes.

Consider this. Gross domestic product (GDP) is the value of all goods and services produced in the economy, and is the most widely used measure of economic prosperity. And by measuring GDP on a per-person basis (and adjusting for inflation), we can track how living standards of Canadians change over time.

According to the latest data from Statistics Canada, as of September 2024, GDP per person was $58,601 compared to $59,905 in June 2019 (after adjusting for inflation). And since the fourth quarter of 2022, living standards have fallen in seven of the last eight quarters.

The driving factor behind this decline in living standards is Canada’s sluggish economic growth in recent years. Moreover, as highlighted in the poll, inflation over the last several years has left Canadians weary and struggling to cope with the elevated cost of necessities such as food and housing.

Again, if governments want to help improve living standards, they should reduce taxes and leave more money in the pockets of Canadian families.

In 2023 (the latest year of comparable data), the average Canadian family spent a larger share of its income on taxes (43.0 per cent) than on food, shelter and clothing combined (35.6 per cent). In other words, taxes are the largest single expense for Canadian families, and governments have the power to lower this expense to help families make ends meet.

Tax reductions would also benefit the overall economy and increase opportunities for workers. Across a variety of income levels ranging from $50,000 to $300,000 a year, Canadians in nearly every province face a higher combined (federal and provincial/state) personal income tax rate than Americans in virtually every U.S. state.

Of course, jurisdictions compete to attract and retain high-skilled workers such as doctors, engineers and entrepreneurs because these individuals contribute greatly to overall economic growth. By maintaining higher tax rates than U.S. states, provinces remain at a competitive disadvantage in attracting these workers. Lowering both federal and provincial income tax rates would improve Canada’s competitiveness and help increase economic growth.

A stagnant economy and rising cost of living are reducing living standards while stretching the finances of Canadian families. This budget season, governments from coast to coast should lower taxes to improve the economy and put more money back in the pockets of hard-working Canadians.

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Grady Munro

Policy Analyst, Fraser Institute
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Energy

Canada must build 840 solar-power stations or 16 nuclear power plants to meet Ottawa’s 2050 emission-reduction target

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From the Fraser Institute

By Kenneth P. Green

The federal government’s plan to eliminate greenhouse gas (GHG) emissions from electricity generation by 2050 is impossible in practical terms, finds a new study published today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

Due to population growth, economic growth and the transition to electrified transportation, electricity demand in Canada will increase substantially in coming years. “To meet existing and future electricity demand with low-emitting or zero-emitting sources within the government’s timeline, Canada would need to rapidly build infrastructure on a scale never before seen in the country’s history,” said Kenneth P.
Green, senior fellow at the Fraser Institute and author of Rapid Decarbonization of Electricity and Future Supply Constraints.

For example, to generate the electricity needed through 2050 solely with solar power, we’d need to build 840 solar-power generation stations the size of Alberta’s Travers Solar Project. At a construction time of two years per project, this would take 1,680 construction years to accomplish.

If we relied solely on wind power, Canada would need to build 574 wind-power installations the size of Quebec’s Seigneurie de Beaupre wind-power station. At a construction time of two years per project, this would take 1,150 construction years to accomplish.

If we relied solely on hydropower, we’d need to build 134 hydro-power facilities the size of the Site C power station in British Columbia. At a construction time of seven years per project, this would take 938 construction years to accomplish.

If we relied solely on nuclear power, we’d need to construct 16 new nuclear plants the size of Ontario’s Bruce Nuclear Generating Station. At a construction time of seven years per project, this would take 112 construction years to accomplish.

Currently, the process of planning and constructing electricity-generation facilities in Canada is often marked by delays and significant cost overruns. For B.C.’s Site C project, it took approximately 43 years from the initial planning studies in 1971 to environmental certification in 2014, with project completion expected in 2025 at a cost of $16 billion.

“When Canadians assess the viability of the federal government’s emission-reduction timelines, they should understand the practical reality of electricity generation in Canada,” Green said.

Decarbonizing Canada’s Electricity Generation: Rapid Decarbonization of Electricity and Future Supply Constraints

  • Canada’s Clean Electricity Regulations (Canada, 2024a) require all provinces to fully “decarbonize” their electricity generation as part of the federal government’s broader “Net-Zero 2050” greenhouse gas emissions mitigation plan.
  • Canada’s electricity demands are expected to grow in line with the country’s population, economic growth, and the transition to electrified transportation. Projections from the Canada Energy Regulator, Canadian Climate Institute, and Department of Finance estimate the need for an additional 684 TWh of generation capacity by 2050.
  • If Canada were to meet this demand solely with wind power, it would require the construction of approximately 575 wind-power installations, each the size of Quebec’s Seigneurie de Beaupré Wind Farm, over 25 years. However, with a construction timeline of two years per project, this would equate to 1,150 construction years. Meeting future Canadian electricity demand using only wind power would also require over one million hectares of land—an area nearly 14.5 times the size of the municipality of Calgary.
  • If Canada were to rely entirely on hydropower, it would need to construct 134 facilities similar in size to the Site C power station in British Columbia. Meeting all future demand with hydropower would occupy approximately 54,988 hectares of land—roughly 1.5 times the area of the municipality of Montreal.
  • If Canada were to meet its future demand exclusively with nuclear power, it would need to construct 16 additional nuclear plants, each equivalent to Ontario’s Bruce Nuclear Generating Station.
  • Meeting the predicted future electricity demand with these low/no CO2 sources will be a daunting challenge and is likely impossible within the 2050 timeframe.

Read the full study

Kenneth P. Green

Senior Fellow, Fraser Institute
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