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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Canada’s recent economic growth performance has been awful

Published on December 16, 2025

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From the Fraser Institute

By Ben Eisen and Milagros Palacios

Recently, Statistics Canada released a revision of its calculations of Canada’s gross domestic product (GDP) in recent years. GDP measures the total production in an economy in a given year, and per-person GDP is widely accepted by economists as one of the most useful metrics for assessing quality of life. The new estimate places Canada’s GDP for 2024 at 1.4 per cent larger than previously reported.

By the standards of these sorts of revisions—which are usually quite small—the recent update is significant. But make no mistake, the new numbers do not change the fundamental story of Canada’s economic performance, which has been one of historically weak growth and stagnant living standards for an unusually long stretch of time.

Let’s get into the numbers (all adjusted for inflation, in 2017 dollars) with some historical perspective. The new figures put Canada’s per-person GDP estimate for 2024 at $59,529. By comparison, in 2019 per-person GDP was slightly higher at $59,581. This means there has been no progress at all in Canadian living standards as measured by per-person GDP over the past five years. Even with the revision, five years of flat living standards is an extraordinary result.

This is historically anomalous. From 2000 to 2018—a period that was itself not especially strong by the standards of earlier decades—per-person GDP still grew at a compounded annual rate of just under one per cent. In the 1990s, growth was faster still at roughly 1.8 per cent annually. In both periods, living standards were rising meaningfully, even if the pace varied. The fact that they have completely stagnated for five years is alarming, even if our GDP numbers aren’t quite as bleak as we believed a few weeks ago.

Some pundits determined to view all economic data through a political lens have emphasized that under the new revisions, the overall rate of per-person growth during Justin Trudeau’s time as prime minister is now approximately the same as what occurred during Stephen Harper’s tenure.

However, this is more relevant as a political talking point than an economic insight. The historical data show that at an average annual growth rate of just 0.5 per cent, the Canadian economy’s performance under Harper was weak by long-term standards. This is something that Trudeau himself recognized when he first sought high office, criticizing the Harper government for “having the worst record on economic growth since R.B. Bennett in the depths of the Great Depression.”

Trudeau was right back then that Canadian economic growth during the Harper era was historically weak. As such, a revision showing that Canada’s slow growth has approximately continued for the past decade is hardly cause for celebration. It simply underscores that both governments presided over a long period of weak productivity growth and very slow improvements in living standards—and that in recent years even that sluggish growth has given way to complete stagnation.

Of course, an upward revision to recent GDP calculations is welcome news, but it must not be allowed to distract policymakers or the public from the reality of Canada’s severe long-term growth problem, which in recent years has gone from bad to worse.

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Charitable giving on the decline in Canada

Published on December 16, 2025

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From the Fraser Institute

By Jake Fuss and Grady Munro

There would have been 1.5 million more Canadians who donated to charity in 2023—and $755.5 million more in donations—had Canadians given to the same extent they did 10 years prior

According to recent polling, approximately one in five Canadians have skipped paying a bill over the past year so they can buy groceries. As families are increasingly hard-pressed to make ends meet, this undoubtedly means more and more people must seek out food banks, shelters and other charitable organizations to meet their basic necessities.

And each year, Canadians across the country donate their time and money to charities to help those in need—particularly around the holiday season. Yet at a time when the relatively high cost of living means these organizations need more resources, new data published by the Fraser Institute shows that the level of charitable giving in Canada is actually falling.

Specifically, over the last 10 years (2013 to 2023, the latest year of available data) the share of tax-filers who reported donating to charity fell from 21.9 per cent to 16.8 per cent. And while fewer Canadians are donating to charity, they’re also donating a smaller share of their income—during the same 10-year period, the share of aggregate income donated to charity fell from 0.55 per cent to 0.52 per cent.

To put this decline into perspective, consider this: there would have been 1.5 million more Canadians who donated to charity in 2023—and $755.5 million more in donations—had Canadians given to the same extent they did 10 years prior. Simply put, this long-standing decline in charitable giving in Canada ultimately limits the resources available for charities to help those in need.

On the bright side, despite the worrying long-term trends, the share of aggregate income donated to charity recently increased from 0.50 per cent in 2022 to 0.52 per cent in 2023. While this may seem like a marginal improvement, 0.02 per cent of aggregate income for all Canadians in 2023 was $255.7 million.

The provinces also reflect the national trends. From 2013 to 2023, every province saw a decline in the share of tax-filers donating to charity. These declines ranged from 15.4 per cent in Quebec to 31.4 per cent in Prince Edward Island.

Similarly, almost every province recorded a drop in the share of aggregate income donated to charity, with the largest being the 24.7 per cent decline seen in P.E.I. The only province to buck this trend was Alberta, which saw a 3.9 per cent increase in the share of aggregate income donated over the decade.

Just as Canada as a whole saw a recent improvement in the share of aggregate income donated, so too did many of the provinces. Indeed, seven provinces (except Manitoba, Nova Scotia and Newfoundland and Labrador) saw an increase in the share of aggregate income donated to charity from 2022 to 2023, with the largest increases occurring in Saskatchewan (7.9 per cent) and Alberta (6.7 per cent).

Canadians also volunteer their time to help those in need, yet the latest data show that volunteerism is also on the wane. According to Statistics Canada, the share of Canadians who volunteered (both formally and informally) fell by 8 per cent from 2018 to 2023. And the total numbers of hours volunteered (again, both formal and informal) fell by 18 per cent over that same period.

With many Canadians struggling to make ends meet, food banks, shelters and other charitable organizations play a critical role in providing basic necessities to those in need. Yet charitable giving—which provides resources for these charities—has long been on the decline. Hopefully, we’ll see this trend turn around swiftly.