Fraser Institute
Government meddling contributes to doctor exodus in Quebec

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.
Authors:
Energy
National media energy attacks: Bureau chiefs or three major Canadian newspapers woefully misinformed about pipelines

From the Fraser Institute
These three allegedly well informed national opinion-shapers are incredibly ignorant of national energy realities.
In a recent episode of CPAC PrimeTime Politics, three bureau chiefs from three major Canadian newspapers discussed the fracas between Alberta Premier Danielle Smith and Prime Minister Mark Carney. The Smith government plans to submit a proposal to Ottawa to build an oil pipeline from Alberta to British Columbia’s north coast. The episode underscored the profound disconnect between these major journalistic gatekeepers and the realities of energy policy in Canada.
First out of the gate, the Globe and Mail’s Robert Fife made the (false) argument that we already have the Trans Mountain pipeline expansion (TMX), which is only running at 70 per cent, so we don’t need additional pipelines. This variant of the “no market case” argument misunderstands both the economics of running pipelines and the reality of how much oilsands production can increase to supply foreign markets if—and only if—there’s a way to get it there.
In reality, since the TMX expansion entered service, about 80 per cent of the system’s capacity is reserved for long-term contracts by committed shippers, and the rest is available on a monthly basis for spot shippers who pay higher rates due largely to government-imposed costs of construction. From June 2024 to June 2025, committed capacity was fully utilized each month, averaging 99 per cent utilization. Simply put, TMX is essentially fully subscribed and flowing at a high percentage of its physical capacity.
And the idea that we don’t need additional capacity is also silly. According to S&P Global, Canadian oilsands production will reach a record annual average production of 3.5 million barrels per day (b/d), and by 2030 could top 3.9 million b/d (that’s 500,000 b/d higher than 2024). Without pipeline expansion, this growth may not happen. Alberta’s government, which is already coordinating with pipeline companies such as Enbridge, hopes to see oilsands production double in coming years.
Next, Mia Rabson, Ottawa deputy bureau chief of the Canadian Press, implied that Smith’s proposal is not viable because it comes from government, not the private sector. But Rabson neglected to say that it would be foolish for any company to prepare a very expensive project proposal in light of current massive regulatory legislative barriers (tanker ban off B.C. coast, oil and gas emission cap, etc.). Indeed, proposal costs can run into the billions.
Finally, Joel-Denis Bellavance, Ottawa bureau chief of La Presse, opined that a year ago “building a pipeline was not part of the national conversation.” Really? On what planet? How thick is the bubble around Quebec? Is it like bulletproof Perspex? This is a person helping shape Quebec opinion on pipelines in Western Canada, and if we take him at his word, he doesn’t know that pipelines and energy infrastructure have been on the agenda for quite some time now.
If these are the gatekeepers of Canadian news in central Canada, it’s no wonder that the citizenry seems so woefully uninformed about the need to build new pipelines, to move Alberta oil and gas to foreign markets beyond the United States, to strengthen Canada’s economy and to employ in many provinces people who don’t work in the media.
Business
Canada has fewer doctors, hospital beds, MRI machines—and longer wait times—than most other countries with universal health care

From the Fraser Institute
Despite a relatively high level of spending, Canada has significantly fewer doctors, hospital beds, MRI machines and CT scanners compared to other countries with universal health care, finds a new study released today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.
“There’s a clear imbalance between the high cost of Canada’s health-care system and the actual care Canadians receive in return,” said Mackenzie Moir, senior policy
analyst at the Fraser Institute and author of Comparing Performance of Universal Health-Care Countries, 2025.
In 2023, the latest year of available comparable data, Canada spent more on health care (as a percentage of the economy/GDP, after adjusting for population age) than
most other high-income countries with universal health care (ranking 3rd out of 31 countries, which include the United Kingdom, Australia and the Netherlands).
And yet, Canada ranked 27th (of 30 countries) for the availability of doctors and 25th (of 30) for the availability of hospital beds.
In 2022, the latest year of diagnostic technology data, Canada ranked 27th (of 31 countries) for the availability of MRI machines and 28th (of 31) for CT scanners.
And in 2023, among the nine countries with universal health-care systems included in the Commonwealth Fund’s International Health Policy Survey, Canada ranked last for the percentage of patients able to make same- or next-day appointments when sick (22 per cent) and had the highest percentage of patients (58 per cent) who waited two months or more for non-emergency surgery. For comparison, the Netherlands had much higher rates of same- or next-day appointments (47 per cent) and much lower waits of two months or more for non-emergency surgery (20 per cent).
“To improve health care for Canadians, our policymakers should learn from other countries around the world with higher-performing universal health-care systems,”
said Nadeem Esmail, director of health policy at the Fraser Institute.
Comparing Performance of Universal Health Care Countries, 2025
- Of the 31 high-income universal health-care countries, Canada ranks among the highest spenders, but ranks poorly on both the availability of most resources and access to services.
- After adjustments for differences in the age of the population of these 31 countries, Canada ranked third highest for spending as a percentage of GDP in 2023 (the most recent year of comparable data).
- Across 13 indictors measured, the availability of medical resources and timely access to medical services in Canada was generally below that of the average OECD country.
- In 2023, Canada ranked 27th (of 30) for the relative availability of doctors and 25th (of 30) for hospital beds dedicated to physical care. In 2022, Canada ranked 27th (of 31) for the relative availability of Magnetic Resonance Im-aging (MRI) machines, and 28th (of 31) for CT scanners.
- Canada ranked last (or close to last) on three of four indicators of timeliness of care.
- Notably, among the nine countries for which comparable wait times measures are available, Canada ranked last for the percentage of patients reporting they were able to make a same- or next-day appointment when sick (22%).
- Canada also ranked eighth worst for the percentage of patients who waited more than one month to see a specialist (65%), and reported the highest percentage of patients (58%) who waited two months or more for non-emergency surgery.
- Clearly, there is an imbalance between what Canadians get in exchange for the money they spend on their health-care system.
Mackenzie Moir
Senior Policy Analyst, Fraser Institute
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