An ambulance arrives at Ste-Eustache hospital in Ste-Eustache, Que., north of Montreal on March 4, 2009.Ryan Remiorz/The Canadian Press
Provinces need to reform their health-care systems to make them more sustainable, but they also need to be aware of the human cost. Quebec Finance Minister Raymond Bachand was consequently right to reverse course and rule out health-care user fees.
What was going to be called a health deductible would have charged Quebeckers for the "consumption of health-care services" and was projected to bring in $500-million as of 2013-14. Charges seemed likely for doctor's office or hospital visits. When mooted in the March 2010 budget, the government said that because "it would not be collected at the service outlet, but instead the following year through the income tax return," it would "not infringe on the right to health care or the principle of equality between citizens."
That claim was dubious. The University of Toronto's Mark Stabile, who has a forthcoming C.D. Howe Institute report on the subject, argues that "the evidence is pretty clear that user fees do reduce utilization across almost all incomes. For the poor, they tend to also result in worse health." At the same time, says Prof. Stabile, "exempting the poor from paying the user fees (which everyone agrees is a good idea) makes it so that the user fees don't raise much revenue."
The fundamental, foundational relationship between patient and doctor or other health-care specialist, and the right to get access to a hospital, should not be metered. Charging for this kind of access dissuades people from using the very services that can identify health problems before they become grave.
The user fees that were contemplated by Quebec would neither have improved health, nor helped the province's balance sheet. That does not mean that health care should be a funding free-for-all. Provinces looking at savings need to consider ways of reducing the demand for, and usage of, expensive procedures for the dying that may at best prolong life for a few, miserable months.
Quebec has not given up on finding ways to fund health care. It is still following the example of Alberta and Ontario and bringing in a health-care premium of up to $200 a year. It's a tax increase, but at least it is preferable to anything that puts universal health-care access at risk.