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Quebec drops plan for $25 user fee for doctors' visits

Premier Jean Charest looks on during a news conference at the National Assembly in Quebec City on Aug. 24, 2010.

MATHIEU BELANGER/Reuters

The Quebec government has retreated from a controversial move to introduce a $25 user fee for doctors' visits, acknowledging that the proposal had met with broad opposition.

Finance Minister Raymond Bachand said that while user fees exist in countries around the world, Quebeckers were simply not ready to accept it.

The $25-per-visit proposal was being watched by decision-makers across Canada in the face of rising health-care costs. While some saw Quebec's move as politically gutsy, others said it amounted to an assault on Canadian medicare.

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The fee, part of the Charest government's budget in March, met almost instantly with condemnation. It was denounced not only by political opponents but by groups representing physicians, nurses, patients and health administrators.

The Finance Minister said in Quebec City on Wednesday that user fees exist elsewhere and may have been a good idea, but "the culture here in Quebec is not ready for it."

The fees were to be collected through declarations on Quebeckers' provincial income-tax returns, based on their number of medical visits that year, and would have generated $500-million in revenue.

Mr. Bachand said in recent comments that while the fees might initially bring in savings, the savings might be cancelled out down the road if patients were deterred from visiting their doctor, thereby reducing prevention.

The announcement may spare the Charest government from even more political damage at a time of deep unpopularity, but it now leaves Quebec facing a budget crunch as it must seek other ways of meeting a $500-million shortfall.

The government's about-turn disappointed Claude Castonguay, a former Liberal health minister who headed a provincial government task force recommending a form of user fee and other solutions to tame Quebec health-care costs.

"I don't want to comment. I find the decision too depressing," he said in a brief telephone interview. Along with increasing revenues to finance health care, the province also has the choice of better management of the health-care system, he said.

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"You can make savings through good management and organization of the system. That's what governments don't seem to want to tackle," Mr. Castonguay said.

Gaétan Barrette, president of the Quebec Federation of Medical Specialists, said the user fee would have almost certainly prompted a legal challenge on grounds it violated the Canada Health Act. And there was no evidence that the user fee was necessary to prevent patients from abusing health care; on the contrary, Quebeckers did not have enough access to health services, he said.

Irfan Dhalla, a Toronto physician who speaks for Canadian Doctors for Medicare, welcomed the move.

"This would have set a very bad precedent and may have resulted in similar policies in other provinces," he said. "It reaffirms that most Canadians and Quebeckers believe that health care should be available based on need and not an ability to pay."

The government announcement does not affect a separate health premium that kicks in this year and is set to rise to $200 a person by 2012; low-income earners are exempted.

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About the Author

Ingrid Peritz has been a Montreal-based correspondent for The Globe and Mail since 1998. Her reporting on the plight of Canadians suffering from the damaging effects of the drug thalidomide helped victims obtain federal compensation and earned The Globe and Mail a National Newspaper Award, Canadian Journalism Foundation award, and the Michener Award for public service. More

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