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Diving into the waters of Quebec extra-billing

The government of Quebec is taking the eminently sensible – and legally mandated – step of abolishing extra-billing for publicly insured medical services.

Good news! But there's a problem: the changes won't take effect until early next year, and nobody really knows how much in extraneous fees is being charged in the province. How is that possible? Overbilling has been a hot-button issue for the better part of four decades.

Depending on whom you talk to, Quebec's doctors are charging patients $50-million to $90-million a year in added fees. Earlier this year, the provincial auditor-general said the Quebec government's own estimates ($83-million) don't seem to be based in verifiable fact. One Montreal-based lawyer is suing the province over extra fees. He says Quebec is Canada's worst offender; he may be right, but who really knows? The Canada Health Act forbids extra-billing, but successive federal governments have mostly treated it with impunity.

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At least Dr. Gaëtan Barrette opted to ban fees outright rather than apply his initial prescription – to pay practitioners an equivalent additional amount out of provincial coffers. Two years ago, he leaped into politics, and has brought about a series of deep reforms. (His many critics think he's a bully and a demagogue.) Probably his hand has been forced by ongoing litigation and federal Health Minister Jane Philpott.

Reportedly, Dr. Philpott wrote to her counterpart earlier this month, intimating Ottawa would start withholding transfer payments if extra-billing is not addressed. Now Dr. Barrette is making the typical spluttering noises about Ottawa invading provincial jurisdiction and claiming credit.

In recent years, the provinces have tended to treat the federal Health Department as a cash machine; the extra-billing skirmish may end up being part of a broader negotiation over a likely reduction in federal transfers.

Let's hope Quebec's decision, and Dr. Philpott's role in it, signal a new era of robust federal defence of publicly funded medicare.

With the British Columbia Supreme Court hearing arguments this week in a case that challenges some key pillars of the Canada Health Act, such robustness is needed.

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