'Rigid' checks are to oversee clinic care

QUEBEC -- The Quebec government tabled legislation yesterday expanding coverage of private health insurance to include three procedures previously covered only by the province.

The changes are in compliance with a Supreme Court of Canada ruling that ordered Quebec to lift its ban on private health insurance for basic medical services.

While the bill expands private coverage to include cataract surgery, knee and hip replacements, it still imposes strict conditions on the expansion of private care.

Last June, the Supreme Court ruled that the government, under its health act, jeopardized the well-being of patients by barring them from timely and reliable care.

Quebec responded in February with a policy guaranteeing access to the three procedures and granted private clinics a role in reducing waiting times. Under the policy, if the public system was unable to guarantee any of the three procedures within six to nine months after an initial professional diagnosis, the operations could be conducted in private clinics affiliated to hospitals and be paid for by public insurance.

Patients who wanted the operation sooner could have it done in unaffiliated private clinics paid for through a private insurance plan. Private insurance coverage would be limited to the three targeted procedures. Doctors performing operations in unaffiliated private clinics would be barred from working in the public health-care system.

These principles were introduced in the bill tabled yesterday.

"Private insurance is not the solution for the health-care system," Health Minister Philippe Couillard said yesterday during a news conference. ". . . We don't want to create conditions that will increase privatization of public health-care services."

Because the majority of Quebeckers can't afford private insurance, he said, the province will foot the bill for the operation in a private clinic if the waiting times are too long. Those who can afford the insurance can have the operation sooner.

Any attempt to add procedures to the bill -- herniated discs, bariatric surgeries and other non-life-threatening operations, for instance -- will be debated before a National Assembly committee.

"We want to tie the use of private insurance to guaranteed wait times," Mr. Couillard said. "You will not be able to get private insurance without first having access to guaranteed services in the public system."

The bill also includes a provision that gives the minister the power to suspend the rights of a physician to opt out of the public system. The provision was included to prevent a shortage of certain types of medical specialists in the public system if too many leave to work exclusively in the private system.

Mr. Couillard said that once the bill is adopted in the fall, Quebec will become the first province to clarify the role private health care can have within the public system.

For instance, private clinics that offer surgery and keep patients overnight will be considered as private hospitals and will be closely monitored. They will need to meet strict accreditation requirements, and according to the bill, ownership of the hospital will have to be controlled at least 50 per cent by Quebec doctors.

"We do not want an uncontrolled proliferation of private hospitals in Quebec," the minister said.

Mr. Couillard said "extremely rigid procedures" will be dictated to private clinics on the type of medical procedures they may conduct.

The government expects to have guaranteed waiting times for cataracts as well as hip and knee replacements in place for hospitals within "a year or two" of the bill's adoption.

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RHÉAL SÉGUIN

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