Thursday, 21 February 2008

Quebec Heath Care Report: Zombie Ideas May Be Laid to Rest Once Again

One of the more heartening things of this not-very-old year is the way that the report on Quebec’s health care system, chaired by Claude Castonguay, has been roundly criticized by the health minister Philippe Couillard and many others, both in and out of government.

The fear had been that in appointing Castonguay to head the inquiry, the current provincial government was stacking the deck. Castonguay was indeed the architect of Quebec’s version of Medicare, but since then he has worked in the insurance industry and has spoken frequently in favour of more private health insurance and a greater role for the private sector.

The report does suggest adding a user fee ($25 a doctor’s visit, to be tacked on your income tax) and/or increasing the sales tax to add more money to the health care pot. A string of research shows that neither user fees, but the idea is what British Columbia health economist Robert Evans calls a “zombie” because it keeps coming back from the dead.

In Quebec its latest resurrection appears to have been soundly put down: Le Devoir’s headline Wednesday was “Couillard Says No!” Also seemingly rejected was the possibility of allowing doctors to practice in both the private and the public sector: currently they must choose between them.

Some of the report’s points probably bear further discussion. Why is it, for example, that Quebec has a higher per capita ratio of doctors than other provinces, but still is running into problems with waiting lists and supply of family physicians? It could be because more Quebec doctors are women who are choosing to share practices or to practice shorter hours, which is not a bad thing necessarily. Or it could mean there are some structural problems that need be rejigging.

Just because the worst seems to have been avoided, and the current government will not rush into undercutting our free, universally accessible health care system, we should not be complacent. Decent governance—like healthful living—requires constant vigilance. And maybe some garlic too, to boost our immune systems and to keep the zombies at bay.

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