Extra Billing: Thousands of Dollars Paid by Patients at Montreal Private Clinic

Extra-billing and kick-backs to doctors in Quebec have been in the news these last couple of days. First the Quebec College of Physicians charged that at least two cardiologists have been accepting "envelopes of cash" to push patients up the waiting list for surgery. Equally as bad, the College alleges that doctors have been directing patients to the private sector by saying that the waiting lists in public facilities are too long.

Next the agency which governs the health care system in this province, the Régie des assurances maladie du Québec, has revealed the results of an investigaton of a private clinic, Rockland MD approved for performing surgery. Extra fees amounting to several hundred thousand dollars have been charged for services covered by the public system. These include charges for nurses and anethesologists present during surgery as well as "forfaits santé" or a fee for being considered for the treatment in the clinic. RAMQ will reimburse patients for these fees, and will collect them from the clinic.

This should be no surprise, really, to anyone who has been following Quebec's health system. Two years ago the protocol for certain surgeries covered by the system was modified. Previously, only three kinds of surgery were approved for private clinics, but under the changes, 56 are now allowed. In addition, doctors are now able to work both in private and public institutions.

Critics at the time of passage of the changes warned that it was an invitation to abuse on the part of greedy medical professionals who wanted to work both sides of the health system. Unfortunately, they were right.

Now it remains to be seen whether these revelations will result in a move away from giving private clinics a larger role in providing surgery. The argument always is that a mixed system will provide more options, but it's clear that the results are bad for everybody except the docs making extra money.