Ottawa looking at Quebec's "health deductible"
Montreal - A potential precedent-setting plan by one province to start charging patients $25 for a doctor's visit is not being blocked by the federal government -- at least not for now.
The Quebec move, which could trigger a ripple effect across the country, is being met with a wait-and-see response from Ottawa.
The federal government said Wednesday that it expects provinces to respect the Canada Health Act, but had little else to say when asked whether it considered the move legal under federal law.
Quebec announced its policy in Tuesday's provincial budget. It even suggested the rest of Canada might follow suit in what would be a historic shift for the country's universal health system.
"Such a health deductible might also interest other provinces faced with major challenges in respect of funding health-care services," the budget documents said.
Ottawa's reaction to the plan will be monitored closely by other provinces anxious to find ways of financing the escalating costs of health care.
For the moment, though, the federal government is avoiding getting sucked into what would be a contentious debate. It offered a curt reply when asked whether it would halt Quebec's move.
"The Canada Health Act is the law of the land," said Prime Minister Stephen Harper's spokesman, Dimitri Soudas.
"Provinces and territories have continuously indicated they respect the Canada Health Act and obviously the federal government expects the Canada Health Act to always be respected."
Quebec says the deductible would respect the Canada Health Act because, unlike a user fee, the poor would be exempt.
Also, the province would collect the money though income-tax returns, rather than at the hospital, allowing it to skirt legal restrictions on money changing hands at health-service points.
But one expert says the plan may violate the spirit of the law.
"It's not a user fee, apparently, but it looks like a user fee," said Antonia Maioni, a political scientist at McGill University who specializes in health policy.
"It's trying to put a fee on utilization, and if that's the case it's going to come up against the Canada Health Act."
According to Maioni, federal Health Minister Leona Aglukkaq is the only person with the authority to declare the deductibles illegal.
If Quebec is found in violation of the Canada Health Act, its lucrative federal health transfers would be in jeopardy.
Charest downplayed the prospect of a clash with Ottawa, saying his government is still working on details of its plan.
"We'll start by having a discussion here, among Quebecers," he said Wednesday. "After that, we'll see if there's a need to open discussions with the federal government."
The deductibles were described in the provincial budget as a way of curbing abuse of the system.
Maioni, however, points to a body of research that suggests user fees, or deductibles, have a negative impact on public health by discouraging people from going to see a doctor.
But political support for alternative funding models is growing.
The federal Liberal party, which proudly cites the Canada Health Act as one of its historic achievements, essentially endorsed the Charest government's move.
Liberal Leader Michael Ignatieff signalled his support, days after attending a weekend conference in Montreal where a series of speakers warned that medicare is financially unsustainable in its current form.
Health care currently accounts for around 45 per cent of program spending in Quebec, and is projected to jump to more than 65 per cent by 2030.
Other provinces spend similar amounts. In Ontario, for instance, health care eats 46 cents on every dollar the government spends, a figure that could top 70 cents in 12 years.
"The Charest government is taking its responsibilities," Ignatieff told reporters in Ottawa. "In our opinion, what counts is maintaining universality of access to the system.
"We believe, and it's a question of detail, that Quebec's propositions conform to the Canada Health Act."
However, Quebec's opposition parties are adamantly rejecting the move, with the Parti Quebecois vowing it would "never see the light of day."
While Quebec is considering how to move forward with the planned deductible, it will also start implementing a new annual health tax that is to rise to $200 by 2012.
The province hopes to raise $945 million with the annual health tax.