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Government meddling contributes to doctor exodus in Quebec

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From the Fraser Institute

By Bacchus Barua and Yanick Labrie

They have not left Quebec’s health-care system but rather have opted out of the province’s publicly-financed framework to provide care to their patients privately.

Quebec’s health minister recently came under fire after reports revealed a record number of physicians left the province’s public system to practise privately. Less discussed are the reasons why physicians made this choice.

Indeed, it turns out that ill-conceived attempts to protect publicly-funded health care by the Trudeau government and successive provincial governments may have contributed to the increasing numbers of physicians opting-out.

To be clear, the 780 physicians in question account for about four per cent of physicians in the province. However, this represents a 22 per cent increase in the number of physicians leaving the public system compared to the previous year—and is part of a growing trend. More importantly, they have not left Quebec’s health-care system but rather have opted out of the province’s publicly-financed framework to provide care to their patients privately.

Why?

One reason, is because governments have forced them to do so.

Until recently, physicians in Quebec (including those who practiced in the public sector) were allowed to charge patients so-called “accessory-fees” in certain instances—for example, if the service was either not covered or insufficiently reimbursed by the government’s fee schedule.

However, the federal Canada Health Act (CHA) clearly states that “extra-billing” of this nature, when charged by physicians who also bill the public system, must result in dollar-for-dollar deductions in federal health-care transfer payments to the province. In other words, the CHA encourages provincial efforts to effectively force doctors to choose between the public and private system if any out-of-pocket expenses are involved.

And so, under financial threat by the Trudeau government, Quebec eventually clamped down on such fees charged by physicians who worked in the public system.

Consequently, physicians who relied on these payments to cover a portion of their operating costs faced an unfortunate choice—stay in the public system at the risk of financial ruin or opt-out entirely and practise exclusively in the private sector.

For many, the choice was obvious. One study found that by 2019 “an additional 69 specialist physicians opted out after the 2017 clampdown on double billing [sic] than previous trends would have predicted.” Several clinics offering endoscopy and colonoscopy services simply closed their doors. Quebecers also ended up with a less convenient health-care experience following this clamp down, as evidenced by the reduction in clinic-provided services that followed.

This attitude to extra-billing stands in stark contrast to the situation in other universal health-care countries such as Australia where consultations with specialists are usually only partially (85 per cent) covered by the universal plan. In fact, physicians (family doctors and specialists) can generally set fees above the government’s fee schedule so long as they forgo the convenience of directly billing the government (i.e. patients claim reimbursement after the fact). Notably, Australia’s health-care system costs less than Canada’s in total (including these private payments) yet delivers more rapid access to health-care services with a greater availability of medical professionals, hospital beds, and diagnostic and surgical technologies.

More generally, a recent study found 22 of 28 universal health-care countries require patients to share a portion of the cost of treatment (with generous protections for vulnerable groups). These include deductibles (an amount individuals must pay before insurance coverage kicks in), co-insurance payments (the patient pays a certain percentage of treatment cost) and copayments (the patient pays a fixed amount per treatment). Crucially, many of these countries including Australia, Germany, the Netherlands and Switzerland also have shorter wait times than we endure.

In these countries, physicians are also generally allowed to practise both in publicly-funded universal settings and private settings (a policy known as “dual practice”) rather than having their activities restricted to one setting only. In other words, Canada’s federal restrictions on cost-sharing and extra-billing (such as Quebec’s accessory fees) and provincial barriers to dual-practice place our universal system in the minority of a small cohort of countries that are not particularly known for stellar performance.

The looming threat of further reductions in federal cash transfers, under the CHA, has led to provinces such as Quebec imposing increasingly restrictive conditions on physicians in the public system. And in response, physicians—by opting-out—are indicating that they’ve had enough.

It’s ironic that the very groups intent on supposedly “protecting public health care” by forcing physicians to choose between the public and private systems have enforced policies that may very well lead to the public system’s continued demise.

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Censorship Industrial Complex

Freedom of speech under threat on university campuses in Canada

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From the Fraser Institute

By Michael Zwaagstra and Matthew D. Mitchell

Obviously, when students feel that their grades are at risk, they will be far less likely to express their genuine opinions or even ask questions during class discussions. Not only does this make classes less interesting, it also undermines the entire purpose of a university education.

Universities should be places where all ideas are welcomed and explored. In many Canadian university classrooms, however, only the “correct” viewpoint is heard.

According to a new survey (conducted by Leger and published by the Fraser Institute) of 1,200 Canadian university students and recent graduates, politically left-of-centre students were far more likely than their right-of-centre classmates to report that their views were welcomed and encouraged in class.

For example, 83 per cent of right-leaning students believe that professors advocate a left-of-centre view—and 45 per cent of left-leaning students agree with them.

Forty-two per cent of right-leaning students say they experienced a university classroom environment that limited discussion and questions on controversial topics to only one side of the argument. In contrast, only 29 per cent of left-leaning students felt the same way.

To make matters worse, 50 per cent of right-leaning students said they sometimes felt uncomfortable expressing their opinions due to the views of the professors leading the class. Only 36 per cent of left-leaning students reported the same experience.

Interestingly, when asked whether there was a “safe” point of view on controversial topics in university classes, a majority from both groups answered “yes” with little difference between right-leaning students (58 per cent) and left-leaning students (51 per cent).

A significant number of right-leaning students (37 per cent) also said they feared formal consequences for expressing honest thoughts, opinions or even asking questions in their classes. Among right-leaning students who expressed this concern, 74 per cent feared their professors would lower their grades for expressing the “wrong” opinion in class.

Obviously, when students feel that their grades are at risk, they will be far less likely to express their genuine opinions or even ask questions during class discussions. Not only does this make classes less interesting, it also undermines the entire purpose of a university education.

Other studies also reveal the politically one-sided nature of university campuses. For example, a 2022 survey published by the Macdonald-Laurier Institute found that 88 per cent of Canadian university professors vote for parties of the left and only 9 per cent support parties on the right. No wonder students feel their class discussions are consistently one-sided.

Similarly, a 2024 survey published by Heterodox Academy and College Plus found that more than half of students were reluctant to discuss certain issues such as the current Israel/Hamas conflict and transgender identity, and nearly half were reluctant to even broach the subject of politics. More alarmingly, a majority of students favoured limiting free expression on campus.

While many university professors are quick to describe themselves as strong supporters of diversity, this does not seem to include diversity of thought. A truly diverse campus would welcome a variety of intellectual perspectives in the spirit of open and scholarly debate. A campus where everyone looks different but thinks the same is not meaningfully diverse. As economist and philosopher John Stuart Mill argued many years ago, we are all impoverished when we silence one perspective.

It’s concerning that most students feel there’s a “safe” political view on controversial topics, particularly when students who hold a minority viewpoint feel the least safe expressing their views.

Of course, things won’t change overnight. But the first step to dealing with a problem is to admit that you have one. In that light, university administrators, professors and politicians should acknowledge that the current lack of viewpoint diversity on campus is a serious problem for all Canadians. Democracies function best when people freely express, and vigorously debate, competing ideas. As institutions of higher learning, universities should exemplify what free and open discussion looks like.

While there’s nothing wrong with professors holding political views and sharing those views with their students, they should not restrict free and open debate in their classrooms. This means ensuring that all students, including those whose opinions are in the minority, are guaranteed the right to share their views without fear of reprisal.

Michael Zwaagstra

Senior Fellow, Fraser Institute
matthew-mitchell.jpg

Matthew D. Mitchell

Senior Fellow in the Centre for Human Freedom, Fraser Institute
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Business

Carney engaging in Orwellian doublethink with federal budget rhetoric

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From the Fraser Institute

By Jake Fuss

In George Orwell’s classic 1984, he describes a dystopian world dominated by “doublethink”—instances whereby people hold two contradictory beliefs simultaneously while accepting them both. In recent comments about the upcoming October federal budget, Prime Minister Carney unfortunately offered a prime example of doublethink in action.

During a press conference, Carney was critical of his predecessor’s mismanagement of federal finances, specifically unsustainable increases in spending year after year, and stated his 2025 budget will instead focus on “both austerity and investments.” This should strike Canadians as an obvious contradiction. Austerity involves lowering government spending while investing refers to the exact opposite.

Such doublethink may make for good political rhetoric, but it only muddies the waters on the actual direction of fiscal policy in Ottawa. The government can either cut overall spending to try to get a handle on federal finances and reduce the role of Ottawa in the economy, or it can increase spending (but call it “investment”) to continue the spending policies of the Trudeau government. It can’t do both. It must pick a lane when it comes to mutually exclusive policies.

Despite the smoke and mirrors on display during his press junket, the prime minister appears poised to be a bigger spender and borrower than Trudeau. Late last year, the Trudeau government indicated it planned to grow program spending from $504.1 billion in 2025/26 to $547.8 billion by 2028/29.

After becoming the Liberal Party leader earlier this year, Carney delivered a party platform that pledged to increase spending to roughly $533.3 billion this year, well above what the Trudeau government planned last fall, and then to $566.4 billion by 2028/29. Following the election, he then announced plans to significantly increase military spending.

While the prime minister has touted a plan to find “ambitious savings” in the operating budget through a so-called “comprehensive expenditure review,” his government is excluding more than half of all federal spending including transfers to individuals such as Old Age Security and transfers to the provinces for health care and other social programs. Even with the savings anticipated following the review, the Carney government will likely not reduce overall spending but rather simply slow the pace of annual spending increases.

Moreover, the Liberal Party platform shows the government expects to borrow $224.8 billion—$93.4 billion more than Trudeau planned to borrow. And that’s before the new military spending. That’s not austerity—even if Prime Minister Carney truly believes it to be.

Actual austerity would require a decrease in year-over-year expenses, smaller deficits than what the Trudeau government planned, and a path back to a true balanced budget in a reasonable timeframe. Instead, Carney will almost certainly hike overall spending each year, raise the deficits compared to his predecessor, and could even fall short of his tepid goal of balancing the operating budget within three years (which would still involve tens of billions more borrowed in a separate capital budget).

While budgets normally provide clarity on a government’s spending, taxing, and borrowing expect more doublethink from the October budget that will tout the government’s austerity measures while increasing spending and borrowing via “investments.”

Jake Fuss

Director, Fiscal Studies, Fraser Institute
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