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May 4, 2016

Organizations across the province are going beyond denouncing Quebec’s medical accessory fees — or extra billing that patients pay out-of-pocket — as abusive and illegal.

article by: Charlie Fidelman, Montreal Gazette

They say they have no choice but to sue the federal government in an attempt to force Quebec to put an end to such illegal fees.

On behalf of Réseau FADOQ (formerly Fédération de l’âge d’or du Québec) and its nearly 450,000 members, malpractice lawyer Jean-Pierre Ménard filed a petition in federal court Monday to force the federal health minister to apply the Canada Health Act, in Quebec and other provinces.

The Canadian law is crystal clear in forbidding extra fees for medically necessary services, Ménard said Tuesday: “It’s zero tolerance.”

But despite several reports documenting extra billing, government officials have turned a blind eye to the practice for many years, said Ménard, who specializes in the defence of patient rights. The purpose of the legal action, he said in an interview, is to obtain a court order to force the minister to fulfil a “statutory duty.”

Surcharges for opening a file, medication, vaccinations, eye drops, and procedures performed outside of the hospital system have increased since the early 2000s and amount to an estimated $50 million to $70 million a year in Quebec.

In an example of inflated billing, patients are charged $40 to $80 for eye drops that cost less than a dollar, Ménard said.

Canada could recover such sums from provinces by withholding federal health transfer payments, he said. And not just in Quebec, Ménard said, although the province is one of the worst offenders. Sections 18 to 20 of the Health Act stipulate that funds can be withheld in cases of over-billing.

Ménard dismissed a leak to the media from an anonymous source earlier this week, on Quebec Health Minister Gaétan Barrette’s plans to put an end to the practice by folding the costs of add-on fees into physicians’ salaries.

“That’s a trial balloon,” Ménard said, noting the upcoming negotiations between the government and Quebec’s medical specialists. “It will take several months to reach an agreement, during which patients will continue to pay extra fees.”

He noted that previous agreements between physicians and the health department also forbid extra billing, except for some medication. “So when you go for a colonoscopy, they charge you $500 for medication that costs a few dollars,” Ménard said. “If the minister wants to abolish the extra fees, he can do it immediately by revoking the power he gave himself in Bill 20 of authorizing extra fees.”

Patients have had enough of paying out-of-pocket fees while waiting for governments to negotiate agreements among themselves and with doctors, Ménard said.

Allowing users’ fees for services that are covered by the public system violates the Canada Health Act and represents a growing and worrisome trend across the country, said Dr. Brian Hutchison of Canadian Doctors for Medicare. It creates a two-tiered system and jeopardizes access for those who are unable to pay fees, he added.

Patients, especially seniors, are facing barriers to care because extra fees are digging into their daily reserves, said Danis Prud’homme, director of Réseau FADOQ. Nearly one of two seniors, 44 per cent, live below the poverty line on pensions that come to less than $20,000 a year, he said, and they’re forced to choose between paying for the rent or their health, between buying food or going to a health clinic.

Barrette was not available to comment. But his press attaché, Julie White, said in an email that the minister considers the lawsuit a futile measure since he intends to abolish extra fees by including them in doctors’ salaries.

“Article 32 of Bill 20 prohibits extra fees,” White said.

But Ménard says Barrette is “playing games. Nothing has changed for the patient.”

Filing the lawsuit was the fastest route to get action, Ménard said, adding that it could take nine months to a year before it is pleaded in court.

Reacting in Ottawa, federal Health Minister Jane Philpott said she is a strong supporter of the Canada Health Act and its principles and Canadians will always have access to care based on need and not on the ability to pay.

Philpott did not rule out reducing federal transfer payments to provinces that flout the law. Asked whether sanctions will be levied, Philpott said: “I will certainly look into what’s going on across the country. The Canada health transfer is written in such a way that there is an expectation that provinces uphold the (Canada Health) Act.”

The Canada Health Act has already been used to sanction provinces that permitted illegal over-billing, largely in Ontario and Alberta, Hugo Viens of the Quebec Medical Association said. Previous federal governments have withheld nearly $225 million, he added.

Doctors, however, say they need accessory fees to boost their income to cover legitimate costs in an underfunded health system.

FADOQ’s cause is supported by several doctors’ associations, clinics, coalitions, citizens’ groups, unions and patient advocate organizations, including Canadian Health Coalition, Conseil pour la protection des malades, Clinique communautaire Pointe-Saint-Charles, Alliance des associations de retraités, Association médicale du Québec, Coalition Priorité Cancer, Fédération interprofessionnelle de la santé du Québec, Alliance des patients, Syndicat canadien de la fonction publique, SCFP-Québec, Council of Canadians, Regroupement intersectoriel des organismes communautaires de Montréal, and patients’ users committees.

Jason Fekete of the Ottawa Citizen contributed to this report.

Montreal Gazette