New proposed surgical regulations spark debate over costs and risks to public health network
By William Crooks
Local Journalism Initiative
The Quebec government’s proposed regulation to expand access to surgical services through private clinics has stirred immediate debate, with unions warning the measure could undermine the public system while driving up costs.
Health Minister Christian Dubé announced on Aug. 20 the prepublication of the draft Regulation on Access to Surgical Services in the Gazette officielle du Québec. The regulation, now subject to a 45-day consultation period, would allow patients facing long waits in the public network to be referred to private clinics for their procedures.
Dubé framed the measure as an overdue step toward easing surgical backlogs. “After several months of work, this is an important milestone to increase access to surgery and reduce wait times,” he said in a press release. “We have always said the public and private networks can be complementary, and we will continue to prioritize the interest of patients.”
What the regulation proposes
The draft regulation sets out a series of obligations for private providers when participating in the coordinated access system. Private medical centres and hospitals would be required to accept any patients referred through Santé Québec and to deliver the procedure within the time limit established by the referral system.
All surgeons and dentists providing surgical services would also be bound to use the centralized referral and distribution system, ensuring patients are not cherry-picked or left in limbo.
In addition, Santé Québec would be required to keep patients informed of their place in line, their priority ranking, and the average wait times associated with their procedure. The regulation specifies that digital tools should be the preferred method of communication.
The measure would come into force 15 days after its publication in the Gazette officielle du Québec.
Union rep: “A false solution”
Danny Roulx, national representative for the Alliance du personnel professionnel et technique de la santé et des services sociaux (APTS), told The Record in an Aug. 28 interview that the regulation presents the private sector as a “miracle fix” when, in reality, it could deepen the crisis in the public system.
“For us, it’s clear that the government is selling this private option as if it’s a miracle that will save the health network,” Roulx said. “But the reality is, the private sector costs up to twice as much. Quebecers will be the ones paying more for surgeries.”
He pointed to a straightforward comparison: carpal tunnel surgery in private clinics costs about $908, while the same procedure in the public system is evaluated at $495. “If the government pays the private sector, it pays more than it would in the public system,” he stressed.
Roulx also questioned the government’s narrative that patients would benefit from faster access without trade-offs. “It looks like an easy solution, but really it’s opening the door wide to private care and slowly dismantling the public network,” he said.
Fears of losing staff to private clinics
Perhaps more pressing for Roulx is the risk of staff drain. He warned that allowing private clinics to expand their surgical capacity will inevitably mean recruiting nurses, laboratory staff, and other professionals away from the public system.
“Each time we fund operations in the private sector, we risk losing staff from the public network,” he explained. “That will leave us even more short-staffed in the public system, making the situation worse.”
He described the process as “vampirizing” the public system, adding: “The more we encourage private surgery, the more we’ll lose people from the public side. We’ll see physicians, nurses, imaging specialists and lab staff pulled out, leaving hospitals with even greater shortages.”
Roulx fears this will set in motion a self-perpetuating cycle. With fewer staff in hospitals, wait times in the public network could rise, giving more justification to shift patients toward private providers, which in turn may further weaken the public sector.
Long-term risks and financial impacts
Roulx also raised concerns about what could happen once private providers become entrenched in the system.
“The day the private sector has the upper hand and tells the government it wants more money for surgeries, we’ll be cornered because we won’t have the expertise left in the public system,” he said.
He argued that once the public sector becomes dependent on private partners to carry out routine surgeries, Quebec will lose its bargaining power. “We’ll be at their mercy, because we won’t have the in-house expertise to continue providing those services at scale,” he cautioned.
According to Roulx, this scenario has already played out in other provinces. “In Alberta, when they opened the door to more private surgeries, it ended up increasing overall costs,” he said. “We risk repeating the same mistakes here.”
Roulx also pointed out that many of the additional funds needed to support private surgery contracts would likely come from budget cuts in the public system. “If we’re giving $908 to a private clinic instead of $495 in a hospital, that extra money has to come from somewhere,” he said. “That means cuts to services, which weakens the network further.”
A precedent for more outsourcing
Roulx argued that Quebec has already been heading down a path of increased reliance on private contracts. He cited the growing use of “purchased services” in laboratories, where analyses are increasingly outsourced instead of performed by CIUSSS staff.
“We’ve seen more and more lab tests being outsourced to the private sector,” he said. “This regulation is another step in the same direction. And every step we take makes it harder to reverse course.”
He warned that if this trend continues, Quebec risks losing not only surgical expertise but also control over other parts of the health care system. “It’s a wheel that once it starts turning, we won’t be able to stop,” he said. “It could accelerate exponentially and dismantle the public network piece by piece.”
Government’s argument
Despite union concerns, the government maintains the measure is designed to ensure patients receive surgery within a reasonable time frame. Officials argue that the regulation is directly tied to reducing waiting list overruns, which have remained a persistent challenge in Quebec’s health care system for years.
By formalizing coordination between the public and private sectors, they contend, the regulation would prevent patients from languishing on waiting lists while private surgical capacity sits unused. Dubé has insisted that the goal is not to privatize health care, but to make sure “patients are prioritized, no matter where the surgery is delivered.”
Next steps and consultations
The consultation period on the regulation will remain open for 45 days, during which any interested party may submit written comments to Santé Québec. The government has invited input from unions, professional associations, and health care users.
Additional details on implementation, including how referrals will be managed, which types of surgeries will be covered, and how monitoring will take place, are expected to be announced in the coming months.
The regulation is being presented under the Loi sur la gouvernance du système de santé et de services sociaux, which allows Santé Québec to impose such mechanisms and obliges private providers to participate.
Broader reactions still pending
While the APTS has voiced strong opposition through Roulx, other key players have not yet commented publicly.
The Record contacted Stéphanie Goulet, president of the Fédération interprofessionnelle de la santé du Québec (FIQ), which represents tens of thousands of nurses and health professionals across the province. She did not respond before press time.
The Centre hospitalier universitaire de Sherbrooke Users’ Committee was also contacted but said it would only be ready to comment after its first meeting on the subject, scheduled for Sept. 4.