Published May 4, 2024

By Dian Cohen

Local Journalism Initiative

I’m also tearing my hair out trying to imagine how we have collectively elected such dunderheads to manage the part of the economy they are responsible for managing.

My rant today focuses on healthcare. The Quebec government has just announced yet another of its seemingly endless ‘innovative’ ideas that, if we’re lucky, will be forgotten before millions of our tax dollars are spent. If we’re unlucky, they’ll spend millions on “mini-hospitals to bridge the gap between family medicine groups (GMFs) and hospitals.”

Leaving aside a description of this profligate idea, remind yourself of our possibilities to access healthcare.

  • We can go to a GMF.
  • We can go to a hospital.
  • We can go to a doctor in private practice.
  • We can go to a health co-op.  

With regard to GMFs, last time I looked, most GMFs weren’t taking new clients. That’s one reason there are at least 834,000 people on the government’s Family Doctor Finder list. And why Quebec now allows primary care nurse practitioners to register patients.

Most emergency rooms are operating over 100 percent capacity and wait times range from 5 to 14 hours – something that hasn’t changed despite the many promises and numerous ‘reforms’ over the years aimed at reducing wait times.

There are about 600 Québec GPs working in private clinics, where patients pay for all services from their own pockets. The government has already gotten rid of family physicians who hung out a shingle and practiced on their own, and they have recently said they want to get rid of physicians who have opted out of the public sector.

Health cooperatives are our last, best hope. Quebec’s co-operative movement traces its history back to 1900, when Alphonse Desjardins opened the first Caisse Pop —  Desjardins is now the largest cooperative financial group in North America and fifth largest in the world. Agropur and La Co-op Federée are two of the biggest farm co-ops in the world. This is not an untested business arrangement.

There are 40 health co-ops in the province managing the medical files of 300,000 Quebecers. They have been created by their communities – ordinary people who got together to fill a need. They voted in a board of directors, raised money for the building, furniture and fixtures, hired the doctors, nurses and staff. Start-up costs range up to $500,000 – money raised in the community, unlike the ‘mini-hospitals’ now being touted.

These co-ops are non-profit organizations that for years have been meeting healthcare needs not met by the public network or the private clinics. Most of them most of them are located in rural areas far from the main hubs of integrated health and social services. Their mission is more than helping sick people get well – they are strong proponents of preventative care and wellness. Funding to operate a co-op comes mainly from an annual membership fee by regular users and extends benefits beyond access to a doctor. Non-members also have access to a doctor, as prescribed by the Canada Health Act.

Yet the Quebec government is not benignly oblivious to health co-ops, it is actively discriminating against them. Here’s how:

Family medicine groups (GMFs), which are mostly profit-making corporations, are heavily subsidized by the government. Health co-ops, which are non-profit organizations, have been excluded from any financial subsidies. On March 29, 2022 the CAQ signalled a major shift in the organization of healthcare – it wanted to “think and do differently”. That was Bill 15, creating Santé Québec. What a perfect opportunity to right the wrong of excluding health coops from financial subsidies. Asked specifically by the Federation of Health Co-ops (FQCS) whether health coops were included as eligible organizations, the minister confirmed that they were. Yet nothing has changed.

Health co-ops are specifically excluded from financial subsidy because they’re not designated Non-Profit Organizations (even though they are). They aren’t designated non-profit organizations because they’re incorporated under the Cooperatives Act rather than the Corporations Act. Talk about convoluted! Because of this, co-op fees have been deemed to be “extra billing”, which is a no-no under the Canada Health Act.

The CAQ knows better. Extra-billing is the difference between the provider’s charge and the allowed amount. For example, if the government rate for a procedure is $100 and the doctor wants to charge $150, the doctor would have to bill you for the remaining $50. That’s the no-no. Co-op fees cover the operating costs to run the health facility – offices equipped with examination tables and diagnostic aids, nurses who triage patients, receptionists who make appointments, everything except the doctors’ fees, which are paid by RAMQ, the government’s Health Insurance Agency. These are the same expenses that the government subsidizes in larger, for-profit GMFs.

The Federation of Health Coops delivered a pre-budget paper asking the CAQ to create a funding program to put health coops on an equal footing with everyone else in the public network. Their ask was $2 million/year — not $2 million for each of the 40 co-ops, $2 million/year to be split between all the co-ops. The 2024 Quebec budget documents spending $62 billion on health and social services this year with nary a word about bringing health co-ops — the one group that’s in place and ready to meet the  needs of regular citizens – into the fold. Meanwhile, Health Minister Dubé’s office has confirmed that the government will allocate $35 million in public funds (borrowed or taxpayer) annually for each non-existent, start-from-scratch mini-hospital.

cohendian560@gmail.com

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