Thursday, August 12, 2010

Welcome to Private Healthcare-Quebec Style!

It was good to see a business associate of mine who was in from Toronto for the first time since having heart bypass surgery last year. He had a difficult recovery and as he recounted his ordeal, he mentioned rather conspiratorially, that he had paid for an MRI in a private clinic rather than wait for the inevitable delays in the public sector.

"So what?" I answered. "That's no big deal, it's business as usual here in Quebec!"

Well, apparently it isn't so par for the course outside of Quebec, where private health care doesn't seem to have taken hold to the same degree as here.

In fact, of the 35 Canadian MRI clinics listed on a referring web site, FindPrivateClinics.ca, seventeen are located in Quebec!

While the country debates the ethics of private health care, the Quebec government has quietly thrown the doors open to private care that is normally covered by the RAMQ (Quebec's medicare agency.)

The tiny Westmount Square shopping mall in downtown Montreal is home to one of the largest private health care clinics in the country, offering practically any diagnostic service for pay. For that matter, it offers just about any other treatment you can think of!
Aside from its diagnostic division, it is home to a bunch of private doctors who moonlight for pay by seeing 'private' patients 'on the side,' a practice that I thought is illegal. Check out their web site.

I recently met a friend going into the clinic with a large bandage covering an eye. I asked what happened and he told me that a metal shard had hit him in the eye and after ten hours in the emergency room of a local hospital he had secured an appointment in the Westmount Square clinic. An hour after arriving, he left, after seeing a doctor who took care of his problem ASAP.
WOW! I don't know how much he paid, but it certainly was worth it.

There seems to be a flourishing business wherein doctors who are on the books with Medicare, operate outside the system quite openly. Not so kosher!!!!

Incredibly the government avails itself of private medicine too. The (CSST) (Workman's Compensation Board) uses the private system to bypass the public system in order to speed up evaluations and treatments so that cases can be disposed of more quickly, thus saving extended benefits that are paid to claimants while they spend time on a medical waiting lists. In fact the CSST is the largest user of private health care services in the province! LINK (French)

The other day the Journal de Montreal ran a story about a man who was told that in order to circumvent an eighteen month long waiting list he could see a certain doctor within two weeks by joining a sports club who would then pay the doctor directly as a third party. Obviously the patient would reimburse the club. Supposedly this is legal. Sounds like a real racket.  Link(French)
The government seems to be turning a blind eye to all this. It seems that they've figured out that each MRI treatment done privately, means one less treatment that they have to pay for, something the defenders of the exclusive public option fail to accept.

I myself recently had a rather strange experience with my very own colorectal specialist who told me  that an appointment for a colonoscopy would take two and a half years and then without blinking an eye, informed me that he could do the procedure privately in two weeks! Here's my card, Ka-Ching!

Now I don't have any problem with private health care, it's a wonderful addition to the public option for those who can afford and don't care about the expense. Every dollar spent privately is a dollar less spent publicly. Personally I'd buy insurance if it was available and I'm sure a large percentage of Canadians would do so as well.

But I have a big problem with doctors floating between public and private systems, essentially trolling for patients. The same goes for private diagnostic tests that propel patients faster up the line for public treatments.

It isn't fair for someone to pay for a private MRI and then jump back into public line to secure a procedure faster than someone who is still waiting for a public MRI.

That is the essential conflict with mixing a private and public health system.
A good number of Quebec surgeons will jump you past the waiting line if you pay them.  I know someone who paid $8,000 to have a painful shoulder repaired within two weeks after having been told by her doctor that the operation would require an eight month wait on the public rolls.

Some doctors even rent out idle hospital operating rooms and hire hospital nurses to moonlight to do private procedures, all of this going on with everyone in the health industry turning a blind eye.

The ethics of the whole thing are disgraceful.

Doctors who choose to go private, shouldn't be allowed to practice in the public system, there's too much temptation for abuse.
Let them open up their own facilities and charge what they want. People should be able to buy private insurance if they want or pay for medical services a la carte.

Let us have private doctors, private hospitals and private diagnostic clinics.  Those who want to use them will pay.
Those who can't will stay in the public system, which should technically run better because of the private option.

Bit mixing systems makes for abuse.

And so while one in three Quebeckers don't have a family doctor, it isn't hard to find one for pay. Here's a list where you can hire one today. LIST

Here is web-site where you can find virtually any medical speciality, all for pay HERE

By the way, here's a list of the cost of a variety of private medical procedures.

- Average cost for an MRI in Montreal is $750.
- Average cost for a PET/CT scan in Montreal is $2500.00
- Average cost for a Mammogram in Montreal is $350.00
- Average cost for an Ultrasound in Montreal is $150.00

Does anybody out there have any experience with private health care? Have you paid for a private test or procedure?

Fess up!

15 comments:

  1. My aunt -- who was treated at Notre-Dame -- was referred to a private clinic on Sherbrooke for a Mammogram. The private vs. public option wasn't even discussed.

    The MRI was done at the hospital though and IIRC, she waited approximately a month for an appointment. Not that much of a delay, all things considered.

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  2. Living in Mississauga, I don't have a personal experience with all this, but my dentist here, who almost set up shop in Montreal when the PQ got in the first time, relocated to Toronto. Montreal's loss was Ontario's gain.

    Anyway, he knows doctors in Quebec, and he told me that when and if Quebec doctors hit their fee cap under RAMQ, they have to keep their offices open. If they shut down, RAMQ claws back at their fees. Once they hit the cap, they have all to lose and nothing to gain. That isn't a good plan, and it encourages cheating.

    Why any younger Anglophone doctor would want to practice in Quebec is beyond my comprehension, aside from loving where they live. When the whole medicare program started, doctors in a sense screwed themselves because they often suppressed income since more often than not they were paid in cash. When the fee structure was set, statistics were taken from tax returns filed by doctors to determine the fee structure. How much income did they NOT declare? The government knew it, too!

    Let's face it. The system encourages cheating, and if the CSST uses private practitioners, that fuels the private system big-time. Like the editor, the way I understood RAMQ, either you're totally on the government payroll, or your totally out--no hybrid income. It probably started that way, but like with most things involving the Quebec government, there was corruption, and the proof is in the pudding.

    What irks me is doctors now probably lie to their patients telling them that the wait is longer than it actually is, and do everything they can think of to encourage private treatment. THAT is unethical!

    One interesting institution in the Toronto area is the Shouldice Clinic, a specialized institution dealing with hernias, and a very unique business model. Go to http://en.wikipedia.org/wiki/Shouldice_Hernia_Centre for an excellent synopsis.

    Shouldice is a PRIVATE institution that earns most of its revenue from the OHIP system. It is THIS business model that should become a model in the future for creating a liaison between private and public institutions.

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  3. The public health care system in Canada is not longer a model of sustainability. Current the cost of health care to all provincial governments is about 42% of revenue. That is a lot of cash. Of course, in one Western Canadian city a nurse had an income of over 250,000.00 due to overtime shifts. The game is played by some, (not all) or the health care people who call in sick so friends can pick up the overtime etc etc. One of the problems is also bloated and excessive administration costs. One thing is sure, the system must be changed as it is not sustainable.

    Now for a little story about wait lists.

    I have an acquaintance whose wife was diagnosed with cancer last december (bladder cancer). She was promptly put on a 3 to 4 months waiting list. After exhausting all efforts for treatment elswhere in Canada the only recourse was to go to the US (in this case the Mayo as I understand). From first call to treatment was less than two weeks with excellent care for the next three months. This particular person is a long term taxpayer in Canada with a successful business. I would estimate he likely paid nearly 150K plus in personal taxes (not taking into account the business activities). At this level his contribution to the Canadian Health Care system was likely about 60,000 dollars. Have any of you any idea of the premium type of health care insurance this man could have afforded in the US (premium with no restriction). I only bring this up to indicate the unfairness of the Canadian system where they Universal System we have guarantees treatment. I believe the expenses for my acquaintance was well over 120,000.00 at the US center considering travel and accomodation. So then, the man has paid all his life for health care with huges expenses and when it was him and his wife turns the Canadian system turned their backs on these people. Unfair, you bet. Further insulting is that the provincial government would not even refund any of the cost of the treatment as they said it was available in the province. (with a three to four month delay which they were told at the MAYO, would have resulted in her death) Essentially the Canadian system was going to allow the woman to die without treatment.

    So
    1. Taking tax money and not deliverying timely service is essentially fraudulent.

    2. Putting the lady on a long wait list knowing it would result in physical harm is a form of criminal negligence.

    Pick one or both of the above and you will be right.

    Its time the politicians admit to the fact that our current universal health care system is on the skids and its time to move to the "hated" two tier system. Intrinsically, we have it now as my acquaintances wife is living proof. Other nations, Britian, Germany, Italy have a system which utilizes both public and private systems.

    Quebec, in this case, may be on the right track. I note that they have actually added user fees although they had to be creative on how they were applied so as not to charge at the point of service (doing it with tax credits as I understand).

    Long wait lists for vital treatment, people waiting 2 days in emergency clinic etc etc is simply not effective health care.

    I guess in the end what I am saying is that you are not getting your moneys worth any longer with the Canadian system.

    The situation in Quebec is just the tip of the icerberg for what is to come.

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  4. To be a staff person working in the hospitals for many years, it is very discouraging to work in a Quebec hospital that is an outdated & demoralizing atmosphere. For nurses working in the private system, it is much more appealing: better pay, flexible schedules, better work conditions, cleaner environment and up-to-date equipment. The public system is wrought with bureaucracy to the point of stagnation. White paint is the usual renovation project for most Montreal hospitals. However, having to work in these institutions for years waiting for the grand hospital to be built, which never seem to surface, is disheartening. Many nurses are leaving the public system to work in the private health centers, leaving the public system stretched to the point of creating a serious problem for the public health care system. The Quebec nursing organization is trying to find a way to prevent public system nurses from working in the private sector. However, instead of addressing the terrible work conditions in the public system, the Nursing Ordre (OIIQ) just wants to legislate where nurses can work. There is something to be said for the private medical system, if it challenges the status quo of the public system and forces it to take a serious look at problems and challenges we currently face and the burden to the system that will occur, as the boomers start aging. A little healthy competition for service may stimulate some movement on the years of stagnation in our public health care system.

    Nurse

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  5. August 12, 2010 1:00 PM RE:
    •“The situation in Quebec is just the tip of the iceberg for what is to come.”
    •“The system must be changed as it is not sustainable.”

    You’ve made an insightful assessment of the Quebec health care situation. Your promotion of the private and public health care delivery may ruffle a few feathers in Quebec. The Unions will definitely fight this to the end. The conflict of interest for the physicians working in both systems will be a can of worms in a Pandora’s Box. The bureaucracy required to change to such a system will be a colossal mission.

    RE: 1. “Taking tax money and not delivering timely service is essentially fraudulent.”
    We pay a huge amount of taxes for our Public Health Care System. To be asked to pay again for private health care, when the public system lets us down, is a scandal. Exactly where is all the money going? We need a serious audit of all the money (our taxes), to see where is the money going, to find out, who or what is siphoning the money from the system. The money is going somewhere and it is certainly not going into the up-keep of the hospitals. If you walk into a Montreal hospital and walk into a U.S. hospital, you feel like you are in a time warp and stepping back 15 years in time, when walking into a Quebec hospital.
    However, there are horror stories on both sides of the border: bankruptcy in the U.S, ER overload, patient suffering and untimely death, as a hazard of the public system. I believe you are right, that there should be a consideration of a mix of public and private system. Yet, our taxes should not increase to support such a system. There needs to be better management of the current funds. The inquiry into the construction industry should be another investigation to note the over-inflated costs of building or maintaining such hospitals.

    RE: 2. “Putting the lady on a long wait list knowing it would result in physical harm is a form of criminal negligence.”
    Who should be responsible for this negligence? The government for creating the backlog of patients, which delay treatment due to their severe budgets or the treating physician, who should find a solution to get the pt treated in the current public system. If the public system is not allowing the physicians to safely treat their patients, the physicians should be the first to say the system is not working and demand change.

    Nurse

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  6. I helped out at Find Private Clinics for a year. Three of us - plus the founder - enlisted clinics/hospitals across Canada visiting and talking to administrators and doctors alike. Let me tell you. Canada's health care would make any Byzantine proud.

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  7. "Who should be responsible for this negligence? "

    Interesting point. I am thinking the system itself is the problem. For instance, in Canada you really cannot sue a doctor for malpractice. The Federal government has a 2.7 Billions dollar fund (CHPP) which will fight any legal action taken against any doctor or institution. They will spend any amount of money necessary to overturn any legal action taken. Why? Because they know the system is flawed and there are mistakes being made every day. The Candian Health Act does not allow for private insurance to be placed on any resident of Canada (other that short trip insurance). Try it out, Call an American Insurance company and see if they will sell you (resident of Canada) a policy.

    The system has become a disgrace and its not only Quebec which has problems. The same issues can be found in all provinces. For instance, In SK, the wait list for non elective surgery (hip knee etc) is not exceeding two years. The lady I spoke about was a resident of SK. In Alberta the Cross Cancer Center and Tom Baker Center in Calgary are no longer taking any patients from outside of Alberta. The situation is a total disgrace and yet the health care regions keep asking for more money and are offering longer wait lists.

    Tommy Douglas would turn over in his grave if he knew where his socialized medical system has went in the past few years. Doesn't work anymore and the system needs an overhaul from the top to the bottom. Nurses making 250000.00 per year because of overtime while younger nurses are not given full time employement. Ridiculous

    Of course those running things are not spending their own money (they are spending yours and mind) so there is no urgency for them to change things from the status Quo.

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  8. RE: August 13, 2010 3:27 PM
    “CHPP) which will fight any legal action taken against any doctor or institution”

    Re above: If no one can take legal action against a doctor or institution, exactly how do you prevent negligence? Does this same law apply to private health centers or does this apply to just public institutions?

    RE: “Of course those running things are not spending their own money (they are spending yours and mind) so there is no urgency for them to change things from the status Quo.

    With the recent suicide of 4 Quebec nurses, do you think this is a sign of the urgency and need for things to change. We have nurses so burnout that they chose suicide as a solution to their plight. There are countless nurses on burnout disability leave. Nurses are constantly calling off sick, forcing the nurses still working, to work extra shifts and not able to leave the job. To have nurses working overtime to the tune of making $250000.00 per year, that is an incredible amount. I know of a few nurses, who volunteer to work overtime for the money, but they are worthless on the job. They are on the job physically, but don’t ask them to do anything. We are constantly working short staffed. There are many days; I’d pray to please get me through the next shift and survive the insanity. It is so overwhelming sometimes. Who is responsible if management makes decisions that leave a solo nurse responsible for up to 18 patients in an area meant for 5-7 patients? Should a patient die on my shift, am I responsible? Is management responsible? Is it the government? Nurses and patients need a solution. If we cannot sue anyone or hold anyone accountable, what happens when errors are made in unimaginable working conditions? These types of work conditions are what are prompting the nurses to leave the public system to work in the private system, only to make the problem worse. Now, the government and Nursing Order are looking for ways for force the nurses to stay in the public system. I feel sorry for the younger nurses coming into the system and not given full time status. Management does this to avoid paying full time benefits, but the nurses continue to work full time.

    Rash of suicides at Quebec City hospitals alarms nurses' union http://www.globalmontreal.com/money/Rash+suicides+Quebec+City+hospitals+alarms+nurses+union/3396684/story.html

    Nurse

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  9. It sounds like Quebec isn't the place to be a doctor or a patient. Thanks for the comment on the prices for those services. Do you know if Montreal is the best place to get an ultrasound? A friend of mine is pregnant and she will be a single parent but she needs an ultrasound to make sure her baby is healthy. Thanks again for all these comments!-Fiona
    http://www.efwrad.com

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  10. The situation with healthcare in Montreal is worse than in many developing countries - except that in developing countries one can get private health care services for reasonable amount of money.

    Honestly, I do not know what factors make the doctors so inefficient here. I think it is the combination of everything: natural laziness, government legal framework, lack of interest in patient's well-being, equipment and methods available. But as result we are not going to see the doctor when it is really needed and walk over pretty nasty diseases. Also spreading them to the colleagues at the office and people at home.

    What is the point of going to a random doctor in walk-in clinic in Montreal if in most of the cases he/she won't even bother trying to figure out what is wrong with you??? Almost every time I go to see a doctor I get the answer like "nothing serious, get some rest, come back if you do not get better in a week". Well, it would be nice to get some rest...but the doctor knows that my chances of coming back to the same doctor at the same clinic are slim! So they either prescribe you antibiotics or just send you back home. And there is absolutely no responsibility. They know that if you are really badly sick in a few days you will end up at ER. And if you will be dying by then - then it will be much easier to diagnose the problem :)

    I was once bounced like this by a doctor - just to end up having to see another doctor 6 weeks later when the symptoms did not go away. And that second doctor has diagnosed a well-developed bronchitis, which I had for weeks...And the first doctor did send me for x-ray promising to call me when he gets the results. He never did. When I talked to the clinic (the first one) after that they told me that the "doctor did not call you because he did not see anything wrong". Well, I guess as long as sick taxpayer can continue paying taxes - nothing is wrong. And the dead taxpayer does not consume too much so they are covered on that side too ;)

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  11. As a doctor in Quebec I disagree with double dipping but you need to be aware of something. The waiting lists in the public system are truely that long. They are not making it up. The problem is a surgeon is lucky to get 1 day of operating room per week! In some groups it is 3 days per month! What to do during the other 4 days of the week? Run your clinic seeing follow-up of patients you have already operated on or consultation of patients you will operate on (and stick them on your waiting list).

    Same thing for your gastroenterologsist. It is because he only gets 1 scope day per week. Say he can do 20 scopes per day. Giving a 48 week year that is 960 scopes per year. Given that fact that they have their chronic patients (Chrons, Ulcerative cholitis, ect) who need regular scopes and that reduces the number of available slots further. It is not abnormal for a GI doc to have 2000 scopes on a waiting list = 2 years. Now then, they rent a scope room in a private clinic 1-2 days a week (on days that the hospital will not let them work because another GI doc is using the scope room) and there you go - instead of being able to only do 960 scopes in a year they can do 960 public scopes and 1920 private scopes thus the shorter wait time if you pay.

    Remember, hospitals are paid by the governement whether they provide services or not (exception cataracts, joint replacements, ect). The minute you walk in their door you start costing them money and squeezing their budget. They would always be on budget if they could only lock all their doors and let no patients in. There is no benifit to the hospital (or the government) to double the number of surgeries or scopes in a year, it just costs them more money in equipment and salary. I have to say we offer damn good service once you get into the system - problem is that the government controls costs by making it hard to get into the system.

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  12. I live in Montreal.I have no family doctor, no I lost one last November when he suddenly could not give me appointments for a whole year. Every appointment was cancelled and re-booked two months away, only to be cancelled.I gave up and called the Regie to cancel the contract. Now am on my own or use the walk-in clinics. Something else beats me, it seems that I can learn a lot about my situation form the internet, than many of these doctors can tell me or help me with. There are tests I have wanted to have but they always give vague reasons for not ordering them. I don't understand, had to go private to get them and what I suspected was the case. Tests should also be liberalized so I can just walk up to a Lab and ask for a test like in developing countries, why should it be reserved for doctors who are not willing to test or will tell you it is in your head or you do not fit the statistics.

    Interestingly nurses do understand quite more about my situation than the doctors now I wonder who got trained for what!

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