The Quebec health system, an exception in North America, free but “asphyxiated”


" In Quebec, it is better to be treated for cancer than to seek treatment for angina”notes Marie-France (the first name has been changed), an executive in a Montreal bank, confronted with the two experiences. “Our hospitals are full of the best specialists, especially in oncology, and after a few chemotherapy sessions, I know I'm almost out of business. On the other hand, if I catch a small virus as winter approaches, I will have great difficulty finding a doctor who will give me the right antibiotics.she sighs.

Like 830,000 Quebecers, or 10% of the total population, Marie-France is a patient "orphan" of a general practitioner. She is on a waiting list which promises her that, within three, four or five years – the period has been further extended since the Covid-19 crisis – she can hope to find her place in the patient population. of a family doctor. In the event of a small glitch, she knows she can find help from her pharmacist, who is able to issue first aid prescriptions. When it gets more serious, she has to seek medical consultation at a so-called “walk-in” clinic, sometimes far from home. Unless she resolves to pay a few hundred dollars a year for a service offering to do the same research for her, or even to find a place in a private structure.

Read the decryption: Article reserved for our subscribers In Quebec, the pandemic reveals a bloodless health system

The Canadian health system, which includes social care and services, is nevertheless an exception, often cited as an example, in North America. Universal and free system, through the Régie de l'assurance maladie, it also offers drug insurance to all those who do not have private mutual insurance. Health, under provincial jurisdiction with co-funding from the federal level, is financed by taxes.

Doctors working less

"Even though we are among the OECD countries among those who invest the most in the healthcare system, we remain among the worst students in terms of access to healthcare, explains Denis Chênevert, director of the health center at HEC Montréal. Our system was built to offer only one entry point to the patient, the family doctor. » However, today, the Federation of General Practitioners estimates that there would be a shortage of more than 1,000 general practitioners in Quebec, for 7,500 in activity.

Cornerstone of the system, these doctors, paid by the State, benefit from significant remuneration, which has risen sharply over the past ten years, up to 300,000 dollars (226,000 euros) per year. But considered as self-employed, they are free to choose their volume of activities and their schedules. The feminization of the profession and the less Stakhanovist relationship to youth work have resulted in a loss of the total number of hours worked. “They constitute a very powerful interest group which absorbs the bulk of health expenditure, and any attempt by the public authorities to lower their remuneration is met with a front of refusal”, notes Olivier Jacques, professor in the department of health policy at the University of Montreal.

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