It was believed that the rise of telemedicine would be one of the beautiful legacies of the pandemic.
Well no.
In the office, doctors quickly returned to their old habits of seeing their patients primarily in person.1.
It must be said that after 20 years of procrastination, Quebec still does not have a platform worthy of the name, while telemedicine is an integral part of health services in countries like Switzerland, France or Italy.2.
What a dream…
A nasty sore throat? Just make a request on an internet platform to be directed to several doctors ready to speak to you via videoconference. The cost of the consultation? Around thirty dollars. In less than an hour, you will be at the pharmacy buying the prescribed medication, as a Quebecer passing through the Milan region recently experienced.
Meanwhile, Quebec remains stuck in the era of the fax machine.
Faced with the inertia of the public network, we cannot blame the private sector for filling the void. Several companies such as Dialogue or TELUS Health have developed telemedicine platforms that are offered through the employer insurance program.
But now Ottawa wants to clip the wings of these private services that cover 10 million Canadians, as our colleague Mylène Crête revealed at the beginning of the week.3.
However, telemedicine is a solution for the future that we would benefit from developing.
This is what patients are asking for, as they do not want to take time off work to go to the clinic because of a health problem that can be solved remotely. This is even more true for patients who have mobility problems or for people in the regions who have to drive a long way to see a doctor.
Wise use of virtual medicine could save patients millions and prevent greenhouse gas emissions, according to a study conducted by the Centre hospitalier de l’Université de Montréal (CHUM)4.
Of course, in-person meetings remain crucial for issues that require a physical examination.
And of course, telemedicine should be defined to avoid excessive consultations and the duplication that some fear. That said, several studies show that only 15 to 20% of patients need to consult a doctor in person after a teleconsultation,5, 6.
But it is not the merits of telemedicine that Ottawa is questioning. Rather, the federal government wants to put an end to fees charged by private companies for virtual health care.
But be careful: the Canada Health Act does not give Ottawa the power to ban paid health services.
This law instead asks provinces that want to obtain federal health transfers to offer public services accessible free of charge to the entire population for all necessary care.
In telemedicine, it is the “double standards” that are disturbing. It is the fact that workers have access to a virtual doctor funded by their employer, while the rest of the population does not have the right to it for free.
It would be politically risky for the Trudeau government to sabotage a service that allows a good third of the Quebec population to have access to medical services, while the next federal elections are approaching.
But if Ottawa follows through on its intentions, Quebec would have several options.
The worst would be to let Ottawa cut transfers, as happened last year because of diagnostic services.
Quebec may have calculated that it would cost less to be deprived of $42 million from the federal government than to have to reimburse the tests that Quebecers pay for out of their own pockets when they go to private laboratories.
However, Quebecers are doubly losing out: not only are they paying for services that are free in Ontario, but they are also deprived of federal funds.
If we come back to telemedicine, the second option for Quebec would be to launch a public platform. The government is considering it. But it wants to first develop the Votre Santé platform, which will not be ready for two years, and then add virtual consultations to it.
There is reason to be skeptical.
Since 2021, Quebec has been dragging its feet miserably with telemedicine. There were round tables, reports, plans… but when the pandemic hit, nothing was ready, lamented the Auditor General. And 99% of remote consultations took place over the phone7.
Faced with the infinite technological slowness of the public network, Quebec could choose to make existing private platforms accessible to all Quebecers. This is what is happening in other countries such as France, where teleconsultations are reimbursed, in the same way as an in-office consultation.
Regardless of the option chosen, the future of our health system depends on innovation. Through new technologies, but also through better ways of organizing work. Telemedicine offers all of this.
It’s time to roll it out for good, for everyone. Not let it die.
1. See the Canada Health Infoway analysis (in English)
2. Read the article “Telemedicine is popular in Switzerland”
3. Read the article “Telemedicine could be hindered by Ottawa”
4. Consult the study of the Quebec Telehealth Network
5. See the article “Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada”
6. See the article “Teleconsultation Between Patients and Health Care Professionals in the Catalan Primary Care Service: Message Annotation Analysis in a Retrospective Cross-Sectional Study”
7. Consult the chapter on telehealth in the report of the Auditor General of Quebec for the year 2021-2022