Last week, IRIS published a study exposing the risks posed by the development of the private virtual care industry to equitable access to care and the sustainability of the public system.
Taking advantage of the context of the COVID-19 pandemic, companies in the sector have experienced dazzling growth over the past two years, some of them having quintupled their turnover since 2020. Rather than closing the legal loopholes favoring this worrying trend as recommended by our study, the Legault government has chosen to open the door wide to this new form of private, for-profit medicine, raising fears of the emergence of a real two-tier health system in Quebec.
It was without much fanfare that the government adopted a decree on December 7 with three main effects: 1) formalize the extension of public coverage to telemedicine services which had been temporarily granted at the start of the pandemic; 2) authorize that teleconsultation medical services may be covered by private benefit or group insurance plans even if they are already covered by the public plan; 3) allow publicly funded physicians to sell their services to private virtual care companies.
The adoption on the sly and without public debate of such significant amendments to the Regulations implementing the Health Insurance Act is worrying to say the least.
Despite their technical and daunting nature, these modifications deserve to be brought to the attention of the public. Indeed, they are likely to have major consequences since they undermine two important pillars of the Quebec public system: the ban on mixed practice (public-private) for physicians and the ban on duplicate insurance. In this, one could even say that these new regulatory provisions are in flagrant contradiction with the spirit of the law whose application they are supposed to allow.
Indeed, these two prohibitions, enshrined in the Health Insurance Act since its adoption, have been put in place to avoid the development of a private health market parallel to the public system. The aim was to ensure that existing professional resources were made available to the entire population and to prevent them from being diverted from the public network by for-profit companies selling their services only to people able to pay or with a private insurance.
Yet it is precisely this risk posed by the extremely rapid growth of the private virtual care industry. Indeed, this growth is accompanied by massive recruitment efforts which are reflected in the explosion of remuneration expenditure by companies in the sector. Some of them have seen these expenses jump between 200% and 900% in two years, in a context where the shortage of personnel is particularly glaring in the field of health and social services and where the public network is already struggling to hire and to retain the personnel necessary to meet the needs of the population.
Despite the risks posed by this industry for the sustainability of the public system and equitable access to services, the Legault government, Investissement Québec and the Caisse de dépôt et placement have not hesitated to financially support the development of some of the virtual care through investments and loans totaling millions of dollars since 2018.
You should also know that the major regulatory changes that came into force on 1er January were adopted following direct pressure from the industry on the government, led in particular by Alexandra Charest (daughter of the former Premier of Quebec) on behalf of Dialogue, one of the major players in the sector. We should also mention that White Star Capital, the company in which Pierre Fitzgibbon held interests which he refused to divest (which earned him several reprimands from the Ethics Commissioner), is one of the main shareholders of this same virtual care.
The decree adopted behind closed doors by the government certainly serves the interest of those who hope to benefit from the development of a lucrative health market. However, it constitutes a major breach in the regulatory edifice, making it possible to prevent the development in Quebec of a two-tier health care system. In this, it should be an object of concern for the entire population.