An Estrie health cooperative found guilty of restricting access to care

The Roxton Pond Health Solidarity Cooperative, in Estrie, was recently found guilty by the Court of Quebec of having contravened the Health Insurance Act because it asked patients to pay an annual contribution to have access to a doctor and a walk-in clinic.

The coop, which will have to pay a fine of $15,000, claims to have corrected the situation. But the case highlights the difficult reconciliation between the requirements of the law and the financial imperatives of health cooperatives. The federation which represents them is also asking for help from Quebec to ensure their survival.

Judge Caroline Meilleur is categorical in her judgment rendered on January 11: the Roxton Pond Health Solidarity Cooperative “made access to an insured service conditional on the payment of a contribution”. This is evidenced by the “information available on the website”, the “messages conveyed” by an employee of the coop and a doctor as well as the testimonies of the two patients who were formerly members of the coop, but who had stopped paying their annual contribution. “Even the founder of the cooperative says it straight away: ‘Without contributions, there will no longer be a doctor and it will be the loss of the cooperative’,” she wrote in her decision.

However, the Health Insurance Act stipulates that it is “prohibited to make, directly or indirectly, access to an insured service conditional on payment by an insured person, or to provide the latter with privileged access to such a service in return for payment.”

Contacted by The duty, the president of the Roxton Pond Health Solidarity Cooperative, Serge Bouchard, admits that his cooperative erred during the events in question, which took place between July 19, 2017 and August 6, 2020. He explains the events by a “bad interpretation” of the law by staff. “The idea of ​​doing this [pour l’équipe], I presume, is that we wanted to retain the members, he said. There are members who pay and there are patients who were members and who stop being members. If we don’t have membership voluntary, the clinic does not exist. »

According to him, the cooperative stopped this practice as soon as it knew it was illegal. She does not intend to appeal the decision of the Court of Quebec, he specifies. Currently, the co-op has 4,200 members and serves 800 non-member patients.

Such a judgment is “quite rare,” according to professor emeritus of law at the University of Montreal Patrick A. Molinari. “The RAMQ has been interested in co-ops for a long time and believes that these structures raise legality issues with regard to the mandatory provisions of the Health Insurance Act. On the other hand, the use of criminal measures provided for in this law is not usual,” observes the lawyer specializing in health policies.

Plea for state aid

The Quebec Federation of Health Cooperatives (FQCS) has 25 members — out of the forty co-ops that exist in Quebec. She “disapproves” of the way of doing things by the Roxton Pond Health Solidarity Cooperative, which joined her group after the offenses. “We must respect the legislative framework. It’s very important,” says its general director, François Allaire.

However, financing health cooperatives remains a challenge, according to him. He recalls that the coops were born from a “citizen’s desire” to offer local health services in “medical deserts”, following the departure of a village doctor, for example. “When the cooperative starts, the whole community is there and pays the annual contribution,” he says. But after a while, there may be disengagement. »

However, members’ annual contributions — $70 on average — are essential to the functioning of the cooperative, explains Mr. Allaire. “They represent around 50% of the financing of operations,” he indicates. A share of 30% comes from the rental of premises by doctors or health professionals not paid by the State. “There is a 20% that comes from the sale of uninsured services [par la Loi sur l’assurance maladie], like foot care, he continues. There is advantageous pricing for members compared to non-members. »

To ensure the survival of health cooperatives, the FQCS is asking Quebec for financial assistance corresponding to 15% of their expenses. She made this request as part of the 2024-2025 pre-budget consultations. “We estimated it at 1.8 or 1.9 million dollars, based on the latest financial statements that we obtained [des coopératives] », specifies François Allaire.

The FQCS argues that cooperatives can help relieve emergency room congestion and that they constitute “part of the solution” to problems of access to the first line. “In certain cases, if there were no health cooperative, there would be no local services,” underlines Mr. Allaire.

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