This is the title that would have better suited Daniel Dufort’s text, published on July 15 in the Free Opinion section of Duty. The President and CEO of the Montreal Economic Institute (MEI) stated that “Ottawa is putting access to telemedicine in Quebec at risk.” We must set some records straight.
First of all, let’s remember that telemedicine has indeed proven itself during the pandemic and is now used frequently by doctors in the public network. This is Already a medical act paid for by the Régie de l’assurance maladie du Québec (RAMQ) and access to this act is not likely to magically “disappear” from current medical practices because the government is asked to cover it. On the contrary, it is a matter of supervising and perpetuating this method, by fully integrating it into medically necessary care that must be covered according to the terms of the Canada Health Act (CHA).
Let’s be clear, it is private and for-profit telemedicine (covered by individuals or by insurance) that would be in danger with the federal government’s announcement: “The federal position is that patients should not pay fees for medically necessary care when these services would normally have been covered if they had been provided in person by a physician,” Ottawa wrote.
It is true that health care spending is colossal, accounting for nearly half of the provincial budget. However, as the author noted, nearly 20 years of privatization in Quebec have failed to reduce the bill or ensure better access to quality care. On the contrary, increased use of the private sector has only led to deterioration: worsening staff shortages, increasing surgical waiting lists, and increasing costs due to outsourcing to the private sector.
It is therefore false to claim that telemedicine coverage by private insurers would reduce the administrative or fiscal burden on the government. Indeed, it is well demonstrated that public and single-payer health care systems are more efficient and generate less costs. Ultimately, citizens are doubly penalized by for-profit telemedicine: not only do they pay through their taxes for services they do not receive, but they also have to pay directly out of their own pockets for a service that is often of lower quality.
When it comes to emergency room overcrowding, telemedicine can be a double-edged sword. Overuse and underuse can increase emergency room visits for physical exams, as was observed in 2021 during the COVID-19 pandemic. The Regroupement des chefs d’urgence du Québec had denounced the uncontrolled increase in telemedicine, which had contributed to emergency room overcrowding. For-profit telemedicine companies often make this problem worse: a consultation of a few minutes for a problem requiring a physical exam or follow-up often results in a visit to the emergency room.
Meanwhile, doctors offering these consultations in the private sector are taking time slots away from the public sector, which is exacerbating the problems of accessibility to quick consultations and pushing more people to consult in the private sector. A vicious circle.
Moreover, it is essential to emphasize that the rapid increase in the private for-profit telemedicine care offer is the result of the discreet adoption of a decree allowing public sector physicians to also offer telemedicine services to the private sector, thereby reducing their care offer in the public system. We had strongly denounced this practice, considering it a form of self-sabotage. Two years later, our concerns were confirmed when we learned that the co-founder of Dialogue Technologies de la Santé, one of the largest private telemedicine companies in Canada, now sits on the board of directors of Santé Québec.
There is no denying that telemedicine is a crucial addition to our healthcare offering. However, it is essential to develop it and integrate it sustainably into our public network. Only a fair and public approach will ensure sustainable and quality access to healthcare for all Quebecers. We must ensure that telemedicine initiatives strengthen our public healthcare system rather than creating additional disparities and inefficiencies. In this regard, we ask the government to fully cover the costs associated with telemedicine and thus curb the incursion of the for-profit private sector in this area.