As our previous text pointed out, the right to health requires that the movement to privatize health care be curbed and examined, because it is very likely to call into question the exercise of this right. Privatization is characterized by the pursuit of profit, that is, the search for a financial advantage that goes beyond simple remuneration for a service rendered. Elementary logic allows us to doubt that this search for profit promotes the realization of rights and freedoms, whether in terms of health, education, housing or the environment, for example.
Too hasty if one takes into account the magnitude of the project in question, too selective in the number and variety of stakeholders invited to comment, the consultations conducted by the National Assembly on Bill 15 (PL15) do not allow fail to address the privatization of the health and social services network in an informed and democratic manner. But privatization is taking place, however, made possible through other legislation and regulations which have not caused as much ink to flow as the PL15… and for which the population is in no way called upon to comment.
While our health and social services system has never prohibited the pursuit of profit, it has limited it by not allowing physicians to be remunerated both by the Régie de l’assurance maladie du Québec and directly by patients, what is called mixed practice.
Moreover, the prohibition of duplicate insurance prevents private insurers from offering protection for care covered by the public plan. Combined, these two measures have curbed the privatization of the system, complicating the search for profit, which is confined to services that are not provided by the public system. The objective is in particular to restrict the exodus of resources trained at great expense from the public network to the private network.
Thus, well before the presentation of the PL15, privatization accelerated, in particular through other components of the Health Plan, the devil hiding in the modification of the coverage offered by the public plan. Recent events provide us with eloquent examples.
Colossal deal-making potential
On December 7, 2022, the Regulations implementing the Health Insurance Act was modified1 discreetly. The changes remove from public coverage the services rendered by a professional and which are the subject of an agreement with an employer or an organization for the benefit of its employees or its members and their family members. Professionals can therefore offer these services concurrently with their practice in the public sector and bill employers or private insurers directly. Remember that approximately 55% of Quebecers currently benefit from private insurance complementary to the public plan.2. The potential for concluding agreements concerning care provision financed by employers and insurers is therefore colossal.
Moreover, a few days ago, Radio-Canada3 reported the proliferation of private clinics in which users pay to obtain the services of a specialized nurse practitioner (SNP).
This proliferation is taking place thanks to the expansion of the field of practice of IPSs and the fact that their services are not covered by the public health insurance scheme.
In another register, on the occasion of the tabling of its annual report in the National Assembly on May 25,4, the Auditor General of Quebec finds that the CISSSs and CIUSSSs are likely to have developed a dependence on the suppliers with whom they concluded contracts without a call for tenders during the pandemic. The integrated centers also cannot do without the services offered by the independent workforce. The pursuit of profit thus clears other paths in the public system.
Without generating the privatization of our network of health and social services, which privatization precedes it and, as we have shown, is taking place elsewhere, PL15 is nonetheless a catalyst. Regrettably, the consultations that have taken place over the past few weeks have not allowed us to debate the bill sufficiently, and no democratic consultation has enabled us to collectively decide on the Health Plan as a whole or on the decree of December 2022. However, democratic participation is essential, while it is important to fully understand and denounce the impacts of privatization on the right to health.