As we saw a few years ago with the ancillary costs file, Quebec generally does not really have the choice of complying, willy-nilly, with the conditions set out in the Canada Health Act (CHA). , if it wants to benefit from federal health transfers. Recent events show that the Quebec government is counting on these transfers.
However, the current fragmented offer of telemedicine services in the public system, coupled with an obvious tolerance for the same services offered by certain private companies, could become a new source of friction between Ottawa and Quebec. It is in particular the conditions of comprehensiveness (coverage of all medically required services), accessibility (without financial or other obstacles) and universality (for the entire population) set by the LCS which could be in question. .
We can anticipate this prospect when reading the latest LCS application report (2020-2021), in which the Federal Minister of Health, Mr. Jean-Yves Duclos, declared that “care is care” and that his “interpretation of [Loi] adapt to changes in the health care system to ensure that regardless of how an insured service is delivered (i.e. virtually or in person), patients do not see each other not charge a fee for access.
So what about Quebec’s situation in this matter?
A certain “Far West” for the private sector
The “Health Plan” presented last spring by the Minister of Health and Social Services, Christian Dubé, clearly indicates a desire to rely on virtual care to increase the accessibility of services to the population, but it is sparing of details. on this subject.
As for Bill 11 introduced by the same minister and adopted last May, one of its objectives is to better regulate telemedicine, obviously in response to certain concerns raised by the Auditor General regarding various shortcomings observed during the pandemic. Thus, this bill and the draft regulation that accompanies it provide, in particular, for the right to face-to-face services for the patient and, as a corollary, the requirement for the person offering the service to have a “corridor of services” pre-established to promote the exercise of this right. The problem is that these conditions only apply to public services, thus excluding those offered by private platforms.
Furthermore, according to a regulatory amendment that came into force on 1er January 2023, private benefit plans will be able to include medical teleconsultation services, which would be the case, for example, with certain employers in the parapublic sector, according to what was recently made public. In other words, depending on whether or not a person holds a job in an organization offering such social benefits, he or she will or will not have privileged access to private medical services, by teleconsultation.
This same measure again opens the door to a certain mixed medical practice, public-private, which is not likely to encourage physicians’ working time entirely devoted to public services.
Meanwhile, in British Columbia, the body that exercises responsibilities similar to those of the Régie de l’assurance maladie du Québec (RAMQ) decided instead to seek an injunction against one of the major companies in the care sector. to put an end to practices that would grant privileged access to medical services for an annual fee billed to patients.
It should be noted that the development of the private sector does not only concern medical services, but those of all health professions. Thus, private companies can set up an extensive offer of teleconsultation services at the expense of patients, by recruiting specialized nurse practitioners, psychologists, nutritionists, etc.
Finally, in the absence of a clear legal framework concerning teleconsultations carried out on an interprovincial basis, it is currently possible that these same private companies may seek to circumvent the rules enacted by the provinces, for example by freeing themselves from the regulations local professional. However, recent case law on the ethical level clearly illustrates the possible deviations of a professional practice which would be first and foremost oriented towards expeditious consultations, without adequate care for the patient.
Ensuring real and equitable access
The LCS does not prohibit private health services, neither in terms of delivery methods nor in terms of financing. It does, however, require provinces to make medically required services available to the general population, based on patient needs, rather than ability to pay or employment status. In the current state of affairs, therefore, it is not certain that the situation in Quebec complies with the conditions of the CHA.
To correct the situation, Quebec could thus do like other provinces and cover, through the public health insurance plan, the costs of access to virtual care on private platforms. It can also choose to develop its own offer of telemedicine services within the public system, which seems to be the preferred option, but which is slow to materialize. A combination of these options would also be possible.
In all cases, a framework should be provided that will not only allow innovation, but also guarantee real equitable access to teleconsultation services for the entire population, by ensuring that all players, including those in the public or private sector, are subject to clear and consistent rules.