HEALTH CARE : Doctors Cry Foul as Quebec Attempts to Overhaul System

Just when U.S. health economists have been homing in on Canada as a model for reforming American health care comes a rash of physician protests and work stoppages in Quebec, a threatened doctors’ wildcat strike and a lurid advertising campaign pitting doctors against the provincial government--all as if to show that things medical are not perfect north of the border, either.

The confrontation has been limited thus far to Quebec, because it is the only province to attempt broad-based reform. But other provinces may soon follow Quebec’s lead. Paul Lamarche, Quebec’s associate deputy minister for health care reform, notes that eight of Canada’s 10 provinces have begun Quebec-style studies of their health care programs. Overhauls can’t be avoided, he said, adding, “If we don’t do something, then our whole system may collapse.”

Quebec’s impasse began late last year, when the provincial government announced plans for sweeping changes. Its existing health system was put in place in 1971 and has been modernized little since.

But the province has changed: The population has aged, costly high-tech equipment has come onto the market and afflictions such as AIDS have taken their toll. These factors have put Quebec’s system under considerable strain.

Today, health care costs in Quebec are growing faster than the provincial budget can absorb them. About 9% of the province’s output of goods and services is spent on health and social services, compared to just 8.2% in the rest of Canada. While that’s much better than the United States--which spends 12.2% of its output on health care alone--it is still more than the province can come up with in these lean times. “Our health care cost is under control,” says Lamarche. “The issue is, are we rich enough to afford it?”

Not only has the Quebec government decided it can’t; after five years of study, it has also concluded that doctors are behind the cost surge.

Over the last decade, while the provincial population was growing by just 5%, the number of doctors in Quebec has increased by 25%. And the number of medical services billed to the government has increased in direct proportion to the increase in doctors--not the increase in population.

Such statistics make health economists think doctors are seeing patients more often than they should, performing unnecessary procedures and dispensing unneeded drugs. Canadian doctors, after all, are paid per service rendered.

So Quebec’s reform comes down firmly on the doctors. One provision would empower regional boards to ship new doctors to the provincial boondocks; if they did not want to go, they could stay in the cities but be reimbursed for just 70% of their bills. Another change would be a small fee--the Canadian equivalent of $4.35--charged to every patient who went to an emergency room when he could have been treated somewhere else.

Quebec’s doctors are fighting the reform fiercely, saying it makes them scapegoats, could threaten patients’ lives and represents a dangerous totalitarian trend.

“We are talking about health, but this is really a power struggle between the bureaucrats and the medical profession,” says Georges Boileau, a spokesman for Quebec’s Federation of General Practitioners.

The doctors have already walked off their jobs three times this year and have threatened a full-fledged general strike if the reform goes through as written. They have also spent hundreds of thousands of dollars on dramatic advertisements on the risks of the reform.

The government recently agreed to negotiate compromises with the doctors. But the talks are likely to drag on all summer.

U.S. vs. CANADA

By most standards, Canadian health care still looks attractive compared to the U.S. system. Canada spends less of its wealth on health care and seems to spend it more rationally. Key Canadian health statistics are superior to those in the United States. There is no massive Canadian underclass struggling to get by without health insurance: all citizens are entitled to coverage. Typically, Canadians are assigned a health insurance number, which they report each time they visit a doctor’s office or hospital. Doctors then give treatment and bill the provincial government.