Quebec health system, an exception in North America, free but “asphyxiated”

Many investments but problems of access to care … with fewer general practitioners and exhausted nurses, the model is on the verge of embolism, as in France.


“In Quebec, it is better to be treated for cancer than to seek to treat an angina,” notes Marie-France (the first name has been changed), an executive in a Montreal bank, confronted with the two experiences. “Our hospitals are full of the best specialists, especially in oncology, and after a few chemotherapy sessions, I almost get out of business. On the other hand, if I attract a small virus as winter approaches, I will have All the sorrows of the world to find a doctor who will give me the right antibiotics, “she sighs.

Like 830,000 Quebecers, or 10 % of the total population, Marie-France is an “orphan” patient as a general practitioner. She is registered on a waiting list which promises her that, within three, four or five years -the deadline has further extended since the COVVI -19 crisis -, she can hope to find her place in patients of a family doctor. In the event of a small glitch, she knows how to find help with her pharmacist, able to issue first aid prescriptions. When it becomes more serious, she has to seek a medical consultation in a so-called “meeting” clinic, sometimes far from her house. Unless it is resolved to pay a few hundred dollars a year a service offering it to do this same research in its place, or even find a place in a private structure.

The Canadian Health System, which includes social care and services, is an exception, often cited as an example, in North America. Universal and free system, through the health insurance management, it also offers medication insurance to all those who have deprived of private mutual. Health, of provincial jurisdiction with co -financing of the federal level, is funded by the tax.

“We may be within OECD countries among those who invest the most in the care system, we remain among the worst students in terms of access to care, explains Denis Chênevert, Director of the pole Health at HEC Montréal. Our system has been built to offer only one gateway to the patient, the family doctor. “Now, today, the federation of omnipractic doctors estimates that it would miss more than 1 000 general practitioners in Quebec, for 7,500 active.

Angular stone of the system, these doctors, paid by the State, benefit from significant remuneration, upstairs for ten years, up to $ 300,000 (226,000 euros) per year. But considered as self -employed workers, they are free to choose their volume of activities and their schedules. The feminization of the profession and the less stakhanovist report at the work of young people led to a loss of the total number of hours worked. “They constitute a very powerful interest group which absorbs most of the health expenses, and any attempt at the public authorities to lower their remuneration comes up against a front of refusal,” notes Olivier Jacques, professor in the department of health policy of the University of Montreal.

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/Media reports.