Health care – What Quebec can learn from Ontario
Health care in Canada was ranked 10th of 11 comparable wealthy countries by the Commonwealth Fund in their most recent report. They were ahead of only the US and that was primarily because the US does not have universal health care. According to the Fraser Institute, we spend 11 percent of our GDP on health care, more than 27 comparable countries but we ranked 31 out of 34 advanced OECD countries in acute care beds per 1,000 population; 26 out of 31 in medical doctors; and 17 out of 32 in nurses.
In terms of provinces, Quebec lags behind the two other large provinces, Ontario and BC. As I have argued in a past article, Prescription for improved medical care in Quebec and Canada, one of the biggest reasons for the high cost and poor performance is the lack of private options whether paid for by the government or not. Canadians are starting to come around with a recent Ipsos poll showing 67% believe private entities can provide health care services faster than publicly funded institutions. 52 per cent of Canadians agree access to private health care should be increased, and 54 per cent of Canadians believe government spending on health care is unsustainable. In Quebec, it is 64% who believe the spending is unsustainable. Further, Quebecers say their health care system is “too bureaucratic” (83 per cent) and the system should be more decentralized (72 per cent), both numbers that exceed the national averages. Yet Quebec is moving in the opposite direction while Ontario is on the right path.
Governance of hospitals and clinics
Unlike Quebec, in Ontario public hospitals are independent corporations run by their own board of directors. They are mostly non-profit and are funded by the Ontario government. There are also a few private hospitals. With Ontario’s Bill 60 passed in May, 2023, both private and non-profit clinics will be able to perform more kinds of surgery, diagnostic tests and procedures. Both for-profit and not-for-profit clinics will be allowed to conduct cataract surgeries, MRI and CT scans, minimally invasive gynecological surgeries and, eventually, knee and hip replacements all covered by the Ontario Health Insurance Plan.
In contrast Quebec’s hospitals are all under the control of regional bodies each with several hospitals. Now, Quebec’s new Bill 15 will create Santé Québec to oversee the entire health care network. Santé Québec, an agency responsible for coordinating the day-to-day operations of the health and social services network, will be all powerful. It will further centralize health care in Quebec and lead to more bureaucracy, just what Quebecers say they do not want. As for private clinics there is limited tolerance but the government has stated that they would like to eventually eliminate them.
Quebec would be wise to scrap Bill 15 and scrap the reginal governing bodies created by Liberal Health Minister Gaetan Barrette. They should return to local boards controlling each hospital but they won’t. The result will be that the gap between Ontario and Quebec in quality health care will get even larger than it already is.
More doctors and nurses
There is a severe shortage of health care professionals in Canada but Ontario has addressed the issue. For years all provinces have accepted immigrants based on qualifications but then the provinces put roadblocks in the way. In Ontario, professionals needed Canadian experience in order to work here. Now Ontario has ended that requirement for 30 occupations including many in the health care field. In anticipation of getting many more health care professionals, Ontario is also expanding the number of hospital, home care and long-term care beds.
In contrast, Quebec has more roadblocks than any other province. They do not accept foreign credentials unless there is experience in Canada and they accept very few doctors into residency programs each year. New doctors educated in Quebec must apply to work in a particular region and many do not get accepted in their preferred region. Those who choose to work where they were not accepted get a 30% pay cut. Is it any wonder that 50% of newly graduated health professionals choose to leave the province. Their first-class education is heavily subsidized by Quebec taxpayers and then they leave.
Most health professionals can work in English since that is the language of science and business but Quebec requires French and that limits the pool of potential doctors and nurses. Add to that restrictions on the schools their children can attend, restrictions on the professions their children can work in without giving up their religious beliefs (Bill 21) and the general limits on English speakers in Bill 96. Taken together, these disincentives guarantee that Quebec will have an ever-increasing shortage of health professionals.
A demographic disaster is about to hit Quebec
The proportion of seniors over 85 is highest in Quebec according to Statistics Canada’s 2021 census and it is climbing much faster than in other provinces. Combine that with the expanding shortage of medical professionals in Quebec and we are heading for a disaster of unprecedented proportions.
It doesn’t have to happen but unless Quebec starts emulating the steps taken in Ontario, it surely will. Why no provincial party has a health care platform along the lines that I have been advocating in my articles is puzzling, especially given the opinions of Quebecers that the province’s health care system is too bureaucratic (83%) and too centralized (72%). It seems that any party presenting a health care platform which features maximum private options, most covered by Medicare, and eliminates all barriers to obtaining health professionals, will get a lot of votes. Health is the number one concern of voters and it will become even more of an issue as it continues to deteriorate.
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4 Comments
Thank you for this comprehensive overview of the Canadian Health system in general and the comparison between the Quebec/Ontario health system in particular.
Sadly, despite the Quiet Revolution, the hierarchical mindset of the Quebec provincial leaders remain the same as shaped and controlled by The Church.
Marilyn
Thank you, Bill, for your overview of Canada’s health system ; especially focusing on the Ontario/Quebec situations.
Very interesting and informative.
I believe that although Quebec had a Quiet Revolution and separated State from Church, the Church’s hierarchical mindset has been incised in Quebec’s political DNA and its citizens are its economical and psychological victims
I read your article and am fully aware of the difference in health care of both provinces. I am going on 82 and all you said was really true. We elders in Québec are being left behind. Thank you for my 1st comment on your blog.
Thank you for joining the conversation.