After years of sending the majority of their medical transfer patients to St. John's, the government of St-Pierre-Miquelon is shopping around for a new health provider.
Rate hikes to a long-standing agreement by the government of Newfoundland and Labrador have the French islands looking elsewhere in Atlantic Canada.
"We are searching for the highest quality of care for the lowest price. It's an obligation for us," says Jacqueline André-Cormier, the president of Social Security Fund St-Pierre-Miquelon.
Health Minister Steve Kent says Newfoundland and Labrador has provided health services that aren't available in St-Pierre-Miquelon to residents who need them.
"They're transported to the province and through Eastern Health they're provided with those services that they need and they receive a discounted rate," said Kent.
"A rate that's better than what we would normally charge to non-Canadian residents, because we have an agreement that's been negotiated over time."
However, those negotiations hit a snag because of rate hikes by the provincial government.
In 2014, St-Pierre-Miquelon's government spent $3.3 million on medical costs of 810 residents. That's up in price from the $2.5 million spent in 2010 for treating 1,100 people.
The added costs have forced the French islands to look at Halifax and Moncton as possible alternatives for business.
In fact, the trend has already started; in 2010, St. John's received 77 per cent of all medical transfer patients from St. Pierre, whereas in 2014 it was down to 64 per cent.
But there's more at play than just the health dollars being spent.
Stéphanie Bowring, from St. Pierre, but works in St. John's with the Newfoundland and Labrador Francophone Economic Development Network, says there's other cash not coming into the province as a result.
"Potential hotel nights, restaurants, basic shopping and that can be makeup, it can be clothing, it can be any sort of product," said Bowring.
"As soon as we get a chance to get out of St. Pierre, we're shopping."
The potential for a loss in business isn't lost on Kent.
"There's definitely an economic benefit to Newfoundland and Labrador of all of these folks coming over to spend time. There's definitely a spin-off of that," he said.
Kent said there's also a long term-relationship with the French islands because of their location. If anything, he said he feels connections with St-Pierre-Miquelon should be strengthened.
"For that reason it's an important issue, and it's one where when I became aware of it I asked Eastern Health to work with my department and the department of municipal and intergovernmental affairs to try to get it moving again," said Kent.