Quebec's largest labour federation is worried an impending report on health-care financing will clear the way for two-tiered care, allowing private services at the expense of the public system.

The Castonguay report on financing Quebec's medical system — to be made public on Tuesday — is expected to recommend private health care be given a greater role to meet growing demands pressuring the system. 

But the public health-care sector also needs fine-tuning to make it run more efficiently, said the Confédération des syndicats nationaux (CSN)

The union hopes Quebec Health Minister Philippe Couillard will "give us a clear signal that he wants to consolidate the public system," even if the province allows more private health care, CSN spokeswoman Josée Roy said at a press conference Sunday in Montreal.

The working group on health-care financing has spent several months studying options to control Quebec's soaring medical costs, which are increasing four times faster than the province's ability to pay, according to government figures.

Couillard said he's not philosophically opposed to private care.

"Numerous countries in the world do so, without being accused of being anti-social or backwards," he said last week.

But even if the private system is given more leverage, the changes won't be radical or immediate, he assured.

"The question and problem we have in Quebec is very practical. It's a question of medical manpower," which manifests in a chronic shortage of family physicians and specialists, Couillard said.

"And it's a question of vast regions sparsely populated, which other countries don't have to face. As long as we don't have the required level of medical manpower, it probably would be unwise to go in this [private] direction."

Opposition parties agree private care is necessary

Two-tiered systems end up costing less and operate more efficiently, said Action Démocratique du Québec Leader Mario Dumont, who recently returned from his first trip to Europe as Opposition leader.

"They do much better than we do" with mixed health-care systems, he said.

Parti Québécois Leader Pauline Marois said that while she understands there has to be a greater role for private services, her party want "preference" to be given to public care.
 
The working group on health financing was led by Claude Castonguay, a former Liberal cabinet minister who has been an advocate of greater privatization, user fees and private insurance in the system.

Quebec's Liberal minority government appointed Castonguay in 2007 to oversee the closed-door committee on health-care financing.

Quebec 1st province to try private care

The province has been forced to experiment with private services for some procedures since a landmark Supreme Court decision in 2005 ruled Canada's health laws were unconstitutional because they prevented patients waiting for public medical care to pay for private insurance to cover treatment.

Private insurance is now allowed for some procedures such as cataract and knee-replacement surgery.

Last month, Montreal's Sacré-Coeur Hospital became the first in the city to rent out a private clinic and staff for day surgery.