Ottawa threatens to cut Quebec's health payments over user fees

The Quebec government is denying pressure from Ottawa had anything to do with its decision to scrap user fees. But a recent letter by the federal health minister suggests otherwise.

Province denies federal lobbying weighed in on its decision to ban extra fees patients pay

In a letter, Federal Health Minister Jane Philpott urged Quebec to address the practice of extra billing by doctors in the province. (Andrew Vaughan/Canadian Press)

Quebec's health minister is accusing his federal counterpart of trying to take credit for his recent decision to scrap user fees in the province.

Gaétan Barrette announced last Wednesday the province would soon eliminate many of the extra fees patients pay at doctors' offices, ranging from $20 for eye drops to $500 for instruments and medication for a colonoscopy.

But a recent letter from federal Health Minister Jane Philpott, addressed to Barrette and obtained by CBC News, suggests the decision came after urging from the federal government.

The letter, dated Sept. 6, stresses that, under the Canada Health Act, provincial and territorial health plans must cover all medically necessary procedures in hospitals and clinics.

Philpott warns that the federal government will reduce transfer payments if the province is found to be relying on user fees.

Her letter references a May report from Quebec's auditor general that confirmed the existence of the extra fees.   

Quebec's health minister has committed to putting an end to user fees. (Jacques Boissinot/Canadian Press)

Barrette: 'I don't understand'

Barrette, however, claims that a plan to ban user fees in Quebec's health system was in the works for several months before the letter from Ottawa.

"They all knew that I would come up with the abolishment of those fees," he told a news conference on Monday afternoon. "So why is it that a few days before my announcement ... she comes up with that [letter]. I don't understand."

The letter, however, also mentions a discussion between Barrette and Philpott about user fees in March, prior to Quebec's stated commitment to abolishing them.

Barrette's office said last week the minister had been pondering his announcement since as early as May. At the time, he was under pressure from health groups in the province upset with Bill 20. 

That bill, which passed in the fall of 2015 despite strenuous opposition from both the Parti Québécois and the Coalition Avenir Québec, codified the charging of user fees in Quebec clinics. 

A coalition of health groups began the process in May of seeking a court order that would force the federal health minister to "fulfil a statutory duty" to prevent overbilling through extra fees.

More details on Quebec's plan to eliminate user fees are expected Sept. 28. The changes are scheduled to come into effect mid-January 2017.

Federal Minister of Health Jane Philpott, front left, is flanked by provincial and territorial health ministers at a January meeting. (Darryl Dyck/The Canadian Press)

Feds want 'reasonable access'

Quebec is due to make a declaration to the federal government in December about the financial state of its health system for the 2014-2015 year. That will help Ottawa determine how much the province will receive in health transfers.

Philpott's letter says that she expects Quebec's declaration to include an accurate estimation of the revenues received from user fees.

It is important to make sure that Canadians know they have already paid for health care. And they will get that health care.- Federal Health Minister Jane Philpott

On Monday, following Question Period in Ottawa, Philpott suggested Quebec could still see a reduction in its health transfer next year.

"The specific details in terms of how much will be reclaimed in the Canada health transfer is a matter we will discuss going down the road in the future," she said.

"It is important to make sure that Canadians know they have already paid for health care. And they will get that health care."

The spat between Barrette and Philpott over user fees comes as the federal government is in the process of negotiating a new multi-year health accord with the provinces.

Ottawa wants to see future funding tied to benchmarks. Quebec, however, has said it will refuse to have any conditions attached to the money it receives from the federal government. 

"When any government makes investments in a particular area Canadians have a right to know what they will see as a result of that," Philpott said Monday.