CMAJ • March 25, 2008; 178 (7). doi:10.1503/cmaj.080294.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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NEWS

For the record

Sneh Duggal

Ottawa, Ont.

Viewing patients as "sources of revenue"

Dubbing the Canada Health Act "a dysfunctional statute," Quebec's ballyhooed Task Force on the Funding of the Health Care System, headed by former Liberal health minister Claude Castonguay, urged a raft of reforms in its Feb. 19, 2008, report, including the introduction of user fees at medical clinics and allowing physicians to work both sides of the public/private street.


Figure 8
Patients should be viewed as potential revenue streams, says former Quebec Liberal health minister Claude Castonguay. Image by: Devonyu / iStockphoto.com

The Quebec government, however, moved quickly to distance itself from many of the task force's recommendations, including one that proposed to hike the provincial sales tax by as much as 1% and another to create a 1% to 2% deductible based on income. The latter notion would also involve the creation of a "$25 deductible" to see a doctor. Castonguay later elaborated to the Board of Trade of Metropolitan Montréal that the time has come for hospitals to be run like businesses whose revenues would be based on the number of patients treated, rather than block funding. "The patients, instead of being seen as an expenditure for the hospital, become a source of revenue."

The task force report proposed that the sales tax and deductible proposals serve as the revenue base for a dedicated health stabilization fund that would pay for all health care costs above a specified threshold pegged to the rate of provincial economic growth. Essentially, the rate of health spending increases would be scaled back from a projected level of 6.5% in fiscal 2008/09 to a level of 3.9% (the projected rate of economic growth) within a period of 5 to 7 years. Monies from the new fund, and ultimately, the deductible, would provide the system with alternative sources of revenue to offset financial pressures stemming from the introduction of that provincial cap on spending increases.

Among other recommendations were ones urging that the private sector be allowed to manage hospitals, that private health insurance cover more procedures now offered by medicare and that Quebec residents pay as much as $100 per year to "access" treatment at a medical clinic. — Sneh Duggal, Ottawa, Ont.





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