POLITICS * POLITIQUE
Amended Bill 120 finally law in Quebec but some physicians remain concerned
David Spurgeon L ast-minute lobbying by Quebec's doctors saved them from some of the most coercive aspects of the province's new health care legislation, Bill 120, which passed into law Aug. 28. But, according to Dr. Augustin Roy, president of the Corporation professionelle des medecins du Quebec, the new act "nonetheless remains heavy loaded, rigid,
complicated, bureaucratic, autocratic, monolithic, costly and difficult to implement." And those were some of the nicer things he said about it. In an editorial of the September issue of the corporation's Bulletin, Roy wrote: "Despite the minister's demagoguery, everyday citizens will not be able to find their way through the underfunded maze. Joining the consuming, paying and decision-making citizens will be a new class of mendicant patient, endlessly shuffled from one institution to another on the whim of an administrator...."
"It's a new partnership between doctors and government." -
Dr. Robert Marier
some resulting from talks between boards could deny hospital privithe minister and the province's leges in urban areas to young spedoctors, who had threatened to cialists, and licences to general strike if the bill was not changed. practitioners. In their talks with provincial Ostensibly, Bill 120 was designed to decentralize and mod- health minister Marc-Yvan Cote, ernize the $1 2-billion provincial the Federation des medecins spehealth and social-services net- cialistes du Quebec countered this work. Regional boards were to be coercive aspect by offering to proThe new legislation was given wide-ranging powers in the vide incentive payments to enpassed during a special session of operation of health care services. courage physicians to work in Quebec's national assembly, Through these boards, for exam- rural areas and smaller centres. called solely for that purpose. ple, the government hoped to These could include bonuses as About 600 amendments were solve medical staffing shortages in great as 40% of the average Monmade to the bill's 494 articles, outlying areas and in government treal specialist's earnings and a institutions such as community- paid 1-year sabbatical in an urban David Spurgeon is a freelance writer living health centres and homes for the centre after 5 years of practice in in Mont Tremblant, Que. aged. With their powers, the a remote area; the year off is 1002
CAN MED ASSOC J 1991; 145 (8)
LE 15 OCTOBRE 1991
supposed to enable doctors to keep current with their training. Another incentive would be a lowcost mortgage program to encourage doctors to buy homes in remote areas. In their negotiations with government, the physicians also guaranteed that in their first 10 years of practice, general practitioners will agree to work in government institutions, where they are said to be in short supply. C6te has put a time limit on the doctors' proposals. For instance, he said the specialists' federation has until Apr. 1, 1993, to come up with detailed solutions to physician-distribution problems that are acceptable to the government. If it fails, the government will solve that problem by decree. The doctors managed to win a significant change in the makeup of regional boards, which will now include physician members. A controversial $5 user fee ticket orienteur - for those who visit hospital emergency rooms for nonemergency treatment has been retained in the legislation, even though it has been opposed by some groups and federal Health Minister Benoit Bouchard has warned that it may contravene the Canada Health Act. The fee will come into effect
only after primary health services have been improved and a publicity campaign has been launched to encourage people to visit doctors' offices for minor problems. After agreement was reached, neither doctors' groups nor the minister gloated. "For me, it's not a question of the minister who won or the doctors who won," said Cote. "It's the citizen who has won. For the first time in 20 years, doctors are part of the reform." Dr. Robert Marier, newly elected president of the specialists' association and a member of the CMA Board of Directors, called the agreement a historic turning point. "It's a new partnership between doctors and government," he said. "Mr. Cote was alone before. Now he will try to solve the problem with doctors and the responsibility for finding solutions will be with [both]." Marier said a new approach was necessary because of provincial budget restraints. Other observers were more outspoken. Roy, for instance, said it will take a decade to sort out problems created by the new legislation. "The patient is not the winner in this," he said in an interview. "It's the bureaucrats certain [ones] in particular."
"The patient is not the winner in this." Dr. Augustin Roy
OCTOBER 15, 1991
Those on regional boards, he argued, will become "mini-ministers of health." Roy said the only beneficial aspect of the negotiations was that specialists were forced to face their moral obligation to provide services throughout the province, and not just in larger centres. "The task is eminently manageable, as 300 specialists, approximately the graduating class, will be sufficient to fill the needs described." Otherwise, he contended, the new law is just "structural reform" that will create budgetary problems because of the government's fiscal constraints. Government has less capacity to pay for medical services, he observed, yet it doesn't want to cut services because the move would be unpopular politically. Remy Trudel, the Parti Quebecois social services critic, said the amendments gut Bill 120's reforms and the new legislation will not meet its original goals of making the health care system more viable, efficient and sensitive to the needs of users. He also denounced the $5 user fee, as did the Equality Party of Quebec. Alex Paterson, chairman of the Board of Governors of McGill University and a member of the advisory board of the Montreal Neurological Institute, wrote in the Montreal Gazette that Bill 120 threatened to strip most of the powers of nonprofit corporations that own assets in the health and social-services sectors, and thus to muffle the community's voice in running the institutions. "In my experience, which goes back 35 years with these hospitals, the difference between a mediocre operation, a good one and an excellent one is the pressure that the community can put on the government," Paterson wrote. "If you remove one of these elements, the government has a freer range - and it's not to do evil, it's to do nothing."CAN MED ASSOC J 1991; 145 (8)
1003
Amended Bill 120 finally law in Quebec but some physicians remain concerned
David Spurgeon L ast-minute lobbying by Quebec's doctors saved them from some of the most coercive aspects of the province's new health care legislation, Bill 120, which passed into law Aug. 28. But, according to Dr. Augustin Roy, president of the Corporation professionelle des medecins du Quebec, the new act "nonetheless remains heavy loaded, rigid,
complicated, bureaucratic, autocratic, monolithic, costly and difficult to implement." And those were some of the nicer things he said about it. In an editorial of the September issue of the corporation's Bulletin, Roy wrote: "Despite the minister's demagoguery, everyday citizens will not be able to find their way through the underfunded maze. Joining the consuming, paying and decision-making citizens will be a new class of mendicant patient, endlessly shuffled from one institution to another on the whim of an administrator...."
"It's a new partnership between doctors and government." -
Dr. Robert Marier
some resulting from talks between boards could deny hospital privithe minister and the province's leges in urban areas to young spedoctors, who had threatened to cialists, and licences to general strike if the bill was not changed. practitioners. In their talks with provincial Ostensibly, Bill 120 was designed to decentralize and mod- health minister Marc-Yvan Cote, ernize the $1 2-billion provincial the Federation des medecins spehealth and social-services net- cialistes du Quebec countered this work. Regional boards were to be coercive aspect by offering to proThe new legislation was given wide-ranging powers in the vide incentive payments to enpassed during a special session of operation of health care services. courage physicians to work in Quebec's national assembly, Through these boards, for exam- rural areas and smaller centres. called solely for that purpose. ple, the government hoped to These could include bonuses as About 600 amendments were solve medical staffing shortages in great as 40% of the average Monmade to the bill's 494 articles, outlying areas and in government treal specialist's earnings and a institutions such as community- paid 1-year sabbatical in an urban David Spurgeon is a freelance writer living health centres and homes for the centre after 5 years of practice in in Mont Tremblant, Que. aged. With their powers, the a remote area; the year off is 1002
CAN MED ASSOC J 1991; 145 (8)
LE 15 OCTOBRE 1991
supposed to enable doctors to keep current with their training. Another incentive would be a lowcost mortgage program to encourage doctors to buy homes in remote areas. In their negotiations with government, the physicians also guaranteed that in their first 10 years of practice, general practitioners will agree to work in government institutions, where they are said to be in short supply. C6te has put a time limit on the doctors' proposals. For instance, he said the specialists' federation has until Apr. 1, 1993, to come up with detailed solutions to physician-distribution problems that are acceptable to the government. If it fails, the government will solve that problem by decree. The doctors managed to win a significant change in the makeup of regional boards, which will now include physician members. A controversial $5 user fee ticket orienteur - for those who visit hospital emergency rooms for nonemergency treatment has been retained in the legislation, even though it has been opposed by some groups and federal Health Minister Benoit Bouchard has warned that it may contravene the Canada Health Act. The fee will come into effect
only after primary health services have been improved and a publicity campaign has been launched to encourage people to visit doctors' offices for minor problems. After agreement was reached, neither doctors' groups nor the minister gloated. "For me, it's not a question of the minister who won or the doctors who won," said Cote. "It's the citizen who has won. For the first time in 20 years, doctors are part of the reform." Dr. Robert Marier, newly elected president of the specialists' association and a member of the CMA Board of Directors, called the agreement a historic turning point. "It's a new partnership between doctors and government," he said. "Mr. Cote was alone before. Now he will try to solve the problem with doctors and the responsibility for finding solutions will be with [both]." Marier said a new approach was necessary because of provincial budget restraints. Other observers were more outspoken. Roy, for instance, said it will take a decade to sort out problems created by the new legislation. "The patient is not the winner in this," he said in an interview. "It's the bureaucrats certain [ones] in particular."
"The patient is not the winner in this." Dr. Augustin Roy
OCTOBER 15, 1991
Those on regional boards, he argued, will become "mini-ministers of health." Roy said the only beneficial aspect of the negotiations was that specialists were forced to face their moral obligation to provide services throughout the province, and not just in larger centres. "The task is eminently manageable, as 300 specialists, approximately the graduating class, will be sufficient to fill the needs described." Otherwise, he contended, the new law is just "structural reform" that will create budgetary problems because of the government's fiscal constraints. Government has less capacity to pay for medical services, he observed, yet it doesn't want to cut services because the move would be unpopular politically. Remy Trudel, the Parti Quebecois social services critic, said the amendments gut Bill 120's reforms and the new legislation will not meet its original goals of making the health care system more viable, efficient and sensitive to the needs of users. He also denounced the $5 user fee, as did the Equality Party of Quebec. Alex Paterson, chairman of the Board of Governors of McGill University and a member of the advisory board of the Montreal Neurological Institute, wrote in the Montreal Gazette that Bill 120 threatened to strip most of the powers of nonprofit corporations that own assets in the health and social-services sectors, and thus to muffle the community's voice in running the institutions. "In my experience, which goes back 35 years with these hospitals, the difference between a mediocre operation, a good one and an excellent one is the pressure that the community can put on the government," Paterson wrote. "If you remove one of these elements, the government has a freer range - and it's not to do evil, it's to do nothing."CAN MED ASSOC J 1991; 145 (8)
1003
