In vitro fertilization will be no longer be covered under medicare in Quebec and private clinics will soon be able to charge patients certain fees after the National Assembly adopted Bill 20 on Tuesday following stiff opposition.
The legislation will also require that family doctors make themselves available to see their patients at least 80 per cent of the time or be penalized 15 per cent of their income. Similar rules will be applied to medical specialists as well.
However, Health Minister Gaétan Barrette has agreed to suspend the enforcement of penalties until Jan. 1, 2018, as long as both general practitioners and specialists start taking steps to improve their availability toward patients.
“Voila, a responsible decision by the Liberal government,” Barrette tweeted shortly after Bill 20’s adoption.
But Parti Québécois leader Pierre Karl Péladeau denounced Barrette’s reform as an unprecedented “step backward in terms of access to health care.”
And Amir Khadir, health critic for the Québec Solidaire opposition party, warned that the legislation will have “grave consequences for patients.”
A total of 63 MNAs voted in favour of the legislation and 48 voted against it, including Coalition Avenir Québec leader François Legault. The bill passed following 150 hours of often acrimonious debate as well as public hearings.
Bill 20 is the second phase of Barrette’s major health-care reforms. The first phase was Bill 10, which took effect on April 1 and abolished regional health agencies, along with the positions of 1,300 managers, to save at least $220 million a year in administrative expenses.
federations assailed Barrette’s plans to dock doctors’ pay as draconian, but struck agreements with him to hold off on the penalties for the next two years.
On Tuesday, the Fédération des médecins omnipraticiens du Québec criticized the legislation as “useless and counter-productive.”
“For general practitioners, Bill 20 will always be synonymous with acrimony and unfortunate improvisation,” said FMOQ president Louis Godin.
The Fédération des médecins spécialistes du Québec raised doubts as to whether Barrette’s reform will improve access to care. The problem, said FMSQ president Diane Francoeur, is not a lack of willingness by specialists to see patients, but that doctors have “less access to outpatient clinics, less time in operating rooms (and) fewer beds in which to hospitalize their patients.”
Delisting IVF under medicare takes effect immediately, but other measures will occur in the coming months.
The legislation will give the health minister the power to regulate ancillary fees that are charged in private clinics.
What that means is that the government will hire an independent accounting firm to determine the true cost of an itemized list of medications, anesthetic agents and bandages that doctors can levy patients in private practice. Once approved by the government, the list will come into force as a regulation by ministerial decree.