The Unintended Experiment with Accessory Fees in Quebec

Summary

• Overuse of low-value healthcare services, providing little or no benefit or even avoidable harm to patients, is a common problem in Canadian healthcare systems, and one that likely contributes to rising health care costs.
• Most countries with universal healthcare systems have introduced some form of cost-sharing initiatives to mitigate overuse, whether user fees, co-insurance, or deductibles, with exemptions for vulnerable populations. Among 29 OECD countries with universal health systems, only eight do not require patients to contribute partially to physician and hospital care costs at the point of service.
• Canada prohibits cost-sharing for medically required services under the Canada Health Act, and the federal government has mandatory penalties for offending provinces.
• Despite this, nearly half of Canadians (and 62% of Quebecers) support the idea of introducing user fees in our healthcare systems.
• Quebec previously allowed doctors to charge "accessory fees" to patients during medical consultations, when they considered that one of the services provided was not covered by the government’s fee schedule, or simply insufficiently reimbursed. These fees were abolished in January 2017.
• While these fees were not intended to discourage unnecessary healthcare use, they clearly provided additional convenience to a large number of Quebecers, as evidenced by the reduction in clinic-provided services following their abolition.
• Implementing cost-sharing initiatives along the lines of what is done in the best-performing OECD countries could help reduce the demand for low-value care and free up resources that could be used to finance other more pressing healthcare services for Canadians.