Abolishing accessory fees : The FMSQ will do its part, but accessory fees... are more than eye drops !

Montreal, September 15, 2016 – With his surprise announcement yesterday, the Health Minister has once again chosen to put on a political spectacle, while carefully avoiding any discussion of his proposed regulation with the two medical federations concerned. He used a press conference to reduce to a mere nothing a complex issue that is far from trivial. And, of course, politicians and a few stakeholders rushed to comment on the announcement and to claim the "victory as their own."

You will recall that it was the Fédération des médecins spécialistes du Québec (FMSQ) that had been asking successive governments since 2007 to clear up the ambiguity resulting from the regulatory fog surrounding accessory fees in medical offices. At that time, Gaétan Barrette considered the situation unacceptable. It was also the FMSQ that presented an ultimatum to the Charest government in 2011 to regulate fees charged to patients suffering from macular degeneration. The government finally recognized that accessory fees had to cover the technical installations, the medical imagery needed for the injections and the anesthetic drops. "The FMSQ fought this battle alone for both patients and medical specialists who were being held hostage by the absence of clear rules on the subject," insisted the President of the FMSQ, Dr Diane Francœur.

"After having petitioned for a solution to the problem of accessory fees during several years, YES, we are satisfied that patients will no longer have to pay fees that are not covered by our health insurance, and YES, we are willing to collaborate in searching for a solution to the problem of accessory fees by privileging access to care that requires cutting-edge equipment in hospitals," added the President of the FMSQ.

"Last April, the FMSQ proposed that the Minister reserve a sum from his overall budget to cover the cost of care and services offered in medical offices so that patients would no longer have to pay. We are still awaiting his response, but the Minister once again decided to impose his views rather than to discuss the matter with us," she added.

Here Are the Facts

With the shift to ambulatory care, imposed by the Parti québécois in the mid 1990s, several services were literally kicked out of hospitals to cut back on budgets and this, without a Plan B, without an alternative, without taking the needs of patients into account. Physicians then opened private offices to continue offering the services that were no longer available in hospital centres as well as to provide additional access to patients. The Liberal governments that followed didn't do any better. "The question of accessory fees is a great example of political hypocrisy. When it suits their plans, governments let things slide. But when it's politically advantageous, they impose their rules unilaterally," continued Dr Francœur.

In 2016, hospital centres continue to close outpatient clinics by kicking out physicians and their patients. In fact, this is the case in the Greater Montreal Area, at the CHUM as well as at the MUHC, where this time they have the current Health Minister's blessing and a complete lack of comment from Opposition parties. "Some 250,000 colonoscopies are performed in hospital, but institutions cannot meet the needs of patients. There are more than 10,000 colonoscopies each year in medical offices. For another example, some 18,000 patients are treated each year in physiatry clinics for various conditions. At the CHUM, less than 700 cases are treated per year, because resources are unavailable," added Dr Francœur.

These interventions require highly specialized and costly equipment that has to be purchased and renewed. All those who limit the question of accessory fees to eye drops and syringes are fooling the population. And the Minister, when he tries to make us believe that no service to the population will be cut, is using the same disconcerting simplification in spite of the complete disorganization of the network that has resulted from the adoption of his numerous laws.

Dr Francœur understands that patients are unhappy. "For the last ten years, we have been asking that this issue be settled, because we completely understand that patients have to pay certain costs in a private office while the service is free at the hospital. Instead of boasting, elected officials who are supposed to represent us should interrogate the Health Minister, to find out why the public system assumes most of the costs of a service when it is dispensed in a hospital, but doesn't cover all the cost of services dispensed in a medical office ? And yet, it's the same service, administered by the same physician, to the same patient. They should also ask him if he intends to abolish all accessory fees in hospitals : for example, some of the intraocular lenses for the treatment of cataracts; the units of botulism toxin used for intersphincteric infiltrations under general anesthesia; the crutches, splints, fiberglass casts and other forms of immobilisation; the pessaries; the dilators and the sleep tests, to name only a few. The population should also demand that the Minister have hospitals reduce parking fees to $5.00."

In addition, each year, the government gives several tens of millions of dollars to insurance companies. Those Quebeckers who pay for private insurance should demand a reduction of their premiums since their policies will no longer be required to reimburse claims for accessory fees when these cease to exist.

Before signing over a blank cheque, physicians also have several questions for the Minister. Where did the Minister get the figure of $13 million to cover all the costs of accessory fees? How was this figure calculated? What are his projections for the years to come? How much money will be needed in 3 years, 5 years or 10 years to compensate for the abolition of accessory fees announced by the Minister? Does he intend to pick and choose the clinics of his choice ?

With regards to how today's decision will be financed, the FMSQ will not ask for money other than what had been agreed to with the government in November 2014 when the 2006 agreement was redistributed. "Those who believe in hidden agendas will be disappointed."

In June 2015, the Minister had proudly announced the creation of a tripartite committee which was to undertake an analysis of the cost of accessory fees. The all-powerful Minister has once again broken his work, backtracked and never called in HIS committee. In this issue, as in many others, the Minister had an excellent opportunity to do things differently. But, as usual, he acted alone," deplored the President.

"The Minister should understand and recognize that the FMSQ is an asset in the partnerships that tie it to the Ministry of Health. For proof, just look at the targets reached in the four measures of accessibility to specialized services resulting from Bill 20. I invite him, as well as the Opposition parties, to stop playing politics with the health of Quebeckers," she concluded.

The Fédération des médecins spécialistes du Québec represents more than 10,000 medical specialists certified in one of 59 recognized medical specialties.