Amélie Quesnel-Vallée outlined how medical imaging came to be delisted in Quebec, its impact in developing private insurance systems, its potential threat to health equity and its future direction at the Pan-Canadian Health Reform Analysis Network in 2013.
decrease in federal funding, failure of contract negotiations with physicians.
to combat national recession, Quebec proposes Bill 27 to regulate physician practice by decree, not by law. This bill was met with strong resistance from physicians, and was not passed. However, a law was passed that gave government the ability to specify lists of insured services by decree.
The reform was implemented. Public coverage of mamograms, thermography and ultrasonography, outside of hospitals were delisted.
CAT scan was delisted.
MRI scan was delisted.
Quebec became the leader of provision with 31 out of 58 private clinics that provide MRI and CAT scans. Although duplicate private insurance for services already insured in public sectors is illegal, because the services are delisted, it’s legal to obtain private insurance outside of hospitals.
cost-containment (though there was no formal evaluation of the reform) and potential choice for patients.
contributed to limited access and delays in public system. With scarce human resources, this created competition from private sectors for physicians, nurses and technicians. A study from her master’s student provided qualitative evidence that physicians face limitations of the public system caused by the private parallel system. There is a strong risk for patients who do not have private insurance to inevitably wait at the end of a long cue to obtain medical imaging.
In response to this rising health inequtiy, Quebec physicians from Medicare teamed up with Quebec medical assoiations and called for the relisting of all medical imaging services. In April 2013, the govern - ment has declared to do so, starting with sonograms.
Delisting Medical Imaging in Quebec