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Normandin Beaudry

Some issues in the Clair Commission report


There, in black and white

NB Bulletin Vol. 4 N. 2, Febuary 2001

In June 2000¸ the Government of Quebec mandated a commission presided by Mr. Michel Clair to examine how health and social services are organized and financed. This article makes a review on some of the findings discussed in the Clair commission report publicly disclosed on January 17th¸ 2001 regarding future health and social services needs and possible ways of financing these services.

In addition to increased costs due to technological breakthroughs (increasingly sophisticated equipment and new treatments) and new drugs¸ the Quebec healthcare system will also have to deal with major demographic changes during the next 20 years. The number of people aged 65 or older is expected to almost double over the next two decades¸ whereas the number of people under age 15 is expected to drop by 20%. As a result¸ this will lead to dramatic changes in the healthcare needs.

To ensure the viability of the healthcare system in the years ahead¸ the Commission believes that we must return to the original concept of insurance offered to the community administered by the government and financed by taxes. To this matter¸ choices must be made regarding insured services¸ given our society´s financial capability. To this end¸ the Commission suggests that a committee composed of scientific and medical experts as well as ethicists should be formed to review the insurable services offered to the population.

The Commission is aware that the people of Quebec would be very sensitive to any direct increase in taxes to finance the healthcare system. This is why¸ in addition to existing tax measures¸ the Commission suggests three financing approaches to extend or maintain the coverage of certain services:

1.Direct user contribution for each use. Many other countries with healthcare systems similar to ours have such user fees. According to the Commission¸ however¸ this source of revenue would be perceived in Quebec as a deterrent fee and a threat to universal access to health services.

2.Mandatory contribution to a public insurance plan. The Commission feels this source of revenue would be more socially acceptable than direct user contribution because it does not restrict access to health services. In addition¸ mechanisms can be established so that low-income earners do not have to pay the annual premium. The Basic Prescription Drug Insurance Plan incorporates both these concepts-direct user contribution (deductible and coinsurance) and mandatory contribution to a public health insurance plan (everyone except low-income earners must pay the premium during annual tax reporting period).

3.Funded plan. This possibility is one of the aspects of the report that has been discussed the most in the media. The idea is to create a separate fund financed by mandatory contributions collected annually during the tax reporting period. The assets accumulated over the years would be used to pay benefits under the plan. The Commission recommends setting up an insurance plan with this type of funding to compensate those no longer autonomous (old age insurance program); the plan would cover most of the costs of long-term home or nursing-home care. As a result¸ this would isolate part of the impacts that ageing of the population has on the healthcare system.

These measures¸ coupled with other recommendations made by the Commission¸ are harbingers of a fragmentation of the healthcare system into several subsectors that would be financed by different sources of revenue. Among other things¸ this would give a better idea of the costs of each component.

Some disengagements from services now covered by the public healthcare plan might be expected in the future. Therefore¸ services no longer insured by the public healthcare plan could be covered by private insurance plans or by creation of other public plans-mandatory contribution plans or funded plans. In any case¸ it is highly possible that taxpayers as well as employers will have to pay the bill-because costs of private plans could increase or specific contributions might have to be made to new public plans.

It will be interesting to see to what extent the Government of Quebec will implement the recommendations of the Commission¸ especially the one concerning the creation of an old age insurance program. The next provincial budget will be a good indicator of the government´s perspective regarding the commission.


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