How Quebec's public system relies on the private sector to improve access to care

In Quebec, the public healthcare system is centralized and financed by the Régie de l'assurance maladie du Québec (RAMQ). However, it does not operate in a vacuum: it relies heavily on collaborations with private-sector players to meet growing care needs. This includes Family Medicine Groups (FMGs), private clinics where doctors are paid by RAMQ, and even surgeries delegated to the private sector. Here's an overview of the mechanisms in place and the implications for patients.

Family medicine groups (FMGs): hybrid clinics

FMGs are an emblematic example of this public-private collaboration. These structures bring together family doctors and other healthcare professionals (nurses, social workers, etc.) to offer accessible, continuous care.

How are they financed?

Physicians working in FMGs are paid on a fee-for-service or mixed model basis by the RAMQ. Although funding comes from the public purse, these clinics are often established on private premises. These premises, often run by investors, are managed as independent businesses. This situation creates an interface between public funding and private management, where operating costs (rent, salaries of non-medical staff, etc.) are covered by the owners or managers of the premises.

The objective of GMF

These clinics aim to relieve emergency room overcrowding by offering primary care and local medical follow-up. They demonstrate a hybrid approach: management is private, but services are publicly funded.

Private clinics affiliated with RAMQ

Some private clinics are staffed by RAMQ-registered doctors, enabling patients to benefit from free consultations billed directly to the public system.

How does it work?

The doctors who practice here work as independent professionals and bill their medical acts to the RAMQ. However, only consultations are covered by the public plan. This means that the owners of these clinics have to cover their own operating expenses, such as staff salaries (receptionists, nurses, technicians), rent and other operational costs.

Benefits for the public system

This increases the supply of care in regions or sectors where public establishments are unable to meet demand.

Surgery delegated to the private sector

Faced with long waiting lists for surgery in public hospitals, the Quebec government has set up agreements with private surgical clinics.

Why this strategy?

Private clinics often have excess capacity that can be used to reduce delays for certain elective surgeries, such as hip and knee replacements or ophthalmic surgery.

Financing surgeries

The government pays private facilities directly for each surgery performed, enabling patients to benefit from a faster procedure at no additional cost.

A recent example

The COVID-19 pandemic exacerbated delays in public hospitals, prompting the government to expand agreements with the private sector for surgeries and diagnostic care such as medical imaging.

Challenges and criticisms

While this public-private collaboration improves access to care, it also raises questions:

Equity

Some fear that these agreements will widen inequalities by creating differentiated access according to the resources available in the regions.

Cost

Recourse to the private sector can sometimes prove more costly than investment in the public system.

Impact on human resources

By allowing doctors and professionals to work in private clinics financed by the RAMQ, the public system risks amplifying staff shortages in public establishments.

Conclusion

Recourse to the private sector by Quebec's public system has become an essential tool for overcoming the challenges of accessibility and capacity. Whether through FMGs, affiliated clinics or surgery agreements, this collaboration offers valuable flexibility. However, to avoid imbalances, it is crucial to invest in long-term planning and maintain a balance between these two spheres to ensure equitable access to care for all.

At Allodocteur.ca, we understand these challenges, and we're working to make family medicine more accessible, in particular through rapid home visits, as in France. Our goal is to meet patients' needs while supporting initiatives to relieve overcrowding in the public system. Book an appointment with us online at Allodocteur.ca for a consultation within 24 hours.