Ottawa threatens to cut Quebec's health payments over user fees

Quebec's health minister is accusing his federal counterpart of trying to take credit for his recent decision to scrap user fees in the province.

Gatan Barretteannounced last Wednesdaythe province would soon eliminate many of the extra fees patients pay at doctors' offices, ranging from$20 for eye drops to$500 for instruments and medication for a colonoscopy.

But a recent letter from federalHealth Minister Jane Philpott, addressed to Barretteandobtained by CBC News,suggests the decision came after urging from the federalgovernment.

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The letter, dated Sept. 6, stresses that, under the Canada Health Act,provincial and territorial health plans must cover all medically necessary procedures in hospitals and clinics.

Philpottwarns that the federal government will reducetransfer payments if the province is found to be relying on user fees.

Herletter references a May report from Quebec's auditorgeneralthat confirmed the existence of the extra fees.

Barrette: 'I don't understand'

Barrette, however, claims that a plan to ban user fees in Quebec's health system was in the works for several months before the letter from Ottawa.

"They all knew that I would come up with the abolishment of those fees," he told a news conference on Monday afternoon. "So why is it that a few days before my announcement ... she comes up with that [letter]. I don't understand."

The letter, however, also mentions a discussion between Barrette andPhilpottabout user fees in March, prior to Quebec's stated commitment to abolishing them.

Barrette's office said last week the minister hadbeen ponderinghis announcement sinceas early as May. At the time, he was under pressure from health groups in the province upset with Bill 20.

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That bill, which passed in the fall of 2015 despite strenuousopposition from both thePartiQubcoisand the CoalitionAvenirQubec, codified the charging of user fees in Quebec clinics.

A coalition of health groups began the process in May of seeking a court orderthat would force the federal health minister to "fulfil a statutory duty"to preventoverbillingthrough extra fees.

More details on Quebec's plan to eliminate user feesare expected Sept. 28.The changes are scheduled to come into effect mid-January 2017.

Feds want'reasonable access'

Quebec is due to make a declaration to the federal government in December about thefinancial state of its health system for the 2014-2015 year. That will help Ottawa determine how much the province will receive in health transfers.

Philpott's letter says that she expects Quebec's declaration to include an accurate estimation of the revenues received from user fees.

It is important to make sure that Canadians know theyhavealready paid for health care. And they will get that health care.- Federal Health Minister Jane Philpott

On Monday, following Question Period in Ottawa, Philpott suggested Quebec could still see a reduction in its health transfernext year.

"The specific details in terms of how much will be reclaimed in the Canada health transfer is a matter we will discuss going down the road in the future," she said.

"It is important to make sure that Canadians know theyhavealready paid for health care. And they will get that health care."

The spat between Barrette and Philpott over user fees comes as the federal government is in the process of negotiating a new multi-year health accord with the provinces.

Ottawa wants to see future funding tied to benchmarks. Quebec, however, has said it will refuse to have any conditions attached to the money it receives from the federal government.

"When any government makes investments in a particular area Canadians have a right to know what they will see as a result of that," Philpott said Monday.

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