Access to public health care is essential to many Canadians. The availability of private healthcare is often seen as a threat to the public system and its purported equal access to healthcare. These fears are reasonable. If medical professionals could make more money somewhere else, why wouldn’t they? Why wouldn't you pay for better care if you or a loved one were sick and could afford it? Because of this, many provinces have created laws and policies to limit competition with private healthcare. However, limiting competition with our neighbours to the south is much more difficult.
Quebec has long been an example of how provinces fight to stave off the presence of private healthcare. In 2005, Quebec faced a legal challenge to its Health Insurance Act and Hospital Insurance Act. Together, these acts limited the use of public health insurance for private facilities or providers. That time, Quebec won and was able to restrict private providers.
Quebec law regarding private healthcare was brought to the courts again in early May of this year. A current bill proposed in the Quebec legislature, Bill 10, aims to eliminate the use of private health agencies in the province by 2026. After Quebec’s legal victory in 2005, there have been very few private medical facilities in the province. However, the province relies heavily on these private health agencies to provide the staff for public facilities. The group representing the agencies, Entreprises Privées de personnels soignants du Québec (EPPSQ), has filed a motion in the Quebec Superior Court seeking an injunction on the bill. Although a decision on the motion has not been published at the time of writing, it seems unlikely the Court will find in favour of EPPSQ. In 2022, Quebec’s Law 28 also set out to limit the use of private personnel placement agencies. When EPPSQ sought an injunction for the law, the Court denied their request.
The EPPSQ might not be successful in court in arguing the validity of the law, but it makes some strong arguments against the practicality of the law. The agencies say that if private jobs disappear, many agency workers will not return to the public sector as the government hopes. One example is the case of an agency employee, Krystel Villeneuve, who went on doctor-ordered leave because of the burnout she experienced working in the public system. She will not return to a job under those conditions.
A survey of agency employees indicates that 70% feel the same as Ms. Villeneuve in that they will never return to the public sector. This means there will be no one to fill necessary healthcare positions. Comments from Patrice Lapointe, a representative from EPPSQ, further support this idea. He notes agency employees make a higher hourly wage but don’t receive the same pension and benefits as public employees. When looking at all aspects of compensation together (wage, pension, and benefits), agency and public employees receive a comparable compensation package. With overall compensation being relatively similar in total value, other working conditions keep employees in the private sector.
The government and the union for public sector employees argue that eliminating private sector jobs is necessary to improve the working conditions of the public sector. The idea is more public sector employees will create a stronger union, and more employees will alleviate stressful workloads. Unfortunately for the government and the union, the Quebec public sector is not the only place for agency employees to go if agencies close.
The US is welcoming these employees with open arms. Many healthcare professionals are moving to the US, which is more than happy to accept Canadian professionals to address its own shortages. Additionally, where it is an option, Canadian healthcare professionals can work for a US company but continue to live in Canada. Individuals with Canadian mailing addresses held nearly 10,000 physician and nurse licenses as of August 2023. Six provinces share their southern borders with the US, and 2/3 of Canadians live within 100 km of the border. This means 66% are about an hour's drive from the US. With this proximity, there is little to stop this trend from growing.
It is clear from Quebec’s battle with EPPSQ that Canadian public health jobs are not the most competitive on the market. While the government can stifle its competition regarding private healthcare, it cannot force employees to work for the Canadian public sector, especially when they can find work in the US. It is also clear that compensation is not the only factor. If provincial governments like Quebec want to compete with both the private sector and the US, changes need to be made in both compensation and working conditions.
