Why a new billing policy is blocking some Quebecers from getting health care in Ontario
She has a house, lives by the lake and chose the community of a few thousand people as her retirement spot.
Despite her love for the town nestled along the Ottawa River and bordering Ontario, a new barrier to accessing health care might tip the scale for Rochon and her husband.
As of Aug. 1, the local health authority for the region, the Centre intégré de santé et de services sociaux de l'Abitibi-Témiscamingue (CISSS-AT) is no longer handling billing or processing claims for services provided by Ontario doctors.
This means the health authority no longer acts as an intermediary between Quebec's public health insurance board, known as RAMQ, and doctors.
A phone call from one of Rochon's doctors located in North Bay, Ont., 65 kilometres south west from Témiscaming, confirmed that the change in policy meant her shoulder surgery in September was cancelled.
"If I want it done, I have to go to Amos, which is 360 kilometres from where we live, and I have to start from scratch," she said.
"It's three steps backwards for me."
'I've had citizens in my office in tears,' mayor says
Alain Gauthier, the mayor of Témiscaming, says he heard about the change through Facebook. He says there's been very little communication from CISSS-AT, especially with local officials.
"It's pretty shameful," he said.
"I've had citizens in my office in tears. Some of them had up to two to three appointments … all cancelled. They had been waiting months."
While Quebec is part of the Canada Health Act — which ensures Canadians, regardless of province or territory, can receive medically-necessary emergency care in a hospital setting — Quebec is not part of the interprovincial reciprocal medical payment agreement.
The latter allows hospitals to bill a patient's home province or territory for physician's services provided to non-residents at reciprocal rates. Quebec is the only province that does not participate in this reciprocal billing agreement.
The latter allows hospitals to bill a patient's home province or territory for physician's services provided to non-residents at reciprocal rates. Quebec is the only province that does not participate in this reciprocal billing agreement.
Still, for 40 years, the CISSS-AT had a practice of taking on the paperwork for those who needed to get specialized care in health centres in Ontario, says Gauthier.
The Ontario specialists made up for several gaps in service in Témiscaming, he says. Those services ranged from minor operations, eye doctors, colonoscopy appointments, orthopedic surgeries and cancer appointments.
But now, doctors serving Quebecers in Ontario either have to take care of the paperwork themselves, charge RAMQ and absorb the loss on their salary, or charge the Quebec citizen in full for a procedure. Those patients will in turn have to put the money forward, claim the expense through RAMQ and absorb the financial loss on their own, he says.
The alternative is to drive upward of 300 kilometres one way to Amos, Val d'Or or Rouyn-Noranda, Que., says Gauthier, while also facing a possibly lengthy waiting list.
CISSS-AT says policy change protects budget
According to Evelyne Grenier-Ouimette, president and general manager of the CISSS-AT, this policy change does not require doctors to stop providing services to Quebecers.
It's about billing and no longer acting as an intermediary between doctors and the RAMQ, she said in an interview with Radio-Canada.
She says certain treatments could cost more for patients who decide to continue receiving care in Ontario, as RAMQ decides what it will and will not reimburse.
For the same procedure, a doctor in Ontario can charge more than a doctor in Quebec due to salary discrepancies, she added. Up until recently, the CISSS-AT covered the difference.
"If we choose to continue to reimburse this difference, we will have to take it out of our operating budget," she said.
In an emailed statement, the CISSS-AT said the previous way it operated was "not consistent with the interprovincial agreements currently in effect."
"[The CISSS-AT] will no longer cover the difference in rates between the Ontario plan (OHIP) and the RAMQ for care. The regional operating budget must be reserved for services provided directly by the institution," read the statement.
But Gauthier says the amount of money the health network would save from this change would be marginal, considering residents will need to travel hours away from home, potentially adding transport costs for the government.
"It's absolutely a shame on our public organizations to see this lack of competence," he said. "And lack of consideration and of foresight."
He argues Quebec should sign an interprovincial agreement to establish reciprocal rates for doctors.
'As you get older you need more health care,' says resident
Bonnie McIntosh has broken down several times trying to figure out what to do for her 84-year-old partner Gerard Raymond who currently sees three specialists for monitoring in North Bay.
"I'm scared," she said. "I want him to live 10 more years and I need to take care of him. So that's why I wouldn't be so upset if I was 50 years old, but I'm in my 80s."
While she is planning on keeping her home in Témiscaming, McIntosh says she put in an urgent request for an apartment in Ontario.
"Gerard was born and raised here …. It's his home. He's been in this home since 1974. It's going to be extremely difficult for him," she said.
"I hope I don't have to do it. I want to fight for us and for all the people here."
Rochon, for her part, doesn't want to move either, but she says it's about thinking about her future.
"As you get older, you need more health care," she said.
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