Telemedicine: the private collides with the public, says IRIS


Several doctors have offered private consulting services in addition to their practice in the public sector in recent years.

Private telemedicine has carved out an important place for itself in the health care of the Quebec population since March 2020, becoming a necessary medical resource for many people and promoting the enrichment of several companies. This is what the Institute for Socioeconomic Research and Information (IRIS) defines in a study made public on Thursday.

“From the outset, it should be emphasized that telemedicine is not a problem in itself since it promotes access to care, believes an IRIS researcher, Anne Plourde. Rather, the problem is that the pandemic has allowed private, for-profit industries to flourish in virtual medicine at the expense of the public.”

A telemedicine firm, Dialogue, has seen its turnover increase by 500% over the past two years while receiving a $14M investment from the Caisse de depot et placement du Québec and a $2M loan from of Investissement Québec. This money which should have been used to improve the public health structure, ”slices IRIS.

Private in favor of the public

One of the major issues revealed by the research is the deterioration in the quality of health services in Quebec due to the exodus of health professionals to these private companies that offer better conditions.

The growth in income generates an increase in recruitment and hiring in these companies and this means that there is an exodus of health professionals and nurses from the public sector to the private sector. We all know that there is a particularly intense labor shortage in the health system in addition to a decline in the quality of working conditions. In fact, this exodus leads to a decrease in the quality of services in the public health system.

Anne Plourde, researcher for IRIS

The researcher adds that studies show that the increase in offers in the private sector does not reduce waiting time and does not relieve congestion in emergencies in the public sector, but quite the opposite, harming the Quebec population who do not has no access to private group insurance in particular.

“Remember that 40% of the population of Quebec does not have access to private group insurance and must therefore pay for each virtual consultation. This poses a problem since telemedicine does not really offer medical follow-ups for patients, especially for more serious cases of chronic illnesses. In addition, there is a significant duplication of costs since virtual patients usually have to go to the emergency room or clinic to treat their medical problems, emergencies devoid of resources in favor of private telemedicine.”

Recommendations de l’IRIS

Although telemedicine is now covered by the Régie de l’assurance maladie du Québec (RAMQ), which was not the case before the pandemic, Ms. Plourde’s research suggests a few additional steps to better regulate the private and public telemedicine sector.

“Before being covered by RAMQ, doctors in the public sector could bill for telemedicine services in the private sector. Even if this is no longer possible today in theory, practice shows that there are still ambiguities regarding the exercise of medical functions. As such, one of our recommendations is to clarify medical practice to ensure that there are no more exceptions in the dual public-private practice by physicians and thus curb the exodus to the private sector. Also, to limit the current vicious circle, a massive reinvestment in public health services is also recommended since the deterioration of the quality of the public network makes the private sector more attractive for health professionals.

In addition to limiting public investment in these companies, the researcher suggests explicitly excluding private telemedicine from the insurance and benefit plans offered by employers to their employees.

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