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Ken Jamieson and his wife Brenda takes a walk at their home in Gatineau, Quebec. Ken was diagnosed with colon cancer late last year. (DAVE CHAN/Dave Chan for The Globe and Mail)
Ken Jamieson and his wife Brenda takes a walk at their home in Gatineau, Quebec. Ken was diagnosed with colon cancer late last year. (DAVE CHAN/Dave Chan for The Globe and Mail)

Part 5: Looking for the cracks in medicare? Try the Ontario-Quebec border Add to ...

The issue, not as high-profile as others in health care, means that it's difficult to find someone willing to pick up the torch, except for the likes of Dr. Shaver. Doctors along the Ontario-Quebec boundary are reluctant to intervene, because they could be portrayed as greedy physicians.

And physicians inside Quebec have their own issues to contend with. Louis Godin, head of the Fédération des médecins omnipraticiens du Québec, says the government needs to resolve the problems in its home province before appeasing doctors elsewhere. Two million Quebeckers don't have a family physician. Meanwhile, in the four faculties of medicine, 250 family-medical spots remained vacant over the past four years because doctors are paid roughly 30 per cent less than their counterparts elsewhere in the country. There's a lack of medical infrastructure, especially along the boundary, which has resulted in a number of doctors moving to private clinics or simply picking up and leaving for other provinces.

"If we have better access, the Quebeckers will stay in Quebec to have their care, and they don't need to go to Ontario," Dr. Godin reasons.

But until that time - and if ever that happens - doesn't Ottawa or the Quebec government have a responsibility to ensure residents living along the boundary don't fork out money for health services?

The Régie de l'assurance maladie du Québec, the province's health insurance plan, says its responsibility is to follow the rules set forth by the government. Quebec spent $169.6-million last year for medical services that residents received in other provinces, out of a total health budget of $27.9-billion. The RAMQ said it doesn't know how much extra it would cost to fully cover medical services for residents travelling to other provinces. Dr. Shaver believes it would cost about $5-million to fill the gap.

Yet, no one budges. Instead, the government encourages its residents to buy supplementary private insurance when travelling within Canada.

What is boils down to, says Doug Angus, a professor of health-care management at the University of Ottawa, is the lack of gumption on the part of those in charge. "What it really has left a number of us in the health policy area thinking about is that the feds can't really be counted on for any real leadership or vision of where this health system should be going in the future," he said.

Some residents along the Ontario-Quebec line have just come to accept that changes in policy move like tortoises in a hundred-yard dash.

Karen Lochhead, who lives in Gatineau, often pays out of pocket. She then submits her receipts to the Quebec insurance plan and is reimbursed her province's rate. She paid $2,000 last May for an artificial knee, for example, and received $1,400 back. She had no choice. She needed the procedure. At the time, it was not available in Gatineau.

"I just think if that is the way it has to go, that's the way it goes," the 69-year-old retiree says. "I don't understand the politics of why Quebec doesn't pay the same rate, but Quebec has always been different."

That difference, however, comes at a hefty price for patients.

If you're a Quebec resident needing elective orthopedic surgery from Mark Charles or many of his colleagues in Ottawa, look elsewhere. He's had such negative experiences with Quebec's health insurance plan in terms of not getting paid in full that the doctor stopped seeing Quebeckers on an elective basis. Collecting directly from patients is not part of his regular practice, he said, in part because, it "muddies the waters." Besides, demand for elective orthopedic services among Ontario patients continues to increase. "The demand for orthopedic care in the Ottawa area is huge. Why would we go beyond our province to treat Quebec residents if we are being forced to comply with this bureaucratic agenda?" Dr. Charles said.

On the other side of the country, where winter enthusiasts descend on the ski hills of Golden, B.C., general practitioner Trina Larsen Soles requires Quebeckers to pay upfront for medical care. She's given up on the RAMQ. There's been times when her office manager has submitted a bill, only to have to resubmit because the RAMQ said it hadn't received it, and was then told it wouldn't pay the amount because the bill had expired.

When it comes to non-emergency services, specialists close to her are not eager to see Quebec patients either, unless they can bill them directly. "[It]doesn't matter if I'm trying to transfer to somewhere in B.C. or Alberta, it's the same: Nobody wants them," Dr. Larsen Soles said. The Canada Health Act, in her mind, has lost some of its shine.

Blame the men and women in scrubs and white coats. Blame the politicians. For Brenda Jamieson, Ken's wife, it was a huge annoyance when she needed a specialist for her husband. She laughs when asked who she blames: "I just think the politicians and the doctors have to get together."

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