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Preliminary data from the accessory fee monitoring registry and investigation into fee-posting

Presenting the preliminary data from the accessory fee monitoring registry and investigation into fee-posting in medical clinics (document in French only)


To safeguard access to healthcare: put the breaks on fees!


Montreal, January 21, 2018 – Following the abolition of accessory fees on January 26th, 2017, the Community Clinic’s Right to Health Committee launched an accessory fee monitering registry. This tool enables the demonstration of the ongoing extent of billing practices that causes disparities in health care access. From January to October 2017, a total of 90 statements were recorded into the registry.


Preliminary analysis of the data shows that for this period the billing in medical clinics for drugs and anesthetic agents (accessory fees) has practically disappeared. “It is clear that the abolition of accessory fees is an important element in the fight against patient billing,” says Élise-Mercier Gouin, member of the Right to Health Committee. In contrast, the billing of administrative fees, for example to fill out forms or for copies of medical files, has continued to increase during this period. Furthermore, many patients denounced the exorbitant amounts that were demanded for various eye care examinations. “In this regard, the problem remains unresolved, because it is impossible to establish whether these particular tests, which are done as a preventive measure or which precede cataract surgery, are necessary,” adds Ms. Gouin. It should also be noted from the monitoring registry data that for 20% of respondents who had to undergo such examinations, the final bill exceeded $500.

For Stéphane Defoy, community organizer at the Pointe-Saint-Charles Community Clinic, we must remain more vigilant than ever, both in terms of patient billing as well as the proper advertisement of this billing in privately-run public clinics. “We welcomed the decision to eliminate accessory fees as a step in the right direction to promote access to care, especially for underprivileged citizens,” he says. “However, it must be remembered that leaving it up to the federations of Quebec physicians to fix the rate of non-covered services further the interests of its members to the detriment of patients. We continue to advocate that any healthcare expenses taken from patients’ wallets must be eliminated in order to keep our public system intact. Until medical billing is completely abolished, we are requesting that the Régie de l'assurance-maladie du Québec (RAMQ) assume the supervision of the pricing of care not covered by Medicare.”


The Pointe-Saint-Charles Community Clinic also called for a clarification from the Ministry of Health and Social Services (MSSS) on billing for a range of eye care exams that are proliferating in many ophthalmology clinics in Quebec. “To avoid any confusion, the solution is simple,” says Stéphane Defoy. “All of these exams must be reintegrated into the services covered by the Quebec public health plan.”


The Community Clinic invites any person who is obliged to pay a fee during a medical consultation to fill out the accessory fee monitoring registry. The ongoing data collection makes it possible to draw a realistic picture of the current situation from the testimonies collected. The monitoring registry can be accessed on the Pointe-Saint-Charles Community Clinic website at the following address:



Striking results from an investigation into fee-posting in medical clinics


In other news, during the summer of 2017, the members of the health committee conducted an investigation at some 40 medical clinics on the island of Montreal. The purpose of this approach was to verify whether these clinics complied with the regulation that requires the posting of the list of fees charged to patients, while also ensuring that none of these fees are prohibited by the abolition of accessory fees. “The results are staggering,” confirms Geneviève McCready, a member of the Right to Health committee. “Of the forty (40) clinics visited, thirteen (13) of them did not display any list of fees charged. For the twenty-seven (27) other medical clinics, seventeen (17) displayed illegal fees, including some accessory fees that are now prohibited.”


In closing, on the issue of posting fees for uninsured medical services collected from patients, Geneviève McCready mentions that “as much at the RAMQ as at the Collège des médecins du Québec (CMQ), there are mechanisms to sanction faulty medical clinics that violate the regulations. In light of our investigation, it is clear that not so much sanctions are applied by these bodies. How do you expect patients to know if they are able to afford costs, if clinics do not display the required amounts?” she concludes.



For more information:


Stéphane Defoy

Community Organizer

Pointe-Saint-Charles Community Clinic



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