MJM 2008 11(1):81-8281Copyright © 2008 by MJM
MJM: Please describe how your divide you practice
on a week-to-week basis.
Dr. Stein: I actually spend about 90% of my time in
the hospital system. I've done it that way since 1974.
Our group has always had a community clinic. I don't
like to use the word “private” clinic, it's a bit of a
misnomer because until about quite recently, patients
didn't have to pay for the imaging that was available at
mammography, barium studies. These clinics started in
the late 1960's as an outlet for patients to get their
outpatient imaging done using their medicare card
without relying on an expensive hospital infrastructure.
Our group had such a clinic, as did radiologists at most
Then about five or six years ago, these clinics started
to include CT, MRI, PET scanning and even nuclear
medicine. This was new in that these procedures weren't
covered by the medicare card and therefore patients had
to pay for that. The Quebec law is very clear regarding
radiological procedures; if it's not insured within a
hospital, you can charge for it outside a hospital. For
some other specialities, there's more of a grey zone.
MJM: What changed five or six years ago?
Dr. Stein: What changed is that CT, MRI and
ultrasound just became more used and everyone saw
that there was probably a group of patients that would
be able to afford or have insurance for these procedures,
and who would benefit from them.
At our clinic downtown, we offer everything we
offered since 1967, and since 2000 we've added to that
these advanced imaging procedures, so 60% of our
volume is medicare covered and 40% isn't. It's legal to
do this in Quebec, as it is in BC and Alberta. Also, in
Quebec, most private health-insurance programs that
people are enrolled in as an employment benefit cover
these kind of procedures, sometimes up to 100%, and
usually about 80%. This is unique to Quebec; if you
have a job, you probably have this kind of insurance.
MJM: What was the reaction when you introduced
these new services not covered by medicare?
Dr. Stein: Well, in 2000 we moved from a smaller
office where we had only offered the covered services
and opened a new and larger office where we offered
the advanced imaging as well.At the time we developed
and opened it, it was fairly unique. Had we done it five
years earlier, I think we would have had gotten a very
negative response, but at the time we actually did it we
got a fairly positive media response. The media were
MJM: What were some of the concerns that you
heard from the media?
Dr. Stein: The nature of the debate was what people
fear most when they hear about private health care, and
that's what happening south of us. They do not want the
American system in Canada. Quite frankly, I don't think
there are many Canadian doctors who want the
American system in Canada either, but that's what
patients fear. They see spiralling costs and a huge
volume of patients who can't afford health care in the
United States, and that's what they're bombarded with in
the media. Canadians are frightened about that. That's
the negative part. What Canadians don't always know is
how good the systems in Europe are, like in France,
Germany and the UK. These systems offer both
government-sponsored and alternative health care
working together. Canada is more like Europe overall
than like the US. Of course, pressure does need to be
maintained on the government to make sure that the
public system is properly supported. I've had career-
long commitment to and support for a strong, vibrant,
well-funded and properly staffed public health care
system where there is timely access to quality imaging
for all Canadians.
MJM: Per unit time, is it more profitable for a
*To whom correspondence should be addressed:
Royal Victoria Hospital
687 Pine Avenue West
A clinician’s view of mixed health care in Quebec
Interview with Dr. Lawrence A. Stein, Radiologist
Interviewed by Samuel Lapalme-Remis for the MJM