I want to come back to Quebec, because that is an example of a public-private hybrid system in Canada. I want to quote from an article by Marc-André Gagnon. He said:
In 1997, Quebec created a drug-coverage system where it is mandatory for workers to enrol in private plans when they are available. Those for whom no private plan is available end up on the mandatory public plan. Thus, all Quebeckers are covered by some form of drug insurance.
Then he said:
What has been the result of Quebec’s hybrid model? Access to medications improved when the plan was implemented, but by keeping a fragmented system based on multiple public and private plans, Quebec has not developed the needed institutional capacity to contain costs. Canada has the world’s second-highest per-capita costs for prescription drugs (only after the United States), and Quebec has the highest costs per capita among all provinces.
He said:
Twenty years ago, Quebec’s system was a great step forward, but it is certainly not a model for the 21st century. While it did provide better access to prescription drugs, the system remains inequitable, inefficient and unsustainable, according to a recent official report by the Commissaire à la santé et au bien-être.
He said:
Inequity persists in the Quebec system because the prices of drugs vary between the public and private plans (...) So who pays? Employers and employees end up paying steep premiums. This increases labour costs and reduces the competitiveness of Quebec’s businesses.
And he said: “Mandatory private coverage is also not related to income, so the costs can be substantial for some—especially the working poor.”
He points out that a student working part time told him she had to pay $190 of her $514 net monthly income for drug premiums. There's also a systemic issue of institutional skimming between good and bad risks: seniors, people on social assistance, or the unemployed end up on the public plan, while those with a good job—the wealthier and healthier population, generally—end up in the private plans.
I am forming a conclusion that here in Canada we have an example of the hybrid model whose virtues, Mr. Blomqvist, you were extolling, and it's not one that we should copy.
Madame Forcier, do you have an opinion on that?