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La santé au Québec : des options pour financer la croissance


  • Marcelin Joanis
  • David Boisclair
  • Claude Montmarquette


The positive social return on most health expenditure leads us to suggest a shift in Quebec to move away from attempts at restricting these outlays and towards a "growth management"" attitude. Such an attitude also proves compatible with the conclusions of the numerous public reports recently published in Canada on healthcare and healthcare funding, which often include recommendations for extending Medicare coverage. In order to materialize the proposed change, elements of solution are put forward in this paper. On the one hand, to face the upcoming population ageing and the increase in care consumption, it is suggested to emphasize fiscal prudence and a progressive payback of the public debt, as well as the ""prevention turn"" of medicine - an approach that could bring only long-term returns. On the other hand, our proposals to manage the inevitable increase in unitary costs are to 1) review all government spending and budgetary priorities on a regular basis to ensure the favouring of healthcare; 2) adopt clear economic growth-oriented policies; and 3) consider revising the coverage mode of certain interventions or categories of care, among those available both today and in the future, with a view of possibly adopting a ""mixed coverage"" scheme extended beyond the existing program for drugs." Le caractère socialement rentable de la plupart des dépenses de santé nous amène à proposer d'adopter au Québec une attitude de « gestion de la croissance » plutôt que de restriction de ces dépenses. Une telle attitude s'avère également compatible avec les conclusions des nombreux rapports publics récemment publiés au Canada sur la question des soins de santé et de leur financement, et qui suggèrent souvent d'élargir la couverture de l'assurance-santé. Pour concrétiser ce changement d'attitude, certaines pistes de solutions sont mises de l'avant. D'une part, il est suggéré, pour faire face au vieillissement de la population et à la hausse de la consommation de soins, de favoriser la prudence budgétaire et le remboursement progressif de la dette publique, de même que le « virage prévention » de la médecine - une approche qui pourrait ne rapporter qu'à long terme. D'autre part, afin de gérer l'inévitable croissance des coûts unitaires, nous proposons 1) de réviser régulièrement l'ensemble des dépenses ainsi que les priorités budgétaires du gouvernement en faveur de la santé; 2) d'adopter des politiques claires en faveur de la croissance économique; et 3) de considérer la révision du mode de couverture de certains soins, parmi ceux disponibles actuellement et dans le futur, dans le sens de l'adoption possible d'un « régime mixte » élargi au-delà des seuls médicaments.

Suggested Citation

  • Marcelin Joanis & David Boisclair & Claude Montmarquette, 2004. "La santé au Québec : des options pour financer la croissance," CIRANO Project Reports 2004rp-04, CIRANO.
  • Handle: RePEc:cir:cirpro:2004rp-04

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    References listed on IDEAS

    1. Marcelin Joanis & Claude Montmarquette, 2004. "La dette publique : un défi prioritaire pour le Québec," CIRANO Project Reports 2004rp-03, CIRANO.
    2. Friedrich Breyer & Andreas Haufler, 2000. "Health Care Reform: Separating Insurance from Income Redistribution," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 7(4), pages 445-461, August.
    3. Feldstein, Martin, 1999. "Prefunding Medicare," Scholarly Articles 2794831, Harvard University Department of Economics.
    4. Daniel Bilodeau & Pierre-Yves Crémieux & Pierre Ouellette, 2000. "Hospital Cost Function In A Non-Market Health Care System," The Review of Economics and Statistics, MIT Press, vol. 82(3), pages 489-498, August.
    5. Martin Feldstein, 1999. "Prefunding Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 222-227, May.
    6. Mark Stabile, 2001. "Private insurance subsidies and public health care markets: evidence from Canada," Canadian Journal of Economics, Canadian Economics Association, vol. 34(4), pages 921-942, November.
    7. Kelly Bedard & John Dorland & Allan W. Gregory & Joanne Roberts, 2000. "Needs-based health care funding: implications for resource distribution in Ontario," Canadian Journal of Economics, Canadian Economics Association, vol. 33(4), pages 981-1008, November.
    8. Frank T. Denton & Byron G. Spencer, 1998. "Economic Costs of Population Aging," Independence and Economic Security of the Older Population Research Papers 32, McMaster University.
    9. David M. Cutler & Louise Sheiner, 1998. "Demographics and Medical Care Spending: Standard and Non-Standard Effects," NBER Working Papers 6866, National Bureau of Economic Research, Inc.
    10. Phillip King & Harriet Jackson, "undated". "Public Finance Implications of Population Ageing," Working Papers-Department of Finance Canada 2000-08, Department of Finance Canada.
    11. Barton H. Hamilton & Vivian Ho & Dana P. Goldman, 2000. "Queuing for Surgery: Is the U.S. or Canada Worse Off?," The Review of Economics and Statistics, MIT Press, vol. 82(2), pages 297-308, May.
    12. Jeremiah Hurley, 2001. "Medical Savings Accounts in Publicly Financed Health Care Systems: What Do We Know?," Centre for Health Economics and Policy Analysis Working Paper Series 2001-11, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    13. Dov Chernichovsky, 2000. "The Public-Private Mix in the Modern Health Care System - Concepts, Issues, and Policy Options Revisited," NBER Working Papers 7881, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Marcelin Joanis & Claude Montmarquette, 2005. "La problématique de la dette publique au Québec : causes, conséquences, solutions," CIRANO Burgundy Reports 2005rb-06, CIRANO.
    2. Claude Montmarquette & Virginie Giroux & Joanne Castonguay, 2005. "Pour un financement durable de la santé au Québec," CIRANO Burgundy Reports 2005rb-08, CIRANO.


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