Montrealers ante up for private surgery

CMAJ 2000;163(6):751

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Levesque (a pseudonym), a busy executive who was in chronic pain, didn't want to wait and asked her physician if she could get the operation done privately. To her surprise, the answer was "Yes." And the $450 price tag, which included the cost of medications, was within her means.

Three months later, Levesque's surgery was performed at the Institut de Polychirurgie de Montréal (IPM), a private clinic in a nondescript professional building sandwiched between a school, a church and a park. Despite its unremarkable façade, the clinic has ignited controversy in Quebec, especially after the Montreal Gazette published a front-page article about it this spring.

The clinic offers day surgery such as orthopedic procedures to patients willing to pay a few hundred dollars in "facility fees." Currently, about 20% of IPM's surgical work involves payment of the facility fee, and it is the only place in the province charging patients a fee for services that are being paid for by medicare. This underground medical economy is attractive to people like Levesque, who don't want to join a queue.

Presumably, the Régie de l'assurance médicale de Québec knew about IPM's work, because the 14 surgeons working part time at the institute have been billing the provincial insurance plan for the services they provided there since 1997. When asked about the legality of facility fees, Pierre Boucher, a spokesman for the plan, was tight-lipped, saying only that an investigation is under way.

The IPM's 4 operating rooms were originally part of the Guy Laporte Hospital, which was shut during a series of hospital closures in 1997. The clinic was designed to provide elective plastic surgery, which is not covered by medicare and which constitutes 80% of IPM's work.

"But there was a demand for other procedures, so we opened the doors to day surgeries because our operating rooms were not being used 100% of the time," explains Dr. Jacques Letendre, an anesthetist who serves as director of professional services at the clinic. Letendre, a former director of professional services at the Guy Laporte Hospital, is a staunch defender of medicare but maintains that inadequate financing is putting patients at risk and creating long-term costs for society.

Dr. Jacques Letendre: faster service, less bureaucracy (Photo by Susan Pinker)

As for his clinic, he says nothing has changed since the Gazette story appeared. "We are continuing our activities in the same way and at the same pace as before," he said. — Susan Pinker, Montreal

© 2000 Canadian Medical Association or its licensors