Eleven Montreal-area colonoscopy clinics say they'll be forced to close their doors in January, unless Quebec's Health Ministry works out a financial arrangement to keep the clinics open or reverses its decision to axe accessory fees.

The president of an association of private clinics, Cliniques d'endoscopie du Québec (CEQ), said it's a "certainty" that his association's 11 Montreal-area clinics will close if they are not allowed to charge patients the costs they incur.

"Basically, we'll have to shut down because without the accessory fees, we can't finance the operations," John Motter said.

The CEQ sent a letter to Health Minister Gaétan Barrette on Oct. 17, urging him to make an exception and continue allowing clinics in his network to charge patients privately for colonoscopies.

RAMQ pays doctors' fees only

Right now, Quebec's health insurance board (RAMQ) pays doctors $160 for the actual colonoscopy procedure.

Motter says typically, a patient who gets a colonoscopy at a private clinic pays an additional $550 in accessory fees, which he says covers staff, equipment, sterilization equipment, disinfectant, sedation and other clinic costs.

Motter said the private clinics in the CEQ perform between 14,000 to 18,000 colonoscopies and gastroscopies annually.

The clinics popped up to combat long wait times in the public sector. In Montreal, Motter said, the average wait time ranges from nine months to about a year, while in Quebec City, the wait is a little shorter.

"Unfortunately, we catch a lot of cancer," Motter said, although he could not provide a precise figure.

In September, Barrette announced doctors will no longer be able to charge patients extra fees for services that are available through the public health care network.

It came out shortly afterward that the federal government had leaned on Quebec to abolish the fees, The new rules come into effect January 2017.

One clinic in the CEQ, MD Specialists in Westmount, has already announced it will close on Dec. 10.

"If you can't charge the patient you can't run a clinic at all," said Dr. Barry Stein, the clinic's co-owner.

Possible increase in wait times

Stein said his clinic treats thousands of patients who choose to go private, and he doesn't know where they will go. Wherever they end up, Stein expects they will to have to wait for care.

"We already have wait lists, and now you're taking all these patients from all these different clinics and you're putting them back in the public health system," said Stein.

Private clinics have long been a point of controversy in Quebec. Some critics say they are a clear breach of the principles of the Canada Health Act and create a two-tiered system.

Talk to Ottawa, says Barrette

Barrette said doctors should speak to Federal Health Minister Jane Philpott if they want accessory fees to stay.

Quebec Health Minister Gaétan Barrette responds to reporters questions after a party caucus meeting, Wednesday, April 27, 2016 at the legislature in Quebec City. (Jacques Boissinot/Canadian Press)

The two levels of government have been squabbling over the issue. In a letter sent to the provincial minister in September, Philpott warned the federal government would reduce transfer payments to Quebec if the province is found to be relying on user fees to offset health care costs.

Barrette said the clinics could continue to stay open if they want to go outside RAMQ and charge patients for the full cost of a colonoscopy.

"Nothing forbids them from then, to bill the whole cost of the procedure," said Barrette.

However, the gastroenterologists, colorectal surgeons and other specialists who do procedures in – and, in some cases, own – the private endoscopy clinics also work in hospitals in the public health care system.

Motter points out that charging patients for the full cost of a colonoscopy, as Barrette suggests, would require them to remove themselves completely from the public system.

That would give rise to other problems beyond financial ones, he said. For one thing, the doctors would no longer be able to provide follow-up care for their patients admitted to hospital.