RAMQ’s black hole - how Quebec failed me as a cancer patient


In spring last year I found myself in an excruciatingly stressful situation. I had no health
insurance. At least not to cover the thing that really mattered at the time. I could fall on
the street, get hit in the head by a soccer ball, or get knocked off my bike. These were all
acceptable scenarios. But being a cancer patient was not.

When I first arrived in Quebec I knew nearly nothing about the health system. I followed
instructions from a colleague to visit the Régie de l’assurance maladie du Québec
(RAMQ) and line up for my health insurance card. Like other immigrants not belonging to
a country on a special exception list, I waited for three months until my card arrived in
the post and my coverage started. I had absolutely no appreciation of the gold I held in
my hands.

Now my friends like to joke that I’m an expert on health insurance in Quebec. And it took
falling into a health care black hole to win this title.

My trajectory to darkness began in 2014 when I was diagnosed with thyroid cancer. I’d
been working full-time for nearly two years in Quebec and underwent surgery covered by
RAMQ to remove my thyroid. Just a few months later, the closed work permit that
granted me access to Quebec health insurance expired and my application for a new
permit was buried under an unexpectedly long waiting list.

The rule that required me to wait three months before being eligible for the Quebec
Health Insurance Plan as a newly arrived immigrant also applies when the time between
an expired and new work permit exceeds 45 days. I spent much of my recovery from
surgery anxious over when my new permit would arrive, counting the days until I would
be engulfed by RAMQ’s dying star.

I filled the time researching case law, visiting RAMQ and contacting lawyers of many
kinds – insurance, immigration, and through telephonic confusion, maritime. I wasted
hours on exhausting conversations that led nowhere but to a teary, hopeless state. It
was unfathomable and infuriating that a person legally allowed to continue working in
Quebec, with ‘implied’ immigration status, could no longer be deemed eligible for health
insurance. I was, in fact, convinced that it was illegal.

Suffice to say, my new permit didn’t arrive in time, and while I could purchase private
insurance to cover accidents and emergencies, anything related to my pre-existing
thyroid cancer was not valid. The usually routine whole body scan, that would check
whether my cancers had spread elsewhere, was delayed by months as a result. As
much as I desperately needed the scan, it could only go ahead as planned if I had $5000
at my disposal.

More recently I found myself in the same situation. I landed as a permanent resident just
days after exceeding the 45 day limit since the expiry of my last closed work permit (I
was still working in Quebec but on a different type of permit that doesn’t allow access to
RAMQ coverage). My first RAMQ card as an official resident of Quebec was due to
commence two days after an appointment scheduled with my doctor. Without a valid
card, I was told I would need to pay for my appointment. But for all the receptionists I
spoke with, none could tell me how I would actually do so.

The system for such scenarios is, I learned, laughably inefficient. The day of my
appointment I arrived at the hospital, took a number to check-in with the receptionist,
who sent me down two floors to Admissions, who sent me down another floor to
Accounting, who asked me to pay a $117 hospital fee (presumably for the luxury of
spending hours in the waiting room) before directing me to the hospital’s only, non-
functional, ATM to withdraw cash of an unknown sum to pay my doctor.

Luckily enough time had passed since my surgery to allow me to follow those convoluted
instructions. Looking back on the preceding year, it all seems a blur of indescribable
fatigue. Having access to health care feels like a right, a privilege that everyone should
have. Being denied it made me feel as though I had been excised from society,
belonging nowhere and being cared for by no one. Coming from the UK and the security
of the NHS, I had no idea how unsettled, disoriented and untethered I would feel without
health insurance.

I love Quebec, I love living here and I’m incredibly grateful for the care I have received.
But in some ways Quebec seems shockingly backwards. Hearing bureaucrat after
bureaucrat give the same cold, uncompassionate, robotic response was extremely
disheartening. Not to mention the long wait times in drop-in clinics, dirty hospitals,
antiquated machinery and seemingly excessive amounts of paper work.

According to RAMQ, the Health Insurance Plan is compulsory for ‘every resident or
temporary resident of Quebec who fulfills the conditions provided for by law’. If someone
could explain why a person living and working in Quebec, paying the annual health
contribution, doesn’t have the right to health care, I would be extremely happy to hear
the answer. Denying health care to a cancer patient, who has already undergone life-
changing surgery, seems nonsensical and frankly inhumane. I sincerely hope that
Quebec will work as hard as it can to prevent these cases, and to protect those who
have chosen to make this wonderful province their new home.