Le régime général d'assurance médicaments au Québec: Un partenariat public/privé confronté à des défis

Objectives: To disclose why Quebec chose to implement a universal, private-public prescription drug insurance program that is unique in North America and to discuss the challenges that the program has faced since its creation ten years ago. Methods: Analysis of interviews with 19 decision-makers who had helped to create the program or who presently manage it. Results: Quebec's prescription drug insurance program, implemented in 1997, is distinct from programs elsewhere in Canada in that participation is obligatory for all residents of the province and coverage is provided by both Quebec's public insurer and private providers. The program is the result of a compromise that protected the interests of private insurers while avoiding a tax increase during a time when the government was pursuing a zero-deficit policy. Over the past ten years, the program has faced three major challenges: its complexity, financial barriers to access and the lack of a pharmaceutical policy. Conclusion: Despite its accomplishments and a number of adjustments, Quebec's prescription drug insurance program must still overcome significant hurdles before it can hope to address inequities between the private and public components of the program and indeed ensure program viability for future years.