[CUPE healthcare list] Quebec Medical Association lobbies for contracting-out and privatization

["Irene Jansen" <ijansen@cupe.ca>]

Quebec needs to change the way it funds hospitals; Health-care institutions should get money based on the number of patients served
Montreal Gazette
Monday, November 19, 2007
Page: A23
Section: Editorial / Op-Ed
Byline: JEAN-BERNARD TRUDEAU
Column: JEAN-BERNARD TRUDEAU
Source: Freelance

Quebec has started to take a closer look at the financial management of health-care services. The task force on health funding (the Castonguay committee) and the health summit being organized by the Collège des médecins are both opportunities to explore different financial management methods.

It is interesting to note that hospital funding in Quebec - the primary expenditure in our health-care system - is not very realistic. A hospital's budget is still very largely allocated on a historical basis, determined by the budget from the previous year.

This funding model creates some major adverse effects. Patients are seen as an expense. Rationing becomes a management method.

Why not introduce market forces that promote competition among public institutions? A recent OECD report (Toward High-Performing Health Systems, 2004) observed that these forces reduce the cost of hospital services even when they are administered primarily by the state.

The Quebec Medical Association advocates public patient-focused funding. In other words, clinicians and managers should see patients as a source of revenues, and not as a source of expenditure. Hospitals should be financed according to the services and care that are actually dispensed. The money should follow the patient, so to speak.

It is clear - and this is supported by experience in Europe - that such a funding mechanism would increase the system's production capacity.

To improve work organization among health professionals, it is absolutely imperative to speed up the development and implementation of technologies to share clinical information. Because they promote continuity and improve the accessibility and general quality of health care while reducing the risk of error and duplication, these technologies contribute directly to optimizing the health-care system. They should be introduced systematically, not just in the network of public institutions and in family medicine groups, but also in independent clinics where more than 75 per cent of front-line services in Quebec are provided.

In Bill 30, the Quebec government reduced the bargaining units at health and social-services networks to four. It is now time to take the next step.

The structural problems that are characteristic of the current organization of work in the health sector are hindering efficiency. Enormous increases in efficiency can be achieved by introducing more flexibility in the organization of work. These changes will require great political courage, but it is the path that should be followed to obtain concrete results that will have an impact on the costs and will optimize the delivery of health care.

Moreover, subcontracting in the non-medical sectors of public institutions needs to be simplified. Salaried employees who work in the food, sanitation, building maintenance and laundry sectors (to name but a few) are public servants.

Local administrations should be given a chance to explore new ways of managing this type of service. The private sector's contribution to management and daily operations in these sectors could perhaps generate substantial savings, without affecting the core business of these institutions.

Today in Quebec, three three cent of the population accounts for 50 per cent of the days in hospital. There needs to be more investment in promotion and prevention, since the best way to limit the cost of a health-care system is to stay out of it. Yet many current indicators are cause for concern. Obesity and diabetes, to mention only two, are becoming more common. In this respect, the cost of prevention will always be much lower than the cost of treatment.

Whatever the solutions proposed, it is essential to examine funding of the system and the medical organization of work with clarity and courage. For several months, the think tank of about 25 physicians and academics that was set up this year by the Quebec Medical Association has been examining the clinical, technological, demographic, economic, social, political and ethical trends related to the evolution of health-care systems.

Revamping management methods, modernizing medical practice, making more room for patients, investing heavily in prevention - these are all options that must be explored if we want to reach concrete, sustainable improvements. It is time to be creative and not be afraid to innovate to ensure the future of our health-care system for the coming decades.

Jean-Bernard Trudeau is a physician and president of the Quebec Medical Association.

Idnumber: 200711190057
Edition: Final
Story Type: COLUMN
Length: 701 words
Keywords: HEALTH CARE; HOSPITALS; QUEBEC GOVERNMENT; SPENDING; FUNDING; MEDICARE