Our healthcare system is at the crossroads of all challenges. But without doubt, the most important challenge remains the worrying disparity between the growth of health expenditure and the growth (decline?) of government revenues. And Quebec is no exception in this regard since we are dealing with a planetary phenomenon.
Posted at 1:00 p.m.
Nevertheless, among the industrialized countries, we are evolving with one of the health care systems least equipped to face this challenge which will shape the delivery of care in the years to come. Will we be able to find the necessary correctives to rectify the situation? Can we remain faithful to the values that gave birth to our health system? Or more prosaically, will we be able to maintain the supply of health care?
The delivery of care, the management methods, in particular of human resources and the modes of governance, are today the fruit of a systemic reflection that took place in the 1960s. Since then, there have been maneuvers of patching disconnected from contemporary issues and above all motivated by political intrigue. We therefore find ourselves today with a heavy, clumsy and backward-looking health system incapable of meeting the challenges of our time.
It is imperative that we resume a deep reflection on the future of health in Quebec. And the economic, social and demographic circumstances make the exercise imperative.
This may take the form of a white paper, a parliamentary commission or general meetings, but we must articulate the change in order to then act.
Contain the bleeding
In the meantime, the various places where the system is bleeding should be contained.
First, we now know that 5% of users of the system generate 50% of health expenditure. Targeting this 5%, mapping their needs and understanding their relationship to our healthcare system offers us an incredible savings opportunity. Several studies demonstrate that targeted and intensive care management for complex patients improves the quality of care delivery and provides a substantial reduction in expenses. An American study, in the context of Medicare, suggests that for every dollar invested, up to $2.60 can be saved. In this study, high-risk patients are targeted according to their metabolic and psychiatric comorbidities (several coexisting pathologies), their rate of use of emergency rooms and/or the heaviness of their pharmacopoeia. Information that is already available in the databases of the Régie de l’assurance maladie du Québec (RAMQ).
From today, we can query our data, target sick patients and recruit them into a targeted and intensive care program and make economies of scale while improving the quality of care.
Finally, the mode of creation of health programs should be reversed. Health programs are intertwined at the base and in the field, this is a fundamental fact. System politicians and technocrats cannot be the only promoters of change. It is necessary to challenge the ideas from the base. The health system must equip itself with an incubator program for the most promising ideas through an appeal to all actors in the health system, in particular health workers. These ideas will improve the quality of care while reducing health care costs. Caregivers are interested in an overhaul of care delivery and many will want to be part of such an exercise. This could alleviate the ambient cynicism by remobilizing our professionals for their health system.
There is still time to act although the hour is serious. The gloom and the gloomy atmosphere that reign throughout the network are worrying. We must remobilize, rethink, act. While the pioneers congratulate themselves on having given birth, during the Quiet Revolution, to a health system that met the needs of the 1960s, we will have to plan for our health revolution. Because that’s what it’s all about, because it’s necessary: a real health revolution. So that we can treat Quebecers according to the needs and challenges of our time. But let’s face it, an elephant cannot be eaten in one evening. Plan ahead and take it one bite at a time.