It is in the hope of improving the lot of patients in Quebec that the Parti Québécois recently offered its collaboration to the government for Bill 15 on health reform. We agree: sweeping changes are essential to improve network access and efficiency. In a spirit of timely improvement of this reform, which, in any case, will be adopted by the CAQ government, we would like to point out four successes of the proposed reform as well as four constructive criticisms.
good shots
First, the desire to organize the workforce according to the needs of the population and the creation of a bank of mobile personnel seems interesting to us and could, with the appropriate mechanisms, make it possible to remedy the phenomenon of investment companies that cannibalize our resources.
The government is pursuing another laudable objective, which we share, that of the Québec state becoming an employer of choice. The message sent is positive and we hope that the negotiations in the public sector will go in this direction. It must be underlined: no reform is possible without an active and resolute commitment to the personnel of the network. We believe that Minister Dubé is well aware that staff deserve to be able to balance work and family.
We also welcome the fact that the reform will make it possible to partially reduce certain inequities in access to care based on place of residence, thanks to the addition of a right for patients to choose the professional or establishment from which they wishes to receive care. This will avoid several unfortunate and unjustifiable situations where a patient is disadvantaged by their postal code.
Finally, Minister Dubé wants to require medical specialists to assume a “population responsibility” to better take care of patients. Specialist physicians will thus have to respond more effectively to requests made by family physicians, take on call shifts in the hospital and accept the sharing of unfavorable shifts. We believe that medical specialists are an integral part of the solution for access to care and that it is crucial to properly distribute medical expertise in hospitals.
Improvements required
We note that the reform project accentuates the trend towards a model that takes decision-making away from the field and reduces the contribution of citizens. Indeed, the CAQ project is the opposite of the promised decentralization: it concentrates power in the hands of a handful of leaders at Health Quebec, who will dictate the decisions to be applied.
The desirable model for our network, in our view, is one where decisions are made at the local level based on the specific needs of the community. This was also the original strength of the CLSCs: as they were democratically managed, the population could report to local authorities, and the programs put in place differed from one CLSC to another according to their needs. . Instead, Minister Dubé is taking the opposite route. In addition to undermining the staff’s sense of belonging to their workplace, centralization by Santé Québec risks leading to decisions that are disconnected in that they will not match the reality and needs of the field.
In addition, the reform project confirms the worrying trend undertaken by the CAQ: a shift towards the private sector. Indeed, we note that many articles establish the rules allowing the multiplication of private services, as with specialized medical centers (CMS). Private healthcare is part of the problem, not the solution.
Each healthcare professional working in the private network is one less staff member in the public network. The private sector siphons off the best resources and will focus only on profitable business sectors. While the technical platforms for performing surgical procedures are closing in the public, those in the private sector are opening by the dozens. The CAQ is on the wrong track in wanting to legislate to normalize the place of the private sector in health, without measuring the consequences of this shift and without broader public debate. Why not focus instead on promoting and strengthening the public network?
We are of the opinion that a crucial point is missing in order to carry out an effective reform, namely the revision of the mode of remuneration of physicians. The CAQ had also committed to this since 2018. From 2006 to 2021, the budget envelope devoted to the remuneration of doctors has increased by 160%, an annual increase of 10%, compared to 2 to 3% in the rest. of the network. To make the network more efficient, it is essential to better distribute the available financial resources, which implies reviewing the remuneration of physicians towards a hybrid model rather than a fee-for-service.
Above all, we must remain aware that the Dubé reform project relies on an overhaul of structures: we therefore want to reiterate that the priority of Quebecers remains the concrete improvement of access to the first line. The proposed structural changes, although commendable, will probably have little concrete impact on services to the population, particularly in terms of emergency waiting times.
To the Parti Québécois, we humbly submit the following solution: further support the CLSCs in their role as the main gateway to the health and social services network, in particular through the contribution at fair value of all competent personnel, including specialist nurse practitioners (IPS), psychologists, social workers, paramedics. Minister Dubé also recently praised the success of the new IPS clinic at CLSC Olivier-Guimond in Camille-Laurin. Quebec has everything to gain from recreating this model in all regions as soon as possible.
In short, the reform proposed by the government can bring improvements to the health care system, but in its current version contains several blind spots. It is the interests of patients that should guide us and therefore lead us to work together to bring about the required improvements. We therefore reiterate our offer of collaboration to the government in this regard.