(Montreal) Will the Dubé reform succeed in “making the health system more efficient”? In order to improve the Minister’s ambitious bill, a host of stakeholders will be heard by the parliamentary committee on Wednesday and Thursday. Further sessions are planned for the month of May.
Before the start of the hearings, Health Minister Christian Dubé told reporters that he still aims to pass the law before the end of the current parliamentary session which ends on June 9. However, he said he was “realistic” about the work to be done. About forty speakers will parade before the Health Commission, then a detailed study of the articles must be carried out with the opposition.
Christian Dubé also welcomed the unanimous adoption of a motion calling on the parties to work together to improve the bill. The Minister sought to simplify the process by reducing the approximately 1,200 articles to four main themes on which agreement can be reached.
He specifies that the law aims to separate the orientations of the operations, to improve clinical governance, to offer better access to users and to decentralize management to get closer to the field.
The Minister of Health introduced Bill 15 last month. The voluminous document notably provides for the creation of a new state corporation called Santé Québec.
This new structure will be responsible for coordinating the operations of the Quebec health network, while the department will retain its role of setting guidelines and allocating budgets.
As the consultations approached, the Minister insisted on his desire to take the time to hear “all of our partners, as well as the people in the field”. He reiterated that his bill “is perfectible” and reached out to network players and opposition to improve it.
On the opposition side, Vincent Marissal of Québec solidaire and Joël Arseneau of the Parti Québécois both raised concerns about the place given to the private sector in health care. We are also trying to ensure that the Minister of Health remains accountable for the performance of the network and that he is not hiding behind Santé Québec.
A pilot in the plane
On Wednesday, parliamentarians first heard from the Health and Welfare Commissioner (CSBE), Joanne Castonguay. She has analyzed many reforms in health networks around the world. She hammered home the fact that “a lot is at stake in managing the transformation”. “It’s the continuous adjustments that matter,” she added.
It invites the government to establish a detailed plan for its transformation, to closely monitor its progress and results and to constantly adapt along the way. “Cultural evolution (of the network) requires a lot of time and a deliberate strategy,” she argued.
The Commissioner commended several strategies employed by Québec, including that of facilitating labor mobility and that of the creation of governing boards that will enable users to make their voices heard by managers.
In terms of decentralization, Mr.me Castonguay fears that the management of local operations will remain in the hands of Santé Québec since the establishments will lose their distinct legal identity. They will therefore no longer be able to enter into service agreements independently unless the government corporation delegates powers to local managers.
Call for transparency
The Auditor General of Quebec (VGQ), Guylaine Leclerc, delivered a plea for transparency in all ramifications of the health network, including the private sector. Giving the example of ambulance services that refuse to open their books, she fears that the refrain will be repeated in clinics and other private resources.
In response to the VGQ’s concerns, Minister Christian Dubé said he had clearly heard its demands and wanted to grant it full powers of verification, including among the network’s private partners, regardless of the method of remuneration of these companies, whether by subsidy or by purchase of services.
The VGQ was also concerned about a loss of intervention power due to an article referring to a shared co-verification with an independent external auditor. Rather, she demanded the autonomy to determine whether or not she needed outside help. A request to which the minister seemed to want to acquiesce.
Other testimonials
Later Wednesday, parliamentarians are due to hear former minister Me Michel Clair who chaired the Study Commission on health services and social services in the early 2000s.
Like the Association of Senior Health and Social Services Executives, the Association of Managers of Health and Social Services Institutions and the Federation of Resident Physicians of Quebec will also be heard.
On Thursday, the Patient Director and Scientific Co-Director at the Center of Excellence on Partnership with Patients and the Public, Vincent Dumez, then the Association of Councils of Physicians, Dentists and Pharmacists of Quebec, followed by the Council for the Protection of patients and the Provincial Regrouping of Users’ Committees will take the floor.
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