You have to give him that: Gabriel Nadeau-Dubois has a sense of the shock formula. “Private health, if it worked, we would know,” said the spokesperson for Québec solidaire, during the leaders’ debate on TVA, in a repartee that sounded like an old Réno-Dépôt slogan.
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Except that our healthcare system is not a hardware store. And the question of the contribution of the private sector – however delicate it may be – deserves to be analyzed at its fair value.
Our network is so sick that we can no longer afford to raise our noses to possible solutions. You have to go beyond taboos and turn all the stones around. The private is one.
Let’s say it straight away, the idea is not to encourage a two-speed system where the wealthiest would pay with their credit card in the private sector and the others with their sun card in the public sector.
It is in this direction that the Conservative Party’s commitment to allow Quebecers to take out private insurance for care already covered by the public, which is currently prohibited, except for certain specific operations, would lead us.
No, it is rather a question of seeing how the private sector can better fit into our health system in order to offer services that would be reimbursed by the State, without jeopardizing the universality of care which is a key principle of the Quebec and Canadian identity.
We are not talking about a revolution, because the private sector is already everywhere. Physicians who practice in offices are self-employed. The Family Medicine Groups (GMF) are private companies. Ditto for pharmacists and many other specialists.
The Coalition avenir Québec (CAQ) wants to go even further. Seeing Éric Duhaime approaching in his right rear view mirror, outgoing Prime Minister François Legault has pledged to create private mini-hospitals, where patients will not have to pay anything.
The Liberal Party also wants to conclude more agreements with private clinics to reduce surgery waiting lists, while QS and the Parti Québécois want, on the contrary, to reduce the use of private clinics.
It must be said, private health can lead to serious abuses. You don’t win if you create a parallel network that cannibalizes public resources and drives up costs, both for the state and for the patient who has to pay all kinds of fees.
We all have in mind the example of employment agencies that exacerbated the shortage of staff in hospitals, by siphoning off nurses who were offered better salaries and better hours by making the jump to the private sector. A catastrophic vicious circle.
But we cannot reduce private health to this sad experience.
If the private sector cannot magically invent the workforce that we are so lacking, it can bring to the health system efficiency gains that it sorely lacks.
In fact, innovation is the lifeline of the network, since we will have to treat more patients with fewer workers due to the aging of the population. Do you think the network is under pressure? Wait a few years!
We will have no choice but to act otherwise.
Economies of scale can be achieved by working in partnership with private clinics or mini-hospitals that have a clearly delineated scope, allowing them to have a smoother and more efficient process. The Villa Medica Rehabilitation Hospital is an example of success.
The smaller size of private establishments also gives them more agility, like rabbits bouncing faster than a mammoth like our public network.
But the secret of the success of the public-private partnership lies in the negotiation of the contract.
Stuck during the pandemic, Quebec has signed agreements with private clinics to reduce waiting lists for surgery. These short-term contracts provided profit margins of 15%. Expensive, very expensive! But by perpetuating these agreements, we could melt these margins which would be downright indecent in the long term.
The other option is to enter into agreements providing for a fixed cost for each operation, which encourages the private sector to innovate… or cut corners.
For the government, it is therefore crucial to maintain active monitoring, using solid performance indicators, and to ensure a fair and equitable distribution of the benefits of innovation between the private and the public sectors.
We don’t want a saga like that of the Center de l’œil des Laurentides, specializing in cataract operations, which had optimized its process so much that it managed to empty the waiting lists… but also to blow up the bill.
It’s all in the art of finding the right dosage.
In his song Clocksrock band Coldplay asks: Am I a part of the cure/Or am I part of the disease? The question applies well to private health care. Let’s get it to help us heal the network, not make it worse.