The day after the tabling of a more deficit budget than expected, the Minister of Health and Social Services, Christian Dubé, announced that the creation of Santé Québec would be an opportunity to “clean up” certain programs. It is presumed that the minister thus wishes to contribute to the effort to “optimize the State” and reduce the growth of public spending by eliminating programs that are less effective, those that do not adequately meet the needs of the population or which are too expensive.
In order to speed up the process, I invite Minister Dubé to read my book, which is being published these days by Éditions Écosociété. In Health Inc. Myths and bankruptcies in private healthI show that private health care meets all the criteria of a program in which it is imperative to “clean house”.
Contrary to the general perception of an essentially public health system, the private sector is very present in Quebec, and has been for a very long time.
Private family medicine groups (GMF), private CHSLDs, private superclinics, private seniors’ residences, private specialized medical centers, private personnel placement agencies, private telemedicine, fee-for-service payment for physician-entrepreneurs, private psychotherapy clinics , physiotherapy, speech therapy, etc. : Quebec models of private service delivery are very numerous, and most of the time they are heavily – often even entirely – financed by public funds.
While spending in the public network is scrutinized and regularly subjected to painful episodes of budget cuts, the government is building real golden bridges to “Health Inc. “. And this, without the hundreds of millions of dollars (or even billions) invested each year by the State in these private for-profit companies being the subject of systematic public examination, whether with regard to use of funds spent or the effectiveness of these investments to improve access and quality of services to the population.
In a context where the current government is resolutely committed to the path of massive privatization of services (surgeries, ophthalmology, endoscopies, telemedicine, private mini-hospitals, etc.), carrying out this examination was precisely the objective of Health inc. The conclusion I reach is overwhelming: contrary to preconceived ideas on the subject, careful analysis of the various iterations of private health demonstrates that it fails to reduce costs, that it is ineffective and that it vampirizes the resources of the public network rather than helping to relieve congestion and reduce waiting lists. Not to mention its deleterious effects on the quality of care and equitable access to services.
There are many local examples of the failure of private health care.
In terms of effectiveness, let us mention that in 20 years of existence, the GMFs have not managed to achieve any of the objectives for which they were created, namely improving access to family doctors and relieving emergency room congestion. This is not surprising when we know that in 2022, 41% of them had concluded agreements with other establishments so that they offer part of the opening hours provided for in the program in their place, and that 17% of GMFs had concluded such agreements… with the emergency services of a hospital!
Likewise, in 2021, 82% of private superclinics failed to provide the number of emergency appointments that they had committed to offering to patients without a family doctor, a percentage which exceeds 50% each year. since the creation of this model in 2016.
Regarding costs, the government itself recognizes that the use of private personnel placement agencies is largely responsible for the current deficit of public establishments. And a pilot project led by the Ministry of Health demonstrated that, on average, the cost of medical procedures carried out in private specialized medical centers is higher than when these same interventions are carried out in public hospitals.
Finally, the long-term analysis of the places of practice of the health workforce clearly shows that the creation of new private clinics does not result in an addition of services, but rather in a displacement of workers from the public to the private sector. Thus, between 1987 and 2019, the proportion of health and social services personnel in the private sector increased from 40% to 52%, while, during the same period, the proportion of them in the public is dropped from 60% to 48%.
Historically, exercises of “state optimization” and “program review” were a prelude to austerity measures imposed on public services, which often resulted in waves of privatization. Thus, these budget cuts, which have had the catastrophic effects that we know on the capacity of the public network to meet the needs of the population, have rarely affected government spending intended for private for-profit companies.
My book demonstrates that it is urgent to change the paradigm, to reverse the trends of recent years and to aim for a complete deprivatization of the health system.