The observation is proclaimed by all: the Quebec health system is precarious. Had it not been for the weak capacity of the network to absorb patients with COVID-19 requiring hospitalization, health measures would probably not have had to be applied with such severity. Let us try to determine why Quebec found itself in such a fragile state.
Posted yesterday at 12:00 p.m.
Comparisons of the number of beds per person confirmed what was already compressing the capacity of the health network. While many socio-sanitary commentators decry Quebec’s hospitalocentrism, we must above all note the dwindling reduction in our ability to offer intra-hospital care for 30 years, without a substantial intensification of extra-hospital care.
The Dr Jean Rochon, who recently passed away, whom many have designated as the father of social and preventive medicine in Quebec, initiated during his time as Minister of Health and Social Services the ambulatory shift. The public goal was to ensure greater productivity in relation to hospital resources. A legitimate objective in the face of technological development. On the other hand, this orientation rapidly reduced hospital capacity through government spending cuts, without consideration for maintaining the minimum number of beds for care that cannot be offered on an outpatient basis. And in fact, despite this direct drain on the capacity to hospitalize patients, the lack of subsequent adjustments in hospital operating budgets has forced, under ALL subsequent governments, periodic closures of additional beds to balance the budget.
The number of beds available, already extremely limited in Quebec, has therefore always been less than what is reported in the statistics, especially during the summer or holidays (holidays, school break, public holidays imposed in the network, etc.).
It should also be recalled, for information purposes, that the creation of the MUHC and the CHUM resulted in an additional reduction in the number of beds available in Montreal, even though these hospitals also have provincial mandates.
It is also striking to note that there is no independent place mandated to observe the evolution of the health network, to compare it, to propose criteria ensuring care capacity. Has anyone seen periodic reports from the National Institute of Excellence in Health and Social Services (INESSS) or the National Institute of Public Health of Quebec (INSPQ) in this regard that would have worried or reassured has to do with the number of beds available in Quebec? Neither has a specific function on this, or even the consequent search capability. There are therefore structural limitations to the science studying the state of the Quebec health care system. Moreover, it would be difficult for them to fulfill this mandate given the paucity of consistent data on the state of health not only of the network, but more fundamentally also of the Quebec population.
For lack of adequate data and of an independent organization to analyze them, it is difficult to specify the number of beds necessary to accomplish the health function of the State, wanting that sufficient and competent care be offered according to criteria confirmed by the literature. world, also taking into account one-off contingencies, such as the current pandemic. Personally, since this is the area of my practice, I wonder if there is any data in Quebec specifying, for oncology, how many beds should be allocated and reserved to provide hospital care. I doubt that any plan in this regard exists in the boxes of the Ministry of Health. As hospitals do not have precise mandates as to their mission and expected volumes, they cannot define annual volumes for each pathology. Each year, hospitals modulate their activity according to the allocated budget.
While we know the exact number of patients hospitalized due to COVID-19 and the percentage of these who are in intensive care, the statistics for other illnesses are invisible, while the lists waits lengthen.
Before discussing and taking action to rebuild the foundations of our health network, could we first agree that there is a need to better understand the things to be done, like the conduct of things for the COVID-19?
I’m not talking here about redoing endless consultations, but about creating an independent organization, able to paint a picture of the state of care in Quebec, to specify the most serious shortcomings, to present its conclusions without political filter and leaving Leaders to announce their decisions on which priorities will merit funding. How many beds are needed according to the expected volumes? Are there care settings to be preferred over others? How many physicians and other health professionals should be assigned to each area of expertise?
After the pandemic, let’s have the relevance of stopping corporate attacks aimed at denigrating this or that group of professionals. Let us evaluate without a priori the strengths and weaknesses of the actors. Let us accept the comparison without pitfall to the ego. Health is a personal well-being, but it is monitored by blood tests, cholesterol level, blood sugar, etc. Let’s hope the same for our beloved healthcare network. That he is able to know his blood pressure, his kidney function, the quality of his heart and his arteries. Only through a good diagnosis can we claim to know how to intervene to ensure its sustainability. And knowingly, we will talk about the changes to be made and the funding that will have to be granted.