Things are not going at all in the wonderful world of ambulances in Quebec.
Private companies whose revenues come from the state refuse to open their books to the government, have developed unhealthy power relations with Quebec and cause service disruptions without being imposed penalties.
Again this month, a boy had to wait two hours for an ambulance after a skiing accident in La Tuque.
These extremely worrying problems were exposed recently in a series of articles published by the Coops de l’information1.
Problems that had already been substantiated in numerous reports that have been gathering dust for a good decade.
We retain one thing: the financial interests of private companies have taken precedence over the interests of patients. It is intolerable and it must change.
The organization of so-called “pre-hospital” services is convoluted in Quebec.
In Montreal and Laval, a public entity, Urgences-santé, takes charge of the ambulance service. Elsewhere, about fifty private companies and cooperatives divide the territory.
It is especially with them that it hangs. In 2014, a report showed that even if the government foots the bill, it “is kept in the dark about how much business actually profits and how they use it”.
The report concluded that the management method “is not based on transparent accountability” and that the companies have established a “balance of power” centered on the “seeking of multiple financial compensations rather than on a true partnership oriented towards the needs of patients and the population”.
Clearly, Quebec pays the private sector without knowing if the money is well spent. In total, the bill is close to a billion dollars each year.
In 2020, the Auditor General came to the same conclusion. She herself was met with refusal from companies when she tried to obtain information that would have made it possible to assess their performance. For people who live on public funds, you still need some nerve!
In June 2021, a new report commissioned by Quebec proposed reform. The idea: to group the 18 regions currently served by ambulances into five “poles” gathered within a “national direction”. The authors insist that this does not necessarily imply all-out nationalization.
These authors, academics who have spent 18 months scrutinizing the Quebec ambulance system, now feel betrayed. There Government policy on the pre-hospital emergency systempublished last summer by the Legault government, rules out their solution.
Rather than embarking on a structural reform, the Minister of Health, Christian Dubé, claims to be able to repair the system from the inside.
Contracts with ambulance companies end on March 31. The Minister affirms that there is no longer any question of signing new ones with eyes closed. He wants to force companies to disclose their financial statements and intends to establish accountability in the delivery of services.
If he actually manages to bring the private sector into line without disrupting the network, we will be the first to applaud. This is all the more true since the minister is already juggling numerous reforms. So much the better if he can avoid another one.
But there are many skeptics. “Ministers have been asking for openness when negotiating contracts for 35 years. Each time, we say that governance will be reviewed and that the books will be opened,” comments Robert H. Desmarteau, professor of strategy at UQAM and one of the authors of the latest report.
We can therefore say that this is the negotiation of the last chance. Minister Dubé has performance obligations. As for companies, they must realize that it is quite possible to entrust ambulance transport to the public, as is the case for firefighters and police officers. It is even done in two of the three largest cities in Quebec!
The survival of these companies depends on their openness to changing their practices.