Private clinics that carry out operations on behalf of the public network will henceforth receive a bonus of 10% or 20% for complex procedures, as well as a bonus of 5% or 15% for patients who have been waiting for six months or more. The Legault government has recently formulated a directive intended for health establishments which governs future contracts with the private sector.
Since the COVID-19 pandemic, specialized medical centers (CMS) that perform surgeries for the public network enjoy a 15% profit margin, rather than 10% as in the past. The agreements to this effect, concluded in 2020 with the aim of catching up on the backlog in surgery, have been extended until March 31.
On December 22, the Ministry of Health and Social Services (MSSS) published a circular outlining “certain elements of future agreements” with CMS, medical imaging laboratories and other private clinics.
The profit margin of 15% disappears from the contracts. But new bounties appear. The price schedule model — presented in the directive — is based on the cost of the operation in the public network (direct costs and supplies), a financial adjustment of these costs according to the CMS as well as a bonus for the complexity and for patient waiting time.
The premium for an act of “medium” complexity is 10%, and rises to 20% for an even more complex intervention. The CMS also obtain a bonus of 5% when the operated patient has been waiting for their operation for six months to a year, and 15% when it has been over a year.
This is where the directive raises eyebrows.
Why offer CMS a latency bonus? “Offer an incentive for the major reduction of waiting lists considered to be out of time,” the ministry replied in an email. However, the CMS have “no leverage on the order in which the integrated center has prioritized patients”, indicates Annick Mongeau, who notably represents Opmédic and Chirurgie DIX30. A CISSS and surgeons contacted by The duty confirm this: health establishments determine and provide clinics with the list of patients to be operated on.
“I understand the objective, but I doubt it’s the best way for the minister to achieve the targets he has set,” said Ms.me Mongeau. According to her, the directive “raises, for the moment, many more questions than there are answers”.
Maude Laberge, professor of health economics at the Faculty of Medicine at Laval University, also wonders about this bonus. “The establishment has no real interest in transferring its patients who have been waiting for a long time because it will cost them more,” she observes.
At the MSSS, it is indicated that “this increase is offered for the first year only” of the agreement, for a minimum duration of three years and a maximum of five years. “The durability of the contracts should encourage the CMS to invest in certain equipment necessary for the realization of certain more complex interventions, adds the ministry. Thus, the CMS will be able to contribute more to the reduction of the waiting list. »
Too much paid or not?
It is difficult to assess, from the directive, exactly how much taxpayers will pay for transactions carried out in CMS.
Professor Laberge nevertheless considers “problematic” that the government “improves the price” offered to clinics “compared to what it costs us in the public network”. “The potential advantage of specialized clinics is that they should have lower operating costs than a large hospital which has a variety of services and which must have more complete technical platforms,” she says. If running costs are lower in specialist medical centers, these should have lower fees than hospitals. Otherwise, we are paying more for services. »
Mme Laberge believes that the distribution of risk between the CMS and the healthcare facility in future contracts will be “interesting”. For example, when a patient does not show up for their surgical appointment, the clinic will have to bear the direct and indirect costs of the operation. The healthcare establishment must do the same if the doctor cancels an intervention on the same day for medical reasons.
The MSSS is also tightening the non-recruitment clause for employees of public establishments before the end of a period of 90 days following their departure from the network, and provides for a “penalty of one year’s salary of the employee concerned” . The latter will not be able to “deal with cases from establishments during the 90 days following its hiring”, it is stipulated.