The day after the publication of an analysis on the high costs of operations carried out in the private sector, the Minister of Health, Christian Dubé, asserts that private clinics have, on the contrary, proven their effectiveness. All that remains is to prove it with new data, argues Québec solidaire.
“We managed to compare the costs and see all the benefits of using the private sector,” said Minister Dubé on Tuesday during the question period. The formula has, he says, proven itself: 155,000 surgeries were performed in the private sector during the pandemic.
On Monday, the Institute for Socioeconomic Research and Information (IRIS) published an analysis concluding that the cost of operations and interventions carried out in the private sector “exceeds greatly” that of the public network. For some services, it is even “up to 150% higher”, argues IRIS.
The minister questions this comparison, even though the data comes from his department. “The cost calculation does not include the same thing for the private and the public,” said his cabinet, adding that this difference is written “black and white” in the document obtained by IRIS. “It is therefore difficult to make comparisons as some do,” adds the firm.
The data presented in the document from the Ministère de la Santé et des Services sociaux (MSSS) — now available online — dates from 2018 to 2020. They compare the costs of five operations and interventions (cataract, carpal tunnel, spring finger as well as colonoscopy long and short) carried out in hospitals and in three private clinics participating in the pilot project launched in 2016 by the former Minister of Health Gaétan Barrette.
How can we compare if we can’t know which part [des coûts] heating, infrastructure, cleaning, maintenance costs of the hospital is allocated to the operating room?
However, Christian Dubé affirms that we “are no longer in a pilot project” and that specialized medical centers (CMS) can have a permanent place in the system. The establishments will also launch new “very targeted” calls for tenders in this regard in the coming weeks, he explained during the question period.
“So much the better” if the minister has “new, more up-to-date figures”, declared the united deputy Vincent Marissal, inviting Mr. Dubé to be more transparent. “We are waiting for them! Will I still need to ask for them and get redacted? Can he make them public to us? »
Average of $1234 per operation
Relaunched later during the study of credits, Minister Dubé said that he could not disseminate this data for fear of perverting competition in future calls for tenders. Deputy Minister Dominique Savoie also let it be known that the government paid $200 million for 162,000 operations carried out in the CMS in the last three years, or an average of $1,234 per intervention.
To reduce costs, the Ministry of Health wants to encourage hospitals to join together in these calls for tenders, she also indicated. Mme Savoie also hopes to reduce costs, since future contracts will be given to the highest bidder, while the previous ones were given by mutual agreement.
At the time of the pilot project, Minister Gaétan Barrette demanded that the three CMS (Chirurgie DIX30, Rockland MD and Opmedic) open their accounting books and inform the MSSS of their actual expenses for carrying out surgical activities. The MSSS financed the direct and indirect costs of the clinics, as well as a 10% profit margin. This margin was increased to 15% during the pandemic.
“Everything was taken into consideration in the analysis [des coûts lors du projet-pilote] : construction, depreciation, renovation, equipment, etc., explains the Dr Barrette. In return, we did the same thing on the side of the totally public system. »
However, the network does not seem to have done its homework, according to the document provided by the MSSS to IRIS. Costs related to the renovation of buildings and the depreciation costs of equipment are not taken into account in the indirect costs of public establishments. “These data exist,” says the former minister. If the department does not make an effort to be precise in the data it discloses, there is a problem. »
Comparisons considered risky
The Dr Barrette adds that the government has accounting software that allows for granular analysis of facility costs. Approximations can be made. “It’s always been the same problem in the public: we don’t make a lot of effort to clearly indicate what the real direct and indirect costs are. That does not mean that there is no one-upmanship in the private sector. What I am telling you is that currently, the evaluation work on the public side is not optimal. »
The former Minister of Health also brushes off the IRIS analysis, which he considers “biased, biased and inadequate”.
The Dr Hugo Viens, medical director of Clearpoint (owner of Chirurgie DIX30 and Opmedic), finds it “demagogue” to compare the public and the private sector based on data that does not include all the costs covered in hospitals. “How can we compare if we cannot know which part [des coûts] heating, infrastructure, cleaning, maintenance costs of the hospital is allocated to the operating room? ” he asks. According to him, the computer systems of the public network do not allow “a level of granularity of financial information” as precise as that of CMS.
For Maude Laberge, specialist in the performance of health systems at the Faculty of Medicine of Laval University, we simply cannot compare the public and the private sector, because “the rules of the game” are different.
According to her, the method of public financing of private clinics favors the growth of expenses, which is not the case for the public network. “At the hospital level, we try to reduce our expenses, then at the level of private clinics, we tell them that we will pay them, no matter what it costs them, with a profit margin of 10%. »