The private mini-hospitals of the Legault government should make it possible to reduce waiting lists for surgery, agree many experts. However, they strongly doubt their ability to guarantee a 24/7 service.
Contrary to a widely held perception, these will not be the first private hospitals in Quebec’s modern history.
SNC-Lavalin managed one in Montreal for many years, the Bellechasse hospital, which closed its doors during the Rochon reform of the late 1990s.
Ironically, this hospital was located in the same area where the Coalition avenir Québec wants to build its mini-hospital in the East, near the Maisonneuve-Rosemont hospital (HMR), recalls David Levine, former president of the Montreal Health and Social Services Agency.
“The hospital used the Maisonneuve-Rosemont medical corps. The surgeons went to work in Maisonneuve-Rosemont in the morning and went to Bellechasse afterwards. A system that has proven to be effective, he recalls. “The surgeons were taking on all the smaller cases that were getting done faster and they were able to get better compensation because they were doing more cases faster. »
With private mini-hospitals, the Minister of Health Christian Dubé says he wants to “reduce the pressure on current facilities”. On Tuesday, he launched two calls for interest to probe the private sector. The target: construction by 2025.
These small hospitals would offer front-line service, with the added bonus of radiology and “minor” operations.
For the former Minister of Health Gaétan Barrette, there is no doubt, the surgeons will follow. “They are underutilized,” he points out. Due to the lack of nursing staff, many operating rooms are not operating at full capacity. Favorable to this opening to the private sector, Mr. Barrette criticizes the CAQ above all for recycling reforms that he was unable to carry out.
Hospitals or large private clinics?
On paper, these mini-hospitals are also very reminiscent of super clinics that the former Liberal minister has launched in 2016, observes Mr. Levine.
These were large “Family Medicine Groups” (FMGs) with 12-hour, 7-days-a-week services, including radiology. FMGs, it should be remembered, are private organizations. And like what is proposed for mini-hospitals, the care they provide is paid for by the state.
Admittedly, the superclinics did not perform surgical operations. Which makes Mr. Barrette say that we are dealing here rather with a hybrid between a GMF and the DIX30 clinic.
Maude Laberge, professor of health economics at Laval University, draws the same kind of parallel and speaks of “an ‘in-between’ between a hospital and a GMF”.
For Damien Contandriopoulos, public health policy expert at the University of Victoria, “the term ‘hospital’ is a bit misleading”. A real hospital, he says, has intensive wards. Otherwise, it’s “a big clinic”. “What will happen to complex cases? ” he asks. “They are going to do knee and hip surgeries. But let’s say you have a surgical candidate who is elderly and overweight. The doctor who will receive it will not take it because there is a risk of complications, of having to go to intensive care. On the other hand, the young 20-year-old athlete who twisted his knee while skiing, he will take it. This raises “ethical questions”, according to the researcher. “Why is the first one waiting in the hospital and the second is treated faster? »
Gaétan Barrette believes that it is downright “dangerous” to give the name of hospital to an establishment which cannot take care of critical cases. The person who has a heart attack or a serious condition could mistakenly knock on the wrong door.
“A hospital with an emergency department is a place where we have the entire continuum of acute care. That’s not it. »
“Nuclear War”
Luc Lepage represents an association of private companies interested in the project, the Council of private companies in health and well-being (CEPSEM). “There is certainly interest among our members,” he says, pointing out that they are not in favor of “two-speed medicine” and want to play a supporting role in the current network.
Its members include various companies such as the Biron group (diagnostic services), the seniors’ residence groups Maurice and Sedna, the medical technology company BD and pharmaceuticals.
No Quebec company will have the ability to take on such projects alone, argues Mr. Lepage. “Some groups are interested in the operational and clinical part; others to the real estate part, others to the technological part, to the innovation part. »
But for that to work, the future consortium will have to have full control over the management of its staff, he says. “We have to get out of all that is rigid and corporatist in the public sector. In short, no union.
He’s not the only one to say it. According to many observers surveyed by The dutyone of the main advantages of using private mini-hospitals is to be able to completely rethink the organization of work.
It is therefore a whole battle that is taking shape between the government and the unions, reports Damien Contandriopoulos. “Unions that represent nurses or other professionals [comme les travailleurs sociaux et les psychologues] are going to be ready to embark on a nuclear war. They will do everything, he warns, to prevent the government from “de-unionising their members by creating a new structure”.
In these future hospitals, only the doctors would be linked to the State since they will be paid by the Régie de l’assurance maladie du Québec (RAMQ).
Nurses and others would live in a parallel system to that of their colleagues in the public. The public system would also be deprived of part of the workforce, thus deteriorating the current situation, denounced several this week.
There is a pool [de personnel] already in the private agencies that we will be able to recover. We must create a new organization of work, proactive management of human resources, a work-family coalition. You really have to go somewhere else.
“The vast majority of the staff who will work in these new hospitals will necessarily come from the public network, already struggling with serious labor shortages,” denounced the president of the CSN, Caroline Senneville.
Defenders of private hospitals, they retort that they will recruit staff who have already deserted the public network. “There is already a pool in private agencies that we will be able to recover, argues Mr. Lepage of CEPSEM. We must create a new organization of work, proactive management of human resources, a work-family coalition. You really have to go somewhere else. »
However, if the mini-hospitals offer attractive enough working conditions to convince people who have left the practice to come back, how can we be sure that they will not also attract staff from the public network? “That’s an excellent question,” says Professor Laberge. This will perhaps force the unions even more to question their ways of doing things. »
Nights and weekends
But whoever the recruits are, they may not want to work nights and weekends, many experts predict. “It’s going to be difficult, note Mme The bank. The private sector that has developed in health in Canada has never worked in this model. They don’t have experience managing labor outside of regular business hours. »
David Levine also sees it as a big challenge. “It’s a fine political objective, but in reality, we have never been able,” he mentions about the attempts by superclinics and some FMGs to open at atypical hours.
However, the documents of the ministry are clear: the mini-hospitals would offer services 24-7 with urgency. Gaétan Barrette, too, thinks that few doctors will want to work at night. Asked about it, the president of the Federation of General Practitioners of Quebec (FMOQ), Marc-André Amyot, replies that this kind of service may not need to be open at night.
“If it takes doctors, we will organize ourselves to find them. But I don’t want some doctor sitting there filling out forms at 3:00 in the morning. The resource is so scarce. […] If it’s really urgent at 3 am, it’s not the mini-hospital that will receive you, it’s the emergency. »
Another aspect that remains to be clarified, and not the least: financing. During the election campaign, François Legault pledged to invest $35 million in each mini-hospital.
Amounts that leave the private quite perplexed. Luc Lepage started laughing when The duty told him about it. “An emergency room costs 35 to 40 million. So if we’re talking about an emergency room with radiology, examination rooms, links with the lab… It’s a big outpatient centre. »
Relaunched about the 35 million this week, Minister Dubé’s office indicated that it was indeed the budget provided by Quebec for the construction of each establishment.
And will the private sector get its money’s worth? Maude Laberge wonders if they will be able to generate attractive profit margins. Otherwise, it will be necessary to ensure that their services are truly free, she points out. “We will have to ensure that these establishments do not charge patients for services, and that penalties discourage them from resorting to such practices,” she says, referring to the ancillary fees that have been abolished in the public network (supplies , devices, etc.). In short, she says, it will be necessary to take into account “the creativity that these new hospitals could show to seek additional sources of income”.