Private mini-hospitals to unclog Quebec emergency rooms? The promise of the Coalition avenir Québec (CAQ), announced last weekend, leaves health system analysts perplexed.
Posted at 5:00 a.m.
Two medical centers of the kind, halfway between family medicine groups (GMF) and hospitals, will emerge in the east of Montreal and in Quebec City if the party is re-elected on October 3. Care will be fully covered by the RAMQ, but the construction and management of these mini-hospitals will be a private matter.
The Minister of Health, Christian Dubé, hopes to reduce the traffic in emergencies by 30% to 40% by redirecting “minor cases” to FMGs and private mini-hospitals.
However, for François Béland, co-author of the essay The private in health: speeches and facts, these mini-hospitals will not improve emergency room wait times for many patients.
“It’s true that part of the bottleneck is outpatients. But there are also all the patients waiting on stretchers in the emergency room corridors, for lack of available beds,” he said, citing the examples of hospitals in Mont-Laurier and Saint-Jérôme, where the occupancy rate emergency room stretchers reached 240% and 155% on Tuesday.
“There is a shortage of beds in hospitals. We’re having trouble getting patients upstairs. When we compare ourselves to countries where the health system is doing quite well, we notice that we have fewer rooms per 100,000 inhabitants and often fewer doctors,” explains the researcher at the Lady Davis Institute at the General Hospital. Jewish.
Roxane Borgès Da Silva, economist and professor of public health, wonders where the staff for these mini-hospitals will be recruited in the context of the labor shortage.
We risk undressing Pierre to dress Paul. We risk harming our public system.
Roxane Borgès Da Silva, economist and professor of public health
The researcher is of the opinion that it would have been preferable to focus on the working conditions of health care personnel and their retention rather than investing in a new structure.
“In the short term, this is a solution that seems interesting, but in the long term, it does not solve the problem of staff leaving hospitals,” she said.
More efficient, but at what cost?
Louis-Martin Rousseau, professor at Polytechnique Montréal and holder of the Canada Research Chair in Healthcare Analytics and Logistics, believes that the construction of these mini-hospitals is good news for patients. And for taxpayers? He is less sure.
“To have this intermediate structure which will be specialized in the simpler cases, the cases which do not require hospitalization, it is a good idea from an organizational point of view. Other countries in the world have this kind of structure which is more focused on volume than on heavy and diversified cases,” he explains.
But the participation of the private sector in these new small hospitals tickles the three experts consulted by The Press.
Businesses will have to make a profit, unlike the CISSSs and CIUSSSs, which are not looking to make money.
Roxane Borgès Da Silva, economist and professor of public health
At a press conference on Saturday, Minister Christian Dubé estimated the construction cost of each of the two mini-hospitals at 35 million. He said that the bill will be provided by the private sector. “But in the end, it is the taxpayers who will pay, because no company will embark on a loss-making adventure,” argues Professor François Béland.
The latter affirms that the announcement of the CAQ leaves several questions unanswered: how will the companies involved recover their 35 million invested in the construction of these mini-hospitals? Will managers have the same salary as those in hospitals? Treating a urinary tract infection – in the public compared to the private – will it cost the same price to the State?
“In fact, why are these mini-hospitals not run by the public? Do we have so little money in Quebec that the government cannot invest itself? asks Mr. Béland, skeptically.
“Is the private sector so efficient that even by paying it profits, it will cost us less? Me, I don’t believe in it and I ask that someone prove it to me! “, he launches.