The CAQ government is preparing a “refoundation” of the health system, where the private sector will have a greater role in order to improve access to care.
This is what emerges from an interview that Martin Koskinen, François Legault’s chief of staff, recently granted to the Homework. It is not a question of abandoning the universality of the health system – one of its sacred principles -, but rather of resorting to private clinics so that they increase the supply of care, particularly in terms of surgical interventions. called elective, which are no longer so if they have been postponed for too long.
By insisting on the contribution of the private health sector, the strategist may have wanted to anticipate the blows that the Coalition avenir Québec will receive from Éric Duhaime and his Conservative Party of Quebec. It turns out that the right-wing party also proposes to resort more to the private sector. The PCQ wants people to be given the choice of being treated in the public network or in private clinics, but at the expense of the Régie d’assurance maladie du Québec (RAMQ). As proposed by the Action Démocratique du Québec at the time, the private network would be called upon to replace the public network if the maximum deadlines for obtaining treatment or an operation were exceeded.
In Sweden—this is the example cited by the PCQ—clinics, and even private hospitals, provide services paid for by the public health insurance plan and thus compete with the public network.
From the outset, it is good to point out that the Quebec health care system already relies heavily on the private sector. Physicians are self-employed and enjoy the tax status of for-profit businesses. Hundreds of millions are thus exempted from tax.
When physicians work in hospitals, they remain entrepreneurs, to whom the public network provides infrastructure and support staff (nurses, technicians, administrative staff, etc.). Subsidized by the state, family medicine groups (GMF) are private entities. Apart from hospitals, medical specialists often offer their services in clinics in which they are shareholders.
Already, the Quebec government is calling on specialized medical centers, such as Chirurgie DIX30 and Rockland MD, for elective procedures. During the pandemic, this recourse has increased.
These private clinics, which work on the assembly line so to speak, show great productivity. However, it should be remembered that they take care of cases that are not too heavy and that do not present a high risk of complications.
As reported recently The duty, nearly 159,000 Quebecers fill the waiting lists for surgical procedures. More than a third has been languishing there for more than six months. It is therefore not surprising that the CAQ government plans to call on these specialized clinics for reinforcement.
In this area, moderation is essential. These clinics rely on medical specialists who come from the public network and who often still work there. The same goes for the nursing staff who, if they did not find themselves in these clinics, would occupy the same functions in a hospital. You cannot multiply the loaves.
This is also the way of laziness. The public network would be wrong to see this as a means of dispensing with improving its practices and increasing its efficiency. Making the most of the capacities of public establishments is a priority project. We must also remind the Legault government of its promise to lower the excessive remuneration of doctors.
By relying too much on the private sector, the public system would expose itself to a loss of expertise and human resources. Moreover, any gains in productivity, rather than going to the population as a whole, would end up in the pockets of pampered shareholders who take no risk.
The PCQ plans to go further by allowing Quebecers to opt out of public coverage to pay for private insurance, much like in the United States. Without saying it outright, it is the introduction of two-tier medicine. For the supporters of this doctrine, the treatments and surgical interventions that better-off citizens would pay for would represent a volume of care from which the public network would be relieved. However, in terms of health, the American system, which poorly covers a large part of the population, drives sick people into bankruptcy and is expensive, is not an example to follow. It must be understood that the Legault government has no intention of going down this path. And that’s good.