With Bill 15 that Health Minister Christian Dubé passed on Saturday under the parliamentary gag procedure, a third major upheaval in twenty years is about to be imposed on the health system. However, like the Couillard (2003) and Barrette (2015) reforms – also adopted under a gag order – the Dubé reform does not provide any solution to the real problems from which the network suffers.
On the contrary, our analyzes show that the current reform, like those which preceded it, will have the effect of accentuating them. Like those that preceded it, it is therefore doomed to failure and will necessarily have to be replaced in the short or medium term.
This observation implies starting to think now about the post-Dubé reform and the solutions that will have to be applied to make the health system truly effective, that is to say capable of meeting the needs of the population. In a recent publication, we identify six remedies to be implemented over a period of three to six years to provide deep and lasting real solutions to the network’s real problems.
1. Against the centralization of the health system and the disconnection that it produces between decision-makers and network managers and the services offered on the ground, we propose the creation of 400 social centers, which will be direct, local points of contact and democratic relationships between the population and the health system, allowing the latter to regain control over its services and adapt them to its needs.
2. To reverse hospital-centrism and succeed in intervening before people are very ill or in crisis, we propose aiming for a 50-50 distribution of budgets between preventive and curative. This would involve reinvesting massively in prevention and front-line services so that in the long term, half of the spending on health and social services will be devoted to them.
3. In order to resolve the major crises which are shaking certain crucial but underfunded sectors of the network, we propose using part of the additional funds invested in prevention and on the front line to urgently double investments in four priority areas: mental health, public health, home services and the community sector.
4. Prevention and first line being areas whose deployment relies mainly on an abundant and adequately trained workforce, we propose to devote part of the funding injected into these sectors to adding 100,000 people to the workforce. of the public network. In the current context of labor scarcity, this major recruitment offensive must be based on paid training and increased salaries, but also on improved working conditions and a completely renewed working framework radically calling into question neoliberal management methods of recent decades.
5. Private healthcare has failed for decades to fulfill its promises of efficiency, cost reduction, preservation of quality and improvement of access. Rather, it contributes to the decay of the public network by the vampirization of its resources. We therefore propose to deprivatize health and social services by extending the provisions of the Health Insurance Act to all sectors and by eliminating public financing to companies that refuse to integrate the public network or to convert to democratically managed non-profit organizations.
6. To counter the disproportionate concentration of financial resources in the remuneration of doctors and promote other categories of services as well as work in multidisciplinary teams, we propose to question their status as independent workers and to pay doctors while reducing their remuneration.
Reform after reform, successive governments in Quebec have only succeeded in making the health system more dysfunctional. The current government’s plan proposes nothing more and nothing less to reproduce the recipe, and therefore the pitfalls, of past reforms. Faced with this approach doomed to failure, we drew on our research to propose an alternative plan that addresses the real problems of the health and social services network, rather than renewing them once again.