Every Tuesday, The duty offers a space to the creators of a periodical. This week, we offer you a text published in Relationshipsnumber 823 (winter 2023-2024).
Bill 15 can, rightly, worry anyone who cares about Quebec’s public health system. The growth in the number of medical procedures carried out outside public establishments – that is to say in places belonging to entrepreneurial doctors and private investors – is one of the main risks posed by this project.
If Minister Barrette’s merger of public establishments was surprising in its scale, that of Minister Dubé reached a total scale. Indeed, the State intends to tighten its administrative controls on the public network by an extreme merger of all public establishments in Quebec and subject them to the centralized management of a single body, its operational arm: the Health agency. Quebec, a new state corporation.
Apart from the numerous control powers entrusted to it (for example in terms of access mechanisms, national register of incidents and accidents, issuance of permits, etc.), Santé Québec’s central mission is to offer all services . It can do this either directly through public establishments, or indirectly through private establishments or other private providers, such as family medicine groups (GMF) and specialized medical centers (CMS).
What does “service integration” mean? This is an expression that comes up often and which is like apple pie: everyone loves it. But beyond its attractive aspect, since the Couillard reform, this term mainly designates the integration that takes place between public establishments and the services provided by private companies or organizations. Thus, talking about the “integrated patient pathway” aims to standardize the routine transfer of the patient from a public provider to a private provider with whom the public establishment coordinates, to whom it provides staff or other resources or to whom he delegates activities in exchange for remuneration.
Minister Dubé has repeatedly repeated in parliamentary committee that his bill changes nothing in the role of the private sector in care. This statement is misleading, since it ignores several other dimensions of the bill, such as the transfer of responsibilities between the public and the private sector, which could be done in a more systemic and massive manner than the recourse to the document which currently prevails, the legalized transfer of staff from CLSCs to GMFs and the transfer of public assets to the private sector.
A highly criticized approach
The first Act respecting health services and social services placed public establishments at the heart of a network dedicated to the provision of health care and social services, while private organizations served on the margins or were intended to fill gaps. more specific needs. This approach was gradually weakened in favor of an increasingly institutionalized place given to private groups of doctors financed by public funds, whether in GMF or CMS, to the detriment of CLSCs and even hospital centers. Bill 15 confirms this change in approach and grants Santé Québec the power to amplify it.
On the one hand, the bill tightens controls on medical practice in public establishments, but, on the other, it promotes an economic and liberal culture of medical practice, by institutionalizing public financing of private medical companies that are GMFs and CMS. However, is it irrelevant whether health services are provided by a public or private organization? The question raises debate, but the facts are hard-headed.
Several studies have clearly revealed the issues surrounding higher private costs, but also the lower quality of care. Minister Dubé rejects any objection by replying that the principle of universality and free treatment is maintained, that the patient will not have to pay anything, whether he is treated in the public or in a private place bound by an agreement. This obscures several dimensions of the subject, and many people have followed the minister in parliamentary committee, showing that they are not fooled.
Even organizations in favor of a transfer to the private sector of free services for patients were more cautious than the minister. The College of Physicians raises the risk of seeing the CMS cannibalize hospitals, while the Federation of Specialist Physicians of Quebec fears undressing Paul to dress Jacques by calling on the minister to be careful.
In the name of access to care, will Quebec’s health system be handed over to private medical companies? This is a question that is more pressing than ever and that should concern the minister, like the entire Quebec population.
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