Last Friday, we learned in an article by Ariane Lacoursière and Fanny Lévesque1 that the Ministry of Health and Social Services could be on the verge of weakening one of the key electoral commitments of the CAQ government in health, namely that of mini-hospitals managed by independent contractors.
The watered-down project would therefore be done without operating theatres, a step back from the success of medical centers specializing in helping to perform minor operations. Such a setback would represent a victory of immobility over the desire of Quebecers to see their health care system adapt and offer greater room for independent management. Indeed, according to an Ipsos poll published by the Montreal Economic Institute in April, 69% of Quebecers support the mini-hospital project.
It will be understood that the Ministry of Health and Social Services – already burned by the project of the Health Quebec agency – is trying to preserve as much management and control powers as possible over the health system. However, the rigidity of the system currently in place leads inexorably to starving results for our fellow citizens in terms of access to the health network. In a system like ours, care is rationed through long waiting lists. In short, 18 years after the Supreme Court of Canada trumpeted, in the judgment Chaoullithat access to a waiting list does not represent access to health care, very little has changed.
What we need is a dynamic management method enabling healthcare establishments to quickly adapt to the reality on the ground. This is why the promise of the first two mini-hospitals, managed by independent entrepreneurs, but accessible with the sun card, represents a step in the right direction. But still it is necessary to go until the end of this logic.
The implementation of hospital funding based on the number of medical acts performed is important news. This will ensure that health institutions will be able to consider new patients as a source of revenue rather than as a cost to be paid from a fixed and immutable budget. Mini-hospitals run by independent entrepreneurs, who are more agile and able to explore possibilities, represent an opportunity to build something solid on these new foundations.
The idea of entrusting the business sector with the management of certain types of health care is, however, far from representing heresy in industrialized countries. Canada and Quebec are in fact exceptions in this regard.
France, for example, entrusts the management of around a third of its hospitals to entrepreneurs. In the Netherlands, we are talking about almost 80%. And that is without taking into account the place reserved for the independent non-profit sector in European countries.
The reality is that the management method to which we currently resort almost systematically struggles to explore possibilities and optimize its ways of doing things. Meanwhile, 49% of patients needing knee replacements have been hanging around for more than six months on a waiting list. Clearly, we need healthcare establishments that will be able to make judicious use of their operating rooms, like specialized medical clinics. Unfortunately, the current bureaucratic system has demonstrated for decades its inability to adapt to the demand for health care and to respond to it in a timely manner.
Minister Christian Dubé shows a great will to stand up against the veritable alphabet soup of acronyms of the health bureaucracy. If he still wishes to respect the electoral commitment made last September, the time has come for him to tame the state monster he inherited as Minister of Health and to entrust even more important missions to our entrepreneurs.