I have a favorable bias towards the private sector, you know that. The obligation of private profitability obliges the promoter to surpass himself, especially when his own money is at stake. And competition forces organizations to innovate and improve.
However, the contribution of the private sector is not a panacea everywhere. In the health sector, for example, the imperative of profitability can sometimes come at the expense of certain qualitative aspects of the services. Public-private cohabitation also poses labor availability challenges, among others.
I’m not saying that the private sector cannot have a place in health, but this place must be scrutinized.
It is with this reservation in mind that I checked the occupancy rate of operating rooms in Quebec, in the context of the call for tenders that the government will make to private clinics for surgical operations.1. The use of the private sector aims, among other things, to make up for the backlog accumulated during the pandemic.
Why resort to the private sector if several public operating rooms are closed? To what extent is this the case?
First, I was able to learn, the occupancy rate of our operating rooms was 80.6% in March, on average, according to the most recent data available from the Ministry of Health and Social Services. This rate is at the lower end of the range of what the Ministère considers to be an optimal rate, namely 80-85%.
The differences are quite significant between the 28 institutions listed in Quebec (CISSS, CIUSSS and non-merged institutions).
In the CISSS de la Montérégie-Ouest, the rate was only 56% in March, the lowest in Quebec. That of the CISSS de la Montérégie-Centre was also rather low, at 71%.
Other centers whose rooms are not very busy, those of Gaspésie (63%), the Islands (63%), Mauricie-et-du-Centre-du-Québec (69%) and Côte-Nord (71 %) (see the table at the end of the text).
According to Assistant Deputy Minister Pierre-Albert Coubat, the Ministry of Health and Social Services is supporting the centers that have had delays since January to find solutions.
Action plans have been developed for each of these regions and rigorous monitoring is carried out periodically. The situation is improving continuously, and the surgery catch-up plan announced should make it possible to reach the targets.
Pierre-Albert Coubat, Assistant Deputy Minister at the Ministry of Health and Social Services
The Sainte-Justine University Hospital Center (CHU) (98%) and the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal (93%) have the highest rates, if we exclude the CISSS of Chaudière-Appalaches (119%), whose rate exceeds 100% due to the contribution of private clinics, I am told at the Ministry.
The CISSS de Laval and the CIUSSS de la Capitale-Nationale rank rather well, with respective rates of 89% and 87%.
At the time of this writing, I had not been able to find out what the rates were before the pandemic.
In short, overall, the rate is less than 81%, on average. Why so low?
“The availability of the human resources required to go beyond the pre-pandemic operating level is the main bottleneck,” answers Pierre-Albert Coubat.
Yes, but precisely, if there is a lack of manpower in the public sector, isn’t it to be feared that the extension to the private sector will harm the situation, despite the penalties that will be imposed on private establishments if they recruit to the public ? Why outsource to the private sector with a room vacancy rate of 19%?
“In particular because public establishments must imperatively accommodate surgeries related to emergencies, such as accidents, incidents requiring an operation, cesarean deliveries, etc. They must also accommodate other surgeries with hospitalization or requiring the presence of an intensive care unit in the facility (oncological surgeries, neurosurgeries, orthopedic and ophthalmological surgeries with hospitalization, etc.), ”he wrote to me.
How does the private help? “Private clinics free up capacity in public facilities by grouping together certain day surgeries that are unlikely to end in hospitalization (cataracts, carpal tunnel, etc.)2. »
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One thing is certain, the Ministry is aware that the complexity of surgical operations will be greater for the public. First, the public will continue to inherit inpatient operations. Then, the public is subjected to a multiplicity of diverse cases, which requires more adaptability and more staff.
The Ministry will take this into account in its payments to hospitals. He also wants to encourage private clinics to take on more complex cases, by giving them bonuses of 10% or 20%, depending on the case.
In all this operation of catching up on surgical operations and calling on the private sector, it would be desirable for the Legault government to show maximum transparency. Will we know the cost of private clinics? Their real contribution to the desired improvements? Their complication rate? Their relevance for the post-remedial years?
2. The costs of private operations in the government call for tenders do not include the fees for surgeons, which are paid by the RAMQ. In addition, the operations will remain free for patients, as well as for the public.