Coming out of the global pandemic, which shone a spotlight on the weaknesses of our healthcare system, the government is proposing a comprehensive plan to launch “a major shift in the organization of healthcare and health services in Québec,” healthcare that it hopes will be more humane and more efficient.

But have we learned the right lessons from the pandemic? Will we have the wisdom to better prepare for the imminent climate crisis? And will we be able to take care of the most vulnerable in our society and of healthcare personnel? The time has come to make choices!

The big projects

The Health Minister plans to take immediate action on what he considers the four foundations of our health system:

  • Personnel
  • Access to data
  • Information technologies
  • Infrastructures and equipment

His plan contains 50 measures in nine sectors deemed critical to improving the access, quality and efficiency of the services:

  • Six areas deemed dysfunctional are targeted: the front line; emergency and specialized care; seniors and vulnerable people; mental health; youth protection; prevention and epidemic preparedness.
  • Three projects aimed at transforming the network will focus on efficiency issues: innovation, funding, governance and performance.

The Dubé plan is an outline for the major shift in culture that the government wishes to see. But is it really reasonable to rush into another reform of the healthcare system now, instead of focusing on the priority issues on which there is consensus?

Do not lose sight of the essentials

A number of international organizations are urging governments around the world to strengthen healthcare and social safety nets. Crises of the scope of COVID-19 require rapid intervention from public authorities, a response that only well-established and properly funded public health and social services can orchestrate.

Isabelle Dumaine 

The priority: healthcare personnel

The Minister acknowledged it: the significant reorganization of services and the reallocation of many activities during the pandemic put inhumane pressure on the personnel constantly on the front lines.

“Now, catching up with the many backlogs accumulated in the various sectors will also bring its own set of challenges,” says the President of the Fédération de la Santé du Québec (FSQ-CSQ), Isabelle Dumaine. “The personnel will continue to be under pressure for several months, or even for several years. In such a context, the issues of burnout and workforce shortages remain extremely concerning.”

The Minister says he needs the collaboration of all his partners – the strength of his plan’s implementation, in his own words – for the plan to be successful.

“We agree that we have to change a number of our practices. And more than ever, we need global, fair and sustainable solutions to convince personnel to remain in or recommit to our public health and social services network. The future of our public services must include improved working conditions. The Ministère de la Santé et des Services sociaux must make this its priority,” emphasizes the President of the CSQ, Éric Gingras.

In his eagerness to simultaneously work on several fronts – certain areas of change could monopolize human resources on a large scale – is the Minister running the risk of losing sight of the essentials?

“If the Minister wants to ‘provide care on a human scale,’ as he says, and to establish a new dialogue, we call on him to read the Déclaration du 26 avril 2022 – Un appel pour retrouver plus d’humanité en Santé!, in which nurses, licenced practical nurses, respiratory therapists who are members of the FSQ-CSQ, along with citizens, make an urgent appeal to the government,” says Isabelle Dumaine.

Measures rejected by the CSQ

Below are the Health Plan measures that the Centrale rejects:

Pursuing the expansion of residential facilities for seniors and alternatives based on the current formula

  • In Québec, the number of people aged 75 and over will double within 20 years. In March 2022, close to 4000 people were waiting for a place in a CHSLD. While the needs are constantly rising, the number of promised places is 2600.
  • By June 2022, the bill jumped to $2.8 billion, nearly triple the $1 billion budget forecast at the outset. The average cost of a room, which was $400,000 in 2019, now exceeds $800,000.

Expanded contribution of private care to the public network

  • No serious study has demonstrated that private healthcare is more efficient. No public evaluation of any of the pilot projects currently underway has been conducted.
  • Giving a 15% profit margin to private partners is an outrage and amounts to another attack on our public health and social services network. In our view, it is indecent to pay profits to professionals who are already very well remunerated, who have a status of private enterprise which allows them to benefit from tax incentives, who are authorized to bill certain users and, to top it all off, who are only required to take limited risks.
  • According to a very recent study (June 2022) by the Institut de recherche et d’informations socioéconomiques (IRIS), of the 50 super clinics (GMF-R) analyzed, 24 use holding companies as shell companies (tax optimization). In addition, the announced construction of two private mini-hospitals funded according to the GMF model is downright alarming.

The implementation of patient-centred funding in the Québec healthcare system

  • This funding model requires exponential gathering of clinical and administrative information.
  • This approach is unrealistic and senseless. Claiming to be able to establish the cost price per user for every service received and for all healthcare channels, in a scientific, clinical, social, territorial and organization environment that is constantly changing, is, in our opinion, absurd.
  • Many of the adverse effects of this funding model have been amply demonstrated in many countries (some have even abandoned it): selection (skimming) of patients; manipulation of data (overcoding) during classification; fragmentation of episodes of patient care; excessive delivery of services insufficiently justified in clinical terms (overtreatment); early discharges leading to readmissions because of complications; keeping certain patients to retain the funding, or in contrast, making hasty referrals to other establishments.