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Health reform: a plan that goes in the right direction, but incomplete

For one of the first times, the government is expressing that the Department should focus on directions and performance measurement, and that it is rather the network that should lead the operations. (Photo: Piron Guillaume for Unsplash)

GUEST BLOG. Last Tuesday, the Minister of Health, Christian Dubé, presented his health system reform plan for the next few years. Unlike the usual poutine, it was particularly a question of making more room for private health. It must be said that since the private sector is being demonized year after year despite all the benefits associated with it, Christian Dubé presents an openness to an increased contribution from entrepreneurs. Now that the cauldrons are out, there remains the crucial step of preparing the pea soup and adding spices to make the plan bolder and more complete.

Who will be the troublemakers?

Given the 50 billion dollars paid annually to the health system, it is unthinkable to continue to be satisfied with a feverish mammoth lacking in dynamism. The pandemic has brought to light the problems we have known for many years, namely the glaring lack of hospital beds, the inflexibility of the system vis-à-vis front-line workers, the culture of silos between professions and the lack of transparency in data-related, to name a few.

Ask any psychologist, the first step in solving a problem is to really get to know it. Step done. Now you have to get up from the chair, look in the mirror, and work on yourself. The proposed plan puts several solutions on paper, and now we need to implement them and make it more comprehensive.

However, who says change says opposition and skepticism. Even if the changes proposed as part of the redesign plan are beneficial. After all, we are talking about patient-based funding (at last!), adding hospital beds, increasing the contribution of private health clinics, breaking down barriers between professions, and all this while maintaining the universality of the system.

History shows us, however, that groups, whether for example opposition parties or trade unions, end up slowing down change and creating a divide between the reforms applied and the desire of the population to have access to a better health system. During these family disputes, the Quebec population continues to count more than 157,000 patients on the waiting list for surgery, 35% of whom have been waiting for more than six months.

The missing solutions

Far be it from me to tarnish the minister’s efforts in his early stage of necessary reforms, but if we really want to unleash the potential of the health care system and provide workers with the means to achieve their ambitions, the government must go much further in its overhaul.

In addition to the proposed solutions, the ban on taking out duplicate insurance for the population must be lifted, then the one that prevents mixed practice. If citizens were free to take out private insurance duplicating the care covered by the public plan, and then to do business with the clinic of their choice, we would contribute, among other things, to unclogging the public system and patients would benefit more.

In terms of mixed practice, we need to stop preventing physicians from practicing in both the government-run system and the contractor-run system. To those who fear an exodus of doctors to the private sector, let us answer that if this measure is combined with the elimination of quotas in medical faculties and if we simplify the integration process for doctors trained abroad , their fears should be much less!

Moreover, while maintaining the universality of the system, more entrepreneurs should be included in the management of health establishments, and the creation of hospitals run entirely by the private sector should be facilitated. And this, let us remember, without the patients having to spend a penny for their care. The state continues to be the default insurer, and management is delegated to contractors. Do I really have to convince you that the government is not specialized in management?

It is, moreover, this type of reform that has enabled Germany, Sweden, the United Kingdom and Switzerland to enjoy health systems that are much more efficient than ours, while improving access to care.

For one of the first times, the government is expressing that the Department should focus on directions and performance measurement, and that it is rather the network that should lead the operations. This desire for decentralization is refreshing, and will only materialize if private sector entrepreneurs and managers are involved in the reforms. Now let’s hope that the boots follow the chops, and that we begin a real redesign process.

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