The future of health care in Quebec

Polls consistently indicate that concern about the healthcare system is one of the top issues on the minds of Canadians. In order to explore fresh perspectives and debate new alternatives for healthcare delivery, the Montreal Economic Institute organized a half-day conference featuring five dynamic speakers on the subject: Doctors Jonathan Meakins, Edwin Coffey, Jacques Chaoulli, David Gratzer and Mr. Johan Hjertqvist.

A broad cross-section of those who work in the healthcare system were present at this event, as were senior members of the business community and politicians. The Institute also made a special effort to encourage the participation of students at this event, resulting in a number of high school and university students being in attendance. A debate was also held under the chairmanship of Dr. Léo-Paul Landry.


Introduction :: Adrien Pouliot & Michel Kelly-Gagnon

Neither magic nor money will cure health care ills :: Dr. David Gratzer

Swedish health-care reform: From public monopolies to market services :: M. Johan Hjertqvist

Le Choix privé universel: Une vision de la santé offrant la qualité, l’accès et le choix à tous les Canadiens :: Dr. J. Edwin Coffey & Dr. Jacques Chaoulli

The Canadian health care system :: Dr. Jonathan Meakins

Round Table Discussion :: Dr. David Gratzer, M. Johan Hjertqvist, Dr. J. Edwin Coffey, Dr. Jacques Chaoulli and Dr. Jonathan Meakins. Moderator: Dr. Léo-Paul Landry

David Gratzer, physician and author of Code Blue: Reviving Canada’s Health Care System set the stage for the day’s discussions by reviewing the current status of the healthcare system in Canada. Gratzer stated that Medicare suffers from a structural flaw that has corrupted the doctor/patient relationship, depriving both parties of the necessary incentives to not over-consume healthcare services. Decisions about how much of what type of care are taken out of the hands of patients and given to the government. Gratzer stated that the doctor/patient relationship must be rebuilt. In order to do this, he argued that Medical Savings Accounts (MSAs) – a system whereby individuals may accumulate in tax-exempt accounts funds to pay for medical costs, private insurance and other health-related matters – should be introduced into Canada.

Johan Hjertqvist, director of the Swedish healthcare reform project at the Centre for Welfare Reform, spoke next on how Sweden has undertaken much needed reform of its state-run healthcare system. Hjertqvist stated that in the early 1990s Sweden had experienced problems similar to those in Canada. He explained that Sweden reformed its public healthcare system so that it continues to pay for basic healthcare needs through general tax revenues, but that the provision of these services is now opened to competitive public bid, creating a type of internal market within the healthcare system. This innovation allowed their system to develop the type of transparency and innovation that markets traditionally provide while maintaining a commitment to the egalitarianism which Swede’s treasure.

J. Edwin Coffey, physician and former president of the Quebec Medical Association, and Jacques Chaoulli, family physician and healthcare researcher, next presented an overview of the findings from their recent study, Universal Private Choice, published by the Montreal Economic Institute. They explained that their system, also called Medicare Plus, was an attempt to reform Canada’s healthcare system by restoring patient control over their personal healthcare. Their proposal accomplishes this by allowing for wide variety of options from which patients can choose. They also believe that their proposed system would provide information critically lacking in Canada’s present system: a way in which to try different forms and types of healthcare delivery so as to encourage innovation and experimentation aimed at improving patient outcomes.

The final speaker was Jonathan Meakins, Chief of Surgical Services at the McGill University Health Centre. Meakins stated that the most important changes needed were reforms to the management and budgeting systems used in regards to hospitals, and that while public funding of the system should remain, important lessons may yet be drawn from private sector practice on these issues. Specifically, he stated, that disincentives to innovation and improved productivity must be removed from the current system, most importantly by having hospital budgets set on a bottom-up, activity based costing system, as opposed to the present system where budgets are assigned in a top-down, fixed budget basis where the ability to add to or innovate on services was severely restricted. According to him, the problem is that the current system is one in which a manager has responsibility but no authority.

The conference was concluded by a panel discussion organized amongst the speakers, moderated by Léo-Paul Landry, a respected member of Quebec’s medical community. While no ultimate consensus was reached amongst the panelists, it was clear that some form of market-based reform of the existing system was needed.

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