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Super nurse clinics: When bureaucracy prevents better access to care

Montreal, April 12, 2016 – Quebec’s Health Department is senselessly blocking the opening of clinics run by nurse practitioners who specialize in front-line care. Yet these doctorless clinics would respond to real needs among the population, access to front-line care being one of the main failings of Quebec’s health system. Moreover, a nurse practitioner costs the health care system around 1/3 of what a general practitioner costs, shows an Economic Note published today by the MEI.

These nurse practitioners specializing in front-line care, also known as “super nurses,” can among other things make diagnoses and prescribe certain drugs, activities normally restricted to physicians. There are 225 in the province of Quebec, compared to nearly 2,000 in Ontario. The neighbouring province also has over 25 clinics led by super nurses, whereas Quebec’s public health care system has none.

“Thankfully, the private sector has come to the rescue. Over the past year, clinics led by nurse practitioners have seen the light of day. This has allowed the emergence of this solution, while the public sector is missing out on a wonderful opportunity,” says Youri Chassin, Economist and co-author of the publication.

Nurse practitioners can, at very low cost, take care of cases of tonsillitis, treat ear and sinus infections, prescribe antibiotics for common ailments, prescribe birth control pills, and place sutures, for example.

“They can offer better access to basic care,” adds Youri Chassin, bringing up the example of the SABSA doctorless clinic in Quebec City. “This clinic is threatening to close its doors, potentially depriving hundreds of families of access to front-line care.”

The case of super nurses illustrates just how difficult it is for innovative solutions to emerge in a health care system characterized by a bureaucratic approach and rationed services. Since the 1970s, with the creation of local community service centres (CLSCs), and again in the 2000s with family medicine groups (FMGs), the solutions that the government tries to implement are always imposed from the top down, and they invariably fail.

“It’s high time to give a chance to the innovative solutions that emerge on their own,” believes Alexandre Moreau, Public Policy Analyst and co-author of the publication. “Super nurses represent a flexible solution for those who do not have easy access to a family doctor.”

Because they can’t work more than 35 hours a week in the public sector, super nurses are turning to the private sector, which offers greater flexibility than the public system and makes fuller use of all of their capabilities.

“It is crucial that available health care resources be used in the most efficient way possible. The government should encourage these new care models and encourage a liberalized approach with a more flexible framework if it wants to improve the overall quality of Quebec’s public health care system,” conclude the authors.

The Economic Note entitled “Super Nurse Clinics: An Innovation for Improving Access to Health Care” was prepared by Youri Chassin, Economist and Research Director at the MEI, and Alexandre Moreau, Public Policy Analyst. This publication is available on our website.

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The Montreal Economic Institute is an independent, non-partisan, not-for-profit research and educational organization. Through its studies and its conferences, the MEI stimulates debate on public policies in Quebec and across Canada by proposing wealth-creating reforms based on market mechanisms.

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Interview requests: Pascale Déry, Senior Advisor, Communications and Development, MEI / Tel.: 514-273-0969 ext. 2233 / Cell.: 514-502-6757 / Email: pdery@iedm.org

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