Quebec’s health minister recently gave an ultimatum to the province’s hospitals: under a proposed amendment, emergency room stays are to no longer exceed 24 hours.
If Gaétan Barrette wants to achieve this objective, and even surpass it, he should take some inspiration from the performance of a certain Swedish hospital.
Saint Göran is a Stockholm hospital funded by the government and run by Capio, a private multinational company. It outperforms its peers in terms of emergency room wait times and the satisfaction of its patients and staff, all while costing the government less money.
It might sound like a dream, but it’s real.
In Quebec, 51 per cent of emergency room patients wait more than four hours. For stretcher patients, who represent one-third of ER stays, the median wait is nearly 10 hours, and can reach 15 or even 20 hours in our large hospitals.
At Saint Göran, the median duration of ER stays is 2.8 hours, and 23 per cent of patients wait more than four hours.
Only one per cent of patients at Saint Göran spend more than eight hours in emergency; in Quebec, 1.6 per cent wait 48 hours or more.
The case of Saint Göran shows how a privately run hospital can be integrated into a universal, single-payer health-care system like ours.
In Sweden, as in Canada, the government finances the majority of care. Whether a hospital is publicly or privately run makes no difference for the patient. The Saint Göran business model, essentially, is to provide patients with quality care and to do so efficiently in order to generate profits.
To achieve this objective, its administrators make use of various performance indicators (in Sweden, these are all public). Capio is so confident in its methods that in the last call for tenders, it offered its services to the county for 10 per cent less remuneration compared to both its previous level and to the remuneration of comparable hospitals in Stockholm.
This reduction of public funding has not led to any decrease in the number of patients treated. The Saint Göran emergency room, which saw some 35,000 patients pass through its doors 15 years ago, treated more than 86,000 last year, as many as Quebec’s largest hospitals.
While the number of patients Saint Göran receives in its ER increases, wait times are falling. Last year, the median wait time to see a doctor was 26 minutes. No Swedish hospital does better.
Saint Göran receives its share of elderly clients, and Swedes use their ERs as much as Quebecers use theirs. Patients there judge that the quality of the care received is comparable or better than in Stockholm’s other hospitals.
As for employees, their degree of satisfaction is higher, while the medical staff turnover rate and the number of sick days taken are lower.
How does Saint Göran do it? Simply by applying basic economic principles.
First, the hospital’s management is decentralized with respect to the health department, and decentralized within its walls as well, in addition to encouraging employee initiative.
Furthermore, the company, motivated by profit, does not cut corners when it comes to patient care, but devotes its efforts to treating them better and faster, which is good both for patients and for the government’s budget.
According to a tenacious myth in Quebec, making more room for the competitive sector in the provision of care would threaten access and quality. The experience of Saint Göran shows this is simply not the case.
The Quebec government could decide, as the Stockholm County Council did, to entrust the administration of a hospital to a private operator, all while maintaining public funding as we know it.
Given the mediocre performance of our health-care system in terms of access compared to that of other industrialized countries, decision-makers here have nothing to lose from such an experiment, and patients have everything to gain.
Patrick Déry est analyste en politiques publiques à l’Institut économique de Montréal et l’auteur de « Saint Göran : un hôpital concurrentiel dans un système universel ». Il signe ce texte à titre personnel.