Calls for substantial health care reform have been ringing across the province of Quebec. It’s time to answer those calls and transform our monopolistic health care system into a mixed, universal system that embraces the value of parallel resources to improve both access and quality of care for patients.
The good news is, these solutions have already been tested and adopted in other countries with universal health systems, such as the United Kingdom and Sweden. All that remains is to learn from their experiences, and add our own personal touch to the recipe where necessary.
The proposed recipe for success is composed of ingredients, or reforms, that mix well with the Canada Health Act and that have proven beneficial to patients. But like any successful recipe, the order in which the ingredients are mixed together is just as important as the ingredients themselves.
The first step: electronic patient records and expanded access to health data. Handwritten records and fax-based communication between institutions, archaic practices still present across the province, must make way for the technologies of the present. Taking this step first will enable evidence-based health care planning and facilitate access to patients’ health profiles, among other benefits.
Next, the prohibition on duplicate health insurance has to go, closely followed by the ban on dual practice for physicians. Allowing Quebecers to purchase duplicate insurance without restriction would expand the number of options available to patients seeking medically necessary care. Once dual practice is permitted, health care professionals will be able to work in both the independent sector and the government-run system simultaneously, and no longer have to jump through administrative hoops to opt in or out of the public system.
Some may fear that mixing in these two ingredients will reduce the available resources in the public system. They can rest easy, as the recipe calls for an increase in the supply of medical professionals with three straightforward measures: streamlining the application process for foreign-trained doctors, eliminating medical school quotas, and adopting national licensure to allow medical professionals to practise across the country. Without such additional human resources, access to health services will remain suboptimal, and our health care system will perpetually lack resources.
Having completed these steps, the ideal conditions would then be in place for the adoption of activity-based funding for Quebec hospitals. Historical budgets, still used today, provide little incentive to innovate or improve the quality or efficiency of care. Activity-based budgets, on the other hand, fund hospitals according to the actual volume of patients they treat and the severity of the patients’ conditions. This ingredient is crucial to the success of the recipe, as it allows the money to follow the patients, making them a source of revenue for hospitals rather than a cost, and consequently removing the need for rationing through long waiting lists.
The final step is to delegate the management of some hospitals to entrepreneurs, all while maintaining public funding. This would in no way undermine the universality of our system because care would remain free at point of use. Rather, by increasing competition to attract patients (a source of revenue, remember), operational efficiency would increase, to the great benefit of patients.
Our health care professionals give their all to care for patients, and they have taken centre stage for the past two years, but the current system is stacked against them. These brave individuals deserve to work in an environment that is flexible and responsive to their patients’ needs.
With a dash of political will and a pinch of hard work, this set of reforms could finally drag Quebec’s health care system into the 21st century, and place the efficiency of institutions and the well-being of patients among the top priorities, where they have always belonged.
Maria Lily Shaw est économiste à l’IEDM et l’auteure de « Real Solutions for What Ails Canada’s Health Care Systems – Lessons from Sweden and the United Kingdom ». Elle signe ce texte à titre personnel.