Mini-hospitals will complement Quebec’s health system, not erode it

An argument that Québec solidaire and the big unions serve up whenever the government talks about its independent mini-hospitals project is that they will take resources and personnel from the governmental system and not solve the waiting list problems.

That’s notwithstanding the fact that the care provided by these mini-hospitals would be reimbursed by the Quebec medicare card, and therefore that these resources would continue to be used in service of Quebec’s universal health care system.

It’s important to understand the gains that such a system would allow.

It may be tempting to consider human resources as a fixed pie, in which each additional worker can only care for a fixed number of patients. While this theoretical limit exists, there’s no indication that the government, as health care administrator, is close to reaching it.

A simple example: with the tools they have made available to workers, the way they organize work and greater flexibility to experiment with new ways of doing things, Quebec entrepreneurs have shown that they’re able to do more with the same staff.

This is the experience of specialized medical clinics. Several of these entrepreneurial health facilities have signed agreements with local hospitals in recent years in order to take charge of a portion of their waiting lists for day surgeries and reduce the pressure on the state health care system.

One of the most oft-cited examples of this is the one between RocklandMD Surgery Centre and the Hôpital du Sacré-Cœur of Montréal. The centre provides the operating rooms, the maintenance personnel and the nursing staff, in exchange for rental fees. Note: the surgeon is thus the same one as in the hospital.

In 2019, when the pilot project was evaluated, 85 per cent of surgeons estimated having been more productive using the specialized medical centres’ facilities than their hospitals’ facilities. And the productivity increase is not small: respondents estimate it to be around 20 per cent.

The reasons given are many and varied.

There is first of all the better organization of the workspaces, the preparation room being adjacent to the operating room at RocklandMD, whereas at the hospital it is generally on another floor.

There is also the matter of schedules being planned out in a more efficient way, with nurses responsible for preparation beginning their shifts a little earlier than the surgeon in order for the operation to start right on time.

And support tasks are planned better, notably since maintenance personnel are ready to clean the room as soon as an operation is over so that the next one can start as soon as possible.

Even though there’s nothing revolutionary in this, the fact is that these independent facilities, run by entrepreneurs, have an incentive to innovate — barring which they won’t make back their money — and a greater capacity to do so given the smaller size of their organizations.

It’s clear that, in such a context, these surgical centres run by entrepreneurs allow us to increase our treatment capacity and to do more with the same resources. That’s why nearly 15 per cent of the operations carried out in Quebec now take place in such specialized clinics.

Nor is resorting to the entrepreneurial sector within the health care system unprecedented. In France and Sweden, for example, the governmental universal health care system counts on a substantial number of independent clinics and hospitals to provide care in support of the governmental system.

Whatever critics may say, the Coalition Avenir Québec government’s mini-hospitals project, specialized medical clinics and the other entrepreneurial components of our health care system will not steal precious resources from our state system. They will instead complement it, and grow our treatment capacity.

That’s great news for the over 160,000 Quebecers languishing on a waiting list.

Emmanuelle B. Faubert est économiste à l’IEDM. Elle signe ce texte à titre personnel.