Private sector has a role to play in revamping health care

This year again, hospital ERs in Quebec are overcrowded. COVID-19, the seasonal flu, and other respiratory viruses have quickly filled up the few beds that had remained unoccupied.

This is nothing new. Our newspapers also reported on this story last year, and two years ago, and the years and even decades before that. For example, a Dec. 17, 1985 story in the Montreal Gazette indicated that solving the problem of overcrowded ERs would be a priority for the incoming Quebec government.

We need to face facts: Our health care system no longer delivers, and hasn’t for quite some time.

The data show that Quebecers, and all Canadians, understand this. An MEI poll published in November shows that one in two Canadians are dissatisfied with the state of the health-care system, a 17-percentage-point increase over last year.

Unsurprisingly, the level of dissatisfaction also increases with age, a sign that those who interact most often with the system are those who see its failings most clearly.

Yet it’s not money that’s lacking. Over the past 10 years, health spending in Quebec has grown by $18.5 billion, or $1,828 per man, woman, and child. Even adjusting for inflation, health care budgets have grown rapidly, and so have waiting times.

Quebecers are no fools; they’ve seen that the enormous sums of money injected into the system by the government have not produced results. Only one in five still thinks this new money has improved the system. And nearly 70 per cent of our fellow Quebecers think that the rate of increase of health spending is unsustainable.

And this is not taking into account the aging population. In 2020, 20 per cent of Quebecers were 65 and older. That proportion is expected to reach 27 per cent in 2066. This means that as time goes on, more and more people will require greater access to health care. Simply injecting more funds into the system, as we’ve done for years, won’t improve the quality and timeliness of health care.

Clearly, the public is not ready to keep pumping more and more money into a system that doesn’t work. What the people want instead is a real reform of the system in order to reduce waiting lists once and for all.

The good news is that we have models we can follow. Setting aside that scary U.S. health system, it is possible to take inspiration from mixed models such as those in France and Sweden, where universal access to health care is guaranteed by public insurance, but where some hospitals are run by independent entrepreneurs.

In France, for example, private companies and non-profit organizations account for 40 per cent of care providers in the governmental insurance plan. In Sweden, the Saint Göran hospital is a successful example of a private hospital operating in a universal insurance system.

It’s clear that these systems work. Neither France nor Sweden are regularly making headlines for overcrowded emergency rooms and endless wait times. Nor do we see the kinds of horror stories that are associated with the U.S. system.

With such results, it’s no wonder that three in four Quebecers say they’re open to the idea of experimenting with mixed systems.

We shouldn’t be surprised that certain politicians decided to tentatively explore the idea during the recent Quebec election. The Coalition Avenir Québec’s mini-hospitals pilot project, for example, is very much in this vein, even if not identical to the French and Swedish models.

And while it is limited to two hospitals for the moment — one in Montreal and one in Quebec City — there’s no doubt that eventually, shaking things up in this way and allowing people outside Quebec’s governmental system to lend a hand in searching for solutions will help improve our access to health care.

Let’s just hope that this promise is kept, as it would form a good basis for building the revamped health care system that Quebecers deserve.

Emmanuelle B. Faubert is an Economist with the MEI. The views reflected in this opinion piece are her own.

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