QUÉBEC CITY, Feb. 19 /CNW Telbec/ – The Task Force Report on the Financing of the Health System was released today in Québec City. In their report, entitled Getting Our Money’s Worth, the chair of the Task Force, Claude Castonguay, and the two vice-chairs, Michel Venne and Joanne Marcotte, propose a new “social contract” for Quebecers to ensure that everyone receives the care they need in a timely manner while remaining within our collective ability to pay.
The members of the Task Force consider that Québec must secure the long-term viability of the public health care system by increasing its productivity and adjusting the growth in public spending on health to the growth rate of the economy, while improving access to care and quality of services. They appeal to the sense of responsibility of all stakeholders of the system.
Curb spending growth
Slowing growth in program spending so that it does not exceed that of the economy is one of the report’s central recommendations. Accordingly, the Task Force proposes curbing growth in public spending on health from 5.8% to 3.9% per year over a period of five to seven years.
To do so, the report proposes a realistic and workable action plan. Since the proposed measures will not achieve their full effect immediately, the group recommends setting up a dedicated health stabilization fund. The fund would receive revenue from a portion of the Québec sales tax (QST), either 1/2% or 1%, and from a deductible varying with income and use of medical care. Such a fund would help limit the encroachment of health on the other government missions. The Task Force rejects introducing user fees.
Coverage of the public system
Noting that some less essential services whose value on a cost-benefit basis has not been proven are covered while others are not, the Task Force recommends that the government review the public coverage of the existing health system, which it considers incoherent and rigid.
Accordingly, it invites the government to undertake a systematic and structured review of the public coverage on an ongoing basis, adopting for this purpose a permanent, credible and legitimate mechanism. The members of the Task Force are aware that they are proposing a profound change, but they are convinced that it is necessary. Far from calling the very idea of public coverage into question, the limits they propose to define would ensure its relevance.
A credible and independent organization
The Task Force recommends creating an Institut national d’excellence en santé whose mission will be to define the public coverage, determine performance indicators and periodically review the list of insured drugs. Formed by merging the Conseil du médicament du Québec, the Agence d’évaluation des technologies et des modes d’intervention en santé and the Commissaire à la santé et au bien-être, the organization would be independent of the Minister. It would inform the public, disseminate the results of research, recommend best practices to practitioners and establish directives for practitioners, the latter consisting of clinical protocols.
More accessible services
The Task Force is convinced that the development of health clinics will help relieve hospital congestion and offer care at lower cost and recommends accelerating their development, with the objective of ensuring that each Quebecer has access to a family doctor within five years.
Moreover, the Task Force makes a number of recommendations concerning aging and loss of autonomy. Accordingly, the Task Force recommends that the government give priority to home care and that to that end, it maintain a high level of investment in this sector. Since resources are limited, the Task Force recommends that eligibility for a tax credit be subject to a means test.
The Task Force also recommends that medical, nursing and covered specialized home care be universally covered by the public system. While recommending that the ministère de la Santé et des Services sociaux award the operation of CHSLDs on a concession basis to the appropriate resources, the members of the Task Force agree on the need to undertake a public debate on the medium and long-term effects of the aging of the population.
Efforts made to date to improve the quality of care have not allowed for the solutions of certain problems noted regarding governance. The members of the Task Force agree on the need to identify the system’s governance structures for the production of services. Accordingly, the Task Force recommends that the ministère de la Santé et des Services sociaux refocus its mission in particular on setting policy and objectives, and that it withdraw from the production of care as such.
Concerning regional agencies, the Task Force is of the view that their mission should be in particular to translate national priorities and policy into implementation strategies in their territories. While recognizing that they need to have broad autonomy, the Task Force suggests consolidating the 18 existing agencies into six to eight. The Task Force also makes a number of recommendations to increase the autonomy of producers of services – the CSSS, health clinics and other institutions – while making them more responsible for their management.
The members of the Task Force advocate a health system based on the recognition of the rights and obligations of everyone. Thus, while acknowledging their professional freedom, they recommend that physicians, institutions and clinics enter into contractual agreements.
Lastly, the Task Force believes that a program should be implemented to evaluate the performance of hospitals and that the results of the evaluations be released periodically. It recommends that each regional agency and each hospital should be headed by a board of directors consisting of a limited number of independent members, selected for their skills, and that they be remunerated.
Allocation of resources
The report notes that almost all industrialized countries have more or less thoroughly changed how hospital budgets are set, with the objective of better controlling rising health costs. These changes stem from a common observation: the old budgeting methods do not encourage efficiency.
Accordingly, the Task Force recommends that for the financing of hospitals, the historical budget method be gradually replaced by the service provider method. In that context, hospitals would have a financial incentive to serve their patients well since the money would follow patients rather than preceding them.
The report proposes a set of initiatives to put new information technologies at the service of patients and managers. For the members of the Task Force, new information technologies are an essential tool to make our health system more productive and efficient.
Given the risks involved, the Task Force recommends that the Dossier de santé du Québec not be deployed until a pilot project has been carried out in a region and the results analyzed. It also recommends that priority be given to the deployment of the electronic patient record in every hospital and clinic.
The health account
Responding to a specific point mentioned in their mandate, the members of the Task Force propose that the ministère de la Santé et des Services sociaux produce a health account each year that the Minister would table in the National Assembly and that would be studied by a parliamentary committee.
In its report, the Task Force presents an example of what the health account might be. The purpose of such a publication is to provide a good picture of health financing as well as a rigorous and operational analytical tool.
Innovations and the role of the private sector
The Task Force proposes a number of initiatives to improve access to care including a greater role for the private sector so that it becomes an ally of the public sector. Accordingly, the Task Force recommends that a physician be authorized to have a mixed medical practice, within prescribed limits and provided there is an agreement with his institution.
The Task Force also proposes that the legislation authorizes private insurance for services already covered by the public system. In addition, it suggests carrying out demonstration projects to test other methods of non-profit hospital management to identify productive new options.
However, a dissenting view on these three recommendations is presented by a Task Force member, Michel Venne. This view is set out in detail in an appendix to the report. Moreover, the Task Force proposes that the initiatives relating to the role of the private sector and those stemming from steps already taken by the government be assessed within five years.
Better use of drugs
The Task Force proposes that the government tighten the rules on the application of exceptional measures stipulated in the Régime général d’assurance médicaments by urgently taking into account the views of the Conseil du médicament.
It also proposes that a single organization have authority over the advices issued within the health system on the therapeutic value and cost-effectiveness of drugs. Lastly, it recommends changing the parameters of the public drug insurance plan so that participants cover the entire cost of the plan for their insured group.
The Canada Health Act
In keeping with its mandate, the Task Force analyzed the Canada Health Act. The Task Force is of the view that the Act hampers the evolution of the provincial public health systems and that sooner or later it will have to be adapted to current realities.
The members of the Task Force believe that the unadapted and unduly restrictive provisions of the Canada Health Act should give way to a flexible framework favouring the adaptation of the provinces’ health systems, based on respect of their jurisdiction in this field.
The report contains a number of other recommendations, in particularly concerning prevention of sickness, health promotion, work organization, labor relations and incidental fees for health clinics. In each case, the concrete solutions comply with the principles set by the government and with which the members fully agree. Lastly, it recommends implementing a permanent program to reassess administrative expenses and fees charged for services.
The Task Force does not call into question any of the basic principles of the existing system. It acknowledges that it is proposing major changes. The main challenge facing us collectively is to adapt our health system to the realities and context of the 21st century.
The Task Force is convinced that in the health sector as in many other fields, we have both rights and obligations. A balance must be struck between what we ask of society and what we hope to receive from it. The Task Force is convinced that there is a pressing need to act. We can maintain a health system that reflects our view of living as a society and the principles we value, provided we act quickly and with resolve.
However, this effort can be undertaken only if Quebecers support it and share the same vision. The Task Force hopes that this report and the thought and study of which it is the culmination will contribute directly to this effort.
All the documents relating to the Task Force’s work are available on its website: www.financementsante.gouv.qc.ca