It’s not about regionalization, it’s about desperation
By Beryl Wajsman
Memo to Quebec Health Minister Hébert: nobody believes anything anymore. And with reason.
The recent back and forth on hospital “regionalization” and where patients could get care, can rightly leave reasonable people thinking that this wasn’t so much a misunderstanding as a trial balloon gone bad. The reality is there is no way to fix it.
As readers may recall, the Health Ministry issued directives several weeks ago to the Jewish General Hospital—world renowned in cancer treatment, among other areas—not to admit as patients, nor administer care to, anyone outside of a specific geographically defined area. The government’s reasoning behind this was that a “strain” should not be put on inner-city hospitals and that people would do “better” in a regional health facility closer to their homes. (To its credit, the JGH is one hospital that turns no one away. Ever.)
This attempted justification was proved specious within hours. It was due to the policies of successive Quebec governments that health care came to be so centralized to begin with. Some 80 per cent of the effective and efficient functioning medical infrastructure in the greater Montreal area is now located in a 30-block area. Who can forget the closures of the Queen Elizabeth, the Reddy Memorial and other centres of health care excellence that were forcibly “integrated” into larger institutions, ostensibly to have economies of scale.
What ended up happening instead was overcrowding and bureaucratic neglect. Quebec has constantly had to cut budgets on a year-over-year basis; cannot keep its medical school graduates here and hospitals like LaSalle General, St. Joseph’s in Lachine and Lakeshore General—all with excellent physical facilities—do not have sufficient staff.
Research dollars and the med school graduates who stay, gravitate to the large institutions like JGH, MUHC and CHUM. The only personnel component of Quebec’s health care system that has grown has been the bureaucracy, something no government has touched because all parties are afraid to butt heads with the unions. Quebec has the highest percentage of bureaucrats as a percentage of healthcare employees in the western industrialized world. At 52 percent, it beats even France by a country mile.
So when Quebec’s health ministry tried to put the issue in terms of “regionalization,” you should think “centralization” and worse still “desperation.” The government is desperately trying to keep the health facilities we have functioning. A government that lost $2 billion and is in severe deficit needs to cut. And it will continue to cut the biggest part of the budget—health care—instead of its cherished social engineering programs which it brandishes like cattle prods in its endless search for the “winning conditions” for a new sovereignty referendum.
Obviously what it should be doing is reducing the bureaucracy. Giving more money to keeping doctors here so that regional institutions can work. Instead, it is trying to pull patients who are already receiving medical care at on-island institutions, off the island to go elsewhere. But there is nowhere else to go. Not only qualitatively—the smaller hospitals can’t offer the treatments the larger ones do—but also quantitatively, since there are not enough doctors. People are going to die.
After days of headlines, this reality seemed to have finally sunk in, and Minister Hébert announced that “funding will follow the patient, not the institution.” Well, that is the way it has always supposed to have been. But nobody believes it anymore.
Particularly not with the almost weekly revelations of corruption and waste in the construction of the two new super hospitals. The rationale for this turbo-charged centralization was that people do better at home. And that with state-of-the-art equipment, some one-third of patients could be seen on an outpatient basis as long as the equipment was bought. So the hospitals were planned with this in mind, and the island’s available beds will be cut by one-third when the superhospitals are up and running.
The only problem is, with so much money poured down the drain, there remains little if any for the amount of state-of-the-art equipment necessary to treat patients out of hospital instead of having them spend days in emergency because of a lack of doctors. Now we will have not only a lack of doctors, but beds and equipment as well.
During the last election, Premier Marois made an issue of the some one-third of McGill medical school grads that leave Quebec. What she failed to explain, in her usually disingenuous fashion, was that most of those who left were foreign students paying up to $50,000 a year for their education. They were not being subsidized by Quebec as she was implying. But what she was totally silent on was the high number of Université de Montréal medical school grads who were leaving. These are mostly Quebecers, subsidized by the system, most of them Francophone, who are voting with their feet and leaving.
The current debate isn’t about regionalization. It’s about desperation. And nobody believes anything anymore.
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