Money alone won’t fix Quebec’s health-care crisis
Access to care is not just a matter of cost; it’s also a matter of time.
If you really don’t feel well and you have to wait five, eight or 12 hours before seeing a doctor, can we truly say that you have access to health care?
It’s understandable that faced with such a long wait, some patients get discouraged and leave emergency rooms untreated.
These discouraged patients are more numerous than ever in Quebec. Over the first 11 months of last year, more than 376,000 of them left an ER without being treated. That’s over one in 10 of the 3,265,349 Quebec patients who visited the province’s emergency rooms over the same period.
This is a huge number, but what’s more worrisome still is the fact that it’s growing.
The last time we crunched the numbers, back in 2018-’19, we found a similar number of discouraged patients — some 378,000 — but that was for a full year, with almost 15 per cent more total ER visits.
More alarming still is the categories of cases of those leaving our emergency rooms before being treated.
The Quebec health-care system sorts cases on a scale of decreasing priority from one to five. A priority five case (or P5) is considered non-urgent. This doesn’t mean there’s no health problem, but rather that the case can wait a certain amount of time with no major risk. In the middle of the scale, a priority three case (P3) is considered urgent, while a priority one case (P1) is a case that requires resuscitation and must be treated as soon as possible.
Among the over 376,000 Quebecers who left an ER without being treated last year, there were 103,715 whose cases were considered urgent or worse. That’s 25 per cent more of these urgent cases leaving untreated than did five years ago.
In terms of access to care, the diagnosis couldn’t be clearer: The patient is ailing with a deteriorating condition and left emergency.
Some will say it’s just a matter of funding, that our government-run health-care system would be a well-oiled machine if we would just inject a few billion dollars more.
But we’ve been giving the health-care system more and more resources for years without seeing any notable improvement in the timeliness of our access to care.
Between 2018-’19 and last year, spending for the Ministry of Health and Social Services grew by 37.8 per cent, reaching a little over $59.4 billion.
To get a sense of what this represents, if we took all the personal provincial income taxes paid last year by Quebecers and added to this all the provincial income taxes paid by Quebec companies, we would still be short $5.6 billion to cover the health-care system’s funding.
And despite the additional $2.5 billion the government plans to dump into it this year, it’s a safe bet the situation will not improve substantially. The reason, we argue, is that it’s not so much a resource problem as it is an organizational problem.
Quebec, and the rest of Canada’s provinces, are not the only jurisdictions with universal health care, accessible to one and all. We are, however, among the only ones to insist on having the facilities that deliver this care be administered by government employees.
In France, for example, nearly one in three hospitals is run by independent entrepreneurs. In the United Kingdom, which served as the inspiration for our health system, it’s nearly 40 per cent of hospitals. In the Netherlands, all hospitals are independent. All of these countries have universal health-care systems, where access is guaranteed to everyone. The difference is in the organization of care, with the government allowing hospitals to compete with one another to attract patients, leading to reduced wait times and, ultimately, timely access to the care patients so desperately need.
For too long, we’ve tried to fix an organizational problem by throwing more and more money at it. It’s time for Quebec to change tack, and let independent clinics and hospitals improve Quebecers’ access to care.
Emmanuelle B. Faubert is an Economist with the MEI and the author of “Quebecers Should Not Have to Leave Emergency Rooms Untreated.” The views reflected in this opinion piece are her own.