Health reform: money is not the panacea, says Michel Clair

More than 20 years after the commission’s work, its former chairman is skeptical about the sudden interest in his report.

ans avant qu’on semble vouloir se réapproprier des orientations qui, dans le fond, tombaient sous le sens”,”text”:”On sent avoir fait un travail utile pour inspirer encore aujourd’hui les décideurs politiques […] mais en même temps on se sent frustré – c’est le mot – de dire que ça a pris 21ans avant qu’on semble vouloir se réapproprier des orientations qui, dans le fond, tombaient sous le sens”}}”>We feel we have done useful work to inspire political decision makers even today. […] but at the same time we feel frustrated – that’s the word – to say that it took 21 years before we seemed to want to undo the orientations that, basically, are self -evident.said Michel Clair, in an interview with Radio-Canada.

Even as time has passed, many of the observations made in the early 2000s are still valid, starting with the need to examine the way hospitals are funded. Currently, the allocation of budgets to health institutions is largely based on their funding history. It’s time, says Michel Clair, to opt for a real one activity -based funding.

: tout protocole chirurgical ou autre, on lui détermine une valeur unitaire. Si vous achetez une paire de lunettes, vous savez exactement quel prix vous allez payer pour la paire de lunettes. Les services à rendre pour une chirurgie de la cataracte [ça devrait être le même principe]”,”text”:”Un financement à l’activité c’est de dire: tout protocole chirurgical ou autre, on lui détermine une valeur unitaire. Si vous achetez une paire de lunettes, vous savez exactement quel prix vous allez payer pour la paire de lunettes. Les services à rendre pour une chirurgie de la cataracte [ça devrait être le même principe]”}}”>Activity -based funding means: any surgical or other protocol, we determine a unit value for it. If you buy a pair of glasses, you know what price you will pay for the pair of glasses. Services to be provided for cataract surgery [ça devrait être le même principe]explanation of the former deputy and minister.

Michel Clair headed a commission on the health system more than 20 years ago and his report will be used for the adjustments that Minister Dubé wants to make.

Photo: Radio-Canada

If this procedure were to be performed, hospitals would be funded based on the specific number of procedures they perform, in the same way that each physician is paid based on the specific number of procedures they charge.

Currently, Michel Clair laments, money is usually transferred to large blocks in establishments and they are told: Do as much as you canwithout it it is really possible to know how it is used.

It is very difficult to know what the full cost of the same knee surgery is, at Drummondville hospital or at Granby hospital. […] This is not an incentive for productivity or clinical or financial performance. »

A quote from Michael Clair
A clinic parking lot.

A private clinic in Jonquière

Photo: Radio-Canada / Steven Tremblay

The role of the private sector

As he recommends in his report, Michel Clair has always pleaded for the creation of specialized medical centers where surgeries and other diagnostic and therapeutic procedures can be performed. Funding of care will remain public, but the organization of care will be entrusted to private managers.

The recommendation to have clinics serves several purposes. It aims to remove the obstruction in the hospital environment due to putting all types of surgery in one place, it is sure to be an opportunity for overcrowding. We make operating rooms that are extremely versatile, expensive, but where there is always a conflict for access to the rooms. Second, the goal is to make medical specialists more accountable and to encourage them. If they are investors in a specialized medical clinic, having a dual interest in clinical success and what people don’t expect is a great motivation to improve the overall performance of the system.said the man who also led Sedna Health Group for 14 years.

According to him, the coexistence of hospitals and private clinics can improve the way things are and contribute to the recruitment of staff.

If we want to bring back nurses, attendants, doctors who have left, I think the diversity of employers, of organizational cultures will provide more opportunities to mobilize people. »

A quote from Michael Clair
Four medical workers were walking with their backs to the hospital corridor.

Nurse staff

Photo: iStock

The lack of staff

Michel Clair is particularly concerned about the network’s ability to recruit staff. The current large structures, created in the wake of Barrette’s reform, act, according to him, as real foils for health workers.

If we want to restore pride, satisfaction and power in their workplace to the thousands of people who work at CLSCs, CHSLDs […]I think we need to examine governance at this level and restore power at the local levelhe argued.

The proliferation of bonuses offered to nurses and beneficiary attendants to attract them to the network, or encourage them to work more, is almost unconvincing to him.

We have taken the wrong path, with doctors like everyone else, thinking that we can solve money problems, only in compensation. Ultimately, it can even be counterproductive, because money has a relative value. […] What really matters, what will motivate people and then keep them in the health network, is the whole culture of the organization, the set of conditions that make you feel valued; part of it is good governance and transparencyMr. explained. Clair.

Some success

Kahit lang small percentage with the recommendations in his report that have so far been implemented, Michel Clair is pleased to see the place taken by family medicine groups (GMFs). At the time of writing his report, he recalls, most general practitioners are not trained to work in groups.

We must now, he says, push the model further: % des médecins de première ligne qui travaillent en GMF. On devrait viser 100%.”,”text”:”Il n’y a toujours que 70, 75% des médecins de première ligne qui travaillent en GMF. On devrait viser 100%.”}}”>There are still 70, 75% of first-line doctors working with FMGs. We should aim for 100%.

Integrating other health professionals within these groups, such as psychologists, should also be a priority.

After meeting with the Minister and members of his team to discuss his report, Michel Clair is now waiting to see what to do with the health system overhaul plan that Christian Dubé will present soon. In any case, he hopes we don’t have to wait another 20 years before acting on his recommendations.

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