The doctor prepares to check the patient's blood pressure.
On October 22, 2018, a team of experts convened at the Department of Family Medicine at McGill University to discuss the state of primary health care in Quebec. The three former ministers of the Quebec government – Claude Castonguay, Jean Rochon and Michel Clair – and the professor of political science and health policy Antonia Maioni presented their views on the actions required to improve the health care system in Quebec. Despite significant differences in professional background and political affiliation, the panelists agreed on the current needs of our primary care system: decentralization of decision making, increased transparency in the costs and outcomes of health care, broadening the role of multidisciplinary primary care and tone (increased cooperation) among stakeholders.
The "one size fits all" model is no longer appropriate. Decision-making power should be gradually decentralized for local health authorities. Local authorities – Centers Intégrés (Universitaires) de santé et de services sociaux (CISSSS and CIUSSS) and départements régionaux de médecine générale (DRMG) – should acquire autonomy in the design, simplification and provision of healthcare in a manner appropriate to the populations they serve. Montreal's needs are different than in Îles de la Madeleine. Organizing health care services in geographical areas and tailoring healthcare services to the specific needs of the population will ensure that relevant services reach the right patients.
The costs of basic health care should be clarified and made transparent. Financing should reflect the real costs of services. In basic health care, dollars for administration and infrastructure should be different from those that are intended for paying doctors. Alternative physician payment systems should be introduced (eg Mixed wage). This new cost transparency must be supported by transparency of results. Performance indicators, developed and monitored by an independent Health Commissioner, are needed to keep the system responsible for achieving goals that have long been ignored.
The healthcare system should focus on strong primary care services, such as family medicine groups and communautaires (CLSC) service centers. This is especially important in the era of aging and chronic diseases, because these patients require a more continuous and comprehensive support network. A multidisciplinary approach to primary care is required. Healthcare is a team sport. In a world of sophisticated technology and complex knowledge, blade practices must develop, mix and collaborate. We need to reconfigure the range of practices for different health professionals. For example, practicing nurses should be able to take more responsibility in caring for the patient.
These changes must be accompanied by a change in tone. Instead of settling in divided camps, policy makers, practitioners and society should strive for a common goal, which is to improve the system for all. This can be achieved through a conference involving health authorities and stakeholders from all relevant groups – not only federations of doctors, but also groups of clinicians and the public.
The conference panel united in the belief that the Quebec health system can and must be repaired. Together, we imagine a healthcare system that is accessible, efficient and meets the standards of citizens and professionals.
We hope that by sharing these reflections, we can stimulate prudent action in the further pursuit of a better health care system for Quebec.
Matthew Hacker Teper is a graduate candidate, and Claire Godard-Sebillotte MD, a PhD student, at the Family Medicine Department of the McGill University. The signing of this article is also: Claude Castonguay, former Minister of Health of Quebec; Jean Rochon, MD, former Minister of Health of Quebec; Michel Clair, former minister of the Quebec government; Antonia Maioni, professor, McGill Department of Political Science; Isabelle Vedel, MD, assistant professor, Family Medicine Department McGill, co-managing McGill Observatory for Health and Social Services Reforms (MOHSSR); Howard Bergman, MD, chairman, McGill Department of Family Medicine; Amélie Quesnel-Vallée, director of MOHSSR.