Healthcare funding in Quebec spikes but fails to reduce wait times
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 have to wait five, eight, or 12 hours before seeing a doctor, can we honestly say that you have access to healthcare?
It’s also understandable that, when 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 more than one in 10 of the 3,265,349 Quebec patients who visited the province’s emergency rooms during the same period.
While this is a huge number, more worrisome still is the fact that it’s growing.
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The last time we crunched the numbers, back in 2018-2019, we found a similar number of discouraged patients – some 378,000 – but that was for an entire year, with almost 15 percent more total ER visits.
More alarming still is the categories of cases of those leaving our emergency rooms before being treated.
The Quebec healthcare system sorts cases on a scale of decreasing priority from one to five.
A priority five case (or P5) is considered non-urgent, which doesn’t mean there’s no health problem. Rather, 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) 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, 103,715 were cases considered urgent or worse. That’s a 25 percent increase in the number of urgent cases left untreated compared to five years ago.
In terms of access to care, the diagnosis couldn’t be clearer: the patient is ailing, and his condition is deteriorating.
Some will say that it’s just a matter of funding, that our government-run healthcare system would be a well-oiled machine if we just inject a few billion dollars more.
Well, we’ve been giving the healthcare system more and more resources for years without seeing any notable improvement in the timeliness of our access to care.
Between 2018 and 2019 and last year, Department of Health and Social Services spending grew by 37.8 percent, reaching a little over $59.4 billion.
To get a sense of what this represents, if we took all the personal provincial income taxes Quebecers paid last year and added all the provincial income taxes paid by Quebec companies, we would still be short $5.6 billion to cover the healthcare system’s funding.
And despite the additional $2.5 billion the government plans to dump into it this year, it’s a safe bet that the situation will not improve substantially.
Why?
Because it’s not so much a resource problem as an organizational problem.
Quebec, and the rest of Canada’s provinces, are not the only jurisdictions with universal healthcare 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 healthcare system, it’s nearly 40 percent of hospitals. In the Netherlands, all hospitals are independent.
These countries have universal healthcare systems like ours, 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, which leads 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 at the Montreal Economic Institute.
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