And if the minister of Health was kind?

News 14 December, 2017
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    Patrick Déry

    Thursday, 14 December, 2017 16:34

    Thursday, 14 December, 2017 16:59

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    We made much of the personality of the minister of Health, Gaétan Barrette, in the last few days. The Press published articles in which it details a number of encounters with former colleagues and an atmosphere of work hard and demotivating for those who treat us.

    To put it politely, the current minister of Health seems not to be the boss may be the most convenient. However, there is a problem that is much more important for quebecers that the personality abrasive to the minister, and that has less attention.

    Columnist Patrick Lagacé has mentioned one of the symptoms of this problem more severe in telling me how the minister is “party with the timbreuse,” forcing a hospital in the Outaouais region to send his mail to Gatineau, an hour’s drive, in order to be able to post it. First of all, the story is wacky, but it is a consequence of the rules nit-picky, which lead to the patients real consequences and drama. Among other things, services that were once available at the hospital, Pontiac is now given as Gatineau.

    This nonsense bureaucratic may be repeated so that our health care system is the subject of an umpteenth attempt at recovery. As usual, the “reforms” start from the center and the ends shall comply with it without complaining. The minister Barrette was undertaken to centralize even more of our health-care system, increasing its decision-making authority to the regional bodies, and hospitals, and providing the means to punish the doctors or the managers recalcitrant.

    I’ll tell you a secret : it won’t work.

    Just think for a moment : the health system in Quebec, it is between the other 119 hospitals, 292 CLSC, 113 000 nurses and attendants, approximately 58 000 technicians and professionals, 77 000 people the support and guidance, more than 20,000 physicians, 975 employees at the department, 1700 other to the RAMQ, not to mention the patients. Only in emergencies, there have been more than 3.7 million visits last year!

    The minister may well claim some short-term success achieved with the threat of the stick, including the reduction stays for a very long time, but it will not be possible to resolve all the problems of his office : our health care system is simply much too big and complex to be effectively managed by a single person, as talented and determined she is.

    The amount of information needed to make good decisions through a centralized planning is immense. In addition, a large part of this information is not accessible to decision makers, because it is known that by the millions of individual actors in our health care system : the managers, the clerks, the nurses, the doctors, etc, and of course the patients. Since it is not yet possible to extract the head of all these people everything they know, it is no more possible for a minister or a handful of bureaucrats deciding everything in an efficient manner, as we are taught by the economic theory.

    The failure of this centrally planned, rigid, and disconnected we all jump to the eye on a frequent basis. The management of summer vacation and the holidays, events that are fairly predictable, but it brings its share of closures and shortages. And if the flu arrives in advance, without telling the officials, everything’s falling apart!

    Fortunately, other models exist. The opposite of Quebec, Sweden, a country that looks like us, offers a management model that is highly decentralized. Health is the responsibility of the regional authorities and the hospitals are managed independently. The ministry determines the broad guidelines and leaves it to other tasting potato powder. In addition, the competitive sector occupies an important place, and this presence of the private in the provision of care does not compromise access to health care, which remains universal. Finally, guess what, not only the patients do not die, but they are well cared for, and more quickly than here!

    In sum, if the emergency overflow for the last forty years, this is certainly not due to the mood swings of the minister.

    A minister nice does not make the employees more happy and patients are better cared for in a system ultracentralisé (it would have happened a long time ago if it was enough). Conversely, a minister rude or controlling in excess will have more influence in a decentralized system, in which decisions will be taken at the level of the employees and patients.

    I leave to others the task of discussing the personality of the minister. What our health system needs an urgent manner, it is a good dose of decentralization, innovation, competition, and transparency.

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