And the award for the best hospital goes to…

File Photo, Simon Clark

Patrick Déry

Friday, January 26, 2018 17:08

UPDATE
Friday, January 26, 2018 17:16

Look at this article

Would you like to know what in what hospital you have the least chance of dying during a stay in the emergency? Which is the better cancers of the breast? Which treats you the more quickly after a heart attack?

In Sweden, it is possible, because these data are public and easily accessible. A Swedish magazine took the opportunity to publish a list of the hospitals.

They are classified according to their size, which gives the winners in three categories. The winner in one of the best “small” hospitals is a hospital in Stockholm, St. Göran. The term “small” here is relative. We are not talking about a bush hospital. The emergency department of St Göran saw 86 000 patients pass through its doors in 2016, as well as the largest hospitals in Quebec. Saint Göran, however, unusual in that it is operated by a private company, the multinational Capio, a publicly-traded company present also in Norway, France and Germany.

Note to the reader distrustful of the “wicked private” : that the hospital should be managed by the private or by the State makes no difference to the patient on the plan of access. I repeat : no difference. The Swedish system is funded by the State. But within this system, unlike here, the competition is possible, as nearly everywhere in the world. Some hospitals are managed by the State, others by private companies.

How, then, St. Göran is it distinguished? By the costs, you might say, since it is private? Absolutely. It boasts the lowest costs per medical procedure among 59 hospitals listed in its category. This is not a surprise, mind you, since the last time that Capio bid to keep the operation of the hospital, it was done at a rate of 10 % lower than the level of funding normally allocated to the State.

However, the economic criterion is only one of the factors, among the least important. The quality of care is the primary criterion, and it is worth more than all the other sets. The second criterion is the most important, accessibility. Saint Göran has made a mark for these two criteria.

For example, for intensive care, St Göran has ranked 1st on unplanned readmission and 2nd on mortality within 30 days. He has also obtained very good performance for treatments related to cancer.

Saint Göran is also distinguished in terms of accessibility, especially for the time required to see a specialist or to undertake a treatment. With regard to the emergency department, his performance is a dream : time to see a doctor was 27 minutes last year. Twenty-seven minutes!

Three-quarters of the patients in the emergency to see a doctor in less than an hour – the best performance of all the hospitals in sweden – and the same proportion leaves the emergency in less than four hours. Tell that to the 61 000 Quebecers who have spent more than 48 hours in emergency last year!

A two-tier system, kind

We remind you : the fact that St. Göran is a private hospital does not change anything for access to care, since the Swedish health-care system is financed by the State, as here. The only thing that’s changing for patients, it is the speed. One could therefore say that St Göran has a second speed : fast, while other hospitals are slower. But as patients to choose where they are cared for, there is no problem. Saint Göran pulls the other up.

It would be beneficial to apply these lessons in Quebec. First, the transparency, where we are twenty years late. The ministry of Health receives all kinds of data in health facilities, but they are not easily accessible. This greatly complicates the work of those who want to measure the performance of the health system, which is necessary for that it improves.

The Commissioner of the health and well-being (a body that comes, unfortunately, to be abolished) reported earlier this year that the data medical administrative are much easier to obtain in the other provinces. However, access to these data is a “necessary condition” for the performance improvement of our health system in terms of accessibility, which are in some respects quite pitiful when compared to other developed countries, or even just the rest of Canada.

Transparency is in itself a strong incentive to change, as it requires organizations to be accountable, on the one hand, and its leaders to ask why and how it’s done better elsewhere with similar resources. He is not here to overwhelm institutions that have more difficulties, to encourage the dissemination of best practices to help everyone to do better.

If one combines this transparency with the activity-based funding, the government seems to want to put in place, and let the patient choose where he wants to be cared for, the good hospitals will have incentive to take more patients!

Spread the word : apply market solutions to a public health system, it has nothing to do with out the credit card for medical care, but everything to do to create the right incentives.

Link to learn more about the hospital of St Göran and the emergency of Quebec

To reach me : patrick.dery@iedm.org

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