Editorial: Patient care, not hospital budgets, must come first

View of the Glen site in Montreal. (Photo courtesy of the MUHC)

Projected spending on health care in 2016-17 in Quebec will increase to $33.7 billion, and critics say it’s not enough. It amounts to about one-third of the provincial budget and remains the lowest proportion of total spending of all the provinces.

Given Quebec’s relatively weak economy and high debt, we cannot expect a dramatic shift, yet all Montrealers are concerned about the financial squeeze being put on two of our most important healthcare facilities – the MUHC super hospital – McGill University Health Centre – and the Jewish General.

For those of us who use the English language, these are the go-to institutions that offer quality care, highly trained specialists, and up-to-date equipment.

It is for these reasons that the hospitals will attract patients beyond their expected quota and regional delimitation. As a result they go over budget.

We strenuously object to the way Health Minister Gaétan Barrette is penalizing these hospitals. While we understand that basic healthcare services must be offered throughout Quebec, it is time for Dr. Barrette and the Liberals to show more flexibility by providing these institutions with additional funds so they can provide the care Quebecers need and not be docked for going over budget.

It is frankly insulting to read that Barrette accuses some doctors attached to the MUHC of possibly “putting pressure on patients” to continue their care there rather than avail themselves of equivalent care close to where they live.

Barrette was responding to an article in the Montreal Gazette, by enterprising journalist Aaron Derfel, reporting that Quebec was blaming the MUHC for accepting too many cancer and emergency room patients, and that is why it refused to finance what it called “volume overruns.” That leaves the MUHC $10 million in the hole in addition to a planned budget cut of $28.1 million.

Barrette faults the MUHC for failing to stick to a 2007 clinical plan that established the volume of patients it can accept. Unless more funds can be found, the MUHC is said to be considering such options as not using some new and costly equipment, closing operating rooms, further postponing elective surgeries, and, according to an unconfirmed report in The Gazette plans, to cut 750 full-time and part-time staff. This would lead to a further deterioration in already stressed healthcare services.

As Jasmine Guénette of the Montreal Economic Institute has pointed out, the current system of lump-sum funding based on past spending offers no incentive for efficiencies since any move that reduces expenditures would lead to lower lump-sum payments in the future. A switch to activity-based funding would accommodate increased volume of patient care. Such a funding system would be much more sensible, and humane, than shifting oncology and emergency patients to other hospitals, as is now the case at the MUHC and Jewish General, with its renowned Segal Cancer Centre. 

As patient rights advocate Paul Brunet has said, the MUHC is supposed to offer “world-renowned tertiary and quaternary-care … Why can’t all Quebecers who paid for that very costly hospital go there from wherever they come?”

Brunet contends that the MUHC, under government pressure, is advising patients to seek care closer to where they live – a violation of the Canada Health Act and Quebec’s Public Health Act, which provide for freedom of choice. We share his outrage. We paid dearly for the $1.3 billion MUHC – let us use it!

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