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June, 2007

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Editorial
Castonguay on healthcare
It failed to get much attention, but one of the most important aspects of the much-contested Liberal budget was the creation of a commission under Claude Castonguay to examine our healthcare system. All who have used the system recently, or know someone who has, understand that reforms are necessary and overdue. And with our aging demographics, which mean fewer people working and more people sick, the pressure on it can only increase.
The budget projected spending $23.5 billion for healthcare, a whopping 44.2% of the Quebec government ’s expenditures of $53.8 billion. The government’s tax base is over-saturated. The controversial $950 million in tax cuts they promised, thanks to increased equalization payments, can only come as a welcome relief. But, with Quebec ’s long-term debt at an alarming $122 billion and climbing, there is no way the current system, wonderful as it once was, can be sustained without additional revenues.
Claude Castonguay, a 78 year-old actuary, was health minister under Robert Bourassa in the early 1970s and is largely responsible for creating our version of the Canada Health Act – free medical care for all – augmented by the universal prescription drug insurance. However, as Castonguay has warned, “If the necessary changes are not made, our system cannot survive. That is a certainty from which we cannot escape.”
What Castonguay has proposed, in a speech to the conservative Montreal Economic Institute last month, is worthy of our attention.
His essential argument is to reverse the over centralization of our current system by separating the role of purchaser and provider of healthcare services. The Régie de l’Assurance Maladie would become the purchaser of hospital and ambulatory services and act as the body that evaluates the performance of service providers. This means the agency that administers the system, not the government that sets it up, will evaluate how hospitals and clinics perform, free of political pressure. Presumably, efficiency will be rewarded and waste penalized.
Castonguay would also take these revolutionary steps:
• Permit private health insurance;
• Eliminate the absolute separation between public and private health care, now in effect, by seeking amendments to the Canada Health Act;
• Enable the use of hospital operating theatres and other equipment for private practice weekends and evenings, when they are not in use, to generate revenue and reduce wait times in the public system;
• Upgrade medical clinics where the needs are greatest, according to a formula best suited for the clientele to be served, with the optimum cost/quality ratio;
• Introduce a coverage plan for long-term care for the elderly that focuses resources on priority service and greatest needs. For the most vulnerable, this would include a caregiver assistance program.
All this is from a speech, and these proposals will generate debate. But Castonguay was never a politician like the others, and his ideas were always clearly articulated and based solidly on the best possible use of limited resources.
There will be tremendous opposition from those with vested interests — in particular the powerful public service unions and those who put dogma ahead of pragmatic considerations — but there has to be a way out of the current impasse so we can provide efficient healthcare to our rapidly aging population.
If our trained medical professionals are restricted for budgetary reasons, and these professionals are eager to work, why not let them?
If we have costly equipment and operating theatres that sit idle because our system puts a cap on their use, why not use this capacity? If private insurance gives Quebecers access to unused capacity, why not allow it? And if this will generate more revenue for the overall system and ease the pressure on it, why not give it a try?
We are looking forward to Claude Castonguay’s return to the public arena and we are tracking these issues so that our health care system will meet new realities.

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