The much-needed transformation of Quebec’s healthcare system – Conference with Joanne Castonguay

On May 25, the CCMM played host to Joanne Castonguay, Quebec’s Health and Welfare Commissioner. She took the opportunity to comment on her report on the management of the pandemic and to offer her vision of the much-needed transformation of Quebec’s healthcare and social services system.

A significant increase in the proportion of public spending in health

In opening her speech, Commissioner Castonguay pointed to the major increase in the proportion of public spending on healthcare over the past 30 years.

“At the beginning of the 1990s, public spending on healthcare and social services represented 35% of spending of the Government of Québec. We are now at over 50%.” – Joanne Castonguay, Quebec’s Health and Welfare Commissioner

She indicated that this increase in healthcare spending is substantially higher than the increase in the wealth of Quebec.

“In the past 20 years, the increase in healthcare spending was greater than the growth in wealth of the Quebec economy. This is hampering our ability to invest in other sectors.”

Report by the Commissioner of Health and Welfare about the government’s management of the pandemic: a collective failure in preparation and governance

After the H1N1 flu, experts made recommendations to better manage health crises. None of them were implemented.

“There were pandemic plans to manage the public health system, but they were never implemented; they were not adapted to the situation. After the H1N1 crisis, a report was issued on the management of the crisis. Despite the findings, none of the recommendations were followed.”

Commissioner Castonguay also pointed to the major factors that contributed to the disastrous situation in the initial months of the pandemic.

“We went into the pandemic with a very weak healthcare system. There was a palpable shortage of nurses as well as managers – something that is never considered in healthcare analyses. When we looked at the results, it was dramatic, particularly for seniors’ homes.”

Public-private partnerships to solve problems of access, personnel, and waiting times in healthcare

In Quebec, the private sector is not used to manage the public healthcare system.

“There is not much consultation of the private sector. This is because of how contracts are awarded and the benchmarks the government sets to ensure public funds are properly managed.”

The Commissioner then discussed the publics mistrust of the private sector and indicated that education was required on that front.

“We have to show that we can contribute to the sustainability of the healthcare system. If we want to protect it, we need to inform the public about how to improve it and create ties with the private sector.”

Little data available to support government decisions

Commissioner Castonguay also pointed to the lack of available data, which prevents the government from justifying measures introduced in the event of a health crisis.

“The fact that our data system is not very accessible is a political challenge. We do not have the data to support the measures put in place. This is the first thing to do to solve this problem.”

While she called for greater access to data, the Commissioner would like a system to be implemented without compromising privacy.

“We need to move from an opaque system based on the protection of personal information to an integrated, transparent system that exploits the potential of data to inform decisions, without compromising privacy.”

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