Changing our health-care system: begin by changing our philosophyViewpoint by Isabelle Hudon

Text signed by Isabelle Hudon, president and CEO of the Board of Trade of Metropolitan Montreal,
published in Voir on March 13, 2008.

Changing our health-care system: begin by changing our philosophy

Unless you've been living under a rock for the past few weeks, you've probably heard about the strong reaction triggered by the Castonguay report.  The debate has centred primarily on the two most controversial aspects of the report: the role played by the private sector and the financing of health care, particularly through the implementation of a deductible and a tax hike.  But other equally fundamental aspects of the report seem to have been overlooked, including the proposal to manage the system by targeting outcomes (the care provided),  rather than outputs (the resources placed at the disposal of institutions).

Overall, the health-care system as we know it has been good to Quebecers.  What the task force headed by Claude Castonguay has recommended is to review the way it functions to give it more flexibility and improve its performance. As president and CEO of a chamber of commerce, I can assure you that such “challenges” are carried out every day by our companies and organizations.  This gives them an opportunity to study what is being done elsewhere, adopt innovative practices to improve productivity, and become more competitive.

An excellent example of this was provided by the Centre hospitalier de l'Université de Montréal (CHUM), which recently made a productivity-based shift in its management practices.  To accomplish this goal, it developed performance indicators.  You might think that this is a normal and logical thing to do.  But it seems to me that it signals an important change: an openness to new ways of doing things to manage our health-care system even more efficiently.

The goal of this undertaking, moreover, was simply to provide high-quality care, accessible to all, in accordance with our means.  Given that our health-care system is central to our quality of life – an asset, moreover, that is the envy of many countries around the world – it must be protected.

I believe that the most important and most irrefutable conclusion drawn by the Working group on health-care financing is that there is an urgent need to act quickly to protect the quality of care to which we have become accustomed in recent decades.  And this is particularly important on the eve of the creation of the new university hospital centres – a bold, world-class initiative.

This report offers solutions inspired by best practices that have been adopted around the world.  We would do well to investigate them further.  Not to do so would be to shirk our obligation to all those who, in the very near future, will require health care.  It is our duty to ensure they have access to the high level of care that has been enjoyed by earlier generations.

One thing is certain: the issue of health care is complex and technical, yet deeply human.  That is why it is of such deep concern to us all.  Now that the dust has begun to settle, we must address it calmly, pragmatically, and with an open mind.  I am therefore taking this opportunity to urge an open discussion of this question, bearing in mind that the status quo is no longer an option.  We are confronted with a critical need to improve the public system now, or face a decline in the quality and accessibility of care tomorrow.  For, while we may criticize or question the various solutions proposed in the Castonguay report, we must not do so without also proposing alternatives.

This will be no easy task, and Mr. Castonguay's report thus belongs more on our bedside tables than on a shelf.

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