Task Force on the Financing of the Health System - Tabling of the Report Getting Our Money's Worth



    QUEBEC CITY, Feb. 19 /CNW Telbec/ - The Task Force Report on the
Financing of the Health System was released today in Québec City. In their
report, entitled Getting Our Money's Worth, the chair of the Task Force,
Claude Castonguay, and the two vice-chairs, Michel Venne and Joanne Marcotte,
propose a new "social contract" for Quebecers to ensure that everyone receives
the care they need in a timely manner while remaining within our collective
ability to pay.
    The members of the Task Force consider that Québec must secure the
long-term viability of the public health care system by increasing its
productivity and adjusting the growth in public spending on health to the
growth rate of the economy, while improving access to care and quality of
services. They appeal to the sense of responsibility of all stakeholders of
the system.

    Curb spending growth

    Slowing growth in program spending so that it does not exceed that of the
economy is one of the report's central recommendations. Accordingly, the Task
Force proposes curbing growth in public spending on health from 5.8% to 3.9%
per year over a period of five to seven years.
    To do so, the report proposes a realistic and workable action plan. Since
the proposed measures will not achieve their full effect immediately, the
group recommends setting up a dedicated health stabilization fund. The fund
would receive revenue from a portion of the Québec sales tax (QST), either
1/2% or 1%, and from a deductible varying with income and use of medical care.
Such a fund would help limit the encroachment of health on the other
government missions. The Task Force rejects introducing user fees.

    Coverage of the public system

    Noting that some less essential services whose value on a cost-benefit
basis has not been proven are covered while others are not, the Task Force
recommends that the government review the public coverage of the existing
health system, which it considers incoherent and rigid.
    Accordingly, it invites the government to undertake a systematic and
structured review of the public coverage on an ongoing basis, adopting for
this purpose a permanent, credible and legitimate mechanism. The members of
the Task Force are aware that they are proposing a profound change, but they
are convinced that it is necessary. Far from calling the very idea of public
coverage into question, the limits they propose to define would ensure its
relevance.

    A credible and independent organization

    The Task Force recommends creating an Institut national d'excellence en
santé whose mission will be to define the public coverage, determine
performance indicators and periodically review the list of insured drugs.
    Formed by merging the Conseil du médicament du Québec, the Agence
d'évaluation des technologies et des modes d'intervention en santé and the
Commissaire à la santé et au bien-être, the organization would be independent
of the Minister. It would inform the public, disseminate the results of
research, recommend best practices to practitioners and establish directives
for practitioners, the latter consisting of clinical protocols.

    More accessible services

    The Task Force is convinced that the development of health clinics will
help relieve hospital congestion and offer care at lower cost and recommends
accelerating their development, with the objective of ensuring that each
Quebecer has access to a family doctor within five years.
    Moreover, the Task Force makes a number of recommendations concerning
aging and loss of autonomy. Accordingly, the Task Force recommends that the
government give priority to home care and that to that end, it maintain a high
level of investment in this sector. Since resources are limited, the Task
Force recommends that eligibility for a tax credit be subject to a means test.
    The Task Force also recommends that medical, nursing and covered
specialized home care be universally covered by the public system. While
recommending that the ministère de la Santé et des Services sociaux award the
operation of CHSLDs on a concession basis to the appropriate resources, the
members of the Task Force agree on the need to undertake a public debate on
the medium and long-term effects of the aging of the population.

    Review governance

    Efforts made to date to improve the quality of care have not allowed for
the solutions of certain problems noted regarding governance. The members of
the Task Force agree on the need to identify the system's governance
structures for the production of services. Accordingly, the Task Force
recommends that the ministère de la Santé et des Services sociaux refocus its
mission in particular on setting policy and objectives, and that it withdraw
from the production of care as such.
    Concerning regional agencies, the Task Force is of the view that their
mission should be in particular to translate national priorities and policy
into implementation strategies in their territories. While recognizing that
they need to have broad autonomy, the Task Force suggests consolidating the 18
existing agencies into six to eight. The Task Force also makes a number of
recommendations to increase the autonomy of producers of services - the CSSS,
health clinics and other institutions - while making them more responsible for
their management.
    The members of the Task Force advocate a health system based on the
recognition of the rights and obligations of everyone. Thus, while
acknowledging their professional freedom, they recommend that physicians,
institutions and clinics enter into contractual agreements.
    Lastly, the Task Force believes that a program should be implemented to
evaluate the performance of hospitals and that the results of the evaluations
be released periodically. It recommends that each regional agency and each
hospital should be headed by a board of directors consisting of a limited
number of independent members, selected for their skills, and that they be
remunerated.

    Allocation of resources

    The report notes that almost all industrialized countries have more or
less thoroughly changed how hospital budgets are set, with the objective of
better controlling rising health costs. These changes stem from a common
observation: the old budgeting methods do not encourage efficiency.
    Accordingly, the Task Force recommends that for the financing of
hospitals, the historical budget method be gradually replaced by the service
provider method. In that context, hospitals would have a financial incentive
to serve their patients well since the money would follow patients rather than
preceding them.

    New technologies

    The report proposes a set of initiatives to put new information
technologies at the service of patients and managers. For the members of the
Task Force, new information technologies are an essential tool to make our
health system more productive and efficient.
    Given the risks involved, the Task Force recommends that the Dossier de
santé du Québec not be deployed until a pilot project has been carried out in
a region and the results analyzed. It also recommends that priority be given
to the deployment of the electronic patient record in every hospital and
clinic.

    The health account

    Responding to a specific point mentioned in their mandate, the members of
the Task Force propose that the ministère de la Santé et des Services sociaux
produce a health account each year that the Minister would table in the
National Assembly and that would be studied by a parliamentary committee.
    In its report, the Task Force presents an example of what the health
account might be. The purpose of such a publication is to provide a good
picture of health financing as well as a rigorous and operational analytical
tool.

    Innovations and the role of the private sector

    The Task Force proposes a number of initiatives to improve access to care
including a greater role for the private sector so that it becomes an ally of
the public sector. Accordingly, the Task Force recommends that a physician be
authorized to have a mixed medical practice, within prescribed limits and
provided there is an agreement with his institution.
    The Task Force also proposes that the legislation authorizes private
insurance for services already covered by the public system. In addition, it
suggests carrying out demonstration projects to test other methods of
non-profit hospital management to identify productive new options.
    However, a dissenting view on these three recommendations is presented by
a Task Force member, Michel Venne. This view is set out in detail in an
appendix to the report.
    Moreover, the Task Force proposes that the initiatives relating to the
role of the private sector and those stemming from steps already taken by the
government be assessed within five years.

    Better use of drugs

    The Task Force proposes that the government tighten the rules on the
application of exceptional measures stipulated in the Régime général
d'assurance médicaments by urgently taking into account the views of the
Conseil du médicament.
    It also proposes that a single organization have authority over the
advices issued within the health system on the therapeutic value and
cost-effectiveness of drugs. Lastly, it recommends changing the parameters of
the public drug insurance plan so that participants cover the entire cost of
the plan for their insured group.

    The Canada Health Act

    In keeping with its mandate, the Task Force analyzed the Canada Health
Act. The Task Force is of the view that the Act hampers the evolution of the
provincial public health systems and that sooner or later it will have to be
adapted to current realities.
    The members of the Task Force believe that the unadapted and unduly
restrictive provisions of the Canada Health Act should give way to a flexible
framework favouring the adaptation of the provinces' health systems, based on
respect of their jurisdiction in this field.

    Other recommendations

    The report contains a number of other recommendations, in particularly
concerning prevention of sickness, health promotion, work organization, labor
relations and incidental fees for health clinics. In each case, the concrete
solutions comply with the principles set by the government and with which the
members fully agree. Lastly, it recommends implementing a permanent program to
reassess administrative expenses and fees charged for services.

    Conclusion

    The Task Force does not call into question any of the basic principles of
the existing system. It acknowledges that it is proposing major changes. The
main challenge facing us collectively is to adapt our health system to the
realities and context of the 21st century.
    The Task Force is convinced that in the health sector as in many other
fields, we have both rights and obligations. A balance must be struck between
what we ask of society and what we hope to receive from it. The Task Force is
convinced that there is a pressing need to act. We can maintain a health
system that reflects our view of living as a society and the principles we
value, provided we act quickly and with resolve.
    However, this effort can be undertaken only if Quebecers support it and
share the same vision. The Task Force hopes that this report and the thought
and study of which it is the culmination will contribute directly to this
effort.

    All the documents relating to the Task Force's work are available on its
website: www.financementsante.gouv.qc.ca
    -%SU: SAN,SOC
    -%RE: 1




For further information:

For further information: Jacques Delorme, Technical Support, Task Force
on the Funding of the Health System, (418) 528-7382

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GROUPE DE TRAVAIL SUR LE FINANCEMENT DU SYSTEME DE SANTE

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