An Exhausting Year for Health Care (Le Devoir)

Minister Barrette has antagonized the system with his reforms

By Amélie Daoust-Boisvert
Originally published on: January 3, 2015
See original French version here: http://www.ledevoir.com/non-classe/427987/reformes-une-annee-epuisante-pour-la-sante

The Minister of Health and Social Services (MSSS; ministère de la Santé et des Services sociaux) is often compared to an ocean liner reluctant to change course. 2014 was marked by an election and the arrival of a minister who launched several rash reforms that have antagonized the system against a backdrop of cuts. Has the ship’s wheel turned?

Elections, major bills being tabled, a budgetary severity that inevitably must affect services : the year in politics, as far as health care is concerned, has been far from easy. In spite of Minister Gaétan Barrette’s willingness to set the machine in motion, strait into high gear at that, it’s clear that it will be some time before results can be seen.

We should note that several issues have progressed in 2014. In February, under the Parti Québécois government, the Public Mother’s Milk Bank was launched, making the precious resource available to preterm infants. Hema-Québec, which manages the bank, has not had much difficulty in recruiting approximately 300 donors necessary to feed 1000 premature infants. It’s a success: the path is clear to widen the scope of the bank in 2015. Also, after having been introduced before the election yet having missed the vote, Bill 52 on end-of-life care was finally adopted in June by a 94-22 majority. Given that Gaétan Barrette committed to enacting the bill within 18 months, 2015 could be the year this law allows for medically assisted death, under a host of requirements.

In Development

Other major projects led by the MSSS are currently in development. Launched at the onset of autumn, the principle of Bill 10 should be soon adopted. While in parliamentary committee, a vast majority of interlocutors were groups denouncing the unprecedented administrative reform that would bring about a massive fusion of Quebec’s health care establishments. Even so, Gaétan Barrette has kept his course in spite of 160 amendments which seek to respond to a number of criticisms.

The reform follows the logic of attempting to halt the growth of health care’s portfolio. Upon being elected, Minister Gaétan Barrette conceded that the directive of restricting his ministry’s growth to under 3% was a “colossal” challenge. “It will lead us to having to make some difficult choices. But the status quo is unacceptable”, he warned.

There were many choices: Public Health was imposed the system’s most considerable cuts. The action plan for mental health was postponed, community organizations saw their funding shrink. The Deputy Minister of Public Health, Lucie Charlebois, admitted that budgetary considerations would stall the launch of supervised injection sites in Montreal, despite Mayor Denis Coderre’s support. Cuts were also made in the allocations to mental health and to senior citizens, for example, considering that health agencies were under pressure to balance their budgets with fewer available funds.

And, in November, the ministerial decision: he announced plainly and simply the end of the public Assisted Reproduction Program, with the exception of the artificial insemination services. The announcement continues to make angry waves amongst doctors and infertile couples alike; this struggle continues.

Sleeper Issues

Stagnation has continued to plague many issues.

Still after years of outrage, the abusive billing of ancillary fees to patients continues. The Collège des médecins [Quebec’s professional order of physicians] attempted in early 2014 to halt the proliferation of these fees by modifying its code of ethics. However, the move has proven to still be ineffective a year later. The matter has since migrated to the judiciary. In May, Philippe Léveillé, a citizen, launched a class action suit against the MSSS, the RAMQ and many clinics. Over the course of some years, the man, who suffers from glaucoma, paid his ophthalmologist “hundreds of times over” the cost of his eye drops.

We still do not know either what will come of the heritage buildings in downtown [Montreal] that are currently the Hôtel-Dieu and the Royal Victoria hospitals. A July report urged Québec to act immediately to prevent them from becoming “urban ghosts”.

The Autonomy Insurance Act, former Minister Réjean Hubert’s flagship project, was completely abandoned by the Liberal government as soon as it came into power. “It was a smoke screen”, declared Gaétan Barrette, a bill that Québec just simply could not afford. Even if its funding was not definitive and that the bill had garnered some criticism, its disappearance does nothing to help the problem of definitively dealing with a large ageing population despite an injection of tens of millions of dollars towards the issue.

The Year of All Confrontations

It started in June with the collective resignation of six public health directors, whose salaries had just been revised and cut. Others in upper management had a taste of the same medicine. In 2014, Québec has stoked the ire of practically each and every worker in the system, from the orderlies to the doctors as well as the upper-level administrators. 2015 is likely to be a year marked by mobilization.

Pharmacist-owners were the next in line to react when Québec decreed a 12% reduction in the honoraria they receive from the RAMQ. And it wrapped up in December with the health care unions, insulted by the first round of salary offers by the government during the public sector wage negotiations. The unions are also in the front lines of the struggle against Bill 10.

And what about doctors? The calling of the elections in March froze a transfer of a 540 million dollar raise owed to doctors. The Parti Québécois government had expressed the will to arrive at a negotiated settlement to stagger the wage increases in order to lessen the burden on the MSSS’ finances. “I do not go back on the State’s word”, stated Philippe Couillard during the election campaign. However, several months later, it was only after turbulent negotiations that the medical federations were to sign an agreement to stagger wage increases. It should be noted that these increases had been agreed to by the former Liberal government, when Gaétan Barrette was on the other side of the fence at the head of the [order of] medical specialists.

A powerful blow was soon to follow. In late November, Bill 20 was tabled and quickly qualified as a “soviet” by doctors. Obliged to a obey a certain level of productivity under threat of wage sanctions, they are outraged. It is hard to recall a similar mobilization by family doctors. Will the bill be modified after its referral to committee? Could it finally solve the accessibility issues that have plagued the system for years?

***

Translated from the original French by Language and Dissent, a collectively-run blog supporting the anti-austerity struggle in Quebec. These are amateur translations written by volunteers; we have done our best to translate these pieces fairly and coherently, but the final texts may have their flaws. If you find any important errors in any of these texts, we would be very grateful if you would share them with us via email (languageanddissent [at] gmail [dot] com). Please read and distribute these texts in the spirit in which they were intended; that of solidarity and the sharing of information.

One thought on “An Exhausting Year for Health Care (Le Devoir)

  1. Tom Boushel January 16, 2015 / 2:46 pm

    A wonderful and very necessary service. Thank you for helping to keep us informed. Ignorance destroys society, information enlightens society.

    As to the article: Anyone can cut expenses, it requires strategic study and analysis to wisely restructure the delivery of services. We have many examples of foolish and expensive cuts to our government services over the past decades. Why do we have so few examples of wise reorganizations? The answer is that most politicians are in a rush to make changes and cuts. The best changes have always come from Commissions that have been led by top experts in their field, who consulted with all of the major constituents. An excellent example is The Castonguay Commission in 1967. What is happening now is cuts on the run. There will be many unintended consequences from these decisions. To quote from Shakespeare: “The evil that men do lives after them; the good is oft interred with their bones”.

    Like

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