Quebec spends more on health care, even as services are declining: Health Commissioner

The government’s spending exceeds its GDP, while the level of health care services is declining. This is stated in black and white in the report by the commissioner health and well-being (CSBE), released on Thursday.

During the period analyzed, from 2015 to 2023, “the average growth in public spending on health and social services was higher than that of the government’s consolidated revenues and GDP.” The report notes that during this period, “the volume of services per capita in the main health service sectors has declined, and, in general, access to services has not improved.”

“In other words, spending is rising faster than our collective wealth,” said CSBE Joanne Castonguay, during a virtual press conference. “Yet the volume of services per capita is declining. Doctor visits are down 1.3 per cent per year, short-term hospitalizations by 1.6 per cent, hospital days by 1.9 per cent, and surgeries by 0.8 per cent. The system is therefore providing fewer services per person, even as spending rises.”

The report notes that human resources are insufficient and physical resources are aging. It states that, to ensure the sustainability of the health and social services system, profound organizational transformations are needed “while the budget allocated to it is constrained by the rate of GDP growth.”

Castonguay argues that the situation regarding material resources is cause for concern. “Quebec has 2.3 hospital beds per 1,000 residents, ranking 17th out of 18 [countries]; 39 per cent of buildings are in poor or very poor condition; and 22.8 per cent of medical equipment has exceeded its useful life. All of this puts direct pressure on the system’s ability to meet the population’s needs,” she says.

The commissioner also focused on timely access to health care. “The findings are unequivocal. Major changes are needed. Getting a medical appointment is still difficult. Access to a specialist, following a referral, is a cause for concern, and wait times in emergency rooms are problematic. In mental health, many needs remain unmet, and wait times exceed standards. In child protection, wait times are very concerning. We believe all these issues need to be addressed. That said, recent data from Santé Québec suggests that improvements are underway and that the efforts being made are heading in the right direction.”

The document emphasizes that the challenges facing the healthcare system stem primarily from organizational issues and budgetary constraints, while healthcare professionals work tirelessly in a context of resource shortages to provide care to the population.

“Have we hit the dreaded wall?” writes Castonguay, in the report. “While the creation of Santé Québec and the reorganization of the Ministry of Health and Social Services (MSSS) demonstrate a commitment to efficiency, our analyses suggest that the system’s long-term viability remains fragile. Budgetary constraints, without changes to the organization of services, limit the network’s ability to continue meeting needs.”

Castonguay adds that the system is still “too hospital-centered, ill-equipped for prevention, and insufficiently aligned with other stakeholders—community, municipal, and social—who influence health and well-being on a daily basis.”

What’s working well

The commissioner does not question that stakeholders share the same goal, namely not only to focus on treating diseases but to improve the health and well-being of the entire population. She notes that this vision is increasingly reflected in public policy directions.

Compared to other provinces, life expectancy at age 65—the number of years a person of that age can expect to live—is 20.8 years in Quebec, among the highest in the world. “For preventable deaths, Quebec ranks second among Canadian provinces. And in terms of the humanistic quality of care, people give a rating of 7.5 out of 10, and 94.5 per cent of them feel they are treated with courtesy and respect,” continues Castonguay, adding that specialized services in Quebec are among the best in the world.

On the downside, she explains that care for chronic diseases and mental health is lacking, the effectiveness of prevention and health promotion needs improvement, and there are areas where measures are lacking, such as primary care and rehabilitation.

The commissioner reiterated that we are now on the right track, but that implementation remains difficult and that we need to give it time to see results. “For years and years, goals have been set in terms of quantity, and we’re not getting better access. So, you have to change the way you look at things. And the way to look at things is to say that, instead of focusing on the quantity of services, we should be focused on health and well-being.”

Three areas needing action

The Commissioner advises the government to undertake three key initiatives. First, to intensify the shift toward population health. To do so, she suggests rebalancing resource allocation in favor of health promotion and prevention, as well as community-based care. She also calls for efforts to improve support for marginalized populations and reduce health inequities.

Second, the value generated by the healthcare system must be increased to meet the population’s needs. Castonguay recommends that the government, among other things, strengthen services that maintain independence and prioritize investments that directly improve the population’s experience in navigating care and services.

Third, the system’s decisions must be more transparent. In this regard, the CSBE recommends that the MSSS document the criteria used to guide decision-making. She also recommends “simplifying and clarifying existing policies, clarifying the existing portfolio of public policies, and ensuring that any new policy takes into account what is already underway.”

“The public wants ‘accessible, user-friendly, continuous, and compassionate care,’” the report states. However, citizens are largely dissatisfied “with the accessibility and user-friendliness of organizational processes, as well as the continuity of care and services, despite a positive perception of the compassionate nature of care.” The Commissioner warns that “this disconnect” risks undermining people’s trust in the healthcare system.

—

The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.

–This report by La Presse Canadienne was translated by CityNews