A winning recipe for a successful overhaul of the Quebec health care system

Montreal, February 17, 2022 – The Quebec government, through Health Minister Christian Dubé, will soon present its plan to overhaul the health care system. The Montreal Economic Institute is proud to unveil a major study by economist Maria Lily Shaw on the best practices of the health care systems of Sweden and the United Kingdom—two examples that Quebec should follow if it really wants its reforms to be successful.

“What I am proposing is a winning recipe that politicians and bureaucrats can draw from in developing the reforms they plan to launch. To succeed, they will also need to follow the steps carefully, since order of application is probably as important as the reform itself,” explains the economist and author of the study.

Sweden and the United Kingdom evolved and made progress while Quebec stood still

Seven decades ago, in the early days of health insurance in Canada, our system looked like those of countries like Sweden and the United Kingdom: universally accessible government-run systems. Today, while both of these countries have moved on to “mixed” health care systems of one form or another that incorporate both governmental and entrepreneurial components, the Quebec system has unfortunately stagnated. As a result of their transition to a mixed system, the populations of Sweden and the UK now benefit from more flexible health systems that respond to their needs in a timely manner—all with a price tag similar to or lower than the cost of many provincial health systems in Canada.

No matter how profoundly the reforms that were adopted in Sweden and the UK have transformed their health care systems, universality was maintained. These systems are models that clearly illustrate the benefits of entrepreneurial involvement in the provision of health care.

“These two countries were able to improve access to care without undermining the principle of equal access. By introducing better incentives into their hospital systems, patients became a source of revenue rather than a cost, as is the case in Quebec and in other provinces that still finance their medical institutions with historical budgets based on recent years’ costs,” adds Maria Lily Shaw.

Winning recipe for meeting the health care needs of Quebecers

“It’s high time for policy-makers to acknowledge the benefits of a liberalized health care system by looking beyond the current legislation and taking note of the successes of other countries,” says the MEI economist.

This winning recipe has six steps that are perfectly applicable under the Canada Health Act, and its success has been proven in other countries with universal health care systems. It does require, however, the close collaboration of different actors involved in the decision-making process, including the Federation of General Practitioners of Quebec (FMOQ), the College of Physicians of Quebec, the Quebec Federation of Medical Specialists (FMSQ), the Quebec Order of Nurses, and the Council for the Protection of the Sick, among others. For the past two years, the devotion of our health care professionals has been more evident than ever; they deserve a system that also puts patients first.

1: Adopt Electronic Patient Records and Expand Access to Health Data

Handwritten medical records and fax-based communication between institutions must make way for the technologies of the present.

2: Remove the Prohibition on Duplicate Health Insurance

Allowing Quebecers to purchase private insurance that covers care already covered by public insurance would increase the number of options offered to patients searching for medically necessary care in the independent health care sector.

3: Remove the Prohibition on Dual Practice

This step will allow health professionals to work simultaneously in the independent sector and in the government-run system.

4: Increase the Supply of Medical Professionals with Three Reforms

These reforms include reducing the regulatory obstacles keeping health professionals trained abroad from entering the labour market here, the elimination of medical school quotas, and adopting national licensure to allow doctors to practise across the country.

5: Adopt Funding and Payment Mechanisms Conducive to Performance, Efficiency, and Productivity

The money has to follow the patient. In this way, patients become a source of revenues for hospitals, and not a cost as they are today. For this to happen, our secondary care institutions must be financed according to the volume of patients treated and the severity of their conditions.

6: Transfer the Management of Some Hospitals to Entrepreneurs and Expand Private Care Provision

To tie it all together, the last step in this recipe is to delegate the management of some hospitals to entrepreneurs, all while maintaining public funding. This reform would in no way undermine the universality of our system because services would remain free at point of use. Rather, by increasing competition to attract patients (a source of revenue, remember, thanks to the previous step), it would increase the efficiency of operations, to the great benefit of patients.

“The provinces have the political power to proceed in all confidence with the introduction of reforms that have proven themselves in many countries; all that’s needed is the political will to do so,” concludes the economist. 

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The Montreal Economic Institute is an independent public policy think tank. Through its publications, media appearances, and advisory services to policy-makers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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