It's time to think outside the box - OPINION - Dr. Hugo Viens, President, Québec Medical Association

MONTREAL, Sept. 27, 2018 /CNW Telbec/ - From the time the election campaign got underway, poll after poll has shown healthcare to be the number-one concern of voters. So, why aren't we hearing about it in the debates? Why are citizens content to put up with empty promises?

Announcing the construction of a new hospital or the renovation of another all amounts to the same thing: a hospital-centred healthcare system. You want super clinics? Done. But until they start operating on a population-based approach and funding model, they won't do much to improve the health of Québecers. Bring back the free IVF program? Install air-conditioning in all hospitals? Convert the CHLSDs into seniors' homes? Potentially all good ideas. But are they more important than covering dental care up to age 18 or reimbursing psychotherapy treatments? An appointment with a doctor or a specialized nurse practitioner within 36 hours, or up until 9 p.m. every night? Why not? Except that the conclusive evidence all shows that patients are better off being treated by multidisciplinary teams rather than solo healthcare providers. And the list goes on and on.

These promises may be meant to address real issues, but they never deal with the root cause: our system's failure to innovate and the endless string of pilot projects that never get off the ground, either because of a lack of repeat funding or an inability to implement them on a provincial scale. So, doctors can get as fancy as they like with their procedures and medical teams can provide top-notch care till the cows come home, but patients still end up feeling like they're in a pinball machine, being bounced around randomly from doctor to doctor, with no one to coordinate their care episode.

And, yet, every day I see doctors who are innovating. We're coming across more and more examples of new practices in our everyday work, such as virtual clinics and remote consultations.

A needs-based healthcare system
There are other models out there for how to deliver care differently. For example, the scientific literature praises systems like Kaiser Permanente, an American integrated managed care consortium serving more than 11 million people. With one of the best track records in the United States for quality and safety of care, it is also one of the most successful, and international assessment agencies even rate it as one of the world's best healthcare systems.

In this type of model, the public network would be able to work with medical groups and other partners, allocating them the funds needed to manage the population in a given territory, while the government continues to pay for the cost of the care. Québec would gain a system built on a population-based approach, where the emphasis is on health promotion and disease prevention. Healthcare professionals, grouped into care teams, would be collectively responsible for patient outcomes, and care and service trajectories. Patients, along with their families and the community, would finally be put in the driver's seat of their own healthcare. These are actually the guiding principles of Kaiser's clinical actions and management decisions.

If we hope to move forward, we need to start being open to new health partnerships, and thinking up new structures that will allow everyone to work together without derailing care trajectories. Basically, we need a vision of health. Do we dare dream of a Québec where being healthy is one day the norm?

Dr. Hugo Viens, B.Sc., M.D., FRCSC 
President, Québec Medical Association

Related Links
http://www.amq.ca/en

SOURCE Quebec Medical Association