Tie hospital budgets to patients, CMA head says

The funding of Canada's health-care system should be directly tied to patient care, so patients become a source of revenue for hospitals rather than an expense, the president of the Canadian Medical Association said Tuesday.

In a speech to the Canadian Club in Toronto, Dr. Robert Ouellet stressed it is not his goal to privatize the health-care system, but for the private sector to offer complementary services to help reduce waiting lists in the public system and keep it viable.

"In Canada, we must stop treating patients as if they were problems for the health-care system and start thinking of the health-care system as being there for patients," Ouellet said in French.

Such an approach might help patients, agreed Marcelle Jomphe, southwest regional president of Fédération des aînés et des retraités francophones de l’Ontario, a Francophone seniors group based in Ottawa, who called the speech "excellent."

Reducing waiting lists

Ouellet said England changed its health-care funding method and philosophy to tie funds directly to patient care rather than giving hospitals global budgets.

Adopting that approach in Canada would reintroduce an element of competition between hospitals to add value by basing funding on performance, efficiency, effort and results, said Ouellet.

The CMA is now sending a team to England, Denmark, France and other countries to see how European research cut waiting times, in the hopes of helping Canada's health-care system overcome similar problems without repeating mistakes.

Ouellet gave the example of France, where he said 60 per cent of surgeries are performed at private centres and are paid for through a mix of government and private health insurance. In France, patients wait two weeks for a hip replacement, compared with Canada's target wait time of 26 weeks.

Today's unpredictable economic climate must not bring a return to the health-care cuts of the 1990s, Ouellet said, while calling on federal, provincial and territorial governments to:

• Reduce waiting lists.
• Develop a national strategy that leads to self-sufficiency in doctors and health-care professionals.
• Establish a national prescription drug insurance plan, such as extending Quebec's universal system of deductibles, user contributions and maximum annual premiums.
• Bring in patient-focused funding for hospital services.
• Recognize, monitor and develop a framework to direct how the private sector can plan an increased and complementary role in supporting the public system.

Ouellet told the audience to "stop being afraid of being afraid" in protecting and transforming the health-care system.

Canadian Doctors for Medicare has warned that over-reliance on payments tied to patients would erode the commitment of hospitals to provide a full range of service to all patients and boost administrative costs.

"What would almost certainly happen is that access would be undermined for people who can't afford to pay for their health care," said Dr. Danielle Martin, chair of Canadian Doctors for Medicare, and a family doctor who splits her practice between Toronto and Northern Ontario.

The governments of Quebec and New Brunswick have said they are considering changing hospital financing to reflect the volume of patients and procedures. 

As the head of radiology department at Cité de le Santé Hospital in Laval 20 years ago, Ouellet proposed that physicians privately invest in CT and MRI scanners on condition that the hospital agree to send patients for the tests. He now runs two MRI clinics, one CT clinic and two digital radiology clinics.