June 2, 2014

Apart from the super clinics, other points from Premier Philippe Couillard’s inaugural address, delivered a few days ago, require our attention. In particular, I’m thinking about activity-based funding: a resource allocation method that rewards institutions based on the quality and volume of services. Thus, the budget allocated for the institutions to provide services would be replaced and care given through payment for each service effectively received.

While this idea may please some, it is important to clearly understand how it works. And when looked at more closely, the seductive speech of “the money follows the patient” and funding “focused on the patient” hides what could certainly be the opposite of a solution to the problems in the healthcare network.

Obviously, by giving institutions an incentive to remain “profitable”, it promotes the higher paying services (one-day surgeries, procedures on patients who are in relative good health) and they are invited to abandon services that “pay” less (more difficult to treat cancer cases, cases with a greater risk of complications, etc.). Furthermore, they look for ways to increase the productivity of healthcare professionals. Don’t they do enough already?

It must also be considered that this ambitious project cannot be achieved without major investments in computerization and bureaucratization. And that’s without counting the many consultants who will have to be hired to ensure the project starts on the right foot: an effect so paradoxical when one thinks that those advocating for the funding of the activity are demanding a reduction in bureaucracy in order to justify this approach.

Fewer services, more management, timed care and less humanity: are the patients’ interests served in all this?

What do you think?