June 9, 2023

Last week the Quebec government announced that it wants to extend the patient focused funding (PFF) to hemodynamics, obstetrics, the emergency department, neonatology and home care within the next five years. These centres of activities are in addition to its 100% surgery target announced with its last provincial budget.

First off, I would like to point out that the PFF is a type of funding inspired by the new public management that aims to “import good ideas from the private sector to public service administration.” For those of you who don’t know, this type of management comes from the famous Lean approach.Moreover, workers in the health and social services network have denounced this approach more than once, emphasizing the fact that the health network is not a car factory.

So, the PFF to which Health Minister Christian Dubé is referring is intended to fund institutions based on the average cost of care and the number of times this care is provided in the institution. The logic behind such a measure is that when you put institutions in competition with one another, they will perform better.

That’s where you can see that Mr. Dubé’s past is never far behind him. When asked why make such a shift in institution funding, his obsession with accounting never fails to surface… it’s in the name of efficiency, he says!

The problem is that successive governments have never finished the experimental projects they started in recent years in order to ascertain the accurate, real price of each type of care. What’s more, it only took a simple request for information from the Ministry of Health and Social Services (MSSS) to learn that the governments have in no way seriously evaluated these projects. So, what the government is asking us to do is to blindly believe that this type of funding is the most efficient and optimal and that ultimately, will benefit the population.

There’s reason for concern when it comes to this rushed, non-transparent deployment of funding. Projects carried out internationally have demonstrated that the standardization that comes with this funding model does not align with the clinical judgement of care teams. What is certain is that this funding puts undue pressure on employees to carry out a certain volume of care, at the expense of patient education or prevention, for example.

So, in terms of care, is efficiency truly only measured in volume? For anyone who works in the health network, the answer is clearly no. Healthcare professionals know all too well that standardization rarely benefits patients. And “more” doesn’t necessarily mean “better”. We are talking about humans caring for humans and often, a good number of unpredictable things happen. This wisdom should be applied to the various decisions and reforms that Minister Dubé proposes. Because being “efficient” means taking the appropriate action, which will have concrete, beneficial and long term impacts.