The following was submitted as a letter to the editor of the Montreal Gazette, and was published in the edition of 2014-11-1.
Re: “Reforming health care” (Opinion, Oct. 22)
Jacques Hendlisz and David Levine point out the danger of leaders becoming disconnected from the professionals who deliver care, when health care organizations become too large. We saw this when Philippe Couillard reformed the health care system a decade ago, with the creation of CSSS in which CSSS boards of directors became responsible for the running of groupings of acute-care hospitals, long-term care institutions, rehabilitation facilities, and CLSCs which had each previously had their own board. Similarly, the previously separate Councils of Physicians, Dentists, and Pharmacists of each institution were merged into one council for each CSSS. Predictably, council members lost interest in participating in council activities, which now required additional time to travel to the institution hosting meetings and called upon members to make decisions about the internal operations of institutions where they did not work and consequently lacked both expertise and experience.
The reforms proposed in Bill 10 are almost certain to worsen this problem, as boards and councils become even further removed from the institutions delivering care. One would hope that Couillard learned from the mistakes of his previous reform. Sadly, it appears he has not. What’s even worse, the pattern here is a repetition of the forced mergers of municipalities enacted by the provincial government in 2002. The goal then was saving money through economies of scale, but sharply higher costs for many municipalities actually resulted. Can the provincial government demonstrate that the forced mergers of health-care institutions in 2004 achieved cost savings then significant enough to offset the disconnection between caregivers and managers? If not, why should anyone believe that Bill 10’s even bigger forced mergers would result in lower costs or improved health care now?
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