Quebec's plan for “small hospitals” has not reached consensus

The Quebec government hopes to deliver the “small hospitals” plan by 2025.

The Montreal Economic Institute (MEI) believes they should include 24-hour emergency rooms, but this recommendation is not unanimous.

In a study released Tuesday, the MEI found that high emergency demand and labor shortages are putting severe pressure on the system.

According to Emmanuel B. Faubert, MEI economist and study author, having emergency services in “smaller hospitals” increases supply and eases the burden on already overburdened hospitals.

“Since the beginning of the year, not a single day has gone by without Quebec's emergency department occupancy rate of 100 percent or more,” Faubert explained. “It's clear that smaller hospitals can help reduce wait times by increasing treatment options using emergency rooms.”

However, Maude Laberge, Associate Professor of Social and Preventive Medicine at Laval University, disagrees.

“We know that we have a stake in the delivery of services in Quebec in relation to demand. However, about half of emergency room visits are for patients who are seen in medical clinics and do not require emergency room facilities,” LaBerge responded in an email. “If we're going to add additional emergency supplies, we're going to send a message to residents to go to the emergency room.”

According to Laberge, it is better to invest in frontline services through general practitioners, specialist nurses and other frontline professionals to improve access to these services.

The associate professor believes that this will increase the efficiency of the health care system and the relevance of care.

“In this sense, I think the government should not require mini-hospitals to have 24-hour emergency rooms,” he says.

Funding in the hospital system is mainly based on approved budgets.

MEI points out in its research that this funding method determines the hospital's ability to intervene.

“Thus, each admitted patient represents additional costs that the institution must pay from a non-growing budget. The result is rationing of financial, physical or human resources,” the research paper says.

The MEI is asking the government to fund small hospitals on a service-by-service basis, as it will ensure “fixed remuneration based on the various medical procedures performed” by adding to the current year's budget envelope.

“Thanks to activity-based financing, the patient is no longer a cost, but a source of income for the hospital, changing the incentive structure for managers,” Faubert said. “This is especially encouraging for doctors and nurses to spend less time spending more time with patients.”

LaBerge said the government began introducing activity-based funding 20 years ago for certain services and volumes above the baseline.

He adds that the Ministry of Health wants to use performance-based funding to replace part of the budget envelope, and this implementation was accelerated in April.

The 2023-2024 budget says the Department of Health and Social Services will expand funding from 1 April 2023, which it calls “patient-centred funding”.

According to the budget plan, the share of activities funded based on the care and services provided to patients is now more than $2.6 billion per year, or 25 percent of Quebec hospitals.

The ministry's goal is to reach 100 percent by 2027-2028, which is more than $10 billion annually.

LaBerge believes that the government will use activity funding to finance most of the services provided in small hospitals.

Last summer, the Ministry of Health did not require operating rooms in small hospitals, but MEI wants to implement this to increase surgical capacity.

The government has confirmed two small private hospitals, one in l'Est-de-l'Île-de-Montreal and the other in la Région de la Capitale-Nationale.

This report from La Presse Canadienne was translated by CityNews.