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Doctors should buckle up for health reforms: Barrette

Lauren Vogel | CMAJ | August 22, 2017

Doctors must cooperate to contain health costs, like it or not, says Quebec Health Minister Dr. Gaétan Barrette.

Quebec Health Minister Dr. Gaétan Barrette warned that there will be “hard decisions” in the years ahead as provinces and territories try to contain exploding health costs.

In an Aug. 22 address to the Canadian Medical Association, Barrette said doctors should expect to see their roles and privileges change. He also urged them to shoulder greater responsibility for the sustainability of public health care – even going so far as to seemingly suggest rationing services.

“Our Canadian health care system is at a tipping point just as important as the one we went through in the sixties when we put public health insurance in place,” Barrette said in French. “You can’t put yourself in a position where you are on the sidelines.”

Health costs are growing at an unsustainable rate, he explained. “In Quebec, to do next year what we’re doing this year without adding a single service, the budget has to increase by 3.8%.”

This doesn’t account for “contradictory” pressures from patients to expand the basket of publicly funded services without raising taxes, or from doctors to promote health yet protect their privileges, Barrette added. Emerging issues such as Canada’s opioid crisis and the legalization of cannabis will further squeeze budgets.

Provinces had hoped to secure “adjustments” in federal funding to keep pace with these pressures under a renewed national health accord, he said. Instead, side deals were “imposed on us and it actually reduces financing in the very era when needs are increasing and budgets are limited.”

Barrette also described proposed reforms to reduce the tax benefits of incorporation as a cash grab. “There’s a financing problem and it’s such a big problem that they need more money so they chose to do it that way, in your pockets.”

In this environment, everything is up for debate, including the very laws designed to protect Canada’s public health system. “Is the Canada Health Act going to remain the same or not? We’re getting contradictory messages,” Barrette said. “The federal government is requiring that the Canada Health Act be applied, but at the same time allows accessory fees in some provinces.”

Hard decisions will have to be made and ultimately, “it’s up to the government,” he said. “You might not be in agreement, but one thing is for sure … there has to be a minimum and even a maximum of collaboration.”

Restrictions on where and how doctors can practice are necessary to ensure access, he added. “We’ve seen, over the years, the medical practice become more and more inclined towards the doctors’ interests. Doctors have to change their ways.”

Barrette also urged the profession to take responsibility for how their clinical choices drive up health costs. “There is overdiagnosis; there isn’t a doctor here who can deny it.” He estimated Quebec could save up to $650 million if doctors followed practice guidelines in certain areas.

However, in addition to “choosing wisely” to reduce unnecessary care, Barrette also urged doctors to consider the “daily decisions you have to make to ensure the system is the most efficient and least costly,” seemingly putting cost above clinical concerns.

“Your responsibility is to ensure you’re making good decisions to ensure sustainability of the system,” he said. “When medical organizations are spending millions of dollars hiring lawyers to sue the government, I would invite you to think about that.”

Photo credit: CMA

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