The shift to ambulatory care could not be carried out until the end because of budgetary imperatives and electoral, regrets the former Health minister Jean Rochon.
“I have regrets. I do not deny that I was a member of the government. I would have been able to do a sudden burst and resign and say that it doesn’t make good sense. I told myself that I would have more chance to minimize the negative impact of this decision if I stayed in the boat, rather,” said John Rochon in an interview with the parliamentary Bureau.
In its edition yesterday, The Newspaper révélait that a majority of Quebecers believe that the health system has deteriorated in the last 25 years. A result that comes as no surprise to Dr. Rochon.
From 1995, Mr. Rochon launches Québec in the “shift to ambulatory care”. The concept : try avoiding going to the hospital, focus on day surgery and the services of local health care, home care, CLSC, for example. Hospitals are closed, and thousands of beds are transferred to a CHSLD.
But the political reality plays with this game plan, and the discussions are “quite bright” to the council of ministers. “The decision has been made to make the zero deficit a year earlier. Some thought to the election, and the possibility of not getting re-elected,” says Dr. Rochon, who is now 81 years of age. To save, the Bouchard government chooses to defer the investment in the first line.
The turn will never be completed. In the aftermath of the 1998 elections, it has not been renewed in his position as minister of Health. “The first part worked well. We managed to decentralize, there has been an integration of care and front-line services and CHSLD on a territorial basis local. But we remained in deficit as compared to what you wanted to do as a transfer of care,” he says.
Victory against the tobacco lobby
Beyond the shift to ambulatory care, Mr. Rochon has, however, left an important legacy. Degree in public health from Harvard, director of the protection and promotion of the health of the world health Organization (WHO), it passed a revolutionary law on tobacco, which prohibits smoking in large enterprises and public establishments and prohibits the sale of tobacco products to minors. Despite the grumbles, the bill will be adopted unanimously.
It creates the national Institute of public health and the directorate-general of public health, are important tools in times of pandemic. It also put in place a drug plan and creates Héma-Québec in the wake of the contaminated blood scandal.
A window to improve the network, due to the crisis
The government Legault has a window of historic opportunity to improve the health care system due to the pandemic, writes former Health minister Jean Rochon.
This window the risk of closing quickly, within six months, with the economic pressure of the budget deficit, which is going to catch up with the government, according to him.
Mr. Rochon is believed that François Legault is on the right track with his concept of the house of the elders, a willingness to tackle the payment to the deed at the doctors, but above all to make accountable the managers of the health network. He also cautions, however, against solutions wall-to-wall, and advocates for a decentralisation.
Already, the pandemic has helped to give more authority to nurse practitioners and pharmacists, folders which were stuck for years to the internal.
“The health network has the largest number and greatest variety of professions and trades. The vast majority of workers have unions, and professional associations who defend their interests,” he says. Sometimes, the system is found “taken hostage from the inside.”
But it’s not all bursts back onto the scene. “There’s no need to make structural reforms, people are tired, but we can decentralize power to the inside of the ISSC and of the CIUSS, make managers accountable for their population,” he says. In return, this will remove the “straitjacket” of the reform Module, which prevents local initiatives.
The public health expert is pleased to see that the pandemic has highlighted the role of this branch of medicine, which has cut off 30 % of its budget with the reform Module.
“A tsunami” is coming
It will be all the more necessary that Quebec will face in the next years a “hidden pandemic of chronic diseases”.
“It’s a tsunami that comes in to the network of health : the burden of the weight of chronic diseases such as diabetes, respiratory diseases, diseases of the heart”, he says.
Quebec is not doing enough to combat obesity, the consumption of drugs and alcohol, for example. These determinants of health will have a much greater impact on the health system than any reform, ” said Mr. Rochon.
“If we do not put the foot on the accelerator, in one or two generations, our system will become unmanageable”.