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This text is the first in a series of five on our health system, its challenges and solutions to avoid hitting a wall in ten years. Today: the extent of the problem.
It seems that we have just rediscovered that our health system cannot cure us.
Recently, many were shocked to learn that 140,000 Quebecers were waiting to have an operation – or one in 60 Quebecers. We forgot that in March 2020, when COVID-19 began to sweep over the province, 125,000 of our citizens were already on a list waiting for surgery.
We speak politely of “elective” surgery, or not urgent, in the sense that we have the choice to fix an appointment and see things come a little. Except it often stretches for months, and the pain that comes with it stretches too.
When a worn hip or knee keeps you from walking, it won’t kill you, but it takes a little bit of your life every day. If it lasts too long, it ends up making the problem worse or causing new ones.
Sometimes, too, elective surgery becomes urgent while the patient is waiting. Benign cancer found by chance is not necessarily the same if it is discovered six months later.
Sometimes it is quite urgent, but the system forgets you. Every year, people die between cracks, like this 72-year-old man who had to be operated on within three months, who died after six months, and called to schedule surgery after nine months. Unfortunately, it is told in the correct order.
That was the reality of our health system before the pandemic. Waiting, suffering, and sometimes absurd deaths, lost in the system.
Years of catching up
Now, tell yourself that over the next few weeks, we will add a few thousand more surgeries postponed to the pile. According to the doctor responsible for the hospital network at the Ministry of Health, we may have for years to try to catch up.
Doesn’t that discourage you enough? Realize that the months of waiting for surgery is only part of the problem.
The number of Quebecers waiting for a family doctor also constantly increasing. In October 2018, they were 475,000; a year later it was 580,000; end of 2020, 668,000. Pandemic, not pandemic, the list is growing.
Several of these patients have needed follow-up since the day before yesterday, but they will have to wait for months to come.
For patients whose priority is “urgent», Those with cancer, serious mental health problems or for monitoring pregnant women, the wait varies from two to six months, depending on the region, on average. Sometimes it’s longer. For some patients, two trimesters of pregnancy will have passed. For others, childbirth will have taken place …
For “urgent” cases – those who have been hospitalized recently or who need rapid follow-up -, the wait is five to ten months.
For “priority” cases, the wait is on average over a year.
For those who stay, the “normal” who simply want to be followed by a doctor, the wait may exceed two years.
The predictable consequence is that patients who do not have a doctor will engulf even more our emergencies perpetually crowded for 40 years. In hospitals in Greater Montreal, where half of Quebecers live, ten to twelve hour emergency room stays to treat an infection or minor injury are not uncommon.
Many Quebecers, discouraged, thus give up being treated. Last year, before the pandemic, more than 1000 Quebecers emerged from a hospital emergency EVERY DAY without having seen a doctor. The fifth of them had a priority 3 rating, which means their condition could be life threatening.
In fact, according to an international comparison among 11 rich countries carried out a few years ago, Canada was last for same-day or next-day access to a doctor or nurse, last for access to a specialist, last for waiting for non-urgent surgery, and last for waiting in emergency. Quebec was below the Canadian average for each of these measures, and the general picture has not improved since.
Moreover, after having waited all their lives for treatment, the most mortgaged Quebecers are still waiting to obtain a place in a place where they can end their retirement years. The wait has even increased in 2020, despite the hecatomb that the pandemic caused in CHSLDs. Even for those who do get a spot, the end of life in double or triple occupancy can taste bitter. An expert in eldercare has calculated that at the current rate, we will need 40 years to fill the need for places in CHSLDs …
Where is the money going?
What is the problem? In part, it is a question of resources. Canada – and by extension Quebec – has fewer doctors, fewer hospital beds, less devicesmedical imaging and less radiotherapy devices than most developed countries.
It is not, however, a question of money. Whether we consider the measure in terms of the amount spent per capita or in proportion to the size of the economy, Canada spends more than the average for developed countries, and Quebec is in the Canadian average, spending even a little more than Ontario.
Rather, the problem is where the money is going and whether it is spent in the most optimal and productive way. A question of allocation, innovation and incentives. More clearly: our health system is not very efficient, it does not spend in the right places, and all kinds of not very logical rules (to be polite) mean that it does not improve easily or quickly. This probably makes Quebec the place in the rich world where the term “patient” takes on its fullest meaning.
The gray tsunami
It won’t get better. About 800,000 Quebeckers are 75 years of age or over. In ten years, in 2031, they will be around 1.2 million, or 50% more than today.
For example, those aged 75 and over represent approximately 350,000 visits per year to our emergency rooms, out of some 3.7 million before the pandemic. A 50% increase in this age category would represent 175,000 more emergency room visits in a year. Our health care system is just not ready to handle this. This is without counting the impact of the aging of the population on cancers, joint ailments, and all the other problems that come with old age and which will explode the demand for care.
In short, the ailments plaguing our health system are of biblical proportions.
The good news is that there are so many solutions, often surprisingly simple and inexpensive, and very much compatible with the idea of a universal system accessible to all. All our decision-makers lack is a little will, imagination and pragmatism.
This is what we will explore over the next four texts, putting ideologies aside and focusing our attention on facts, data, and the experience of other countries that are more successful than us – we are going to look more at Europe than that of the United States – and see how we can import the best practices here, as much for the benefit of our parents as for that of our children and our grandchildren.
The first step will be to break down the barriers and counterproductive rules that slow down or block access to care.