EDITORIAL - Is it Health Care efficiency under attack or what?
At a time when everyone is asked to do more with less the bureaucrats of the Montreal Health and Social Services Agency have decided to target the Jewish General Hospital administration whose efficiency ratings established by the same health agency ranks first, (yes first, it is not a misprint) among major hospitals and second of all hospitals in Montreal. A budget deficit of $17.5 million on a budget totalling over $335 million dollars or 5% cost overrun has the board screaming bloody murder.
In a news story released to French media La Presse newspaper, administrators of the Montreal Health and Social Services Agency were quoted as being deeply concerned by the recurrent deficit of the Jewish General Hospital. Their experts have been mandated to verify human resources number of hours worked which have soared in recent years. Also activities related to the construction of a new pavilion intensive care, emergency unit as well as the management of the facility will also be scrutinized.
According to chief financial officer of the health and social services board in Montreal, François Lemoyne important questions remained unanswered to this day such as the number of employee hours billed which he insists the hospital is unable to explain. The Jewish General Hospital simply said that the increase is due to the fact that the volume of business is increasing. Lemoyne dismisses this response as he is quoted in the La Presse article saying, "The indicators that we have do not show that there is an increase in customers".
In fact according to an article published in the Montreal Gazette the number of outpatient visits at the Jewish General has soared by 72 per cent from 2007 to 2012. That includes visits to the emergency room. If that does not qualify as an increase in customers what does? Laurent Zini, the Jewish General’s director of finance noted that the hospital has also reported a 20-per-cent increase in the number of patient-days requiring acute care in the past five years with its associated higher costs. In addition, the hospital opened eight new beds in the intensive-care ward, requiring 24-hour monitoring. These numbers are public knowledge as they are reported to the regional boards.
The other fly in Lemoyne’s ointment is that agency officials had previously scolded the executive director of the Jewish General, Dr. Hartley Stern, concerned that the hospital’s Segal Cancer Centre was treating too many off-island cancer patients, and urged him to refer them back to health facilities in their regions (which in some cases had already refused to offer treatment due to budgetary constraints), while also complaining that doctors at the Jewish General Hospital deliver health care to patients who do not belong to the institution’s target population.
While the Jewish General has already offered $7 million worth of cuts not affecting patient care the agency is not satisfied. To resolve the standoff independent auditors have been mandated to find additional cuts that would not affect clinical care.
One has to wonder what in fact has motivated this belligerent attack on a very visible and successful health care institution. When one considers that most Quebecers do not have a family physician and most English speaking patients living in the 450 off island corridor have little or no access to health care services in English in their region is it any wonder that institutions like the Jewish General have been called upon to bridge the gap. The initiative to open a walk in clinic adjacent to the emergency services to which much of the emergency room traffic is redirected to has won acclaim as a working model that can successfully help fill the gap left in the system which lacks family doctors.
Unlike other hospitals the Jewish General facilities have also grown because of unmatched fund raising efforts and significant community donations. The E building extension which houses the Segal Cancer Centre was partly financed by a private $30 million donation. The hospital has numerous support auxiliaries and volunteer services that provide direct and indirect support to staff and patients alike. In fact one can argue that the Jewish General Hospital is the example of what a university affiliated, community hospital should be. The hospitals excellence is validated by the special clientele that have sought care in this institution including family members of three Quebec Premiers Bouchard, Landry and Charest.
So with the new pavilion soon becoming operational the question that has to be asked is, why allow and build extensions in this hospital if there is no intention to fund the expanded services. If you build it they will come is a field of dreams in health care because facilities do not provide services they house the human resources that do and human resources especially specialized ones cost a lot of money.
When Hartley Stern says that his cancer centre will not turn anyone away it is also with the knowledge that his staff were delivering care at a lower cost. Universality may be a principle of our health care system but it is not necessarily a quality that can achieve and aide efficiency. At a time when money is the primary concern it behooves bureaucratic agencies to be open to alternate approaches and to reward efficiency, innovation and effort.
The Montreal health board which would not answer the Gazette enquiries in this matter should take a good hard look at its own motivations. While the tone of the intervention in the French media was flagged as one of concern it can easily be viewed as scorn for an English institution that is slowly becoming the diamond in the rough of a health care system on the border of bankruptcy. The Quebec government will have to take a long hard look at what elements of our prized public health care system it can still afford.
The time has come when the principle of universal accessibility is no longer affordable and weighs down the system dangerously. For now this principle hampers the development of excellence and endangers future innovation. If efficiency, initiative and health care for all are not virtues that are rewarded by the bureaucracy then the day of accounting may be much closer than we think.