An idea for fixing what ails Quebec’s hospitals
There is some dispute as to why it is so difficult to to get a timely colonoscopy at Quebec hospitals.
As The Gazette reported this week, the Royal Victoria and Montreal General hospitals are systematically turning away patients requesting the procedure, even those who have symptoms that might indicate the onset of colon cancer.
It is a problem not only at these two hospitals but provincewide, where wait times of up to two years are common.
Authorities at the two McGill University Health Centre hospitals say the refusals are due to an overwhelming volume of requests coming on top of a significant backlog of people awaiting testing.
The reason for that, according Barry Stein, president of the Colorectal Cancer Associa- tion of Canada, is a shortage of resources to cope with the growing demand. According to Quebec Health Minister Réjean Hébert, on the other hand, the problem is hospital mismanagement.
Whatever the reason — and perhaps there is some truth on both counts — the situation is unacceptable.
Colorectal cancer is the second-highest cause of cancer-related death in the province, yet it is eminently preventable if diagnosed at an early stage.
People over 50 are strongly urged to get a colonoscopy, even in the absence of warning symptoms, and to have the procedure repeated at least once a decade. The aging of Quebec’s population accounts for the steadily increasing need for colonoscopies to be readily available.
One way of responding to the situation, as suggested by the health minister, is to broad- en the use of a relatively simple stool test that can reliably detect early warning signs of colon cancer.
It is not as complicated, invasive or costly as a colonoscopy. But some experts suggest this will actually cause a bump in the demand for colonoscopies because followup tests will be needed in some cases.
One frequently suggested way of dealing with wait times for such procedures is a shift in the way hospitals are funded.
It would mean moving from the present system, whereby budgets are essentially allocated on the basis of previous budgets, to an activity-based system, whereby hospitals are funded on the basis of the number of patients they serve and the treatments they provide.
Proponents of the change say that under the present system, patients are seen as an expense, whereas under an activity-based system they are viewed as an asset that hospi- tals compete to serve. Activity-based funding is said to favour innovation and expansion of services, both of which the present system discourages.
It has been instituted in other parts of the world, notably Britain and Scandinavia, and wait times have been substantially reduced. It is perhaps not a panacea, but it is a promising remedy for an ailing system.
Quebec’s former Liberal government set up a committee of experts last year to study the possibility of implementing activity-based hospital funding here. That committee should receive the encouragement and resources it needs to reach a conclusion in the shortest possible order.
Lack of access to essential health procedures should certainly be a greater preoccupation for the provincial government than fretting about what the providers of health-care wear on their heads.