The public is painfully unaware of health-care options

With the McGill University Health Centre about to take possession of its new Glen Yards facility in September, the provincial government needs to start doing a better job managing public expectations about how the facility will operate amid larger changes

As it is, wait times for emergency treatment within the MUHC and Centre hospitalier de l’Université de Montréal networks are very long. And with experience elsewhere showing that patient visits rise 20 per cent in the first year after a hospital move — because people are curious to see the new complex — the Ministry of Health has undertaken an effort to redirect new-patient demand for front-line services to clinics and community hospitals. However, the government has done a very poor job promoting public awareness of this new effort.

Ten years ago, the former Charest government tried to take pressure off downtown ERs by creating local networks to improve local delivery of routine care. In the Montreal region, there are 20 such networks, known as Centres de santé et de services sociaux, overseeing general practitioners, clinics, hospitals, rehabilitation centres, assisted-living facilities and nursing homes within their territories. The idea was to have these CSSSes bring patients closer to home, and to free up the teaching hospitals for more complicated health-care delivery.

But the CSSS virage, instituted by current Liberal Leader Philippe Couillard when he was minister of health in 2004, never really succeeded. Now, with the two teaching hospitals expected to be up and running by 2016, a sense of urgency has set in. CSSSes are under pressure to drive transformation in patient attitudes and behaviour — but government funding for the facilities under their management has fallen short of what is required.

If Montreal were an American city with a private health-care system run by insurance companies, Health Maintenance Organiza- tions (HMOs) would be telling people where to go for treatment. But one of the hallmarks of the Quebec, and Canadian, public system is that patients have freedom to choose where they go. So policies in Quebec designed to change patterns of patient demand need to recognize this reality.

One problem in Montreal is that 30 per cent of the population does not have a family doctor, even though Montreal has more doctors per capita than many other Canadian cities. As a result, too many people routinely show up at hospital ERs looking for basic front-line care.

To their credit, the CSSSes have done a good job helping people find family doctors. People who phone a CSSS and ask to be assigned to a doctor are usually able to get one. The government needs to do more to promote awareness of this matching-up success.

More also needs to be done to improve the quality and reputations of community hospitals. In the West Island region, rightly or wrongly, there is not a high level of confidence in Lakeshore General Hospital. Many families prefer to scoot downtown in the event of a perceived ER need. In off-island suburbs, there is a similar prejudice against community hospitals, and preference for Montreal Island options.

Changing patient attitudes and behaviour will not be easy. But it is a challenge that has to be met, and one that logically must fall primarily on the three regional health agencies — one each on Montreal Island, in Laval and in Longueuil — that oversee the 20 CSSSes in Montreal. This is, after all, a metropolitan problem. These three regional agencies are among 17 Agences de la santé et des services sociaux that employ more than 1,000 bureaucrats in total. They have to start delivering on change.

Time is running out. The MUHC’s move to the Glen will take place over six months beginning this September, and Phase 1 of the CHUM’s transfer of clinical services will be completed in 2016. People are going to be angry if these two “superhospitals,” as the public calls them, open up with great fanfare and then spend a lot of their time redirecting people for routine services elsewhere. The government needs to be able to demonstrate to Montrealers a clear advantage to being served closer to home.