THE BLOG
05/31/2014 07:03 EDT | Updated 07/31/2014 05:59 EDT

Healthcare Funding Is Not the Problem. It's How We're Using It

Scientific and technological developments mean that people with complex health problems are living longer, with a better quality of life. If we want to maintain this quality of life, we have to bank on the contributions and expertise of all our nurses. I can already hear our detractors saying, "You're doing that so as to demand more pay for nurses!"

Last week, I talked about the urgent need to reform the way doctors are remunerated. This reform would have major, very positive consequences on our capacity to reorganize our services to meet the needs of the population in much more acceptable timeframes. Briefly, what was the context in which I made this proposal?

We propose three reforms and a truly audacious moratorium that would provide permanent control of rising costs in the health-care system without reducing the purchasing power of unionized employees in the system year after year, and without reducing services to the population.

1. Overhaul how doctors are paid;

2. Review the contribution of other health-care professionals, in particular nurses;

3. Stop acting powerless about the rising costs of prescription drugs (Rx);

4. Stop cutting back on support services.

Review the contribution of health-care professionals

Another priority in the reorganization of services would be to review the contribution of health-care professionals, in particular nurses. We know that we don't make optimal use of nurses' skills and qualifications, especially in hospitals, CHSLDs and primary care. The reform of the method for remunerating doctors would make it possible to review the organization of work of care teams that use the strengths of each team member (specialty nurse practitioners, nurses, nursing assistants, respiratory therapists and attendants, all of whom are essential).

For today, let's concentrate on nurses. We can see that there are more and more nurses opting for the combined college-university (DEC-BAC) training. These professionals have developed tools for making a greater contribution in the health and social services system. If there was a real political will to recognize their competencies, this would free doctors from some of the work they now do, giving them time to work with more patients -- for example monitoring patients with chronic health problems more closely. Nurses' training enables them to carry out interventions in increasingly complex specialties, be it in the emergency department, intensive care or primary care.

It is obvious that we will have to set aside turf wars between professional orders and the college of physicians. The professional orders have to work together to see how the contributions of each professional on the care team can preserve free access to quality services for the population. For the time being, some orders seem to work in silos, while others run up against against the College of Physicians or the federations of physicians. We know that the outcome of the recent work done by the Ministry of Health and Social Services was a consensus on promoting the DEC-BAC training for nurses to meet the needs of patients.

Care has become increasingly complex. Scientific and technological developments mean that people with complex health problems are living longer, with a better quality of life. If we want to maintain this quality of life, we have to bank on the contributions and expertise of all our nurses. I can already hear our detractors saying, "You're doing that so as to demand more pay for nurses!" It's true that if their work is more complex, they will have to be paid more. But paradoxically, even if they are better paid, it will still be less expensive for the system!

With this reorganization of teams, we would be able to intervene faster with patients. We could thus avoid the numerous complications that occur and make the waiting lists even longer. We would avoid the additional interventions that become necessary because people have to wait too long. This would also help reduce the length of hospital stays and reduce the number of visits to the emergency department. All this would reduce costs for the health-care system.

Nurses aren't paid on a fee-for-service basis; they are hourly rated employees. Banking on their competencies would reduce working in silos. Furthermore, their work is not overly influenced by how they are remunerated.

Nurses are enthusiastic about the idea of contributing more

With these two reforms -- of the method of remunerating physicians and of the contribution nurses can make -- we would free up a lot of money that could be used to improve the system without asking the population to contribute more. Let's debate the real issues.

Next week, we'll discuss inflationary pressure on prescription drug costs, which have resulted in skyrocketing expenses for government and for the population.

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