Citing the alarming state of Québec's public finances, Conseil du trésor chair Martin Coiteux warned that the remuneration of government employees might well be tied to their productivity in the very near future. It is hoped, so the explanation goes, that this will improve the system's performance and thus reduce costs.
Performance-based remuneration usually consists in adjusting pay to reflect individual contributions to the success of a business. If success is judged solely on the basis of costs, it has to be admitted that the contribution made by employees in Québec's public health-care sector means that remuneration should be highest in Québec!
Provincial governments in Canada spend an average of $4,083 per capita in public funding for health care. Québec is the province that spends the least: $3,735 per capita. This means that employees in Québec are currently asked to make do with less than in the rest of the country.
A little-known aspect of this is that, looking at government spending on health as a proportion of all program spending (composed of all provincial government spending less the cost of the debt), this proportion is lowest in Québec. On average, provincial governments spend 37.9 per cent of their total program spending on health, while the figure for the Québec government is just 30.7 per cent. In passing, you'll agree that this is a far cry from the alarmist rhetoric about "hitting the wall" of 50 per cent of the budget spent on health care!
So there's no denying that in terms of public costs, Québec's health-care system has the best performance in the country. So why are workers in the field of health not better paid?
Reduce costs by tackling the private sector and taking action upstream
If there is a real desire to reduce health-care costs in Québec, the savings have to be found elsewhere, in the components of the system that are in private hands. For example, why is Québec the province that spends the largest proportion of total health-care spending on medications -- 19.5 per cent -- compared to the Canadian average of 16.5 per cent? And what explains the fact that Québec has let spending on medications grow to $8.7 billion from 5 billion since 2002?
Of course, the performance of the health-care system is more than a mere matter costs. A productive health and social services is first and foremost a system that does an effective job of preventing illness, that succeeds in keeping its population healthy while guaranteeing access to services for all who are sick or injured.
In this regard, there is good reason to be concerned when we see that Québec has the lowest spending in Canada on public health (3 per cent of total spending compared to the Canadian average of 5.2 per cent) and when we see that it is in Québec that the portion of spending dedicated to funding hospitals is the lowest (27.3 per cent compared to an average of 29.5 per cent).
A few proposals for better health
To improve the performance of our system, government authorities have to begin by realizing that health and social services employees are currently the most productive in the country. So the government must avoid putting undue pressure on people who are already at the end of their rope.
It must also reinvest in prevention services and stronger primary care, so that workers in the system can take effective action on the social determinants of health. Finally, the government must put a stop to the dismantling of our public system and the transfer of its mission to the private sector.
This is the only way to improve the productivity of our public system, i.e., keep the population healthy longer and give access to services to all who need it.
For our part, we are very actively looking for solutions to ensure the future of our public health and social services. This is why we are organizing the first national Rendez-vous on the future of the public health and social services system bringing together all the various components of the system for the first time to consider its future.
For more information, please see the January 2014 Bulletin d'information sur les dépenses de santé comparatives tant à l'échelle canadienne que sur le plan international (Newsletter on comparative health expenditures Canada-wide and internationally).
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