McGill doctor to diagnose health care system

McGill doctor to diagnose health care system

Daniel McCabe | When it comes to political hot potatoes, you won't find any hotter in Quebec right now than the state of our health care system.

With ERs unable to treat patients for hours on end and Quebec cancer patients being shipped to the US for treatment, the state of health care tops the charts in terms of producing widespread anxiety.

Dr Howard Bergman

McGill's Dr Howard Bergman will play a leading role in the months to come in handling this particular hot potato. He hopes he doesn't get scorched in the process.

Last month, Bergman, an associate professor in the Departments of Family Medicine and Medicine and the director of geriatric medicine for both McGill and the Jewish General Hospital, was named to a special commission by health minister Pauline Marois.

The commission, headed by former Treasury Board president Michel Clair, has a broad mandate. It's supposed to determine Quebecers' core values with respect to the health care system — what are the elements that are widely viewed as absolutely essential. It will also look at how the system is funded, how services are delivered and whether user fees should become part of the health care equation.

When asked if he feels any nervousness over tackling this task, Bergman answers, "A tremendous amount." But he adds, "It's a good time to take a look at all of this," given the public interest in the subject.

The commission will begin hearing expert testimony from authorities from Quebec and other jurisdictions next month. Regional health boards will arrange for local consultations this fall. In October, the commission will hold formal public hearings featuring presentations from major groups and organizations — "universities, nurses' groups, unions, business groups," says Bergman, citing some examples.

In mid-December, the commission will issue its report, a report that is expected to have a major impact on how the government deals with health care.

Bergman says there has already been plenty of talk about the state of Quebec health care — existing studies already identify some of the major problems. "Our orientation is to look at all this from the point of view of offering solutions. It's not enough to talk about the problems. We have to propose ways of dealing with them."

He stresses that the commission, while set up by Marois, "is totally independent" of the government. The commission is free to present whatever recommendations it wants to.

Bergman is the only physician on the commission, but he doesn't feel any special pressure to represent doctors' views. "We're not representing anybody but ourselves," Bergman says. "I'm [on the commission] because I can offer a certain understanding of the health care system, I can offer my own experience." In any case, Bergman adds, "I have views about these issues that other doctors wouldn't have."

Some of those views are what likely got him named to the commission in the first place.

Together with the Université de Montréal's François Béland, Bergman heads a McGill/U de M research group that examines how the frail elderly receive health care.

Their work has been supported by the Quebec Ministry of Health and it has drawn international attention — according toThe Jerusalem Post, the Israeli health ministry is considering revamping its own delivery of health services to the elderly based on Bergman's proposed model.

Bergman believes that health care is too "fragmented" when it comes to older, frail Quebecers. Such patients bounce around from CLSCs to ERs to day hospitals to retirement homes without any one agency keeping a close tab on how they're doing.

Nobody is taking the time to track these patients' progress through the system or to thoughtfully put together a coordinated plan to look after their needs. For instance, other health care players are happy enough to consign the elderly to long — and expensive — stays in hospital wards because it means that "the money [for the patients' care] will be coming out of somebody else's budget."

Bergman and his collaborators propose a more integrated model, one where a central agency keeps watch over patients' progress. "Let's say, for argument's sake, this agency gets $20,000 a year for each patient it looks after. If Mrs J goes to the hospital, it has to pay the hospital."

Bergman believes such a set-up would encourage the responsible agencies to make sure that Mrs J doesn't stay in the hospital any longer than is necessary. It would also motivate the agency to invest in preventative medicine and see to it that Mrs J has easy access to vaccines and other treatments that will help to keep her healthy.

A pilot project testing these principles is currently underway. Backed by a $7.6 million grant from the Health Transition Fund, 13,000 patients are being tracked in the Côte-des-Neiges and Bordeaux-Cartierville districts. A joint effort with the Montreal Regional Health Board, the project will result in a report in January. According to a recently completed interim report, the approach seems to be resulting in "more preventive measures, greater use of community resources and less use of emergency room services."

Bergman suspects that Marois wonders if such a coordinated approach to patient care might pay dividends for the health care system in general.

"Is it just about more money? I don't think so," Bergman says of the health care system's woes. He likens the different players in health care to "a series of silos that sometimes talk to each other and sometimes don't." He thinks patients often feel lost in the system as a result and that's why the appeal of privatized medicine is growing.

Earlier this year, Bergman and François Béland published "Evaluating innovation in the care of Canada's frail elderly population" in the Canadian Medical Association Journal.