Concerns about increasing use of ambulatory care raised at QMA annual meeting

Steven Wharry

Canadian Medical Association Journal 1996; 154: 1755

Steven Wharry is associate editor of CMA News.

In Brief

Quebec Health Minister Dr. Jean Rochon is pushing for a regionalized health care system that favours ambulatory care, day surgery and home care over hospital admissions and acute care in hospital. The Quebec Medical Association is concerned these changes will lower the quality of care in the province.

En bref

Le ministre de la Santé du Québec, le Dr Jean Rochon, veut faire prendre au système de santé de la province un virage de régionalisation reposant sur les soins ambulatoires, la chirurgie d'un jour et les soins à domicile, plutôt que sur l'hospitalisation et la prestation des soins actifs en milieu hospitalier. L'Association médicale du Québec craint que ces changements nuisent à la qualité des soins dans la province.

Quebec physicians are warning that the province's recent push to cut health care costs by emphasizing ambulatory care could mean difficult working conditions for physicians and a lower quality of care for patients.

"I am very worried because I see physicians seeing more and more patients with fewer and fewer tools to treat them," Dr. Jean-Bernard Poirier, a family physician from Rimouski, told the 58th annual meeting of the Quebec Medical Association (QMA) in April.

At issue is the Quebec government's "virage ambulatoire" -- its shift to ambulatory care -- that transfers patient care from hospitals to ambulatory-care centres whenever possible. Dr. Jean Rochon, the health minister, has plans that call for community clinics to replace many acute-care hospital beds. The reforms could mean that 3000 hospital beds disappear.

The Quebec government will close five hospitals in the Montreal area and change two others to long-term-care centres by the end of 1996, while Quebec City is losing three acute-care hospitals. Critics of the plan argue that community clinics are not prepared to deal with the large influx of patients that will result because of hospital closures.

"Montreal is on the cutting edge of the deterioration of health care services," said Dr. Mark Roper, who practises family and emergency medicine in the city. "When will the public realize their health comes before some utopian principle being chased by the government?"

With the shift to ambulatory care, Rochon is also pushing for more day surgery, home care and regionalized plans for health care delivery.

In 1991, Quebec became the first province to embrace regionalized health care delivery. The province created 18 regions, each with its own board of representatives, to decide health care priorities in each region. Since the inception of the regional boards, however, the question of who should serve on the boards has been contentious. "Regionalization is a bad joke," Poirier told colleagues. "There is a real problem with the system."

Participants at the annual meeting also debated what roles other health care professionals should have in treating patients, physician remuneration, the ethics of regionalization and new training requirements to help physicians respond to regionalized care.

Most participants agreed that the key concern arising in any plan to reform health care delivery must be the guarantee of quality care for all patients. Dr. Jack Armstrong, the CMA president, told the meeting health care reforms do not always mean better care for patients. "I think quality of care has dropped tremendously as a result of health care reforms and cost cutting," he argued. A key issue, added Armstrong, is that governments are implementing regionalized plans without researching their effectiveness.

"Regionalization is like a prairie brush fire sweeping across the country," said Dr. Armstrong. "If 5 years down the road we find out it wasn't the way to go, we'll have wasted a lot of time and effort."

| CMAJ June 1, 1996 (vol 154, no 11) / JAMC le 1er juin 1996 (vol 154, no 11) |