March 31, 2006 — Le Protecteur du citoyen

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Special consultations and public hearings on the Minister of Health and Social Services' document Guaranteeing access: the challenge of equity, efficiency, and quality

Summary

Comments by Le Protecteur du citoyen presented to the Social Affairs Committee

Québec City
March 2006

Since April 1, 2006, Le Protecteur du citoyen has been fulfilling the duties that previously fell to the Health and Social Services Ombudsman. While this brief was submitted prior to April 1, it was prepared and drafted in collaboration with the Health and Social Services Ombudsman and Le Protecteur du citoyen and based on their respective experience. The comments by Le Protecteur du citoyen are therefore based on an understanding of the problems brought to light by the complaints it examines under the Act respecting the Health and Social Services Ombudsman, as well as on its experience as Public Protector with regard to the government and its programs.

In debating the issues raised in the consultation document with regard to organization of services and long term funding in the health and social services system, we must keep the following values in mind: equality and equity, solidarity, and the freedom of individuals to make informed choices. The principles of accessibility and universality must be reaffirmed and should continue to guide the government in its decisions.

Le Protecteur du citoyen believes that preventive actions must take into account individual physical and social needs so that all socioeconomic health determinants are addressed. We must avoid penalizing certain categories of individuals by only seeking to modify behaviors and not accounting for the individual’s ability to act. This ability must be analyzed in light of their socioeconomic, physical, and mental situation, as well as their autonomy and human dignity.

A review of complaints received reveals the real difficulties many users—particularly the less affluent—have gaining access to services. Le Protecteur du citoyen believes access to affiliated specialized clinics and private health insurance plans may be attractive solutions, provided they guarantee better access to health services. However, these options must not be considered solely from a standpoint of enhanced services. This broader vision must also be consistent with the respect of individual values and rights, regardless of whether patients use public or private-sector health and social services.

This is the basis for the recommendations to the Health and Social Services Minister aimed at creating a normative framework for affiliated specialized clinics. Recognition criteria, service quality standards, and control measures will have to be drawn up for these clinics, and the authority in charge of applying them must be determined. These clinics must also be subject to a certification process, meet safe service delivery requirements, and have a code of ethics just like public network institutions offering the same care and services.

Le Protecteur du citoyen believes users should have access to the complaint review system, including to the medical examiner or review committee, regardless of whether the service provider is a public institution, an affiliated specialized clinic, a private physiotherapy clinic, or an organization offering home support services.

Moreover, Le Protecteur du citoyen is of the view that the difficulties Quebecers face in obtaining rehabilitation and home support services should be addressed in detail to gain a clearer understanding of the challenges regarding user rights and to ensure equity among all users—workplace and highway accident victims, those with insurance, and those without.

Le Protecteur du citoyen has also made recommendations on the right of users on waiting lists for cataract, knee, or hip surgery to be kept personally up to date on their status. Waiting list management must also follow parameters that take into account the situations individual users face and the patient management capabilities of the clinics that will treat them.

Le Protecteur du citoyen also recommends that the Minister of Health and Social Services review the rules of the various policies and programs granting financial assistance to users who must travel to receive care and services at another institution, with a view to ensuring equity. Users referred in this way should not have to cover costs they wouldn’t have incurred if they had been treated in the public system.

Lastly, with regard to the creation of an insurance plan for the frail elderly, Le Protecteur du citoyen reminds the minister that the values of equity, transparency, and equality must prevail. There are too many unanswered questions at this time to take a firm stand on such a plan.

Recommendations

That the Minister of Health and Social Services make public the normative framework for affiliated specialized clinics, and that this framework include criteria for recognizing these clinics, measurement standards for the quality of services they provide, control measures imposed on them, and the authority in charge of applying these criteria, standards, and measures
That the Minister of Health and Social Services amend Section 107.1 of the Act respecting Health Services and Social Services to require affiliated specialized clinics to obtain certification for the health and social services they deliver, just like public network institutions that continue to offer these services
That the Act respecting Health Services and Social Services be amended to allow users referred by the public sector, through service agreements, to have access to the medical examiner and review committee to ensure the respect of their rights laid out in the Act, thereby giving them the same rights and recourses as in the public system
That the Minister of Health and Social Services ensure that the health and social services complaint review system be available to users referred by an institution for rehabilitation and home support services, regardless of which service providers the clinics sign contracts with
That the Minister of Health and Social Services lead broad-based discussions on the difficulties individuals face accessing rehabilitation and home support services, to ensure equity in patient management that reflects the individuals’ real needs, regardless of which plan covers the cost of these services
That the Minister of Health and Social Services ensure that institutions regularly update users on waiting lists for cataract, knee, or hip surgery, in a personalized manner, as per Section 8 of the Act respecting Health Services and Social Services
That waiting list management be entrusted to a central authority whose mandate is to define parameters that take into account user specificities and the patient management capabilities of the clinics to which they are referred
That the Minister of Health and Social Services review all the rules of the policies and programs for granting financial assistance for travel to users who cannot receive the required services at their initial place of treatment
That the Minister of Health and Social Services ensure that users who are referred to affiliated specialized clinics not have to cover any fees they would not have incurred if they had been treated in the public system

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