It’s a hospitable ability, you idiot

In 1970, Canada had 7 hospital beds per 1,000 residents, up from 2.5 in 2019 (Photo: Getty Images)

Economic analysis. I love paraphrasing a famous quote from James Carville (It’s the economy, you idiot), Bill Clinton’s strategist during the 1992 US presidential election, because it shows what really matters. The main lesson to be learned from COVID-19 is that hospital capacity in Quebec must become the priority so that a health crisis never causes a crisis again. story our economy.

Of course, in the coming months, vaccination, treatment and natural herd immunity will be our main tools to defeat the epidemic. Eventually, we will also learn how to better manage health risks, and then live with SARS-CoV-2 that causes COVID-19, when it is in an endemic form, like the influenza virus that causes seasonal influenza.

On the other hand, if Quebec does not finally increase the capacity of its hospitals to make its health system more resilient, then one day we will face the same social and economic crisis that we have been mired in since March 2020.

We may even have a hard time managing the annual peak of COVID-19 in an endemic form…

Nobody wants to star in this bad movie again.

One statistic should convince you that Quebec should indeed prepare for the next health crisis.

Between 1940 and 2004, there were outbreaks of more than 300 infectious diseases in the world, including HIV, Ebola, West Nile virus, H1N1 and SARS, journalist Sonia Shah revealed in her seminal article Pandemic: Tracking epidemics, from cholera to coronaviruses (Published 2016, but recently translated into French.)

I am not a health systems specialist.

On the other hand, I understand that the Government of Quebec – like the rest of the governments in the world – impose health measures and restrict our freedoms in order to protect our health system under pressure, and therefore its ability to treat our patients. sick citizens.

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It’s the right thing to do under these circumstances, and it can’t be repeated enough.

Strict system security measures

However, if Quebec had more capacity in hospitals, the government might not have needed to impose a second curfew, and then close restaurants, cinemas, theaters and gyms, not to mention restrictions on gatherings in private housing (among vaccinated people).

France was also hit hard by the Omicron variant.

But restaurants are still open and the government has not imposed another curfew as it has in previous waves. On the other hand, wearing a mask has again become mandatory on the streets of Paris and in part of the Ile-de-France region.

On Wednesday, January 5, France recorded 332,252 new cases of infection within 24 hours, which is a new record. All things considered, it’s as if Quebec recorded 42,151 cases in one day…

On Tuesday, January 4, Quebec Public Health registered 14,194 in the past 24 hours, with a daily average calculated over seven days at 15,221.

The quality of the French health system – one of the best in the world – is not related to its great flexibility.

In 2019, France had 5.8 hospital beds per 1,000 inhabitants (purple bar in the graph below), according to the latest international comparison data from Organization for Economic Co-operation and Development (OECD).

In terms of the number of hospital beds per 1,000 inhabitants, the world champions are Japan (12.8) and South Korea (12.4). (Source: OECD).

By comparison, Canada had an average of 2.5 (in 2017, Quebec had 2.7 beds per 1,000 inhabitants, according to the Statistical Institute of Quebec), slightly less than the United States (2.8).

The world champions are Japan (12.8), South Korea (12.4) and Russia (8.0). Germany is not far off, in fourth place, with a rate of 7.9 beds per 1,000 inhabitants.

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Of course, this statistic is an imperfect order of magnitude, because it confuses acute care beds with critical care capacity. However, it allows us to take into account the lack of capacity of the Canadian Hospital and Quebec.

However, this was not always the case.

In 1970, Canada had 7 households per 1,000 people Historical analysis by the University of Sherbrooke.

Higher costs, lower risks

Increasing hospital capacity in Quebec will undoubtedly increase the costs of the health system, while Health already accounts for 43% of the Quebec government’s budget And that this job is increasing by more than 5% annually.

Raising the health budget to 50% of all government spending, for example, would necessarily force Quebec to cut other state tasks and raise taxes. We can certainly demand an increase in federal health transfers, but in the end, it’s the taxpayer themselves who pays…

Another great interest in increasing hospital capacity is the availability of human resources, emphasizes Pierre-Luc Fournier, a professor at the University of Sherbrooke’s School of Management and a specialist in operations management in the health system.

“We must find staff (nurses, doctors, etc.) in the context of labor shortages,” he says.

For example, the Quebec government will never be able to double the number of hospital beds per 1,000 inhabitants to 5 if there are not enough people available on the ground to make those beds work. Because a bed without a nurse is useless!

Make public order more attractive

So we must find a way to recruit new people in the coming years, insists Mr. Fournier. how? By enhancing the value of the nursing profession and providing better working conditions.

A health system executive, who prefers to remain anonymous, is proposing to increase the number of vacation days offered to employees (flexible and adapted to their needs) in order to attract more employees to the network.

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Teachers have two months off during the summer.

Why not offer these terms also to nurses, who are always at the end of their rope, and whose leave culminates in five weeks after 25 years of service?

In a discussion forum on this topic with colleagues at the University of Sherbrooke’s MBA, three of them also raised interesting points in an effort to increase hospital capacity in Quebec:

  • Planning and resource allocation in hospitals must be improved.
  • The migration of employees from the public sector to the private sector, where working conditions are more attractive, must be stopped.
  • Staff efficiency for each hospital bed should be increased by automating some administrative tasks where possible.
  • Selection criteria should be relaxed in order to increase the number of medical students.
  • There should be mandatory basic care courses in CEGEPs, particularly in order to learn how to vaccinate. Thus, in times of health crisis, the government will have “reserve soldiers” to vaccinate the population, thus reducing the demand for nurses outside hospitals.
  • There should be more recognition of the skills and credentials of internationally trained doctors and nurses.

At the risk of repeating my words, all of these actions will entail significant additional costs to the Quebec government, but we will also reap benefits or, better yet, avoid costs.

Because that is the question to ask: How much will it cost us collectively, economically, socially and culturally, the confinement of the population and the periodic shutdown of several sectors of the economy, not to mention the deterioration of mental health?

And I’m not even talking about the loss of social cohesion, which all societies systematically underestimate.

Let’s get our calculator out!

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