Quebec has increased its announcements this winter to reduce the administrative burden on family doctors. Each measurement is accompanied by an estimate of consultations saved. “When you add up all the appointments that would be better rerouted with this reduction in paperwork, we’re talking at least 750,000 appointments. It’s still huge! », boasted in May the Minister of Health, Christian Dubé. However, this was before the confirmation of additional measures. Quebec estimates that it will save between 868,000 and 917,000 consultations per year with what has been presented to date (SEE BOX).
But how does Quebec arrive at these figures? The Legault government’s estimate has its limits, admits the assistant deputy minister at the General Directorate of Strategic Planning and Performance at the Ministry of Health and Social Services (MSSS), Marc-Nicolas Kobrynsky. “It’s not perfect. I don’t have a doctor’s code that tells me that the patient came to get a ticket,” he illustrates. According to him, the inputs (data at the source) “are very firm”, but the rest is mostly based on a “most conservative possible” hypothesis which is based on “common sense” and what is reported from the field.
Let’s take a specific example. Quebec estimates that it will recover 135,000 appointments per year by giving doctors the power to determine the frequency of medical follow-ups for a person with a disability, rather than this being established by the private insurer. Some 2.9 million Quebecers are covered by disability insurance, according to the Canadian Life and Health Insurance Association. The disability rate is 6% per year. This means that 180,000 people find themselves on short- or long-term disability each year. Quebec then hypothesizes that it can at least eliminate one appointment in 75% of cases, which gives some 135,000 appointments saved per year.
In education, the absence of data makes the exercise more complex. Quebec estimates that it will save between 50,000 and 99,000 appointments by eliminating the obligation to have a medical note to justify an absence of five days or less or during an examination. However, some schools require it, others do not. “No one has any figures on that,” Mr. Kobrynsky admits. In universities and colleges, it is particularly common to ask for tickets. In the school network, it is uncertain, and Education did not know it either. » The evaluation is therefore based on an unvalidated hypothesis of an absenteeism rate of 2% (for reasons which require an absence ticket). “Mr. [Bernard] Drainville decided on 50,000 because we don’t know. I have no stake,” adds the deputy minister, who nevertheless believes that the evaluation is reasonable due to the large pool of students.
Although some are questionable, Marc-Nicolas Kobrynsky is “very comfortable” with the estimates presented. “Everyone would have liked more precise figures, but they don’t exist. Did I have a year and a half to continue sampling? I don’t think so, I think there is an urgent need to act [to relieve congestion on the first line],” argues the deputy minister, whose mandate is to improve the performance of the system. “We acted and afterwards, if our estimates are not completely precise, I am comfortable with that,” he maintains, recalling that the MSSS is based on issues raised by doctors. The government chose to present data, even imperfect, because “it is requested by civil society, journalists” and even by the Ministry to justify the deployment of measures. These modifications may also “lead to other initiatives” in the months to come, always with the aim of reducing the administrative burden on general practitioners.
Quebec promises to measure the success of its measures by creating “a small sampling tool” which will be deployed in December in a certain number of clinics. “At the end, we will be able to see, according to our estimates, whether we saved the appointments or not. If we continue to have them, well we [will] have a problem,” explains Mr. Kobrynsky. The tool will be “as light as possible” and “statistically valid”. The Deputy Minister reminds us that we must first wait for Jean Boulet’s bill, tabled at the end of the parliamentary session, to be adopted. The legislative text should be studied next fall.
Following the presentation of Minister Christian Dubé’s Health Plan, the Ministry of Health and Social Services is implementing the “reduction of the administrative burden on doctors” project, nicknamed the “paperwork committee”, in February 2023. he objective is to reduce the administrative burden on general practitioners by 10% to “ensure maximum availability of doctors to the Quebec population.” The Federation of General Practitioners of Quebec (FMOQ) collaborates in the work of the government.