The Health Commissioner should report directly to the National Assembly
Danielle McCann, Minister of Health and Social Services, has announced that a new Health and Welfare Commissioner is expected to be appointed in June. This is good news! Given that the health and social services system accounts for more than 50% of program expenditures, it is essential that its performance be assessed, and neither the department, nor the network, nor its stakeholders are able to do so independently.
Let’s be honest, who else but the Health and Welfare Commission would have dared to survey the public about the care and services included in the basket of services and therefore covered by the province? Who else could have demonstrated, in one report after another, that there’s a problem with access to data in our healthcare institutions, on the front lines and within the department itself? Who else would have collected unpublished data for Québec from the Commonwealth Fund (CWF) International Health Policy Survey to compare the province’s performance with that of other systems? And finally, who else would have had the courage to fund not just one, but two independent studies to assess the effects of physician compensation payment methods on access to care?
The Commission has proven its worth over the past 10 years
The Health and Welfare Commission was created in 2006 by then Minister of Health and Social Services Philippe Couillard. Over the years, the QMA has been involved in many of the Commission’s initiatives. The QMA is also the only association that worked with the Commission until it was dismantled, making it possible to disseminate the results of the research it funded on physician compensation methods.
Although many people expressed doubts about the creation of the Health and Welfare Commission, it proved to be very productive. The Commission’s thematic reports addressed key issues such as primary care, chronic diseases, mental health, aging, etc. Its performance studies (emergency, CWF, etc.) and opinions on new legislation (medically assisted reproduction, end-of-life care, etc.) helped inform the public on complex issues.
Year after year, while continuing to rely on rigorous studies and conclusive scientific evidence, the Health and Welfare Commissioner demonstrated increasing incisiveness. The Commissioner brought the debate on health care issues into the public domain while addressing increasingly political issues such as the basket of insured services, accessibility, safety in health care, and physician compensation methods.
An essential role whose independence must be safeguarded
It’s not surprising that some people wanted to silence this independent and increasingly influential voice. By cutting off funding to the Health and Welfare Commission, the Liberal government surprised many people in 2016, just as it did again in May 2018, when it announced the reinstatement of the Commissioner just a few months prior to the impending elections.
To avoid seeing the same tactics used by future governments, we must ensure that the Health and Welfare Commissioner reports directly to the National Assembly—a position we’ve held since the very creation of the office. It’s been clearly proven that when the Commissioner and his team are seen to be causing too much trouble, the simple solution is to cut off their funding. Likewise, it’s dangerous to give governments the final say in his appointment—as stipulated in the Act respecting the Health and Welfare Commissioner—as this can expose the Commissioner to political pressure. Because appointments are made by the government, they are always considered to be political.
However, in order to be relevant, the role of the Health and Welfare Commissioner must be neutral and objective. His independence will enhance his credibility and lend more weight to his recommendations. For that to be the case, the Commission must be protected from political interference. Let’s not forget that the Health and Welfare Commission’s ultimate goal is to improve the health and well-being of the people of Québec. It is therefore in our best interests as caregivers, as well as in the best interests of our patients, that we as physicians demand that the Commissioner be appointed by and accountable to the National Assembly.
Dr. Hugo Viens, B.Sc., M.D., FRCSC
President, Québec Medical Association
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