Politics and Preventing Overdiagnosis
In his conference opening address, the Minister of Health and Social Services, Gaétan Barrette, acknowledged the overdiagnosis issue and its impact on the health care system in Québec. “There is no doubt that overdiagnosis exists, and that procedures are performed that shouldn’t be,” he said. He also admitted that “money could be used differently.” In 2014, the QMA calculated the waste to be $3 billion, based on studies that have since been confirmed. However, the Minister estimated the amount to be $650 million, since he took only the unnecessary procedures into account and not their consequences. “These $650 million correspond exactly to the cuts in health care in the last three years. These disruptions in the system could have been avoided if the system had tackled overdiagnosis earlier,” responded QMA president Dr. Hugo Viens in a press release.
Nevertheless, the Minister acknowledged that savings could be made. To do so, he felt that “it was necessary to change behaviour.” A change that had to come from the medical establishment itself. That is why he needed the collaboration of the QMA, a “neutral” and “non-partisan” association that “can reach out to both family physicians and specialists in the field to start a conversation.” The Minister felt that persuasion would be required to successfully convince everyone to “have an organizational structure making it possible to maintain the ongoing quality of the actions taken and to promote good practices.”
It is in fact necessary to promote the dissemination of good solid information and the acceptance of evidence-based practices. “It is not simple, but it can be done. It starts with a small group that becomes a medium group that becomes a big group. And that is where we are,” pointed out Mr. Barrette before concluding that it was also necessary to engage the patients.
Of course, the QMA accepted the hand offered by the Minister. However, it is waiting to see how he plans to implement his desire for collaboration.
The Opposition’s position
Diane Lamarre, the Official Opposition critic for health and access to care, attended the conference and used the opportunity to meet with journalists. She questioned the Minister’s sincerity about taking action. According to the PQ member, solid data about many procedures and tests already existed. “With Choosing Wisely Québec we now have treatment guidelines that tell physicians what should be prescribed. Why should we not have treatment guidelines for what should not be prescribed, whether it is procedures, lab tests, medical imaging or drugs?” she asked.
In her opinion, Québec had fallen significantly behind whereas it had once been at the leading edge of this issue in 2013 thanks to the QMA’s work. Alberta and Manitoba had already succeeded in greatly reducing tests, with the agreement of physicians. “Who is responsible for managing the health budget?” she asked. “It is the Minister. And yes, it must be done in collaboration with physicians, but it is up to the Minister to take the initiative and bring the people together and tell them he wants to reach those targets quickly.”
Ms. Lamarre also criticized the Minister for having abolished the Health and Welfare Commissioner who could follow up on current practices. “The Commissioner’s reports allowed us to detect the signs of an overuse of medication, and the poor use of tests. And he abolished that for $2 million when there are millions of dollars to be saved.”