Solidarity health clinics

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swallow swallow's picture
Solidarity health clinics

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swallow swallow's picture

With the lack of family doctors in much of Quebec reaching extreme levels, there seems to be a movement towards not only more use of private medicine, but also towards a cooperative model. "Solidarity clinics" are being formed in which cooperative members (by paying a membership and annual fee and taking part in collective governance) can access a range of services, including access to a doctor who is paid by the Régie de l'assurance maladie. I'm told there are now 40 of these across Quebec, almost all in poorly-served rural areas, with community ownership of the project. I'm joining one myself so that my son can access medical services when needed, and we will clearly enver find a family doctor in out here in "the regions."

The purpose is pretty clearly to get access to services that the RAMQ does not provide, but it remains public health care since the doctor is paid by the RAMQ. A good model to address the multiplying problems in "the msot efficient health care system in Canada," or are there better answers? 

shartal@rogers.com

As someone from Ontario I do not fully understand this post. Are these services covered by publicly funded health care or is this some form of a private health care system?

swallow swallow's picture

Depends if you like them or not. Supporters call this public medicine with increased community ownership. Oppenents, and right-wing supporters, call it a hybrid public-private system. 

The doctor's pay is paid by public medicare. Additional costs are born by coop memebrs through annual dues. 

What I'm debating is whether this is a community-based model that shoud expand, or creepign privatization of health care that needs to be nipped in the bud. 

lagatta

Originally, the CLSC system was supposed to be community-based and democratic, and doctors were on salary like other healthcare professionals. It was never generalized as originally planned, which would have prevented so many problems. And while some doctors would have moved elsewhere in Canada or to other countries where they would earn higher pay, it takes a lot for people here (in particular francophones, but not only) to move to other Canadian or North American locations).  Other than cultural familiarity, good food (doctors are notorious foodies) etc, medical professionals could find good houses with vintage and style, for much cheaper prices than in newer, blander places.

Before the CLSCs, there were some community-based clinics. I'm more familiar with those in urban areas here, but I believe there was also a movement to create them in smaller towns and rural areas (perhaps related to the caisses populaires and progressive Catholics?)

http://ccpsc.qc.ca/en/node/12 History of the Pointe-St-Charles community clinic

As cco said in another thread, corruption and collusion play a major role in the lack of funds for health and other services (and for pension funds). Many of us questioned the need for two new "super hospitals" rather than simply building state-of-the-art facilities for some new medical and surgical procedures and incorporating them in the many existing hospitals here. Building those was a gift to the construction industry and other cronies, and the abandoned hospitals, some of the most historic and well-located major sites in Montréal, are giving speculators greedy dreams.

Imagine the publicity for Hôtel-Dieu or Royal-Vic Condos, with spectacular views of Mt-Royal and lovely old stones.

http://fr.wikipedia.org/wiki/Centre_local_de_services_communautaires

There is also a wiki article in English, but it is even more of a stub than the French version, and neither gives a sense of the desire for a more democratic form of health care in the wake of the Quiet Revolution.

Slumberjack

It's not that there is a lack of doctors, just a lack of doctors willing to take up family practice.  They prefer the more lucrative fee for service walk in clinic model where they reap the same benefits per patient as a family practice physician, but do not have to also ensure continuity of care to individual patients.

Bärlüer

If you read French, here are two documents that might be of interest.

The first one is an article published in a health law & policy journal, authored by jurist Marie-Claude Prémont and Réjean Hébert (before he became minister in the PQ government). It expresses some serious reservations about the development of these coops as it currently unfolds.

The second is a report by a working group mandated by Réjean Hébert (once he had become a minister). Among other recommendations, it suggests that the legal framework be reviewed so that the principle of universal access is not undermined by subjecting it to payment of annual fees, etc. (as can easily happen in the context of coops).

sherpa-finn

There's a fair amount of information readily available on health co-ops from a consumer / co-op member perspective.  Here's a link to a couple of related papers, including a fairly informative piece on Quebec.  http://communityrenewal.ca/health-co-ops-quebec

And here's a link to the national federation of health co-ops. http://healthcoopscanada.coop/

A local co-op was formed here in Gatineau ten years back, when a community group came together to purchase an under-utilised private medical centre, then raised funds for improving the facilities and encouraging doctors to practice there. Over the decade it has gradually grown in size and services to several thousand members, - promoting itself:

- to the public as the only local place a new resident can get medical services other than via the emergency unit at the local hospital. (We have a terrific little CLSC just down the road but the waiting list to get registered with a doctor there is now years long. And they are not great with walk-in traffic even from registered patients); and

- to doctors and health professionals as a 'turnkey' operation for setting up practice.

IMHO, the coop model skates pretty close to the dividing line between public and private health care, which is a murky line indeed here in Quebec. But its a community-owned response to a failure of the state ...  so hard to be too critical of teh coop itself. 

Slumberjack

The health care system has been under assault from all sides.  From physicians, from IT software companies requiring expensive upgrades every now and then in order to turn a handsome profit, from big pharma and their greedy mits, from medical equipment corporations, from the increasing levels of sickness in society.  Political interference also conspires to present a significant impediment to the effective delivery of health care.  The lack of community health capacity for long term care also weighs down an already heavily burdened health care system.  It's crumbling all around us, through neglect, through political incompetence and spinelessness, and because for corporations, the already profitable Canadian health care system represents great untapped potential.  They just need to nullify the health act, not through overturning it politically because the public wouldn't accept it outright like that, but by bleeding it dry with a thousand surgical cuts.

swallow swallow's picture

Thanks for the terrific resources, all!

sherpa-finn wrote:

IMHO, the coop model skates pretty close to the dividing line between public and private health care, which is a murky line indeed here in Quebec. But its a community-owned response to a failure of the state ...  so hard to be too critical of teh coop itself. 

That's pretty much my thought at the moment. I'm wishing ideas like keeping the CLSC's open longer hours so people did not spend 10 hours in emergency waiting to get a throat swab for their kid didn't happen any more. But since the government is only going to ration health care further, the solidarity clinics are likely to spread, especially in rural areas. 

lagatta

24hr CLSCs are a key demand in Québec solidaire's health programme. And of course, there should be far more CLSCs, with all health professionals including doctors on salary.

Of course both the Liberals and the PQ have poured so much money into the so-called "superhospitals" that it is beggaring the rest of the system. Lots of contractors rubbing their hands in glee.