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Health and Intergenerational Solidarity

Country: 
Canada
Partner Institute: 
Canadian Policy Research Networks (CPRN), Ottawa
Survey no: 
(7)2006
Author(s): 
Patrick Fafard
Health Policy Issues: 
Role Private Sector, Long term care, System Organisation/ Integration, Funding / Pooling, Quality Improvement, Access, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Abstract

The Report of an advisory committee to the Government of Quebec, chaired by Mr. Jacques Ménard, raises concerns about the long term sustainability of the provincial health and social services system and, more importantly, about intergenerational equity. Among other things, the Menard Report calls for more private delivery and the creation of a separate pension-like scheme to fund services that citizens require when they lose their autonomy, that is to say long-term care and home care.

Purpose of health policy or idea

The purpose and mandate of the Menard Committee was three fold. First, the Committee was asked to make recommendations with respect to the financing challenges facing the health and social services system in Quebec.  Second, the Committee was asked to make medium and long-term recommendations designed to ensure the sustainability of the health and social services system but in a way that respects the interests of current and future generations.  Finally, the Committee was asked to propose a global action short-, medium- and long-term action plan.

Main points

Main objectives

The Report has two objectives. First, the Report tries to make the case that the current health and social services system in Quebec is fiscally unsustainable given the rates of growth of the economy, government revenues, government expenditures on health and social services, and perhaps most importantly, the demographic future of the province. Second, the Report offers a series of recommendations designed to reform the health care system to make it more fiscally sustainable and address what the Committee sees as the major challenge - continuing with the status quo will mean very serious issues of intergenerational equity.

A copy of the Report can be found at: www.solidaritedesgenerations.qc.ca/

Type of incentives

For the most part, the incentives emphasized in the Report are financial. In the short term the Report calls for more private delivery making the usual arguments that private delivery will add capacity to the system. In the longer term the Report calls for a highly structured pension-like scheme to require Quebec residents to set aside funds to cover the costs of the home care and long-term care they will need later in life.

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low low very high
Transferability strongly system-dependent system-dependent system-neutral

Political and economic background

The Menard Report is part of a larger effort by the centre-right Government of Premier Jean Charest to focus attention on issues of public debt and the associated issues of intergenerational equity. The Government and a number of influential observers from civil society (see www.pourunquebeclucide.com) are trying to focus attention on what they see as the need to revisit some of the fundamentals of the approach to government that has dominated Quebec since the "Quiet Revolution" of the 1960s (e.g., large public sector supported by relatively high levels of taxation).

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Origins of health policy idea

The ideas in the Report are, for the most part, not new in health policy debates in Quebec, in Canada, and in many other OECD countries. Thus, the Report calls for a reorganization of the delivery of health services (e.g., the use of care pathways), increased private delivery, and a stronger focus on health promotion and population health.

The most innovative and far-reaching recommendation of the Report is also not new. An earlier Report on the state of the Quebec health system by a committee chaired by Michel Clair ("Emerging Solutions - Report and Recommendations of the Commission d'étude sur les services de santé et les service sociauxÈ (2001)) also recommended the creation of a a separate pension-like scheme to fund services that citizens require when they lose their autonomy that is to say long-term care and home care.  In fact, Michel Clair was a member of the Menard Committee.

Initiators of idea/main actors

  • Government
  • Providers
  • Others
  • Political Parties

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The Government is generally speaking receptive to the general orientation of the Menard Committee Report as demonstrated by the White Paper recently released by the Charest Government (see http://msssa4.msss.gouv.qc.ca/fr/document/publication.nsf/cf4a108863ca20ed8525680900713c29/5d64e6e0f5543b99852571240053333f?OpenDocument

The Official Opposition, the Parti Québécois, is much less supportive and has emphasized its opposition to the recommendations with respect to private delivery. In fact, it is these recommendations that have receieved the most emphasis -- and opposition -- leaving to one side the longer term idea of a penion-like fund to set aside monies for health care.

Providers are, not surprisingly, divided. Physicians in Quebec do not speak with one voice but have offerred cautious support for many of the recommendations in the Report.  Nurses, on the other hand, while divided, are generally more supportive of a single-payer system and are thus concerned about the recommendations about private delivery.

Actors and positions

Description of actors and their positions
Government
Premiervery supportivesupportive strongly opposed
Minister of Healthvery supportivesupportive strongly opposed
Providers
Physiciansvery supportiveneutral strongly opposed
Nursesvery supportiveopposed strongly opposed
Others
Labourvery supportivestrongly opposed strongly opposed
Political Parties
Parti Québécoisvery supportiveopposed strongly opposed

Influences in policy making and legislation

To date the Report has led to the introduction of the Government White Paper mentioned above and legislative hearings that are currently underway (April 2006).

Actors and influence

Description of actors and their influence

Government
Premiervery strongvery strong none
Minister of Healthvery strongvery strong none
Providers
Physiciansvery strongstrong none
Nursesvery strongweak none
Others
Labourvery strongweak none
Political Parties
Parti Québécoisvery strongweak none
Premier, Minister of HealthPhysiciansNurses, Parti QuébécoisLabour

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The implementation of the many different recommendations of the Menard Report will require action on the part of many different actors in the Quebec health system and, if the option or more private delivery were to be pursued, the Government of Canada.

The recommendations dealing with how services are delivered (e.g., care pathways) will require action on the part of regional health authorities, hospitals, physicians and other health professionals and the provincial government. In point of fact, some of the organizational recommendations of the Committee are already being implemented in Quebec.

The recommedations designed to address issues of intergenerational equity are more ambitious and will require significant leadership from the provincial government (and possibly the Government of Canada which has much influence over tax and saving policy). To date (April 2006) the Quebec Government has not indicated clearly what, if anything, it intends to do with respect to the recommendation for forced savings for home care and long term care.

Expected outcome

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable two system more equitable
Cost Efficiency very low high very high

References

Sources of Information

A copy of the Report of the Menard Committee can be found at: www.solidaritedesgenerations.qc.ca/

A copy of the February 2006 White Paper of the Quebec Government which is, in part, a response to the decision of the Supreme Court of Canada in the Chaoulli case, incorporates several of the recommendations of the Menard Commitee Report.  The White Paper can be found at: http://msssa4.msss.gouv.qc.ca/fr/document/publication.nsf/cf4a108863ca20ed8525680900713c29/5d64e6e0f5543b99852571240053333f?OpenDocument

Author/s and/or contributors to this survey

Patrick Fafard

Suggested citation for this online article

Patrick Fafard. "Health and Intergenerational Solidarity". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/ca/b7/3