According to our sources, the CEOs of the Quebec health network have received the message to reduce their spending as much as possible, while almost all of them are expecting significant deficits. Budget data obtained by Radio-Canada predicts a $1 billion hole in their coffers in 2023-2024.
The use of independent workers, overtime and inflation are weighing on the start of the fiscal year for many healthcare facilities in Quebec.
The Health Minister’s office assures that the wall will be avoided, that there will be no cuts and that no services to patients will be affected, but at the moment the management of the institutions is anything but reassured. The words cost rationalization and optimization, usually synonymous with savings, are on everyone’s lips.
The message to CEOs and even the MSSS is not to innovate and spend less. […] You must aim for a balanced budget.
The challenge is great because currently only the CISSS de Lanaudière plans to balance its budget at the end of the year. All other companies in the province are expecting losses, some of which will be significant.
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Minister Christian Dubé’s office assumes that the fiscal year will not end with such a large deficit. He confirmed that the numbers will be adjusted over the weeks as Quebec reimburses establishments for certain expenses and funding is renewed. Last year, for example, the deficit was three times smaller than expected.
Still, several plant managers are concerned, waving a red flag in budget documents they submitted to the Department of Health earlier this year. Until they receive confirmation of refinancing of certain programs, they have no choice but to report a shortfall.
The CISSS of the Laurentides explains in a budget document that in the absence of a positive response, measures will be taken, although without specifying which ones. The CIUSSS du Nord-de-l’Île-de-Montréal writes that certain uncertainties remain and could have an immediate and significant impact on our results. The budget balance is very fragile, as we can also read in a document from the CIUSSS de l’Estrie-CHUS.
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We must exercise great caution with the figures since they are estimates that only take into account the first 12 weeks of the financial year, Minister Dubé’s office would like to specify.
Still a lot of money for self-employed workers
Some companies are so dependent on the employees of employment agencies that their budgets suffer as a result. For example, the CISSS de la Côte-Nord plans to spend $146 million to hire this workforce in 2023-2024, representing 27% of its total budget.
Radio-Canada said in February that using independent workers had cost the health network $3 billion between 2016 and 2022. COVID-19 was one of the excuses, although the surge continued in 2022-23 as the pandemic largely subsided.
Since 2015-2016, corporate spending on private placement agencies has exploded even more. In the CISSS des Îles it is 77 times more, in Bas-Saint-Laurent 48 times more, in Gaspésie 36 times more and in Abitibi-Témiscamingue 24 times more.
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Healthcare facilities have received the message to limit the use of employment agencies. A new regulation takes effect Wednesday that imposes a salary cap of $71.87 an hour for hiring an agency nurse. Quebec expects significant savings from this measure.
We will also begin the transition to end the use of agencies from October 2024 for large centers and by October 2026 for more remote regions, reminds the Minister’s Office.
Overtime is a major source of costs
In other companies it is overtime that increases the deficit. The CIUSSS de l’Est-de-l’Île-de-Montréal, the CISSS de Laval and that of Chaudière-Appalaches are preparing to use it four times more frequently in 2023-2024 compared to 2015-2016.
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Quebec is calling on companies to adopt better human resources practices to reduce their costs. This summer, the Maisonneuve-Rosemont hospital managed to abolish mandatory overtime for the first time in 25 years.
We need to become more efficient and that requires a culture change. We are currently experiencing change management and need to be able to work differently.
Minister Dubé’s office also claims to have saved $40 million through extended absences. A total of 1,300 full-time equivalent network employees would have returned, which would have a positive impact on the companies’ budgets.
The effects of inflation are noticeable
Several institutes also point out rising prices and interest rates for loans. Currently, Quebec is unable to quantify the impact of inflation on the network. To reduce the impact, the government could issue refunds before the end of the year.
In a budget document, the CISSS de l’Abitibi-Témiscamingue cited the rise in drug costs as a factor increasing the deficit. The ministry confirms to us that prices for certain treatments have skyrocketed.
In addition, health facilities are still waiting for reimbursement from the ministry for the millions of dollars spent to combat COVID-19 during the pandemic.