OUTAOUAIS – Three years after l’Institut de recherche et d’informations socio-économiques (IRIS) released a study highlighting the underfunding of Outaouais’ health and social services system, they released another on November 4. This one confirms access to health care is lacking in the Outaouais, particularly for the MRCs farthest from Gatineau like the Pontiac.
The study, Portrait des inégalités d’accès aux services de santé en Outaouais (Portrait of inequalities in access to Outaouais health services), claims there are links between lack of access to health care in the Outaouais and the socioeconomic situation of the various communities in the region that suffer serious inequalities.
Not only are the more remote MRCs lacking services, but their life expectancy is lower than the Quebec average (82.8 years); 79.4 years in the Pontiac and 79.3 years in La Vallée-de-la-Gatineau. Communities with the highest proportion of Aboriginal people suffer the most disadvantages.
Insufficient primary care
In Pontiac and Gatineau, primary care services like consultations at CLSCs and medical clinics are lacking to the point where the population must fall back on emergency rooms, which are saturated.
“In the Pontiac, many of the services usually provided by general practitioners are performed in the emergency department. In other words, the hospital facilities in these areas largely play the primary care role normally provided by family medicine clinics and CLSCs,” says the study.
The delay in receiving medical attention in the Outaouais’ emergency rooms (3 hours, 10 minutes) is much higher than the Quebec average (2 hours, 23 minutes). However, the average wait is lower in the Pontiac (2 hours), compared to 3 hours 14 minutes at the Hull Hospital and 3 hours 56 minutes at the Gatineau Hospital. Between 18.9% and 20.4% of patients leave the emergency rooms in Gatineau and Hull before being treated, which is double the Quebec average (10.2%).
In the Pontiac, only 6.5% leave.
According to the study, centralization of the health network contributed to making services less adapted in remote regions like the Pontiac and the Vallée-de-la-Gatineau where access to second and third line care (more specialized interventions like psychological and high risk pregnancy services, radiology and surgeries) is very limited or non-existent. For example, the Gatineau Hospital provides 96.6% of the region’s maternity care while only 72% of the Outaouais’ population lives in Gatineau.
“Centralization … reduces the capacity of local communities to offer services adapted to their population. Specialized services and mental health care are almost entirely concentrated in Gatineau,” the study reads.
With only 1.54 physicians per thousand inhabitants, the Outaouais falls far behind the Quebec average of 2.51. This shortage of physicians is worst in Collines-de-l’Outaouais (0.24) and Gatineau (1.59). However, Papineau (2.87) and Pontiac (2.61) have more physicians per inhabitant than the Quebec average.
“This can be explained by the lower population density of these MRCs compared to more populated regions. However, the regional ratio remains below the general average for Quebec, which demonstrates the low number of physicians in the region,” says the study.
The ratio of specialist physicians in Collines-de-l’Outaouais (0), Pontiac (0.49), and Vallee-de-la-Gatineau (0.78) are significantly lower than the average for Quebec (1.25) and the Outaouais (0.93). Gatineau and Papineau sit at 1.11 and 1.13 respectively.
The number of nurses is 7.34 per thousand inhabitants in Quebec, but 5.00 in the Outaouais.
An entire region underfunded
In 2019, a year after the IRIS study highlighted the underfunding of health and social services in the Outaouais was published, the Quebec National Assembly officially and unanimously recognized the problem.
Deficiencies drive people to Ontario for services. In 2017, nearly 12,700 people turned to Ontario hospitals to obtain first, second or third line care. On average, RAMQ spends more than $100 million annually on health care provided in Ontario to Outaouais residents.
A view from the ground
Dr. Ruth Vander Stelt said the study once again shows the sad reality the Pontiac region faces and the dire need of reinstating local governance. “If Pontiacers could own and act on this data, if we had the organization and decision-making power to address these issues, I’m sure we could make a difference,” she added.
To change the current trend, Vander Stelt said frontline services must be reinforced, obstetrics returned, and all primary and community care provided locally.
“The current system is heading in the exact opposite direction. The urban center has already drained many of our services, resulting in decreased quality of care to the Pontiac population. If this continues, the mega-hospital shaping up in the city is sure to drain both beds and additional resources, further aggravating [the situation],” she told the Journal, noting local decision-making is the only way to improve quality of life and life expectancy in the Pontiac.
“Pontiac and Vallée-de-la-Gatineau should benefit from a greater share of financial compensation than the rest of the Outaouais in order to tackle these important inequities. This includes
proportionately increased health worker wages across the board: housecleaning, maintenance and kitchen staff, clerical personnel and caregivers,” she concluded.