“The healthcare system is complex, it’s true. But everyone is able to understand. Just use simple and clear words, trusting people. I try to write as if I was talking to him,” says the geriatrician.
This mandate, he fulfills it well in his book, which brings together sometimes unpublished texts and revised versions of chronicles already published in La Presse.
He also reveals a little bit about himself, just enough for us to understand his commitment to the public system.
His maternal grandfather was a successful farmer in Saint-Agapit before glaucoma prevented him from working. The surgeries ruined it. He will end his life blind and poor in a basement in Quebec.
Dr. Hébert worries about the future of those he affectionately calls “the old.” Don’t say the phrase “our elders” to him. “It’s very childish. We take away their autonomy, we dispossess them, as if they no longer belong to themselves. »
And on a larger scale, that’s kind of what’s happening, he laments. Quebec is slow to make the shift to home care. The bulk of the money goes into the concrete. He sees it as an economic and human problem as well.
In 2001, the Clair commission proposed a form of autonomy insurance. The elderly would receive a sum that they would then use to pay for care adapted to their needs.
It was the big fight of his short political career as minister from 2012 to 2014. He only managed to table a white paper and launch consultations. But the PQ minority government did not have time to carry out the substantial reform. And we will never know if he would have dared to spend the required billions while the budget cuts were being prepared.
“But it would have been an investment,” he argues. Look what’s coming. It’s going to cost even more not to take this turn…”
Young Réjean was born into a modest family in Quebec. He has two older brothers. Her father is a railway worker, her mother works as a hat maker and as a telephone operator in a store to help pay the bills.
A gifted student, he was admitted to medicine. In his early days as a general practitioner, he became interested in the elderly. He will become one of the first geriatricians in Quebec. He is one of the co-authors of the Précis pratique de gériatrie, a reference work published in 1987 and still taught today. He also co-founded the Gerontology and Geriatrics Research Network. In 2000, he directed the brand new Institute of Aging, a chair funded by the federal government. He will then be dean of the faculty of medicine at the University of Sherbrooke.
One of his first scientific papers already set the tone for his future career: The Old Man at the General Hospital, From Dumping to Blocked Beds.
Public engagement was never far away. He participated in the working group created by Philippe Couillard in 2003 to develop an action plan for services to seniors, then he co-chaired in 2008 the consultation on the living conditions of seniors.
After giving advice, he wanted to decide. He became Minister of Health under the short-lived government of Pauline Marois, for 18 months.
This makes him a privileged observer of our health system. He knew him as a practitioner, as a researcher and as a politician. And he is surprised to see the same mistakes repeated.
According to him, the Dubé reform contains the same vice as those of Gaétan Barrette.
“As Henry Mintzberg demonstrated, it is a complex system. We cannot understand or predict everything. Nor can we wait for the information to reach the leaders and then for the solution to come back down to the floor. People on the ground must be given the means to take innovative initiatives on their own. »
But isn’t that what Christian Dubé is trying to do by appointing a director in every hospital, CHSLD or other facility? “That’s not a bad idea per se,” he replies. But to decentralize, the key is not to change the structures. It is to integrate the services. To bring people together and let them coordinate together. We don’t do that. The power still resides in the large establishments [the CISSSs and CIUSSSs], which are only changing their names. »
A return to basics. That, in short, is what Dr. Hébert advocates. “Effective health systems focus on three things: the front line, prevention and home care,” he insists.
The former dean of the School of Public Health at the University of Montreal declines the statistics. “About 60% of chronic diseases and 80% of cardiovascular diseases are preventable. They can be treated in the first line. The CLSC should be at the heart of the system and the hospital at the periphery. »
The same phenomenon is observed with home care, which does not receive all the money promised. Budgets are allocated to the CISSSs and CIUSSSs, which rely too much on hospitals. “Doctors weigh heavily in decisions…”
Dr Hébert is a critic of his profession. He recalls that in 1970, doctors opposed health insurance. To rally them, they were offered a gift: self-employed status. Today, they are like entrepreneurs with a captive clientele. The best of both worlds.
The College of Physicians wants to establish a “population responsibility” for the profession. When patients no longer have access to certain care in a territory, doctors could be forced to adjust their practice.
Minister Dubé is precisely proposing this in his reform. Dr. Hébert is in favor of this measure, while wondering how we will manage to apply it.
And he would like to go further. “Ideally, medical specialists should be salaried. It’s like that in the United States by the way, even in private groups. He would also like general practitioners to be paid according to the number of patients cared for, with performance indicators on waiting and follow-up.
The geriatrician is also critical of the Legault government’s seniors’ homes. “They are very beautiful,” he said, “but the money would have been better spent otherwise. There are still 40,000 people waiting for home care. »
“I understand that an autonomy insurance project scares the government. These are considerable recurrent expenses. But in the current model, the costs are both larger and more unpredictable. »
He does not despair.
While waiting for this project, he would like his love of old people to become contagious. “In France, you see them in cafes, in theaters, I think they are better integrated into society. In Denmark, they are even included in homes with the youngest. In North America, unfortunately, we see ourselves as a young and dynamic society, so we marginalize them. However, it is not a disease, old age. And it will happen to all of us. »