Soins de santé et la Suède: le modèle à suivre !
Je retranscris ici intégralement un article de Mme Nathalie Elgrabli paru dans le Journal de Montréal de la semaine dernière.
Je dois tout simplement dire que ce texte est clair et limpide comme de l’eau de roche et que je trouve le modèle génial !
Il fallait y penser
Le Journal de Montréal, p. 26 / Nathalie Elgrably, 07 septembre 2006Après avoir discuté des systèmes de santé canadien et cubain, voici, comme promis, un modèle intéressant.
Il y a 20 ans, le système de santé suédois était caractérisé par de longues listes d’attente, des équipements vétustes et des établissements non performants. Et malgré l’injection de fonds et les hausses d’impôts, les hôpitaux étaient incapables de répondre à la demande croissante, ce qui ressemble fortement à ce qui se produit chez nous.
Déterminé à améliorer la qualité des soins, le gouvernement suédois a entrepris une importante réforme. Mais pas celle à laquelle nous nous serions attendus d’une social-démocratie dont l’économie performe mal, comme je l’expliquais récemment.
Les vertus de la concurrence et les vices des monopoles sont indiscutables. Ainsi, plutôt que de renforcer le monopole étatique de la santé, l’État suédois l’a brisé. Il a progressivement mis en vente tous les services médicaux publics (sauf les urgences) et a permis à des entrepreneurs de rivaliser avec un système public surchargé.
Si les Suédois ont entrepris cette réforme, c’est qu’ils ont compris qu’un système étatisé qui fonctionne sur la base de budgets considère chaque patient comme une source de dépenses. Dans ce contexte, il existe peu d’incitations à améliorer la productivité et les services, puisque cela ne permet d’augmenter ni les revenus de l’institution ni les salaires des employés. Pour respecter leurs budgets, les gestionnaires rationnent les services, d’où l’apparition de listes d’attente. Par contre, dans un système où règne la concurrence, le patient devient une source de revenus. Il va de soi qu’une source de dépenses ne reçoit pas autant d’égards et de considération qu’une source de revenus!
Qualité et rapidité
Le virage suédois a permis d’augmenter la qualité et la rapidité des soins, ainsi que la performance générale des hôpitaux privatisés. Mais il est particulièrement intéressant de noter que les Suédois ont bénéficié de l’efficacité des mécanismes de marché sans faire de compromis sur l’équité.
À l’instar du Canada, la Suède avait opté pour un monopole étatique de la santé dans l’espoir que tous les citoyens puissent se faire soigner, quels que soient leurs revenus. Mais les Suédois ont compris qu’il est inutile pour réaliser cet objectif que l’État soit à la fois l’assureur universel et l’unique fournisseur de soins de santé. L’objectif d’équité peut être atteint même si le patient est traité dans un établissement privé dans la mesure où l’État règle sa note.
C’est ainsi que la Suède a établi des modalités de remboursement pour plus de 1000 procédures médicales. Que l’établissement soit privé ou public, les montants versés sont identiques. Ce qui est attrayant avec ce modèle, c’est précisément que chaque patient représente un revenu. Plus les services offerts par un établissement sont de qualité et le personnel de haut niveau, plus il attirera de patients et mieux iront ses affaires.
La réforme suédoise n’a rien d’exceptionnel et s’apparente au fonctionnement des compagnies d’assurance. Suite à un accident de voiture, l’automobiliste fait réparer son véhicule chez un mécanicien privé et l’assureur règle la facture. Aucun assureur n’envisagerait de réparer lui-même les autos, alors pourquoi l’État devrait-il soigner lui-même les malades?
Notre système de santé nécessite des soins intensifs. Or, aucune amélioration n’est à espérer tant que nous ne changerons pas de paradigme. Ce n’est pas sans raison que la Suède a retiré à l’État son rôle de fournisseur de soins de santé tout en lui permettant de jouer le rôle d’assureur universel. Un système d’inspiration suédoise nous permettrait à la fois de bénéficier des avantages de la concurrence et de respecter notre objectif d’équité. Il suffisait d’y penser!
* Cette chronique a aussi été publiée dans Le Journal de Québec.
Nathalie Elgrably est économiste à l’Institut économique de Montréal et auteure du livre La face cachée des politiques publiques.
Excellent article! Les pays scandinaves sont vraiment des pays innovateurs sur le plan social. Le Québec devrait s’en inspiré. Je vais tenté de retrouver une série de reportage faite par la radio de Radio-Canada sur le sujet.
Comment by Thierry Bélanger Clermont — September 10, 2006 @ 11:20 pm
J’avais écris un petit billet sur les reportages de la SRC.
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