About the evaluation of computerised health care services: Some critical points

Abstract

This article analyses the concept of productivity underpinning the implementation of an information-technology-driven virage ambulatoire, or shift to outpatient care, as a solution to the productivity ‘crisis’ in Quebec’s health care system. This ‘crisis’ was diagnosed in the 1970s and based on expenditure trends. These trends were regarded by the State as an ‘obstacle’ to balanced budgets and more generally, economic growth. Into this situation stepped the IT-driven virage ambulatoire with a structural reorganisation following a productivist logic. Unrolled in the 1980s, this connected health care to the economistic discourses of the 1960s which were developed to boost productivity in a service- or information-based economy. The State thus came to draw on analytic categories, developed for a very particular mode of economic analysis, to produce a hospital restructuring program oriented around IT-based ambulatory care. The result was the reduction of health care’s principles of clinical and therapeutic efficiency to the administrative imperatives of time, quantum, cost, and optimisation, all of which became variables to be controlled, and the placement of economic logics ahead of clinical imperatives. Quebec has thus moved to a neoliberal productivist system in which clinical and therapeutic effectiveness are subordinate to economic need.