Quebec's new health minister is talking tough and warning the era of half-hearted efficiency is over.

Gaetan Barrette told Quebec's Health and Social Services Association (AQESSS) that health care administrators and doctors will have to toe the government's line about managing health care spending.

With public health care expenditures consuming more than $30 billion of the provincial budget, Barrette said it would likely take more than four years to fix the system.

Barrette, the former president of the Medical Specialists Association, told the 400 health care administrators and doctors at Friday's meeting that he is considering altering the incentive-payment system that is currently used.

He also said that during the election campaign he saw obvious signs that the current incentive systems is not working.

"There are operating rooms that are idle in Quebec three days a week," said Barrette. "I've seen in the campaign, in large cities, facilities that were open only three days a week. Brand new, lots of advancements, all the modern equipment, everything. But they are closed two days a week, three days, so this is something that cannot go on forever."

One area that could be easily cut is the volume of reports that health boards are required to fill out.

"Some of them are essential but some of them are useless and we even wonder if anybody reads them," said Michel Gervais of the Quebec Association Of Health Care Facilities.

He notes that local agencies cut $627 million in cuts over the last four years without any major catastrophe. "We're ready to deliver but of course the next millions will be harder to collect," said Gervais.

Voices of dissent

Many at the conference were doubtful that the health care system could run any better than it does currently, and were skeptical of being able to do more with less money.

Ron Rayside is the Chair of the CSSS Jeanne Mance, and oversees seven long-term care facilities with a $170 million budget.

He said a $3 to $5 million cut would affect the lives of patients.

"It could be a reduction of people's services at people's homes. It could be a reduction in support in schools, senior citizens in homes," said Rayside.

"Nothing major, we're not at a panic stage but it's just there's an awful lot of pressure."

Other voices expressed concern that cuts could spur a rush to private health care, while expanded user fees could be a killer.

“Some people don’t have the money to get access,” said Alain Vadeboncoeur of Quebec Doctors For Public Health. “For example during an exam in the clinic that should be out of the system, it's not so much but it's quite important for the people who don’t have the money.”