In 2023–2024, the Coalition Avenir Québec (CAQ) spent six billion dollars on private healthcare. According to a CSN calculation, however, the cost would have been $700 million less if the government had hired public-sector workers for the same services. How could this option have been overlooked?
The CAQ was elected on a promise to make the healthcare network more efficient and less expensive for the population. The new provincial agency tasked with achieving this goal, Santé Québec, has since demonstrated that it is not afraid to make budget cuts in services that are important to the functioning of the system. But it is also spending nearly a billion dollars in the private system, without remorse, directing public funds into the pockets of the oligarchy.
So, who are these healthcare reforms really for?
Dishonesty or incompetence?
When the CAQ announced the creation of the Santé Québec agency, it sold the project to the public as a solution to a surplus of administrative jobs encumbering the public sector. The government also claimed that cuts were essential to reduce the deficit of recent years.
This is not entirely untrue. The increase in bureaucracy caused by the centralization of the public system under the reforms of recent governments has indeed led to a number of efficiency problems in the network. Last year, in 2023–2024, the budget deficit was over a billion dollars.
In addition to the $700 million wasted by the State, the massive reforms that brought in Santé Québec have meant that the healthcare network's top executives cost almost twice as much as they did before the agency was created.
In fact, according to a calculation by La Presse, remuneration of ministers, deputy ministers and “top guns” from the private sector has risen by 89% since the reforms. That's about $7 million more in the budget to pay these civil servants.
Furthermore, since the creation of this agency, there has been a sharp increase in the number of civil servants working for the Ministry of Health and Social Services and Santé Québec. Some 300 additional civil servants have recently added to the network's bureaucracy.
According to the Ministry of Finance, headed by Éric Girard, $300 million in cuts have been made to the healthcare network. On the ground, several healthcare workers confirmed to The North Star that these budget cuts, combined with job cuts and a hiring freeze, have greatly affected services to the population and made working conditions more difficult.
It should be remembered that, until March 2025, the cuts were supposed to amount to 1.5 billion. At the time they were made, however, they were deemed unrealistic, with the remainder of the deficit having to be absorbed by the State. When the cuts were announced, the CAQ government claimed that these measures would not affect service to the public.
The private sector has never been cheaper
The CAQ government and previous Liberal governments have continually claimed to want to reduce healthcare costs. But with each reform, whether under Philippe Couillard's Liberal government or François Legault's, funding for the public sector has been reduced by a third.
It's worth noting that numerous studies have already been carried out on healthcare costs. For example, in 2016, Quebec launched a pilot project to compare the cost of certain surgeries performed in the public network with those performed in the private sector. This project cost the public $80 million. The results, analyzed by Anne Plourde of the Institut de recherche et d'informations socioéconomiques (IRIS), reveal that private surgeries can be up to 150% more expensive than public ones.
An example from the researcher's analysis reads, “In 2019–2020, the cost of carpal tunnel surgery averaged $908 privately versus $495 publicly, a difference of 84%, and the cost of a short colonoscopy was $739 privately, nearly triple the cost of the same procedure in a public facility, which was $290.”
Acting in bare self-interest
Contrary to its rhetoric, the CAQ government has thus increased spending in the healthcare system, increased the number of civil servants and cut services to the population. Despite costly studies comparing public and private costs, the Ministry of Health dismisses their findings. It chooses another path, which is just as costly: further centralizing the network and investing more in the private sector.
These policies distance decision-making from ordinary people. They place CEOs and managers, chosen without public consultation and unaccountable to institutions, at the head of certain parts of the network. The influence of employers is growing, while that of local institutions is waning.
As a result, local services such as CLSCs are gradually losing their place in decision-making. These centres, where citizens and workers used to have a say through local assemblies and elected boards of directors, are gradually losing their place in decision-making. elected from among the population, are increasingly being sidelined.
It's not surprising that these kinds of decisions are being made at Santé Québec. Its CEO, Geneviève Biron, comes from a well-established family in the world of private healthcare. Since the 1960s, Groupe Biron has profited from this sector. In 2011, she also co-founded, with other companies, the Council of Private Health and Wellness Companies (Conseil des entreprises privées en santé et mieux-être), a lobbying association that seeks to strengthen ties between the public and private sectors in the healthcare network.
Also at the head of Santé Québec's board of directors is Christiane Germain, the head of the hotels of the same name and one of the founders of the CAQ. Once again, key positions are held by figures with close ties to the business world and political power—not to mention the Premier himself, former CEO of Air Transat.
Against this backdrop, it's hard to believe that the reforms underway are designed in the public interest. Instead, they seem to serve the interests of Quebec employers, private healthcare companies and the upper echelons of the bureaucracy. Meanwhile, workers and users are gradually losing their influence over the organization of healthcare.
It's worth noting that the last Common Front succeeded in putting the brakes on certain setbacks. But if the aim is to regain control of the healthcare system by and for the population, we'll undoubtedly have to go further, and above all, strike harder.