As Quebec’s healthcare mega-reform takes effect, what will change?

The implementation of the CAQ's health reform began yesterday. The healthcare system will now take the form of the Santé Québec agency, which has already been criticized for opening up to the private sector. It will also be headed by Geneviève Biron, former president of a medical company. But what will this really change for the people of Quebec?

As everyone knows, Quebec's healthcare system is in crisis. The media are constantly talking about access problems, staff shortages, long wait lists, working conditions and so on.

In response, Premier François Legault is introducing a new vision of healthcare with his reform. He and his party seem to firmly believe that expanding the private sector will be the cure for the system's ills.

But is it really?

Privatization: far from working well

The Santé Québec agency will have the power to coordinate and support private establishments, opening the door to entrepreneurs who want a piece of the pie. This is the first time that the healthcare network has moved so down this path, but it's nothing new.

For several decades, all governments have slowly but surely privatized several parts of the healthcare network. For example, there are front-line medical and social services, which for many years have been handed over to publicly funded private clinics (e.g. family medical groups).

There are also mental health services, which are already largely privatized. Now, private telemedicine companies like Dialogue and Telus Health are starting to get involved.

More recently, public funds have increasingly financed private mini-hospitals, with the aim of relieving congestion in public emergency departments. These are very similar to the super-clinic projects in previous health reforms, such as the Barrette reform. The mandate of these mini-hospitals is to receive a certain number of emergency medical visits from patients who do not have family doctors, in exchange for government subsidies.

Between 2017 and 2021, these hospitals failed to meet their target each year, with no loss of funding. For example, in 2020, 92% of super-clinics had not made the minimum required number of visits, for a total of 674,121 visits not made. The year with the least catastrophic result was 2018, with 54% of visits not made.

What's more, they create more problems than they solve. For example, the manpower required for these new establishments is contributing to the exodus of workers from the public to the private sector.

Centralization: a lingering failure

The Santé-Québec agency is the latest stage in a long process of centralizing the healthcare system, giving Quebec oligarchs absolute control over internal decisions. Once again, this is not a new idea.

All the political parties in power over the past 25 years have centralized the healthcare network, merged institutions, and gradually eliminated elected positions on boards of directors. The result: today, no member of these boards is democratically elected.

This is how, in 2003, hundreds of hospitals, CLSCs and CHSLDs were merged to create 95 Centres de santé et de services sociaux (CSSSs). Then, in 2015, these 95 CSSSs were merged into 22 mega-establishments called Centres intégrés de santé et de services sociaux (CISSS).

Today, the reform centralizes the entire healthcare network into a single institution, Santé Québec, run by a board of directors appointed directly by the government.

In other words, this reform has mainly served to take away the control that the public had over the healthcare system and give it to a few bureaucrats and collaborators of the CAQ in the private sector.

There is an example of what could be in store for the public with Santé Québec: starting in 1994, governments in Alberta gradually took 200 health establishments and merged them, until a single health agency was created in 2008. Fifteen years later, the Alberta government admitted its failure and was forced to completely overhaul its healthcare system by decentralizing it.

The studies are clear: Quebec does better than Alberta in many aspects of healthcare. Alberta is the second most expensive province in terms of healthcare costs, but it does no better than the Canadian average when it comes to access to services. It also has more patient returns to hospital after surgery and more deaths after major surgery than the Canadian average.

There is no reason to believe that a health agency similar to Alberta's would have a different result. 

Division among network workers

Following the centralization and merger of the network into a single institution, the government will abolish local union certification. So, for example, there will no longer be a union for nurses in a particular hospital. The unions will then be forced to represent an entire group of occupations (job categories 1 to 6). 

Going from unions with a maximum of a few thousand members to huge machines made up of tens of thousands of workers could make them less accessible and less democratic. What's more, it could lead to an inter-union war for accreditation, which could cause division and tension.

Bureaucracy: don't expect a more "humane" system

Another consequence of all these changes is that managers will be less and less present in the field. And yet, to be able to make decisions, they need to be informed about what's happening on the ground.

This could lead to the creation of cumbersome and complicated administrative measures, which would then be imposed on employees. These additional tasks would affect not only their working conditions, but also the time they can spend with patients.

In short, the CAQ's health reform seems above all to reinforce the privatization and centralization of the system. By distancing decisions from citizens and workers, it could worsen working conditions and limit access to care. Rather than solving the crisis, this reform mainly benefits a private elite, leaving the people of Quebec high and dry.