In December 2023, Quebec’s national assembly passed a law enacting a major reform of the health care system in the province. The law created Santé Québec, a new agency which would, once implemented, act as a singular governing body for the province’s health care system. Workers in the health care sector are deeply concerned about the new entity, and the changes it’s making across the system. Understanding the new entity and its potential consequences is crucially important.
First, an outline of the structure. Santé Québec is a corporation owned by the Québec government whose mission is to centralize and reorganize Québec’s public health and social services system. The government wants to reduce costs, simplify administrative processes, and improve care and services by bringing together, under one entity, the institutions managed by the province’s CISSSs (integrated health and social service centres) and CIUSSSs (integrated university health and social service centres), which previously acted as the main governing bodies for the health care system.
The reform affects some 1,500 institutions, including local community clinics and service centres (CLSCs), publicly owned long-term care centres (CHSLDs), and hospitals. The architects of the plan intend for the transformation to improve management of the health care system and to make it more responsive to Quebecers’ needs. With over 330,000 employees, Santé Québec is now the province’s biggest employer, ahead of Hydro-Québec.
One of the first effects of the reform is the disappearance of CISSSs and CIUSSSs, to be replaced by regional entities such as “Santé Québec – Laval.” This might seem like a way of making management simpler, but critics see it as further centralization of a system that is already felt to be inadequate, too bureaucratic, and too slow to respond to local needs.
The government claims the project will reduce expenditures by $1.5 billion by March 2025. These savings will undoubtedly be carried out at the expense of quality of care and support for employees. So far, this cost-cutting has been one of the defining aspects of the reform.
Santé Québec has a mission to reduce waiting lists, which currently include some 160,000 people waiting for surgery; 11,000 of them have been waiting for more than a year. Reaching this goal without compromising quality of care will require significant resources, not cost-cutting.
The organization will also manage access to family doctors, at a time when over 2.3 million Quebecers don’t have one. How can the agency accomplish this without increasing the pressure on already exhausted personnel? These questions, for the most part, go unanswered.
Impacts of the reform
The provincial government’s creation of Santé Québec is a turning-point for Québec’s health care system, and may bring a number of negative impacts on Quebecers, employees, and the quality of care.
Recently, the province has enacted serious budget cuts which affect the ability of the system and its employees to meet Quebecers’ needs. In one Montréal institution, a hiring freeze led to a shortage of professionals in essential sectors such as mental health and youth services. Santé Québec has abolished key positions in vital programs, such as psychologists and social workers, depriving many people of essential services and increasing the pressure on already overloaded employees.
Other budget cuts have hit sectors such as care for seniors or people living with a disability. Suspending the “Residential Adaptation Assistance Program” in CLSCs, for instance, means that seniors and people with reduced mobility can’t get the help they need while the pressure on hospitals continues to rise.
Although centralization under Santé Québec is supposed to make things simpler, it could make the system more rigid and bureaucratic. Decisions that administrators make on the basis of quantitative data, disconnected with what’s happening on the ground and that don’t take specific regional factors into account, may lead to gaps in the care offered by the system.
Implementation has also meant budget cuts, and such austerity measures worsen the working conditions in health and social services. Job cuts and work overload are harmful to workers’ mental and physical health. Workers, above all else, sustain the public system. Without them, there can be no care or services.
These austerity measures are likely to have long-lasting repercussions on the health and social services system. Politicians may argue that reducing spending seems necessary in the short term, but these reductions will end up costing us more by increasing hospitalizations and expensive treatments that could have been avoided with early preventive support.
They will also drive patients towards private care. An increased reliance on the private sector, combined with reduced public service, makes the situation worse. Private institutions are not equipped to deal with complex, continuous care. This two-tier system penalizes the most vulnerable and exacerbates social and health care inequality. People with low incomes do not have private insurance and cannot access the care they need.
A stronger system
The government must urgently rethink its priorities and review budget decisions that jeopardize the quality of care, working conditions for personnel, and Quebecers’ health in the long term. Investments in prevention, training, and ways of keeping workers in the public sector are also crucial: they are needed to guarantee equitable access to care for all and to restore trust in a public system that must remain accessible and free.
We have to push back against the Santé Québec reform—it’s a slippery slope leading to the destruction of our universal access to health care. We need to think of new solutions to guarantee an accessible, high-quality health and social services system for all Quebecers.
The longer it takes to access health care, the more that care costs— in money, time, and quality of life. This is a real crisis in Quebec health care. Interminable waiting times compromise patient care and increase the risk of complications. The lack of access to preventive care means more visits to emergency departments, more hospitalizations, and treatment that is more costly in the long run.
Policymakers need to focus on ensuring access to family doctors—2.3 million Quebecers don’t have one, generating health care emergencies that could be avoided with appropriate front-line services. That is a core part of the real crisis in Quebec health care—not a bureaucratic reshuffle.
This is the perspective that led APTS (Alliance du personnel professionnel et technique de la santé et des services sociaux) to launch a campaign called “A strong public system: What if we dared to do it?” The union, which represents a broad section of health care workers, is demanding appropriate funding for the public system, criticizing budget cuts that directly undermine services provided to Quebecers.
It suggests bold measures to stabilize funding for the public system—setting up a budgetary shield, taxing the wealthiest one per cent, ending physicians’ incorporation as private companies, and reducing the role of the private sector. APTS denounces the government’s narrow-minded accounting approach, which gives precedence to short-term savings over human needs, and warns against the disastrous consequences of such decisions.
Public health should not be a budget adjustment factor but a collective priority, guaranteeing the existence of a strong system that is accessible to all.
