55 years of health reforms
The health network has undergone several reforms in the last 55 years, reforms that have had major impacts on the work of healthcare professionals. With the Dubé reform, we are witnessing the culmination of these major reforms, which are unravelling, law by law, the very foundations of the RSSS.
Understanding past reforms to face today’s reform.
1970 – Creation of the RAMQ
- Universal access
- Adoption of the ARHSSS
- Creation of the MSSS and CLSCs
It was the beginning of the public network which aimed to offer health care that is accessible to everyone. CLSCs were created to provide front-line care in communities.
1990 – Côté reform
- Regional boards
- Decentralization
- Participatory governance
- Labour shortage
After the Rochon Commission, an attempt to modernize the health network began. The government wanted to decentralize the system and give more decision-making power to communities. Even then, they wanted to relieve overcrowding in emergency departments and the government cited the labour shortage as a major challenge.
1995 – Rochon reform
- Outpatient shift
- Budget restrictions
- Massive retirements
The organization of the network is now focused on reducing the length of hospital stays and bringing care and patients closer together. The money freed up by reducing hospital services is not being reinvested in local care, and the government claims that there are suddenly too many nurses in the network.
2003 – Couillard reform
- Mergers (from 4,592 to 182 institutions)
- Austerity
- Privatization (FMG, SMC and public-private partnerships)
The grouping of institutions into CSSSs provided a lucrative playground for a number of private companies that appropriated public resources through subcontracting agreements. The integration of the quest for performance and principles of competition clearly worsened working conditions in the network, particularly under Minister Yves Bolduc.
It also made it possible to misuse public funds! Arthur Porter 😉
2015 – Barrette reform
- Mergers (from 182 to 34 institutions)
- Austerity
- Centralization of decisions
- Disorganization
CISSSs and CIUSSSs were created and became mega institutions where power was centralized. The reform aimed to reduce administrative costs and increase the network’s efficiency. Healthcare professionals’ workload increased, and services were cut.
2020 – COVID-19 pandemic
- Governing by decree
- Outrageous mobility
- Huge expansion of the private sector and IL
The government took advantage of the health crisis to appropriate powers and centralize decision-making in the health sector, creating appalling working conditions and a mass exodus of healthcare professionals, in particular to the private sector and employment agencies.
Dubé reform
- Mergers (from 34 to 5 institutions)
- Privatization
- Austerity
The creation of Santé Québec was the ultimate merging of institutions: unprecedented centralization in the network. The role of private for-profit companies has been formalized, and the structure made more complex, all against a backdrop of unprecedented budget cuts. The government is citing a labour shortage yet is cutting jobs.
Acronyms
CISSS: Centres intégrés de santé et de services sociaux
CIUSSS: Centres intégrés universitaires de santé et de services sociaux
CLSC: Centres locaux de services communautaires
SMC: Specialized medical centre
CSSS: Centre de santé et de services sociaux
FMG: Family medicine group
RAMQ: Régie de l’assurance maladie du Québec
ARHSSS: Act respecting health services and social services
IL: Independent labour
MSSS: Ministry of Health and Social Services