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

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

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

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

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

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

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.

2023 - Dubé reform

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.