Improving Accessibility to Services and Increasing Efficiency Through Merger and Centralization in Québec

• Main Authors: Amélie Quesnel-Vallée, Renée Carter
• Format: Article
• Language: English
• Published: McMaster University Library Press 2018-03-01
• Series: Health Reform Observer - Observatoire des Réformes de Santé
• Subjects: centralization; institutional merger; organizational reform; accessibility to health care; integration of care; Quebec
• Online Access: https://mulpress.mcmaster.ca/hro-ors/article/view/3216/3036

On 25 September 2014, Bill 10 was tabled to reorganize Québec’s health and social services network through the abolition of an administrative layer at the regional health authority level and institutional mergers of health and social services facilities under a new governance structure. Thus, the province’s 182 health and social services facilities were merged into 34 Centre intégré de santé et des services sociaux (CISSS) / Centre intégré universitaire de santé et des services sociaux (CIUSSS). CISSS/CIUSSS are responsible for delivering a range of health and social services in a designated territory through the administrative integration of facilities including: local community health centres, generalized and specialized hospitals, psychiatric hospitals, child and youth protection centres, residential and long-term care centres, and rehabilitation centres. These mergers were operationalized notably by a new governance structure whereby the minister-appointed board of directors in each CISSS/CIUSSS reports directly to the Minister of Health and Social Services. As such, a centralization of powers was also achieved. While formal evaluations of reform performance have yet to be completed, analyses projecting potential difficulties of the reform were presented during special consultation hearings. Among the key concerns identified was whether there was evidence to support claims that administrative mergers increased efficiency by achieving economies of scale. Additionally, implicit to Bill 10 is the assumption that continuity of care will follow from administrative mergers. Strategic mergers through professional networks can promote more streamlined approaches to information sharing.