Explainer: How will Quebec's new health-care agency change the system?

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Starting next month, Quebec’s entire health-care system, currently managed by more than two dozen organizations, will come under the control of a single agency: Santé Québec.

Organized as a state-owned enterprise, like Hydro-Québec or the SAQ, Santé Québec is part of a wide-ranging reform that Health Minister Christian Dubé says he believes will reduce surgery delays, improve emergency room wait times and offer better service.

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Santé Québec CEO Geneviève Biron has also said she plans to find “efficiencies.” During a recent series of media interviews, she said her first job is to find $1 billion in savings.

But critics question whether the plan — the third major health-care reform since the mid-1990s — will actually make an improvement or simply create another bureaucracy. There have also been concerns about Biron’s close familial ties to the large private health-care company she used to run, leading to fears of creeping privatization, and about the high salaries the new agency will pay executives and board members.

So what is Santé Québec and how is it supposed to change the health-care system? Here are three things to know:

How will the new agency work?

For the vast majority of Quebecers, health care is governed by 23 regional health authorities, known by the French acronyms CIUSSS, CISSS and, in the northern Jamésie area, CRSSS.

Several major hospitals and specialized institutes, which serve patients from across the province, are independent of those agencies.

On Dec. 1, all the health-care facilities managed by those regional authorities and the independent institutions will become part of Santé Québec.

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In Montreal, that includes five CIUSSS, three independent hospitals — including the McGill University Health Centre — and the Montreal Heart Institute.

Under the new system, the health ministry will be responsible for policy and strategic planning, while Santé Québec will be responsible for day-to-day operations.

But there have been fears about what the takeover of independent university-affiliated hospitals, hospital networks and institutes will mean for the quality of those institutions. Last year, six former Quebec premiers, both Parti Québécois and Liberal, wrote an open letter criticizing the takeover of those institutions, whose work combines research and innovation with health care.

Why is the government doing this?

When he announced the reform, Dubé said that by increasing the level of organization in the health-care system, he thinks Santé Québec can reduce wait times for surgeries, emergency room delays and offer better customer service.

Dubé has also suggested that running the health-care system more like a business — with what he called “top gun” managers from the private sector — will create efficiencies.

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The reform will also see all health-care facilities get an on-site manager — something that was cut during a 2015 health-care reform led by then-Liberal health minister Gaétan Barrette — which is intended to fix issues that emerged during the COVID-19 pandemic, when individual facilities were unable to adapt to a rapidly spreading virus as they waited for instructions.

The reform will also put all health-care workers under a single employer and reduce the number of union bargaining units from 136 to four. That means workers will be able to transfer between facilities more easily without losing their seniority, Dubé has said, and patients can be offered appointments at any public facility in the province, such as one that used to be in a neighbouring CIUSSS, as well as in private facilities.

Biron has said the unified system will reduce competition for resources between different public health-care organizations and reduce the duplication of services.

What are the concerns?

Health-care unions have accused Santé Québec of being a back door to increased privatization. Biron was the president and CEO of Biron Health Group, a private health-care company founded by her father, for nearly seven years. Her sister took over as head of the company, which specializes in medical testing, in 2021.

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In interviews, Biron has said her job at Santé Québec is to build a strong public health-care system but that Quebec currently needs to use private health-care providers to fill in the gaps.

There have also been concerns about salaries at the top. For the first two years of her mandate, Biron will receive $652,050 annually, a 15-per-cent boost over her base salary of $567,000, while the chair of Santé Québec’s board, hotel magnate Christiane Germain, will be paid $173,000 a year. 

And while workers may be able to move more easily between health-care establishments, those who work at one facility and moonlight at another have been told they now have to pick one, raising fears that this will put further pressure on a system that’s already short of workers.

Some experts and opposition parties have also questioned how creating a new bureaucracy will address issues like the need for 10,000 additional nurses.

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