Reorganising health and social care in Québec: a journey towards integrating care through mergers

Abstract

ContextTwo reforms (2014, 2015) characterised by the merger of public health care establishments profoundly shaped the current organisation of Quebec’s healthcare system. In 2015, 22 megastructures called Integrated Health and Social Services Centres/Integrated University Health and Social Services Centres (IHSSC/IUHSSC), were created and mandated to organise care delivery to their local populations.ObjectiveTo describe the service configuration of the 2015 healthcare system reforms, emphasising on how it shaped the organisation of primary health care (PHC) in Quebec.ResultsWith the creation of IHSSCs/IUHSSCs, Quebec’s healthcare system passed from three to two levels of governance, leading to a centralisation of decision-making powers. Most health services are delivered by the new organisations, while most PHC is delivered by semi-private medical practices, mainly Family Medicine Groups (FMGs). The FMG model is the preferred strategy to develop interdisciplinary team-work and inter-organizational collaborations with other PHC services.Conclusionmechanisms through which centralised healthcare systems achieve community oriented integrated care (COIC) need to be properly understood in order to improve meaningful clinical outcomes. Mergers may not sufficiently achieve integration of services in all its dimensions. These reforms should be monitored and evaluated on their capacity to mobilise all providers as well as physicians to participate in COIC.

Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study

“…12 For example, in 2015, Quebec's health and social services system has been reformed with a centralisation process that abolished Regional Health Authorities. 13 The government of Quebec explicitly stated that this reorganisation was put in place to 'facilitate and simplify access of services to the population, to improve the quality and security of services, and to increase the efficacy and efficiency of the health system'. 14 The Patient-Centred Innovations for Persons with Multimorbidity research programme was developed to evaluate two complex interventions implemented in two Canadian provinces (Quebec and Ontario).…”

Multiple Perspectives Analysis of the Implementation of an Integrated Care Model for Older Adults in Quebec

“…The health and social services system in Quebec underwent significant reorganisation again in 2015 [41]. The Government pursued a centralisation process that abolished regional health authorities.…”

“…As a result, the territory of Quebec is currently divided into 22 functional units with the creation of 13 Integrated Health and Social Service Centres, and nine Integrated University Health and Social Service Centres (which have additional research and training roles). They directly answer to the Ministry of Health and Social Services [41], and form strategic partnerships with community organisations and private organisations in their territories [42]. Furthermore, they retained the mandate to implement Local Health Networks for various subpopulations within their territories.…”

“…Furthermore, they retained the mandate to implement Local Health Networks for various subpopulations within their territories. Finally, there have been few “serious” evaluations of the 2004 and 2015 health system reforms in Quebec [41].…”

London Journal of Primary Care – a PAUSE

“…In 2004, Quebec developed Local Health Networks to facilitate better collaboration at the local level [2]. A paper in this Issue of LJPC discusses the impact of the 2015 health care reforms that merged public health care organisations under a single governance [3]. Some argue that these larger organisations would better manage joint budgets and achieve economies of scale.…”