Are you tired of health reforms?

Not tired of healthcare reforms?


In the midst of a pandemic, Prime Minister François Legault promised the “refoundation” of the health network. A year later, the Minister of Health, Christian Dubé (in the main photo), delivered an important piece of this this week with the bill on the future health agency, which will oversee the entire network. Another reform that adds to several attempts over the past 20 years to make the system more efficient. Here is a summary of these attempts, some of which were unsuccessful.  

20 years of reforms and initiatives


  • Green: Excellent
  • Yellow: Fair
  • Red: Null 

1. François Legault
Hospital Bulletin – 2002

Many forget it, but François Legault briefly held the post of Minister of Health. Its best-known initiative is undoubtedly the hospital bulletin. In September 2002, he presented a bulletin ranking the 105 hospitals in Quebec with letters ranging from A to E.Unsurprisingly, some Montreal hospitals such as Hôpital Notre-Dame and Hôtel-Dieu had been rejected due to the situation of their emergencies. Hospitals were also rated on their compliance with the budget. Those who had no deficit had the best grades. The bulletin, which Legault refused to call a list of winners, did not survive him.

2. Philippe Couillard
Creation of CSSS – 2004

In 2003, Jean Charest had recruited the neurosurgeon by profession to make him his Minister of Health. He is notably responsible for the creation of local health networks (RLS). At the heart of this reform, we also find the health and social services centers (CSSS) created by the merger of several establishments (CHSLDs, CLSCs, hospitals) on the same territory. The idea was to facilitate the patient's journey within the network and to pool certain resources. However, the CSSSs of a territory continued to report to the regional health agency.

3. Yves Bolduc
Toyota Method – 2008

The one who succeeded Philippe Couillard surprised many when he arrived with the Lean approach, also called the Toyota method. As we had done in car manufacturing plants, the idea was to review all the processes to improve efficiency. Everything was there: organizational culture, employee empowerment and decision-making as close to the action as possible. While some processes have remained, the expression “Toyota method” has practically disappeared from the network.

4. Réjean Hébert
Autonomy Insurance – 2014

Doctor Réjean Hébert did not have time to implement his autonomy insurance reform during his short term as minister between 2012 and 2014. First presented in a white paper in 2013, the proposal was abandoned after the defeat of the Parti Québécois. A sum of $500 million was to be injected by the government into a fund dedicated to autonomy insurance. In particular, we wanted to promote the development of home care for seniors.

5. Gaétan Barrette
Creation of CISSSs and CIUSSSs – 2015

Minister Gaétan Barrette struck a blow in 2015 by introducing Bill 10. This led to the creation of 34 integrated centres, huge establishments bringing together up to forty CHSLDs, CLSCs, hospitals, rehabilitation centers and youth centers. Hundreds of management positions were subsequently abolished, as were health agencies. Appointments of CEOs and some board members are now the responsibility of the Minister.

Christian Dubé
2020 – 2023  

After leading the system during the pandemic, Christian Dubé presented his bill this week to create the Santé Québec agency. A structure that will oversee the entire network, a bit like Hydro-Québec. The Minister of Health will remain responsible for the orientations, but the management of the establishments will be the responsibility of the agency. On the menu: a single employer for the entire network, fewer union certifications, more responsibilities for medical specialists, a public personnel placement agency and changes to the distribution of family doctors. 

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