One Step Forward, One Step Back: Quebec's 2003-04 Health and Social Services Regionalization Policy

By Martin, Elisabeth; Pomey, Marie-Pascale et al. | Canadian Public Administration, December 2010 | Go to article overview

One Step Forward, One Step Back: Quebec's 2003-04 Health and Social Services Regionalization Policy


Martin, Elisabeth, Pomey, Marie-Pascale, Forest, Pierre-Gerlier, Canadian Public Administration


Public policy-makers from around the world have moved to decentralize health-care systems in recent years in the hopes of achieving better governance and a more judicious distribution of management and service production responsibilities (Denis 1997; Saltman, Bankauskaite, and Vrangbaek 2007). Originating in the 1990s, Canada's enthusiasm for decentralization has caused regionalized health-care services organizational models to dominate the country's provincial health-care governance schemes. One of the most prominent advocates of regionalization in Canada is the province of Quebec, which first began to regionalize health-care structures nearly forty years ago and now boasts the longest continuous experience in regionalization of any Canadian province. Saskatchewan experimented with regionalization in the 1940s but let the idea drop before reintroducing it in the 1990s (Lewis and Kouri 2004).

Established in the 1970s, Quebec's regionalization model began with the implementation of regional health and social services councils (Conseils regionaux de la sante et des services sociaux), invested by the ministry with limited advisory powers but in charge of the planning of health-care delivery at the regional level (Turgeon 1989; Turgeon, Anctil, and Gauthier 2003). In 1991, Quebec changed the model considerably by replacing the councils with regional health and social services boards (Regies regionales de la sante et des services sociaux--"regional boards") that were given full decision-making authority over resource allocation and the planning and organization of services. The next significant change to Quebec's regionalization policy took place in 2003. In that year, Quebec's provincial electoral campaign was dominated by health-care issues, with all three leading political parties advocating large-scale reform of Quebec's health and social services system. The issue of regionalization took centre stage after the Quebec Liberal Party pledged that, if elected, it would abolish regional-level structures of the province's health-care system (the regional boards) (Quebec Liberal Party 2002). A few months later, in December, the newly elected Liberal Party passed Bill 25 (An Act Respecting Local Health and Social Services Network Development Agencies [Loi sur les agences de developpement de reseaux locaux de services de sante et de services sociaux] [L.S.Q. 2003, c. A-8.1]). While the law did not actually abolish regional-level structures, it altered their functions substantially by transferring health and social services management responsibilities to the local level. With goals of improving accessibility, speeding integration, ensuring continuity and making it easier for patients to navigate the health-care system (Quebec, Ministry of Health and Social Services 2004), the reform was implicitly pursuing objectives of accountability, efficiency and effectiveness, all principles of the "new public management" movement (Aucoin 1990; Denis 1997; Farrell and Morris 2003).

Once rumours that the regional level would disappear had been dissipated, the proposed reform succeeded in rallying a majority of stakeholders around its objectives--this, despite initial objections to the means chosen by the government to implement the reform (Contandriopoulos et al. 2007). In the end, the government chose to retain a three-tier health-care governance structure but gave the local tier increased responsibilities. Originally slated for eradication, the regional tier survived but in a new form.

Despite many years of experimentation with regionalization in Quebec, the motives for the decision on this issue have been largely occulted from the public eye. This article will attempt to elucidate the reasons for which the crafters of the 2003-04 reform maintained the regional tier rather than abolishing it as originally planned. Analysing the question from a political science perspective, we suggest that behind the government's public goal to decentralize power to the local level lay the hidden intention to maintain the regional level as a means of retaining centralized control over Quebec's health-care system. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

One Step Forward, One Step Back: Quebec's 2003-04 Health and Social Services Regionalization Policy
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.