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Bill 15: Quebec is centralizing again

Montreal, March 29, 2023 – The creation of the Santé Québec agency will reduce the autonomy of facilities and do nothing to keep nurses from leaving the profession, warns the Montreal Economic Institute following the tabling of Quebec’s Bill 15 on health care.

“If nurses are leaving governmental facilities to work for an agency, it’s because the government as employer discourages them,” says Emmanuelle B. Faubert, economist at the MEI. “Essentially making them return to the employer they left risks leading even more nurses to leave the profession.”

Bill 15 is a first step in creating the Santé Québec agency, destined to become the sole employer of health care workers in the province. It follows on the heels of Bill 10, tabled earlier this year, aiming to eliminate the use of employment agencies in health care and bringing workers back under the authority of the government as sole employer.

Over the past five years, on average 9 young nurses have left the profession for every 20 who joined it.

The Santé Québec agency will also replace the local boards of directors of the integrated health and social services centres (CISSS and CIUSSS) as accountability structures.

“Centralization assumes that a bureaucrat in an office tower in Quebec City knows the reality on the North Shore better than the people on the ground in Baie-Comeau,” explains Ms. Faubert. “The health systems that work the best are those like Sweden’s that recognize that the people on the ground are more aware of local issues.”

A 2017 MEI study explains that one of the secrets of the Swedish health care system’s success is the respect for the autonomy of care facilities, the central government limiting itself to establishing guidelines and quality standards.

Recently, the government announced other key elements of its health reform, notably publishing calls for interest for the construction of two mini-hospitals to be run by independent entrepreneurs, but accessible with the Quebec medicare card, a decision applauded by the MEI.

The Institute also approved of the expansion of patient-based funding to surgical activities, announced in the latest budget.

“The mini-hospitals and the expansion of patient-based funding are two decisions going in the direction of decentralization—the opposite of Bill 15,” adds Ms. Faubert. “It’s all the more disappointing given that the government had started out on the right foot up until now with its other announced health reforms.”

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The MEI is an independent public policy think tank with offices in Montreal and Calgary. Through its publications, media appearances, and advisory services to policy-makers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship. 

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