Experts Question Quebec’s Plan to Merge Health Agencies Amid Concerns

Concerns are mounting over the Quebec government’s proposal to merge two significant health agencies as part of a broader initiative aimed at reducing bureaucracy and improving efficiency. The plan, outlined in Bill 7, introduced by France-Élaine Duranceau, the President of the Treasury Board, is projected to save $35 million primarily through the elimination of 220 full-time positions, including approximately 100 within the healthcare sector.

The bill seeks to combine the Institut national de santé publique du Québec (INSPQ) and the Institut national d’excellence en santé et en services sociaux (INESSS), creating a new institute that would oversee their functions. Additionally, it proposes transferring the operations of three INSPQ medical biology laboratories to Santé Québec and reallocating organ and tissue donation coordination from Transplant Québec to Héma-Québec.

While the government emphasizes the need for this merger, experts express serious reservations about its implications for public health services.

Concerns Over Public Health Impact

Professor Olivier Jacques, a health policy specialist at Université de Montréal, has publicly criticized the merger, questioning the justification for the proposed savings and the potential negative impact on services. He remarked, “We have difficulty to see what is the intent of policymakers there,” during a discussion with CBC News. He highlighted that the plan does not present a clear connection between cost-cutting and improved efficiency, warning that it could jeopardize public health in the province. He referenced the adage, “if it ain’t broke, don’t fix it,” to underline his skepticism.

In a statement released by Duranceau’s office, the government argues that the merger aims to address issues that became apparent during the COVID-19 pandemic. The statement noted that the pandemic exposed limitations in the existing fragmented model, where a lack of coordination between the two institutes impeded timely responses. The government asserts that merging these organizations will enhance efficiency and clarify responsibilities, ultimately better serving current and future health system needs.

Despite these assurances, experts remain unconvinced about the merger’s effectiveness. Professor Nathalie Clavel, also from Université de Montréal, voiced similar concerns during a parliamentary committee meeting. They both warned that consolidating these agencies could fragment essential services and reduce preventive care efforts.

Potential Risks to Preventive Care

Jacques emphasized that merging the agencies could result in a concerning shift in funding priorities. He explained that public health initiatives are integral to long-term health improvements, while immediate healthcare demands often overshadow them. “I am really concerned that the budgets would be much more allocated toward the curative functions related to INESSS to the detriment of the preventive, long-term oriented functions of the INSPQ,” he stated.

He further elaborated that the historical trend shows that when budgets for preventive and curative care compete, preventive care consistently loses funding. This pattern persists despite public health’s proven effectiveness, as the general public tends to favor immediate responses to acute healthcare crises over long-term preventive measures.

Jacques argues that even if the government proceeds with the merger, maintaining separate budgets for preventive and curative functions is essential. He raised a critical point about the lack of evidence supporting the success of similar mergers in other jurisdictions, stating, “I don’t think the fusion is a good idea. It’s two institutions that have two very different perspectives and two very different missions.”

As the Quebec government moves forward with its proposal, the debate over the implications of merging these two crucial health agencies continues to unfold, underscoring the delicate balance between efficiency and the quality of public health services.