Santé Québec: Reflections on Québec’s 2025 Health System Reform

Abstract

Québec retains a unique set of social and health policies which distinguishes it from other Canadian provinces. Québec’s welfare state, distinct within Canada and North America more generally, is the product of the province’s history of secularization and detachment from traditional institutions, all tenets of the Quiet Revolution of the 1960s (D. Béland and Lecours 2008; Rocher 2002). Examples of unique policy initiatives include generous family policies (parental leave including paternity leave, universal daycare programs), as well as the democratization of education through generous government subsidies for higher education. Québec’s health care system, like those of other provinces, guarantees publicly funded physician services and hospital care. But the province has also used its jurisdictional autonomy to pioneer innovative health and social programs that expand beyond universal coverage, addressing broader determinants of health and embedding equity considerations across all sectors of policy-making. Examples include the Local Community Service Centres (Centres locaux de services communautaires; CLSC), a cornerstone of primary care in Québec; embedding the responsabilité populationnelle (accountability for population health) into health and social programs; a publicly subsidized drug insurance plan introduced in the late 1990s; and the integration of health and social care under the same governing authority, the Ministry of Health and Social Services (Ministère de la Santé et des Services sociaux; MSSS) — with the latter two innovations unique in Canada. This orientation was further institutionalized with the adoption of Article 54 of the Public Health Act, which facilitated the adoption of the Health in All Policies framework by requiring ministries to assess the health impacts of their proposed legislation. (continued in full text PDF / HTML