The face of the Quebec health system will change significantly in the coming months, when the Legault government will create the Health Quebec agency. The province will not be the first to embark on such a project; its neighbor Ontario is one of the last to have done so. Quebec could learn from its experience.
Former Ontario Minister of Health Christine Elliott began thinking about possible improvements to her province’s health care system in 2015, when she served as Patient Ombudsman. “Patients told me they were unhappy with the system, that they felt disconnected,” she says. In 2018, she was elected MP, then appointed Minister of Health in the Ford government. She begins sometime later having conversations about a superagency. It was finally created in March 2019.
The agency’s responsibilities include managing health service needs and implementing Ministry of Health strategies. Abi Sriharan, a researcher at York University’s Krembil Center for Health Management and Leadership, describes Ontario Health as a “managing branch of the ministry”: it allocates resources and oversees the system. The agency also includes Ontario Health Teams, groups of multidisciplinary health organizations that serve different segments of the population.
According to Professor Sriharan, the reform includes good things, but there would still be a lot of unknowns. Provincial organizations, such as Cancer Care Ontario, have been brought into the agency, but “it’s not always clear who does what,” she says. His advice to Quebec: mergers can promote the integration of care, but they must be done transparently. Jean-Louis Denis, a professor from the University of Montreal specializing in health management, believes that the agency seemed “less accompanied by a transition plan” than other provinces.
A different system
The health care systems in Quebec and Ontario are very different, so a successful model in one province will not necessarily work in the other. In Ontario, for example, hospitals are not sponsored by a regional authority like the CISSS or CIUSSS in Quebec. Until 2019, Ontario had regional authorities, called Local Health Integration Networks (LHINs), but these networks did not provide services. Regional authorities now have a different name and are part of Ontario Health.
When the pandemic was declared, Christine Elliott was happy that regional authorities had been brought into the agency. “We just had to organize with Ontario Health to respond to COVID. The answer would have taken longer to arrive if we had had to negotiate with 14 different LHINs,” she explains in an interview. University of Toronto professor emeritus Gregory Marchildon, who studies health policy, believes the minister may have been right to think so. After all, the LHINs could not have vaccinated like the CISSSs.
Abi Sriharan, however, believes that Ontario Health and the Ministry of Health have mostly worked well together during the pandemic because of the good personal relations between leaders, not necessarily because there were clear protocols. Matthew Anderson, the president and CEO of Ontario Health, appointed in December 2019, was already a well-known figure in the Ontario health community. If Quebec wants to create a superagency, it will have to clarify the role and responsibilities of the decision-making authorities, explains the York University professor.
Innovative approach
Ontario Health Teams have somewhat replaced LHINs since the reform, although the province does not say so explicitly. Ontario has 54 teams, including seven in Toronto. They are made up of several organizations, for example a hospital, a transition house or a municipal service. These organizations agree among themselves to join forces, then ask the ministry to recognize their team. “They make sure patients don’t fall through the cracks,” says former minister Elliott.
Steven Lewis, a health policy analyst, argues that this is the real innovation of the 2019 reform. But are the teams working? “No one knows,” he wrote. “What is complicated is that you have teams that focus on different diseases,” notes Professor Sriharan. At the end of the day, she says, mergers are very expensive. “Quebec will have to have a clear vision of the agency and the costs it eliminates. Following Ontario’s example will not be enough,” concludes the researcher.
This story is supported by the Local Journalism Initiative, funded by the Government of Canada.