The impacts of the creation of Santé Québec—Part I

The various functions and vocations of the Ministry of Health and Social Services

To mark my first day as President and CEO of the Private Health and Wellness Business Council (CEPSEM), I am devoting my second text to the healthcare system, hoping, with the coming texts, to allow everyone to better measure the extent of the actions taken by the government in place.

The Minister of Health and Social Services, Christian Dubé, is currently working on setting up one of the important pillars in his overhaul of the health system, namely the creation of Santé Québec. A first step to properly situate this important change in our environment is to understand the multiple functions and vocations assumed by our Ministry of Health and Social Services (MSSS) and how they evolve over time.

The MSSS oversees the application of more than thirty laws that have different functions. Essentially, until the creation of Santé Québec, the following functions or vocations could be identified: structural and organizational function, protection of the population function, insurer or payer function, and above all, a system regulation function.

In terms of organization, of course, there is the Act respecting the Ministry of Health and Social Services (CQLR c. M-19.2), the first version of which dates back to 1936 with the creation of a health department. But with the increasing complexity of the health environment, other structures have been added, such as the Régie de l’assurance maladie du Québec (1978), the Institut national de santé publique (1998), Héma-Québec (1998), the Commissaire à la santé et au bien-être (2005) and the Institut national d’excellence en santé et services sociaux (2010).

Another important function of the MSSS, in the context of a public healthcare regime, is that of insurer or payer. In this category, we find the Hospital Insurance Act (1970), which was a first step in the establishment of the public system. This law was subsequently followed by the Health Insurance Act (1970) and the Act respecting Prescription Drug Insurance (1997).

The MSSS has the responsibility of ensuring the protection of certain classes of the population. Thus, it supervises laws such as the Youth Protection Act (1977), the Act respecting the exercise of the rights of disabled persons (1978), the Act to combat the mistreatment of seniors and any adult in a vulnerable situation (2017) and the Act respecting the protection of persons whose mental state presents a danger to themselves or to others (1997). It should be noted, however, that this last law is derived from one of the oldest health laws in Quebec: the Act respecting insane asylums in the province of Quebec (1885), whose framing, protection and insurance functions were split with the creation of the first Act respecting health services and social services (LSSS) (1971).

This brings us to the function that will be of interest with regard to the creation of Santé Québec: the system regulation function where the MSSS does not assume a direct role in the provision of services but regulates the actors in the network.

The first regulation functions date back to 1885 when the government assumed a certain level of specific oversight for insane asylums. This was followed by the oversight of hospitals (Private Hospitals Act of 1935, Hospitals Act of 1962, and the Public Assistance Act of 1921, revamped in 1964). This oversight began when the government started to assume part of the financial burden in the operation of hospitals with the establishment of the Canada Hospital Insurance and Diagnostic Services Act (1957). Following the adoption of the Canada Medical Care Act in 1966, the provinces continued to develop their healthcare networks with the introduction of various health insurance laws (in 1970 for Quebec). The LSSS underwent a major reform in 1991 and several adjustments that we will discuss in future texts until ultimately the law that creates Health Quebec. So far, with the LSSS as the backbone and several other satellite laws (essential services—1996, medical laboratories—2001, pre-hospital care—2002, access to medical services—2015), the role of the MSSS is primarily one of overseeing various quasi-governmental bodies endowed with more or less autonomous governance.

With the creation of Santé Québec, we are witnessing a significant development of the function of employer of the MSSS.

We will explore the evolution of this governance in the coming texts. Until then, if you have questions or need help on this topic, MEDIATOR is here to help you!