Reorganising health and social care in Québec: a journey towards integrating care through mergers.

Paul Wankah,Louise Belzile,Yves Couturier,Maxime Guillette,Sophie Dumas,Dominique Gagnon,Mylaine Breton,Yahya Mosbah

doi:10.1080/17571472.2018.1453957

Abstract

ContextTwo reforms (2014, 2015) characterised by the merger of public health care establishments profoundly shaped the current organisation of Quebec’s healthcare system. In 2015, 22 megastructures called Integrated Health and Social Services Centres/Integrated University Health and Social Services Centres (IHSSC/IUHSSC), were created and mandated to organise care delivery to their local populations.ObjectiveTo describe the service configuration of the 2015 healthcare system reforms, emphasising on how it shaped the organisation of primary health care (PHC) in Quebec.ResultsWith the creation of IHSSCs/IUHSSCs, Quebec’s healthcare system passed from three to two levels of governance, leading to a centralisation of decision-making powers. Most health services are delivered by the new organisations, while most PHC is delivered by semi-private medical practices, mainly Family Medicine Groups (FMGs). The FMG model is the preferred strategy to develop interdisciplinary team-work and inter-organizational collaborations with other PHC services.Conclusionmechanisms through which centralised healthcare systems achieve community oriented integrated care (COIC) need to be properly understood in order to improve meaningful clinical outcomes. Mergers may not sufficiently achieve integration of services in all its dimensions. These reforms should be monitored and evaluated on their capacity to mobilise all providers as well as physicians to participate in COIC.

Highlights

Developed countries are constantly reorganising their healthcare systems
The paper described the introduction of new primary care models promoting family physician group practices such as Family Medicine Groups (FMGs) and network clinics, and integrated Local Health Networks (LHNs) to promote the creation of local strategic alliances between Health and Social Service Centres (HSSC), FMGs, and community organisations
This paper describes two approaches to improve Community Oriented Integrated Care (COIC): (i) the creation of Integrated Health and Social Service Centres (IHSSCs)/IUHSSCs through the merger of all public healthcare organisations, and (ii) two strategies to enhance the participation of family physicians in COIC

Summary

Introduction

In line with the quadruple aims of healthcare reform goals, these countries implicitly or explicitly aim to improve patient care experiences, population health, the healthcare system cost efficiency, and the working lives of health care providers [1] This usually involves the implementation, routinization, and sustainability of innovative organisational care delivery models. The paper described the introduction of new primary care models promoting family physician group practices such as Family Medicine Groups (FMGs) and network clinics, and integrated Local Health Networks (LHNs) to promote the creation of local strategic alliances between HSSCs, FMGs, and community organisations. This was intended to improve the delivery of integrated health and social care at the community level through inter-organisational collaborations with primary health care (PHC) organisations [6]

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