Bill 10 - The QMA Requests Redistributing the Regions in the New Structures and Reducing the Minister’s Powers
Montréal, October 23, 2014 - During its presentation before the health and social services commission on Bill 10 this morning, the Québec Medical Association (QMA) expressed its interest and concerns regarding the Bill, which poses a high risk of disrupting the health care system over the next few years. It requests that the regions in the new structures be readjusted and that the powers be redistributed to the regional structures in order to reduce the powers granted to the Minister under this Bill.
The QMA welcomes the provisions of Bill 10 that aim to reduce the bureaucracy in the health and social services system. These provisions are consistent with comments the QMA has made in the past regarding the administrative burden. However, the fact that the regional structures, called CISSSs (integrated health and social service centres), will be completely controlled and managed by the Québec Health Minister could make it difficult for the CISSSs to adapt their services to the needs of their population. The role of the government and the MSSS is to set the main directions and not to manage the organization of health care. The QMA recommends that the scope of the Minister’s control be reduced by redistributing the powers to the regional structures in order to ensure that CISSSs have manoeuvring room and greater autonomy.
Furthermore, as set out in the Bill, the integrated health and social service centres (CISSSs) will be very large institutions in some regions, with daily operations that could present significant challenges. The QMA proposes that the government show more moderation and increase the number of CISSSs without affecting the basic principle of the regional groups. It also recommends revising how the regions are redistributed so that each CISSS is a reasonable size in terms of the area covered and number of service points managed. These concerns apply to the size and management of the CPDPs as well. The QMA also requests that the supraregional mission of the university medical centres in Sherbrooke and Québec City be recognized, like that of the CHUM, MUHC, Sainte-Justine University Hospital Centre and Montreal Heart Institute, and that they maintain their separate board of directors.
The QMA would like the Bill to include greater integration of physicians in the decision-making process and in managing the health care institutions in order to recognize their medical expertise and knowledge of the local organizational reality of the institutions. Moreover, centralizing the powers in the Minister’s hands will take the decision-making process farther away from the regional boards. The roles and responsibilities of the regional agencies will thus be shared between the MSSS and the CISSSs, and a reading of Bill 10 suggests a centralization of power towards the top and not locally.
In addition, the QMA is concerned about the fact that the members of the board of directors of the regional institutions will be appointed by the Minister, which will reduce the democratic power of the population and increase the politicization of the health and social services system.
The QMA also expressed reservations about the transition period that will follow adoption of the Bill. It will be difficult to focus the energy of the professionals on innovations to clinical processes that would translate into an improvement in the quality of services. The teams and professionals should be properly guided in these changes to ensure that they are implemented successfully. As for clinical services, the QMA deplores the fact that Bill 10 contains no guarantee of improvement in primary care services and the quality of care.
“The QMA is aware of the budget constraints that are guiding the government’s action and of the need to transform the health care system,” stated Dr. Laurent Marcoux, President of the Québec Medical Association. “However, this Bill and the powers that would be granted to the Minister do not offer the assurance of better access to care and services, reduced wait times, better chronic disease management or action from the Minister to deal with glaring problems such as overdiagnosis. Last August, the QMA released an action plan to counter the adverse effects of overdiagnosis, overtreatment and overmedicalization, as well as more effective use of the funds invested in health. Our organization is still waiting for a sign of leadership from the Minister to address this scourge.”
The Québec Medical Association’s brief is available on its Web only in French.
About the QMA
The QMA comprises some 10,000 general practitioners, specialists, residents and medical students. Its mission is to bring together members of the Québec medical community in a context that promotes reflection and action in the best interests of the health of Quebecers.
Québec Medical Association
Tel.: 514 866-0660