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Some experts are sounding the alarm over the Quebec government’s proposal to merge two flagship health agencies as part of a broader plan to reduce bureaucracy and increase state efficiency.
Bill 7, tabled last month by Treasury Board President France-Élaine Duranceau, is designed to save $35 million, primarily by cutting 220 full-time positions, including about 100 in the health-care system.
The bill would fuse the Institut national de santé publique du Québec (INSPQ) and the Institut national d’excellence en santé et en services sociaux (INESSS) into a single new institute.
It would transfer the activities of the three INSPQ medical biology laboratories to Santé Québec, while assigning the functions of organ and tissue donation co-ordination currently exercised by Transplant Québec to Héma-Québec.
However, not everyone agrees with the plan.
Olivier Jacques, a professor specializing in health policy at Université de Montréal, recently raised concerns with the government, saying he sees no clear line between potential savings and the cost to services as each agency serves its own important function.
“We have difficulty to see what is the intent of policymakers there,” Jacques told CBC News.
“There’s not much money to save, and there’s not much efficiency gains to have and, in contrast, it could be a real issue for public health in the province in general.”
Citing the old saying, he said, “if it ain’t broke, don’t fix it.”
Problems exposed during pandemic
In a statement issued this week, Duranceau’s office insists the merger will fix problems exposed during the COVID-19 pandemic.
“The pandemic revealed the limits of a fragmented model in which the lack of co-ordination between the two institutes hindered the speed of the response on the ground,” the statement says.
The statement says that by combining these areas of expertise, the government can work more efficiently, make responsibilities clearer and better meet the health system’s current and future needs.
“The government’s intention remains to fully preserve the missions of both organizations, which are highly complementary,” it says.
It added that the government has “heard the concerns” raised by INSPQ senior officials during parliamentary consultations and that teams across affected ministries are reviewing submitted briefs “to assess whether follow-up is warranted to improve the bill.”
Preventive care always loses, expert says
Jacques said he’s not convinced fusing these agencies will create more efficiency.
Neither is his colleague, Nathalie Clavel, assistant professor specializing in health services management at Université de Montréal.
They both spoke to a parliamentary committee about the bill last week, expressing several concerns with the bill — including the fragmentation of key services and the reduction of preventive care.
In a later interview with CBC News, Jacques expressed concerns about the possible loss of expertise and prevention with, for example, the research and INSPQ labs going to Santé Québec.
Public health is about improving the population’s health in the future, whereas health-care problems are acute in the present, he explained.
“I am really concerned that the budgets would be much more allocated toward the curative functions related to INESSS to the detriment of the preventive, long-term oriented functions of the INSPQ,” he said.
Because one agency is controlling the budget, short-term curative care may ultimately get the bulk of funding, he said, adding his research shows when the two budgets are in competition, preventive care always loses.
Despite the effectiveness of prevention, he said even the public prefers to see funding go toward the immediate curative-care crisis rather than prevention.
While he sees the merger as a mistake, he explained, separate budgets should at least be maintained for the two functions if the government goes through with it.
He also says there is no proof that other governments have successfully done the same merger.
“I don’t think the fusion is a good idea,” he said. “It’s two institutions that have two very different perspectives and two very different missions.”
