Quebec’s government is now trying to pass Bill 7. This bill isn’t just political grandstanding. Combining these two large health agencies could lead to real savings of $35 million. To this end, Treasury Board President France-Élaine Duranceau tabled a bill to increase government efficiency. It also proposes to cut the equivalent of 220 full-time positions, with about 100 of those immediate cuts directly affecting patient care. Activists, artists, and experts are all raising their flags about the detrimental effects this merger would have. These proposed rules are moves that endanger our public health and preventive care.
With this proposed merger, the action of the Institut national de santé publique du Québec (INSPQ) medical biology laboratories will be combined. This much-needed consolidation will happen underneath Santé Québec. Moreover, management of organ and tissue donation coordination will be passed on to Héma-Québec. The government argues this scheme is a positive step in the state’s ongoing battle to reduce red tape and make the state more efficient. Health authorities say that these proposed modifications would jeopardize key health services.
Expert Opinions on the Merger
Olivier Jacques, a professor specializing in health policy at Université de Montréal, has voiced significant concerns regarding the merger’s implications for public health. He believes combining these two separate institutions would be damaging to healthcare. It risks moving downstream, away from long-term preventive work, and only doing short-term curative work that misses the point.
“I don’t think the fusion is a good idea,” – Olivier Jacques
Jacques continues, explaining how the unique mission and focus of the two agencies might impede optimal healthcare delivery. He proposes an interesting change in budget priorities. This shift may place a greater focus on acute care responses at the expense of longer-term preventive health approaches.
“It’s two institutions that have two very different perspectives and two very different missions,” – Olivier Jacques
His research shows that when budgets from cross-cutting health sectors are merged, preventive care usually loses out. Jaques believes it is critical to distinguish between spending on curative versus spending on preventive measures. Without this bright line, vital public health services and health care delivery will be decimated.
Government’s Justification
In answer to some of these concerns, Duranceau’s office argues that the merger responds to needs identified during COVID-19. They contend that a more convergent strategy is needed to better coordinate and increase effectiveness in response of health specialties.
“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,” – France-Élaine Duranceau’s office
The federal government insists that in spite of these cuts, they wish to keep intact the complementary missions of both entities at play. They emphasize that the goal is still to build, not shrink, public health capacity.
“The government’s intention remains to fully preserve the missions of both organizations, which are highly complementary,” – Government
Critics such as Jacques are right to be skeptical about these mergers. They ask how the savings produced can be reconciled with possible decreases in service quality.
Broader Implications for Public Health
Nathalie Clavel, an assistant professor in health services management at Montréal’s Université de Montréal, has similar fears. She points out that cost-saving measures seldom save as much money as they appear to on paper. In practice, they end up resulting in negative unintended consequences. This unrelenting pursuit of efficiency measures could come at the expense of short-term healthcare delivery, infrastructure, and mobilization efforts that are crucial to ensuring long-term public health success.
Jacques ends on a thoughtful reminder about policy intentions. He states, “We have difficulty to see what is the intent of policymakers there.” His feelings are symbolic of a larger concern among healthcare professionals. They doubt this merger wants to actually improve services and instead fear it is a maneuver for more financial gain.
