General Organization and Medical Organization

General Organization

Under review

The Organization of the Services

With respect to the organization of services, the public system operates on three levels: a central level, a regional level, and a local level.

Power sharing between the levels has been transformed over the years. In the 1970s, the system was very centralized and most decisions were made at the central level, that is, at the ministère de la Santé et des Services sociaux (MSSS). Over the course of time, many social players advocated decentralization of the system. In 1987, the Rochon Commission made it one of its key recommendations. As a result, the regional boards of health and social services were created in 1991. But in practice, these new boards did not have the necessary means to create what could be called regionalization in a true sense. Throughout the 1990s, the central level held onto the reins of major decision-making, such as the rules for budget allocations to institutions, the rules for work organization and the distribution of resources to institutions. It must be said that the climate of budget cutbacks that prevailed as the regional boards took their first steps was not conducive to decentralization.

Recently, a new trend has taken over: the government has chosen to bring the decision-making centers even closer to the action. To make the local services networks more effective, all of the establishments in a given territory were grouped together under one board of  directors, creating a new type of institution called the health and social services centre (CSSS).

The roles and responsibilities of the health and social services system’s three levels are now divided as follows: 

The Ministère

The ministère de la Santé et des Services sociaux (MSSS) fulfils a two-fold mandate:

  • To propose, on behalf of the government, to other ministries and public agencies, as well as to all social players, action priorities, with a view to positively affecting the health and well-being of the population.
  • To ensure that the health and social services system functions properly, and that individuals have access to a complete range of services of the highest quality.

To fulfill its mandate, the MSSS must act at several levels:

  • developing policies in matters of health and social services, their implementation and evaluation;
  • approving regional priorities stemming from ministerial policies;
  • coordinating the provincial public health program and instituting measures to protect the health of the population;
  • equitably distributing human, material, financial and information resources among the regions of Québec;
  • establishing the necessary management frameworks for the effective and efficient use of these resources;
  • establishing policies and orientations relative to the network’s manpower;
  • ensuring inter-regional coordination of services;
  • ensuring inter-sectorial activity;
  • assessing the effects of policies in matters of health and social services.
Health and Social Services Agencies (ASSS)

After an administrative transition phase, the health and social services agencies replaced the regional boards. Since 2003, these agencies have assumed strictly regional functions, namely:

  • specialized services funding;
  • health services and social services planning and coordination;
  • functions entrusted to it under the Public Health Act,  that is, the promotion and protection of public health, and prevention.
Health and Social Services Centres (CSSS) and Local Services Networks (RLS)

The local services networks (RLS) bring together all service-providers in a given territory to ensure access to a complete range of services, including the care management and support of persons who need services, particularly those most vulnerable. Two basic principles underlie the operation of these local services networks:

  • responsibility toward the population, which is entrusted to all the care-providers;
  • prioritizing of services.

In practice, a local body called a health and social services centre (CSSS) overseen by a board of directors, is responsible for bringing  together the resources, coordinating the activities and establishing the partnerships essential to the operation of the networks, particularly those with physicians, regional institutions and university institutions.

Services Provided to the Population

 With respect to services provided to the population, the health and social services system maintains its objective to fulfill  five missions, defined according to the categories of services offered by the five types of institutions originally composing it. As a result of the groupings and mergers aimed at creating real services networks, one institution may now fulfill many missions. The notion of “centre” therefore refers to a mission and not to a physical space.

  • The local community service centre (CLSC) offers everyday health and social services of a preventive and curative nature, as well as rehabilitation and reintegration services. Over the years, the CLSCs have concentrated their efforts on services to children and youth (well-baby clinics and post-partum follow-up, immunization clinics, health services in schools), on the one hand, and to the elderly, on the other. In 2004, home care and assistance counted for half of all the CLSC’s activities.
  • The residential and long-term care centre (CHSLD) provides, on a temporary or permanent basis, a substitute living environment as well as necessary services (rehabilitation services, nursing services, psychosocial services, medical services and pharmaceutical services) to the elderly who have lost their independence and to handicapped persons who cannot stay in their natural environment despite the support of their family.
  • The hospital centre (CH) offers diagnostic services as well as general and specialized medical care in the physical health and mental health sectors.
  • The rehabilitation centre (CR) provides adjustment, rehabilitation and social
    reintegration services to persons who need them because of physical or intellectual handicaps, behavioral, psychosocial or family problems, or alcoholism and other drug dependencies. It also provides accompaniment services and family support to the persons involved.
  • The child and youth protection centre (CPEJ), or youth centre, as it is commonly called, provides, in its region, services of a psychosocial  nature, emergency social services included, to youth whose situation requires it under the Youth Protection Act or the Young Offenders Act (Canada). The youth centre also provides child placement services, family mediation, medico-legal assessments to the Superior Court on child custody, adoption and, finally, research into biological history.
  • The Health and Social Services Centre (CSSS). Since 2005, a new type of institution called the health and social services centre (CSSS) has been established at the heart of every local services network. It groups together, under one board of directors, one or more CLSCs and CHSLDs and, in the majority of cases, the hospital centre in a territory.

The CSSS acts as a base  for the local services network, ensuring accessibility, continuity and quality of services for the population in its territory. The CSSS has a responsibility to promote health and well-being; to receive, assess and direct persons to the services required, and to assume care for the most vulnerable. As an institution, the CSSS must also provide a range of general health services and social services, as well as certain specialized services. In order to cover all of the needs of its population, it must also enter into service agreements with other partners (medical clinics, GMFs, community organizations, rehabilitation centres, youth centres, university-hospital centres, etc.).

The CSSSs were established to improve the follow-up care given to persons, since the CSSS, along with the family physician, will become reference points for people, in case of health problems or psychsocial  problems. Here, they will receive the appropriate services or be directed to another service-provider in the local network.

Advisory Agencies

Many agencies report directly to the Minister of Health and Social Services. These advisory agencies perform a variety of functions: consultative (Comité de la santé mentale du Québec); administrative (Régie de l’assurance maladie du Québec); concerted action (Office des personnes handicapées du Québec); etc. Four of these are particularly important for medical practice: the Institut national de santé publique du Québec, the Commissaire à la santé et au bien-être, the Agence d’évaluation des technologies et des modes d’intervention en santé, and the Conseil du médicament.

Institut national de santé publique du Québec (INSPQ)

This agency’s main function is to support the Minister of Health and Social Services and the health and social services agencies in matters of public health.

The creation of INSPQ makes it possible to coordinate public health expertise in Québec. Fulfilling its mission assumes:

  • pooling and sharing of expertise;
  • research development;
  • transmission and best use of knowledge;
  • international exchanges.

INSPQ offers a variety of activities and services:

  • consulting services and specialized assistance;
  • research and development of new knowledge;
  • educational activities;
  • information activities;
  • specialized laboratory services;
  • international cooperation and knowledge exchange.

INSPQ has many sites in Québec where it conducts its activities.

Commissaire à la santé et au bien‐être (CSBE)

The position of Commissaire à la santé et au bien-être was created in 2006, its objective being to provide a relevant perspective in matters of public debate and government decision-making applicable to health and well-being. Certain functions devolving to the Commissaire were once exercised by the Conseil de la santé et du bien-être (CSBE) and the Conseil Médical du Québec. The Commissaire took over from these two agencies charged with advising the Minister of Health and Social Services. The mandate was also broadened and includes essentially the following functions:

  • evaluating and assessing the results achieved by the health and social services system;
  • consulting with citizens, including experts and other players in the health and social services system;
  • informing the Minister of Health and Social Services, the National Assembly and all citizens in order to promote a better understanding of the big issues in matters of health and welfare;
  • recommending improvements. 
Institut national d’excellence en santé et en services sociaux
The Institut national d’excellence en santé et en services sociaux  (INESSS) was created on January 19, 2011. It succeeded the Conseil du médicament and the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS).
INESSS’s mission is to promote clinical excellence and the efficient use of resources in the health and social services sector. At the heart of the mission, INESSS assesses, in particular, the clinical advantages and the costs of the technologies, medications and interventions used in health care and personal social services. It issues recommendations concerning their adoption, use and coverage by the public plan, and develops guides to clinical practice in order to ensure their optimal use.

In implementing its mission, INESSS blends the perspectives of network professionals and managers and those of patients and beneficiaries. It brings together knowledge and know-how from myriad sources in order to shape them in a way that is useful to achieving the objectives of the pursuit of clinical excellence and the efficient use of resources. Lastly, it helps to rally the parties involved with a view to improving the care and services provided to the public. It acts with a constant concern for equity and ethical conduct.