in brief The Québec Health and Social Services System

Transcription

1 in brief The Québec Health and Social Services System

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3 in brief The Québec Health and Social Services System

4 Produced by: Direction des communications, ministère de la Santé et des Services sociaux This document is available online at by clicking Documentation and then Publications. It may also be ordered at Masculine pronouns are used generically in this document. Legal deposit Bibliothèque et Archives nationales du Québec, 2008 Library and Archives Canada, 2008 ISBN: (print version) ISBN: (PDF) All rights reserved for all countries. Any reproduction whatsoever, translation or dissemination, in whole or in part, is prohibited unless authorized by Les Publications du Québec. However, reproduction in whole or in part for personal, non-commercial purposes is permitted solely in Québec, provided the source is mentioned. Gouvernement du Québec, 2008

5 Instituted by the Act respecting health services and social services adopted in December 1971, the Québec health and social services system aims to maintain, improve and restore the health and well-being of the population by making a set of health services and social services accessible to them. In Québec, health services and social services are integrated into a single administration. This distinctive feature of the Québec system makes it possible to respond to all the health and well-being needs of the population and represents a major challenge to be taken up in terms of a mode of organization of services. Universality, equity and public administration are at the centre of the fundamental principles which have guided the evolution of the health and social services system since its beginnings. Thus, health services and social services are accessible to all without discrimination. This principle of universality has been established in successive stages in both the health sector and the social services sector. In the health sector, two public universal plans allow the whole population to obtain free-of-charge hospital and medical services, that is, the Hospital Insurance Plan since 1961 and the Health Insurance Plan since In 1997, the Public Prescription Drug Insurance Plan (RGAM), a mixed universal plan based on a partnership between the state and private insurers, was added to complete the public coverage of the whole population in the health sector. In addition to the legislative framework instituted in December 1971 which integrated the sectors of health and social services, policies and programs continue to be defined today. The management of social services involves psychosocial services aimed at the whole population and specific services for more vulnerable individuals (young persons with problems, seniors with decreasing autonomy, persons affected by an impairment or mental health problem, victims of addiction and other persons) as well as other services such as those related to community activities or international adoption. The Québec health and social services system is public, since the state acts as the principal insurer and administrator of the range of services. The funding of services is based on general taxation, which results in a more equitable risk distribution in society. The funds used to finance health services and social services come from income and property taxes paid by individuals and businesses, contributions to the Health Services Funds (Fonds des services de santé), consumption taxes, duties and license fees, and revenues from government corporations and federal transfers. THE MODEL OF ORGANIZATION OF SERVICES To ensure equitable access to quality care and services for all citizens, the Act respecting health services and social services proposes a model of organization that is based on three levels of governance and the complementarity of institutions grouped into networks. THE QUÉBEC HEALTH AND SOCIAL SERVICES SYSTEM 3

6 RESPONSIBILITY FOR GOVERNANCE With regard to governance, the health and social services system comes within the results-oriented management framework which is aimed at strengthening accountability between each of its three management levels: the central, regional and local levels. At the central level, the ministère de la Santé et des Services sociaux (MSSS) establishes the policy directions in the area of health and social policies and assesses, for the entire health and social services network, the results obtained in relation to the goals set. Consequently, in view of enhancing the health and well-being of the population and the quality of services, the MSSS centres its actions on its basic responsibilities which are: planning, funding, allocating financial resources, follow up and evaluation. At the regional level, the health and social services agencies are responsible for coordinating the establishment of services in their respective territories. They must, in particular, develop policy directions and regional priorities, exercise the regional public health functions, facilitate the deployment and management of local networks of services, and ensure the allocation of budgets to institutions and subsidies to community organizations. The agencies must also ensure that the population participates in the management of services, the safe provision of services and respect for users rights. At the local level, the local health and social services networks bring together all partners, including family physicians, in order to collectively share a responsibility for the population of a territory. At the heart of the local network of services, the health and social services centre (CSSS) is the basis for an integrated provision of services and ensures accessibility, case management, follow up and coordination of services for this population. The model is based on the provision, close to the living environment, of a wide range of primary care services, including public health services, and on the establishment of mechanisms of referral and follow up to ensure access to secondary and tertiary care (specialized and highly specialized services). Thus, the various providers of health and social services to this population are able to respond to all the needs of the individuals concerned and to facilitate their progression, and more particularly that of vulnerable individuals, through the system. A LOCAL NETWORK OF HEALTH AND SOCIAL SERVICES LOCAL TERRITORY Physicians (GMF, medical clinics) Social economy entreprises Private resources HEALTH AND SOCIAL SERVICES CENTRE Grouping of one or more CLSC, CHSLD and CH* Community-based pharmacies Community organizations Non-institutional ressources Hospital centres Youth centres Rehabilitation centres * A CSSS might not include a hospital centre because of the absence of such a structure of services in its territory or the complexity of integrating or grouping these services. Other activity sectors: school, municipal, etc. 4 IN BRIEF

7 MINISTER 14 ADVISORY BOARDS: Régie de l assurance maladie Office des personnes handicapées 12 other advisory boards MINISTÈRE DE LA SANTÉ ET DE SERVICES SOCIAUX Clinics and private medical offices including family medicine groups (GMF) (Around 2000) 18 HEALTH AND SOCIAL SERVICES AGENCIES Community organizations (Over 3000) Hospital centres* Residential and long-term care centres* Rehabilitation centres* 95 HEALTH AND SOCIAL SERVICES CENTRES (AROUND 85% OF WHICH INCLUDE A HOSPITAL CENTRE) Child and youth protection centres* Private institutions* * Institutions or organizations that are not part of a CSSS ESTABLISHMENTS FORMED INTO NETWORKS The Québec health and social services system has approximately 300 institutions providing services in more than 1700 service points, including approximately 200 public institutions, around 50 non-profit institutions under agreement and around 50 private institutions offering residential and long-term care. It also comprises over 3000 community organizations and approximately 2000 private medical clinics and offices. The whole sector employs more than 10% of the active workforce in Québec. The ministère de la Santé et des Services sociaux ensures that the system operates smoothly, while the eighteen (18) regional authorities are responsible for the organization of services in their respective territories, and five categories of public institutions, listed below, provide health services and social services under a configuration which favours integration as a mode of organization: Health and social services centres (CSSSs) were born out of the merger of local community services centres (CLSCs), residential and long-term care centres (CHSLDs) and, in most cases, a hospital centre (CH). These centres: provide the population of a local territory with services of a preventive, evaluative, diagnostic and curative nature, rehabilitation, support and public institutional residential services; coordinate the services offered by all providers working in the local territory; offer general and specialized hospital services (emergency, outpatient services, local medical specialties and basic diagnostic facilities). THE QUÉBEC HEALTH AND SOCIAL SERVICES SYSTEM Residential and long-term care centres (CHSLDs): offer services to persons with decreasing autonomy and older persons. Hospital centres (CHs): ensure the provision of short-term primary, secondary and tertiary services in general or specialized health care and in psychiatric care. Rehabilitation centres (CRs): offer specialized health services and social services to persons suffering from a physical impairment (related to hearing, vision, language and speech or motricity); or offer specialized health services and social services to persons affected by a mental impairment or persons with a pervasive developmental disorder; or offer specialized health services and social services to persons suffering from alcoholism or other problems of addiction. 5

8 Child and youth protection centres (CPEJs): ensure the provision of social services to young persons with developmental or behavioural or social adjustment problems (abuse, neglect, delinquency, etc.); ensure the provision of social services to the families of young persons with problems; ensure the provision of specialized services devoted to young persons (adoption, placement and social rehabilitation). Fourteen (14) organizations report to the Minister of Health and Social Services. Most play an advisory role with regard to a specific mandate. Others, such as the Office des personnes handicapées du Québec (OPHQ) and the Régie de l assurance maladie du Québec (RAMQ), have a broader mandate and more considerable resources. The MSSS collaborates with all the organizations in accomplishing their mandates. In 2007, these organizations, in alphabetical order, were as follows: the Agence d évaluation des technologies et des modes d intervention en santé (AETMIS, the Québec government agency responsible for health services and technology assessment); the Bureau de gestion des projets de modernisation des centres hospitaliers universitaires de Montréal (Centre hospitalier de l Université de Montréal, Centre universitaire de santé McGill, Centre hospitalier universitaire Sainte-Justine); the Research Ethics Central Committee; the Hemovigilance Committee; the Public Health Ethics Committee; the provincial committee on the provision of health services and social services to persons from ethnocultural communities; the provincial committee on the provision of health services and social services in English; the Health and Well-being Commissioner; the Conseil du médicament; the Corporation d hébergement du Québec; the Corporation d urgences-santé (Urgences-santé); the Institut national de santé publique du Québec; the Office des personnes handicapées du Québec; the Régie de l assurance maladie du Québec. OTHER PARTNERS Among the other actors in the health and social services system, the following should be mentioned: private medical clinics and offices, including family medicine groups; community organizations; social economy enterprises in home-care service; community-based pharmacies; private residences with services for older persons; family-type resources and intermediate resources attached to the public health and social services institutions. Although they are independent workers, the overwhelming majority of general practitioners and specialists work exclusively within the frameworks of the public system since the latter has always been able to establish partnerships with them. Among the various types of practice, family medicine groups (GMFs) should be mentioned. This mode of practice is favoured by Québec to improve access to a family physician for all citizens. A GMF is a group of family physicians who work in close collaboration with nurses from the public network, in an environment that fosters the practice of family medicine to registered individuals. Registration with a GMF physician is on a voluntary basis and free of charge. Medical practice based on the GMF makes it possible to: extend the hours of access to family physicians; ensure that family physicians are more available by working in groups and sharing activities with nurses; improve patient follow-up and service continuity by strengthening links with other professionals in the health and social services network, in particular the CSSSs. 6 IN BRIEF

9 Furthermore, the leading role played by subsidized community organizations vis-à-vis the population should be highlighted. These organizations are recognized by the MSSS, the agencies and institutions as autonomous partners in their own right working within the health and social services system. They devote themselves in particular to: providing prevention, support or assistance services, including temporary lodging services; conducting activities related to promoting, awareness-raising and defending the rights and interests of users of health services or social services; furthering social development, improvement of living conditions or health promotion for all of Québec; responding to new needs, by using new approaches or aiming at specific groups of individuals. In addition, four integrated university health networks (réseaux universitaires intégrés de santé, RUIS) have been set up to ensure delivery in specialized and highly specialized care to all regions of Québec. Associated with the four universities which include a faculty of medicine, their main mandate is to make recommendations to the Minister and the health and social services agencies on: the provision of service, the establishment of corridors of service and the prevention of breaks in service in institutions in all regions of Québec; medical training and distribution of students, coordination of research activities and knowledge transfer; the organization of specialized medical services to enhance their effectiveness and avoid duplication; the development of a university medical staffing plan in relation to the regional medical staffing plan. OTHER CHARACTERISTICS In Québec, the health and social services system is divided into service programs and support programs such that the organization of services is guided by the needs of the population or population groups grappling with a particular problem. This configuration provides a framework for planning, allocating resources and accountability reporting. There are currently nine service programs, that is: two service programs responding to needs involving the whole population: public health, i.e. the promotion, prevention, and protection of health and well-being as well as surveillance of health status; general services clinical and assistance activities, which cover primary care services in the area of health or specific social problems. seven service programs devoted to specific issues: loss of autonomy linked to ageing; physical impairment, for disabilities linked to hearing, vision, language and speech or motor skills; mental impairment and pervasive developmental disorders (PDDs); young persons with problems; dependencies, such as alcoholism, drug addiction, pathological gambling, etc.; mental health; physical health, which covers emergency services, specialized and highly specialized services, continuous services requiring systematic follow-up (ex.: chronic diseases, cancer) and palliative care. The support programs, two in all, include administrative and technical activities providing support to the service programs. They are as follows: administration and support; buildings and equipment management. THE QUÉBEC HEALTH AND SOCIAL SERVICES SYSTEM 7

10 SELECTED INDICATORS ON THE HEALTH STATUS OF THE POPLATION IN QUÉBEC, ELSEWHERE IN CANADA AND IN SOME OECD COUNTRIES LIFE EXPECTANCY AT BIRTH IN 2002, HEALTHY LIFE EXPECTANCY AT BIRTH IN 2001, INTERNATIONAL COMPARISONS CANADIAN COMPARISONS DENMARK 74,8 79,5 ALBERTA 67,6 69,7 UNITED STATES 74,5 79,9 NOVA SCOTIA 66,5 70,1 IRELAND 75,2 80,3 ONTARIO 68,2 70,1 PORTUGAL 73,8 80,5 SASKATCHEWAN 67,3 70,2 UNITED KINGDOM 75,9 80,5 NEWFOUNDLAND AND LABRADOR 68,4 70,2 GREECE 75,4 80,7 MANITOBA 66,7 70,4 NETHERLANDS 76 80,7 CANADA 68,3 70,8 BELGIUM 75,1 81,1 NEW BRUNSWICK 67,4 70,9 NEW ZEALAND 76,3 81,1 BRITISH COLUMBIA 68,9 71,2 GERMANY 75,4 81,2 PRINCE EDWARD ISLAND 67,3 71,7 FINLAND 74,8 81,5 QUEBEC NORWAY 76,4 81,5 WOMEN AUSTRIA 75,8 81,7 WOMEN MEN QUEBEC 76,6 82 MEN CANADA 77,2 82,1 SWEDEN 77,7 82,1 AUSTRALIA 77,4 82,6 ITALY 76,8 82,9 FRANCE 75,8 83 SWITZERLAND 77,8 83 SPAIN 75,8 83,5 JAPAN 78,3 85,2 Source : Institut national de santé publique and ministère de la Santé et des Services sociaux, in collaboration with the Institut de la statistique du Québec, Portrait de santé du Québec et de ses régions 2006 : les analyses. Deuxième rapport national sur l état de santé de la population du Québec, Québec, gouvernement du Québec, pp The data in these charts will be updated in the later versions of Portrait de santé du Québec et de ses régions. THE POPULATION S HEALTH Canadian and international comparisons often highlight a positive bill of health in the case of Québec. This is true in particular for life expectancy at birth, that is, Québec is among those countries enjoying the longest lifetime, having ranked ninth in Moreover, if only the years lived in good health are considered, then among the Canadian provinces, it is in Québec that one can expect to live in good health for the longest time. Significant progress has thus been made in Québec in recent years. For example, the mortality rate due to a disease of the circulatory system has dropped by half over the last 20 years. In fact, since 2000, these diseases no longer constitute the leading cause of death. Moreover, a steady rise in life expectancy at birth and a continuous decline in smoking can also be observed. However, sustained efforts must still be made. Among women, the rise in lung cancer has reduced the modest gains observed to date for other types of cancer. Among men, considerable problems are also noted, such as a high level of alcohol consumption and a high rate of suicide mortality. The progression of obesity is another phenomenon which gives rise to concerns, given its serious consequences for health. Lastly, there are still great disparities with regard to the health status of disadvantaged persons in remote regions and the most socio-economically disadvantaged groups. 8 IN BRIEF

11 ALLOCATION OF BUDGETS BY FUNCTION ( ) Community organizations 2% Central administration 1% TOTAL $23.8 G Medical care 15% Drug insurance 9% Institutions (five missions) 60% Others 13 % ALLOCATION PER PERSON: $2518/CAPITA PROVIDED FOR IN $ $ $ $ $ $ $ $ $ $ $ IN 1997 CONSTANT DOLLAR TERMS Source: Ministère de la Santé et des Services sociaux. The data presented above are updated yearly and can be consulted at BUDGET ALLOCATION FOR THE HEALTH AND SOCIAL SERVICES MISSION Based on the budget estimates for , the amounts allocated to the health and social services mission come to $23.8 billion. In constant dollar terms, the per capita allocation is $2518, which constitutes a progression for the ninth consecutive year. More than half of the budgets (60%) are directed at institutions, followed by, in order, medical care and the public share of the Public Prescription Drug Insurance Plan, whose budgets are administered by the Régie de l assurance maladie. The funding of around forty (40) programs aimed at specific clienteles (ex.: optometric and dental services), the Office des personnes handicapées du Québec and other advisory bodies is accounted for in the function called Others. Lastly, community organizations (2%) and the central administration (1%), including the agencies, complete the budget allocation by function. THE QUÉBEC HEALTH AND SOCIAL SERVICES SYSTEM 9

12 ANNEX 1 GOVERNMENT AND MINISTERIAL ORIENTATIONS AND POLICIES RELATING TO HEALTH AND SOCIAL SERVICES Publications on the themes which appear below are available in French only, in electronic version at Organization of the health and social services network Plan stratégique du ministère de la Santé et des Services sociaux (2005) L intégration des services de santé et des services sociaux. Le projet organisationnel et clinique et les balises associées à la mise en œuvre des réseaux locaux de services de santé et de services sociaux (février 2004) Projet clinique. Cadre de référence pour les réseaux locaux de services de santé et de services sociaux. Document principal (octobre 2004) Rapport du comité sur l organisation universitaire des services sociaux Le développement de la mission universitaire dans les établissements du domaine des services sociaux (2005) Cadre de référence sur les ressources intermédiaires (avril 2001) Physical impairment Cadre de référence pour les services surspécialisés de réadaptation en déficience physique (février 2007) Pour une véritable participation à la vie de la communauté Orientations ministérielles en déficience physique. Objectifs (octobre 2003) Mental impairment and pervasive developmental disorders De l intégration sociale à la participation sociale Politique de soutien aux personnes présentant une déficience intellectuelle, à leur famille et aux autres proches (2001) Un geste porteur d avenir Des services aux personnes présentant un trouble envahissant du développement, à leur famille et à leurs proches (2003) Dependencies Plan d action interministériel en toxicomanie (2006) Pour une approche pragmatique de prévention en toxicomanie (2001) Orientations ministérielles en prévention de la toxicomanie (2001) Young persons with adjustment problems De la complicité à la responsabilité Rapport du Comité sur le continuum de services spécialisés destinés aux enfants, aux jeunes et à leur famille (avril 2004) Une responsabilité à mieux partager Rapport du Comité d experts sur la révision de la Loi sur la protection de la jeunesse (février 2004) Stratégie d action pour les jeunes en difficulté et leur famille (2002) Medication La politique du médicament (2007) Loss of autonomy linked to ageing Plan d action sur les services aux aînés en perte d autonomie : Un défi de solidarité (2005) Chez soi : Le premier choix La politique de soutien à domicile (2003) Un milieu de vie de qualité pour les personnes hébergées en CHSLD Orientations ministérielles (octobre 2003) Orientations ministérielles sur les services offerts aux personnes âgées en perte d autonomie (2001) Respect for individuals Orientations ministérielles relatives à l utilisation exceptionnelle des mesures de contrôle : contention, isolement et substances chimiques (2002) Cadre de référence pour la promotion, le respect et la défense des droits en santé mentale (mai 2006) 10 IN BRIEF

13 Mental health La force des liens : Plan d action en santé mentale (2005) L implantation de réseaux de sentinelles en prévention du suicide Cadre de référence (septembre 2006) Physical health Pour lutter efficacement contre le cancer, formons équipe Programme québécois de lutte contre le cancer (octobre 1997) Politique en soins palliatifs de fin de vie (2004) Groupes de médecine de famille (GMF) Fonctionnement et inscription : dossier=7402&table=0_ L organisation des services de génétique au Québec. Plan d action (avril 2005) Urgences préhospitalières Un système à mettre en place (rapport Dicaire) (2000) Public health Programme national de santé publique (2003) Stratégie québécoise de lutte contre l infection par le VIH et le sida, l infection par le VHC et les infections transmissibles sexuellement. Orientations (2004) Investir pour l avenir Plan d action gouvernemental de promotion des saines habitudes de vie et de prévention des problèmes reliés au poids (2006) Plan québécois de lutte contre le tabagisme (2006) Plan québécois de lutte à une pandémie d influenza Mission santé (2006) D abord, ne pas nuire... Les infections nosocomiales au Québec, un problème majeur de santé, une priorité Rapport du Comité d examen sur la prévention et le contrôle des infections nosocomiales (2005) Les infections nosocomiales Plan d action sur la prévention et le contrôle des infections nosocomiales (2006) Les services intégrés en périnatalité et pour la petite enfance à l intention des familles vivant en contexte de vulnérabilité Cadre de référence (2004) Naître égaux Grandir en santé. Un programme intégré de la promotion de la santé et de prévention en périnatalité (2001) Conjugal violence and sexual assault Orientations gouvernementales en matière d agression sexuelle (2001) Politique d intervention en matière de violence conjugale Prévenir, dépister, contrer la violence conjugale (1995) THE QUÉBEC HEALTH AND SOCIAL SERVICES SYSTEM 11

14 ANNEX 2 LIST OF LAWS WHOSE APPLICATION COMES UNDER THE PARTIAL OR TOTAL RESPONSIBILITY OF THE MINISTER OF HEALTH OR SOCIAL SERVICES The laws listed below are available in French and English in electronic version at Chapter A-28 Hospital Insurance Act Chapter A-29 Health Insurance Act Chapter A An Act respecting prescription drug insurance Chapter A-33.1 An Act respecting Cree, Inuit and Naskapi Native persons Chapter C-17 Non-Catholic Cemeteries Act Chapter C An Act respecting the Health and Welfare Commissioner Chapter C-68.1 An Act respecting the Corporation d'hébergement du Québec Chapter E An Act to provide for balanced budgets in the public health and social services network Chapter E-20.1 An Act to secure the handicapped in the exercise of their rights Chapter H-1.1 An Act respecting Héma-Québec and the haemovigilance committee Chapter I-11 Burial Act Chapter I An Act respecting Institut national de santé publique du Québec Chapter L-0.2 An Act respecting medical laboratories, organ, tissue, gamete and embryo conservation, and the disposal of human bodies Chapter M-1.1 An Act to ensure that essential services are maintained in the health and social services sector Chapter M-19.2 An Act respecting the Ministère de la Santé et des Services sociaux Chapter M An Act to implement the Convention on Protection of Children and Co-operation in Respect of Intercountry Adoption Chapter P-31.1 An Act respecting the Health and Social Services Ombudsman Chapter P-34.1 Youth Protection Act Chapter P An Act respecting the protection of persons whose mental state presents a danger to themselves or to others Chapter R-5 An Act respecting the Régie de l'assurance maladie du Québec Chapter S-0.1 Midwives Act Chapter S-2.2 Public Health Act Chapter S-4.2 An Act respecting health services and social services Chapter S-5 An Act respecting health services and social services for Cree Native persons Chapter S-6.2 An Act respecting pre-hospital emergency services Chapter T-0.01 Tobacco Act Chapter U-0.1 An Act respecting bargaining units in the social affairs sector 12

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