Intégrer les soins de santé et les services sociaux du Québec : la réforme Couillard de 2003

In December 2003, the Liberal Government of Quebec, under the leadership of Jean Charest, adopted Bill 25 under closure. This Bill, an Act respecting the development of local health and social services networks was aimed at reforming the structure of the health system in Quebec. The main idea driving the reform was to create Centres for Health and Social Services (CSSS), which, under the authority of regional Health and Social Service Agencies (ASSS), would provide direct health care services fitting the needs of the local population. This approach to public health had been proposed since the Rochon Commission, but was not implemented until more than twenty years later—a transformation that was to take place in the context of a strategy to modernize government services proposed by the Charest government with the goal of downsizing government intervention and cutting public budgets. This context has coloured the reform of the health system, the latter being under increasing pressure from demands of outcome-based management or accountability inspired by the new public management (NGP) approach