Intégrer les soins de santé et les services sociaux du Québec : la réforme Couillard de 2003
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Abstract
En décembre 2003, le gouvernement québécois sous la gouverne du parti Libéral de Jean Charest, adopte sous bâillon, le projet de loi 25. La Loi sur les agences de développement de réseaux locaux de santé et de services sociaux vise à réformer la structure du système de santé du Québec. L’idée principale de cette réforme est de créer des Centres de santé et de services sociaux (CSSS), qui, sous la responsabilité des Agences de santé et de services sociaux (ASSS), seront responsables de développer des soins de santé adaptés à la santé de la population des territoires qu’ils doivent couvrir. L’approche de la santé des populations proposée depuis la Commission Rochon est appliquée plus de 20 ans plus tard. Cette transformation se réalisera toutefois dans le contexte du plan de modernisation de l’État du gouvernement Charest qui vise alors la réduction de la taille et des dépenses de l’État. Ceci teintera la réforme du système de santé qui se verra imposer de manière plus marquée qu’auparavant des mesures issues de la nouvelle gestion publique telle que la gestion par résultats ainsi que la reddition de compte.
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.
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