Health: What's the point of another fix?

Another health reform has just been passed under a gag order. Draft Law No. 15 is not without increased fatigue among stakeholders. They see it as an exercise in managerial acrobatics in an endless oscillation of centralization-decentralization-decentralization-hypercentralization. Management struggles to manage day to day life. How can it hope to succeed in such reform?

Eternal repetition has just given us a healthy start. The myth you fuel appears again and again on the horizon: Network repair fixes it. However, more than 40 years of history tells us otherwise.

We will have to wait several years before we see the impact in action. However, some associations with the impasse reached by the recent reform should indeed trouble us.

Law

First of all, these two reforms are based on a poorly drafted law, many aspects of which are on the books. The bill's twists and turns speak for themselves. Managers will remember the “radical adversity” of the last reform, where they imposed a series of contradictory orders, in an arrangement of structures that are almost incomprehensible.

Next, a series of group reps require a Almost unanimous vote To slow down the adoption of the bill in order to ensure minimal consistency with the complexity of the network. However, these actors share only one common denominator. They are the “chosen ones” responsible for implementing this reform on a daily basis. However, they cannot oppose it, or even minimally modify it in a coherent way…

Finally, the ministerial refusal that falters once again In uncompromising ideological stubbornness. The public network still exists And always at mercy Management, both fierce and inflexible. This administration seeks Still and always – Imposing a one-dimensional vision of change. If he possesses hierarchical power, he loses the moral authority to change.

So. How to get out of the maze of intersections in health? What a lesson Basic Should we strive for a model of care with global aspirations?

Lesson

The main lesson is clear. Health management is never directly Responsible for its decisions, directions, or reform projects. Health bills are never subject to the practice of transparency with society. Therefore, she can act With impunity.

The crux of the problem comes from British parliamentarism. A political party announces a health reform across its entire platform without asking the community to comment on the content. it's not never He called for a decision to be made on the details of its health program before the party comes to power. The political party will be able to say “You voted for us.” He might add that the political program supported the main lines of his health reform. He can propose that his draft law be discussed in the Council. but From each other I cannot say that civil society spoke directly and exclusively about the content of the proposed health reform.

I am not addressing here the thorny issue of social health management, which is being undermined at all levels, without any direct accountability to civil society. Neither does appointing “senior officials” coming from “a better place elsewhere”… another self-evident health truth Change the player, without changing the nature of the game. Who still believes that?

Difficult and rigorous thinking on legitimacy We must start with health governance. To get out of the social and health recession, we have to think boldly…

Sebastien Simard, Psychotherapist TS MSS, DEA (EHESS-Paris), MA

Lecturer and supervisor

Faculty of Social Work, University of Montreal