Santé Québec: Abolish the Structure or Demand Results?

**Quebec’s election debate now presents two simple choices: keep Santé Québec to avoid another upheaval, or abolish it to reduce bureaucracy and return power to the front line. The available evidence does not yet support such a clear verdict. It does, however, show what the new organization must prove—and what its opponents should establish before dismantling it.** An opinion piece published by *La Presse* on September 16, titled “Santé Québec: a necessary debate, but the wrong question,” brought former health minister Christian Dubé’s defence of the reform back into the campaign. It should be read for what it is: an intervention in a public debate, not an independent assessment of Santé Québec. Its title nevertheless raises a useful question. Should the election become a referendum on the existence of a Crown corporation, or a review of whether Quebec’s health system is improving access, working conditions and the use of public funds? The Parti Québécois is campaigning on a promise to abolish Santé Québec, decentralize management and reinvest at least $40 million in projected savings into care. The Conservative Party of Quebec also proposes abolition, along with a 25 per cent reduction in bureaucracy. Health Minister Sonia Bélanger counters that another restructuring would consume years of energy and resources that should go toward access to services. Those positions identify a real choice. None, on its own, proves its case. ## What Santé Québec actually changed Quebec’s [Act respecting health and social services governance](https://www.legisquebec.gouv.qc.ca/en/document/cs/G-1.021) was adopted in December 2023. Santé Québec became the network’s operator and employer on December 1, 2024, when 30 institutions and more than 347,000 workers were brought into a single organization. The model was supposed to separate roles. The Ministry of Health and Social Services retains responsibility for broad directions, policies, programs and rules. Santé Québec is to organize and deliver services, coordinate institutions and improve operational efficiency. The separation is not airtight. The law assigns Santé Québec the task of implementing the directions, targets and standards set by the minister. The minister may also establish the principles and practices the organization must promote. Its 15-member board is appointed by the government. The regional establishment boards have advisory functions, support local executives and monitor patient experience, among other duties; they do not restore the former institutions’ legal autonomy. Santé Québec is therefore neither a fully independent administration nor merely a branch of the ministry. It centralizes the operation of the network in a Crown corporation while the political executive retains broad direction and several levers of control. That architecture can clarify accountability if objectives are public and results can be attributed. It can also blur accountability if the minister and the agency blame each other when things go wrong. The debate over “who is in charge” must therefore be joined to a more practical question: “who is accountable for what?” ## Too soon for a verdict, not too soon to measure Santé Québec has been fully operational for less than two years. The 2025-26 fiscal year was its first full year, and its first measurable strategic plan runs from 2025 to 2028. That timeline weakens definitive claims of either triumph or failure. It does not justify a blank cheque. The organization’s [2025-2028 strategic plan](https://fichier.sitesq.apps.ti.sante.quebec/sq-1/2026-03/plan_strategique-complet.pdf) sets concrete indicators. They include reducing the number of patients waiting more than a year for surgery from 6,316 to 1,000; cutting the average emergency-department stay for admitted patients from 24.7 to 19.5 hours; lowering the share of beds occupied by alternate-level-of-care patients from 13.9 to eight per cent; increasing home-support hours from 34.5 million to 43.1 million; and reducing administrative costs, excluding information technology, from 4.86 to 3.77 per cent of spending. Those targets have two virtues. They are understandable, and several directly reflect the patient experience. They also create a benchmark against which both the government and Santé Québec can be judged. The difficulty, as of September 17, 2026, is that Santé Québec’s official reports page still lists 2024-25 as its latest full annual report, covering mostly the organization’s start-up period. Results appear in dashboards and occasional documents, but the page does not yet provide a consolidated 2025-26 annual report that would allow every target to be assessed under a stable methodology. The prudent interim conclusion is that individual gains and setbacks can be checked, but the overall “Santé Québec effect” cannot yet be isolated cleanly across the health system. ## The numbers that do not settle the argument Santé Québec says it generated nearly $750 million in savings during its first four months. Its first annual report also records a $240-million operating deficit—less than one per cent of its budget—after a $1.149-billion government contribution announced in the 2025-26 budget. The final deficit in the financial statements is higher because it includes accumulated liabilities transferred during the merger, among other items. These figures show that the organization carried out a major cost-reduction exercise. They do not, on their own, prove that care improved. “Savings” can mean spending avoided relative to a projection, while the deficit depends on the accounting perimeter and government funding. Financial results must therefore be connected to service volumes, waiting times, quality and effects on staff. The same caution applies to the PQ promise. The party says abolishing Santé Québec would save at least $40 million a year and points to growing administrative headcounts. But gross savings are not net savings. Transition costs must be subtracted, indispensable functions identified and their destination specified. Abolishing a legal entity does not eliminate payroll for 347,000 workers, budget allocation, procurement, data systems or the coordination of surgical capacity. The meaningful calculation is therefore: which functions can be eliminated, which must be moved, what will the transition cost, and when will any savings actually improve care? ## Real results, difficult attribution Recent data present a mixed picture. In the Eastern Townships, the number of people waiting more than a year for surgery reportedly fell from roughly 1,800 in 2022 to 153 in 2026. That is significant progress, but it began before Santé Québec became fully operational and concerns one region. Province-wide, the PQ cited 3,590 people waiting more than a year and 109,485 people waiting for surgery in total in August. Those figures should be monitored in government datasets using consistent definitions. In emergency departments, an access-to-information compilation released in August placed the median stay in 2025-26 at five hours and 12 minutes, 41 minutes longer than in 2018. That comparison covers almost the CAQ government’s entire tenure, not simply the period in which Santé Québec existed. It documents a persistent problem; it does not establish which structure caused it or which one will fix it. That is why both positive and negative anecdotes should be treated as signals rather than causal verdicts. The reform is unfolding in a system shaped by an ageing population, staff shortages, the aftermath of the pandemic, negotiations with physicians and rising demand for home care. Governance matters, but it never acts alone. ## What parties should make verifiable A better-framed debate would require every party to answer the same questions. For parties proposing abolition: what organizational chart will replace Santé Québec? Who will become the employer? Which decisions will return to the regions? Which administrative functions will actually disappear? What will dismantling cost, over how many years, and how will interruptions to care or digital projects be avoided? For parties proposing to keep it: which 2025-26 targets were met? Which gaps can be traced to Santé Québec’s decisions? Which decisions have genuinely moved closer to the front line? How can the public distinguish the responsibilities of the ministry, the board and regional executives? And what consequences will follow repeated failure? The Fédération interprofessionnelle de la santé du Québec offers a useful test: a new structure is not enough. It calls for greater local discretion, recognition of regional realities and measurable results, along with improved working conditions. That test belongs to no political camp. A centralized organization can delegate authority; a decentralized one can also multiply layers of management. The structure’s name does not guarantee genuine clinical control. ## A fixed review date instead of an act of faith The choice need not be reduced to “keep everything” or “abolish everything now.” A new government could preserve the architecture provisionally, release an auditable 2025-26 assessment promptly, and submit Santé Québec to an independent review on a fixed date. That review should compare results with the targets already announced, calculate administrative costs on a uniform basis, measure time devoted to direct care, document local autonomy and estimate the transition cost of every replacement option. Regional data should be published so that a provincial average cannot hide either success or failure. If Santé Québec improves access, lowers administrative costs and clarifies accountability, its defenders will finally have stronger evidence than an appeal to stability. If it fails, its opponents can design a replacement around the functions that did not work instead of simply turning the clock back. Santé Québec therefore deserves a demanding debate. But the right unit of measurement is neither the number of news releases nor the size of an organizational chart. It is appointments obtained, hours of waiting avoided, care delivered at home, conditions that allow staff to remain at work, and every administrative dollar converted—or not—into a useful service. At this stage, the evidence does not deliver a verdict. It does, however, show exactly where to look for one. *Research current to September 17, 2026. The La Presse column is treated as opinion; its full text was not accessible during research, so no factual claim from it is repeated without a separate source.*