Integrating public health to healthcare local governance in Québec : Challenges arising from bringing closer population and organization perspectives

Introduction: The search for attaining a greater efficiency in health systems incites governments to bring closer two fields of practice which have largely developed in parallel in industrialized countries: public health and healthcare services. In this regard, the Quebec Government has initiated an important move in creating Health and Social Services Centers at the local level of governance. This reform formally integrates these two fields within a common governance structure.

Objectives:  The objective of this communication is to discuss the issues arising from this formal integration of public health services to the planning and delivery of local health care services, and the potential effect on the overall performance of the health system.

Research methodology: We completed a literature review (English and French) on the characteristics of these two sectors developed in parallel: public health services and health care. Also, we conducted an in-depth longitudinal analysis of 2 case studies (2005-2007). Data collected include real-time observation of top management meetings, 46 interviews with managers and key stakeholders and secondary data (planning documents, organizational charts, minutes of executive board meetings, etc.).

Discussion : We describe the current reform in Quebec and discuss the impact of various transitions (epidemiological, technological and organizational) that induce greater convergence between public health and healthcare services. We discuss the obstacles and potential opportunities of this reform with respect to: a) the development of population-based health planning within health care delivery organizations; and b) the convergence of public health and health care services concerns at the local level.

Conclusion: The ongoing reform in Quebec is a unique opportunity to maximize the resources invested in the health-care system within a collective vision for improving population health. This experience may suggest lessons for countries involved in healthcare reforms.