In the early 1970s, budgets at Quebec hospitals were skyrocketing, but many people still were receiving inadequate medical care. To address that problem, provincial officials decided to move beyond hospital walls, out into the community, with an innovative program of preventive and primary care. “There was a growing realization that social determinants such as level of education, employment, poverty and nutrition had a tremendous impact on health,” says Yves Vaillancourt, a social policy specialist at the University of Quebec in Montreal. In 1972, the province opened the first Centres locales de services communautaires (CLSCs)—-or local community service centres—to combine neighborhood social work and medical services. The theory was that assembling a diverse group of salaried professionals—including doctors, nurses and social workers—under one roof would increase efficiency, lower expenses and pinpoint early problems before they became more serious, and costlier. Two decades later, experts say the system may serve as a model for community-based health care in other parts of the country.
The CLSC network now includes 161 centres across Quebec, employs 15,000 people and costs $730 million annually—or 5.2 per cent of the province’s total $13-billion health budget. Almost all CLSCs offer a wide range of basic health and social services—including home care; medical and mental-health consultations; pregnancy, birth-control and AIDS clinics; and since last year, a popular health information hotline. Many centres also work closely with local groups such as women’s shelters and employment agencies. “The strength of a CLSC is that it offers multidisciplinary services which are tailor-made to the different conditions, needs and resources of its population,” says Dr. André Munger, president of the 850-member association of CLSC doctors.
The Quebec system has inspired similar community-based health initiatives elsewhere—notably in Ontario and New Brunswick. But the concept has its detractors. The fact that CLSCs are run locally, some critics charge, leads to wide disparities in the quality of their services. Still, experts predict that the current overhaul of Quebec’s health-care system—including such cost-cutting measures as increasing day surgery and home care—will only increase the system’s importance. “The CLSCs are on the leading edge of a marriage between medical and social services and the volunteer sector,” says Vaillancourt. “That’s the way of the future.”
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