Every government that sets out to fix its health system eventually reaches for the same instrument: it centralizes. In 2023, Quebec passed legislation creating Santé Québec, a Crown corporation designed to consolidate the province’s regional health networks and oversee day-to-day operations with the stated aim of maximizing systemic efficiency.

The remedy is not to abandon central stewardship. Rather, it must be paired with a small number of recognized innovation hubs: bounded, accountable, and time-limited environments where new clinical, digital, and organizational models are rigorously tested in real care settings before being scaled.

Quebec is not alone in navigating this structural dilemma. In 2022, New Zealand merged its 20 regional health boards into a single national agency, only to confront billion-dollar deficits and a subsequent legislative reversal of the policy. England has arrived at a comparable verdict, moving to abolish its arm’s-length national body and fold it back into the central department.

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