Successful countries set broad health goals and funding centrally, then let local players go to it. Quebec has favoured micro-management

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Quebec is living a primary-care paradox. It has more family physicians per capita than most provinces and in the past two decades has spent billions on health-care reforms and built hundreds of interdisciplinary care teams. Yet today, 26 per cent of Quebecers don’t have a regular health care provider — more than in any province except P.E.I. About three-quarters of Quebecers report difficulty accessing same-day or next-day appointments and after-hours care. Emergency rooms are overwhelmed, with 41 per cent of visits being for conditions treatable in primary care.

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This isn’t a resource problem. It’s a design failure with important lessons for all provinces. My recent C.D. Howe Institute commentary shows that over the past 20 years Quebec has designed and operated primary care centrally — an approach that has failed to improve access over the long term, despite some temporary gains.

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