Is consumer control possible in health care services? The Quebec case.

In the late 1960s, the Canadian province of Quebec carried out a major reform of its health and social service institutions. As a consequence of the ideology dominating that period, the reform placed great emphasis on citizen participation, establishing local community service centers (centres locaux de services communautaires-CLSC) with boards of directors composed principally of residents of the districts served. This article examines the possible changes brought about by the granting of formal power to health institution consumers. Does this formal power permit citizens to exercise any real control over the institutions? And if so, what does this consumer control modify in terms of the nature, quality, and adaptability of the services offered? Afer a brief description of the Quebec health and social service reform and the resulting CLSCs, this article evaluates consumers' power in these institutions and analyzes the conditions under which such power is exercised. The next section outlines changes that have taken place in the CLSCs, singling out three types of changes for further examination: innovations, adaptations, and transformations. The following section examines the consumers' role in bringing about these changes. On the basis of this analysis, it is possible to conclude that consumer participation is necessary to effect certain types of changes which, otherwise, can deteriorate into bureaucratic processes. The analysis also indicates the existence of diverging and even antagonistic interests between providers (professional employee) and consumers. These contradictions may eventually call into question the classical models of producer self-management.