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For fifty years, there have been numerous and virtually continuous reforms of the Quebec healthcare system. Four major phases of its evolution can be identified: 1961-85, State take-over of the system and bureaucratization of governance; 1985-2000, technocratization and democratization; 2000-07, managerial push; 2007-10, the inclination to privatize. Structural changes have largely dominated and reveal a continuing trend toward integrated management and the “populational approach” to responsibility. However, such important aspects as the status of doctors and the providers’ payment terms have scarcely changed. Now, after all these efforts, the performance of the system is still perceived as unsatisfactory and solutions remain elusive. The more conspicuous presence of ideologies is therefore hardly surprising and more recently, that of privatization has become the subject of renewed interest.