Characterization of relationships between State and Third Sector in health care social system of Quebec: the emergence of new modes of coordination

The growing recognition of the role of the Third Sector in health social services in Quebec in the 70s and 80s cannot be separated on the one hand from the realization by politicians and administrators of the Welfare State limits and on the other hand from the struggles of Third Sector actors themselves to impose their principles of action within the social health care system. This recognition has developed around a specific institutional structure: the programme to support community agencies. This financial subsidy programme allows Third Sector organisations to support their overall mission. The rather unique arrangements of this programme have then enabled, within the social health care system of Quebec, the articulation of modes of coordination based on the technocratic efficiency principle with other principles like reciprocity, participation and innovation. This arrangement of different modes of coordination, and its supporting institutional architecture, represents an important element of the originality of the Quebec model of social development in North America.