In December 2024, Santé Québec (SQ), a province-wide agency overseeing health and social services delivery, was launched. Denis's essay offers an insightful and valuable lens to analyze the reform's underlying assumptions and to reflect on the opportunities and challenges ahead. SQ aims to separate policy making and planning from service delivery, a distinction that may prove difficult in practice. Moreover, the infrastructure for meaningful decentralization might be lacking, given Quebec's health system legacy of extensive structural integration. Nonetheless, existing assets – such as health regions, population-based responsibility and local health and social services networks – could prove to be valuable tools for stakeholder engagement and innovation.

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