Revisiting Health Regionalization in Canada (original) (raw)

Health reform in Alberta: The introduction of health regions

Canadian Public Administration, 2008

In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abolish nearly 200 existing local hospital and public health boards and replace them with 17 regional health authorities. Consistent with the larger fiscal agenda, the intention of the government was to address the issue of efficiency of the health system through the creation of larger integrated management and governance structures. In this article, we examine why Alberta decided to create Regional Health Authorities through legislation to assume responsibility for the management and delivery of a significant range of health services? In examining the interaction of ideas, interests and institutions, we conclude that the government was partially successful in altering existing institutional and interest relationships to align with an emerging political consensus related to cost and sustainability of the health system.

Devolving authority for health care in Canada's provinces: 1. An introduction to the issues

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1997

In 9 of Canada's 10 provinces, much of the decision-making in health care has recently been devolved to local authorities. Provincial governments want this new governance structure to at least contain costs and improve service integration. However, there has been little evaluation of devolution to determine whether these and other goals are being met. Although devolved structures in the provinces vary somewhat with respect to the number of tiers, accountability mechanisms, degree of authority and method of funding, the only structural element that varies substantially is the scope of services under the authority of local boards. The real authority of the boards depends, however, on their negotiated compromises among 3 areas of tension: the provincial government's expectations, the providers' interests and the local citizens' needs and preferences. The boards' abilities to negotiate acceptable compromises will largely determine their effectiveness. This article in...

One step forward, one step back: Quebec's 2003-04 health and social services regionalization policy

Canadian Public Administration, 2010

This article focuses on Quebec's most recent reform in the regionalization of health care to understand why the government chose to transform the regional boards into agencies. This case study used interviews and documentary analysis. Rooted in a political science perspective, the conceptual framework is inspired by the work of John and draws on the four variables that influence the choice of policy: ideas, interests, institutions and events. Results of the case study suggest that Quebec's Commission of Study for Health and Social Services (the Clair Commission) in 2000 and the 2002 pre-electoral environment put the issue on the agenda. In 2003, the newly elected Liberal government passed Bill 25 -An Act Respecting Local Health and Social Services Network Development Agencies, which represented a political compromise: originally slated for eradication, the regional tier survived but in a new form. The element that sparked reform was the change in government following the elections. Different inquiry reports spread the reform's ideas, while interest groups articulated contrasting visions on the transformation. Above all, regional institutions showed great resilience in the face of change. From a historical perspective, this regionalization policy is a step backward: the regional tier is now stronger from a managerial and technocratic point of view, but it is politically Elisabeth Martin is a doctoral candidate,

The integration challenge in Canadian regionalization

Cadernos de Saúde Pública

In the 1990s, regionalization was introduced in Canada through administrative delegation in order to achieve a number of reform objectives, but among the most important was to improve the integration of services across diverse health sectors. Despite the failure of regionalization in fulfilling its promise of integration, regionalization still provides a foundation for achieving system-wide integration. For this to occur, however, regional and provincial health authorities need to be given the effective accountability for primary care. Given that primary healthcare physicians provide the majority of primary care in Canada, the funding for primary care physicians should be returned from provincial ministries of health to regional (or provincial) authorities in order to allow them the opportunity to become responsible for coordinating health services for their patient populations across the continuum of care, and to contract providers with the necessary incentives and penalties.

Regionalization and Health Services Restructuring in Saskatchewan

Health Services Restructuring in Canada: New Evidence and New Directions, edited by C.M. Beach et al., pp. 33-57, 2006

This chapter provides a historical review of the development of health system regionalization in Saskatchewan, Canada, including the original policy objectives as well as the outcomes from thisl health system reorganization.

A Policy Research Agenda for Health Systems in Canada's North

Healthcare Papers, 2018

In Canada, remoteness is mainly a northern phenomenon, with Indigenous residents constituting the majority population in the vast majority of northern communities. Despite this reality, there has been a surprising lack of research focus on the interface between remote and Indigenous health. From the perspective of health policy and system reform in Canada's north, there are at least three areas that are worthy of far greater research attention. The first, and perhaps most pressing, field of research would involve comparing various models and approaches for regional and Indigenous governance and administration and delivery of health services. The second concerns a program of research on the inevitable trade-offs in cost, responsiveness and quality between providing a broader range of health services in northern communities or transporting northern residents to southern urban centres for such services. The third research area should explore the ways in which primary care can be made even more effective in remote areas. Properly designed comparative research can take advantage of the past and current policy and system differences in the provinces and territories.

Promise and peril: how health system reforms impacted public health in three Canadian provinces

Canadian Journal of Public Health

Objectives Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations. Methods A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes. Results Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising “value for money” and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public hea...