Getting the foundations right: Alberta's approach to health-care reform (original) (raw)
Related papers
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.
McGill-Queen's University Press eBooks, 2013
Like other Canadian provinces, Alberta undertook significant health-care reforms during the 1990s. The Alberta approach, while driven by fiscal pressures similar to those experienced by other provinces, was shaped by its own unique interplay of institutions, ideas, interests, technological change, and economic forces. A growing fiscal crisis, combined with a change in political leadership, but not in the governing party, led to aggressive reform in health care. Once economic growth returned, commitment to health-care reform waned. However, the enduring legacy of initial health reforms has been a shift away from the Ministry of Health and local health-care in decision-making institutions and interests (i.e., traditional forms of governance) to new decision-making institutions and interests (i.e., new forms of governance). Overall, this had a centralizing effect on decision-making. The intent of this chapter is to discuss how Alberta addressed health policy reform around six key policy decisions: the regulation of health services delivery by private facility operators; the introduction of health regions; the introduction of a population-based funding model to support health regions; the introduction of a voluntary, centralized wait-times registry; the expansion of drug benefits to cover the children of parents moving off of social assistance to return to work, and palliative care
Healthcare Management Forum, 2010
Alberta Health Services formally came into existence on April 1, 2009, potentially signaling the start of a new wave of health restructuring in Canada. This article situates that change in the context of international trends in health restructuring and reviews some of the challenges faced by the new organization.
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...
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...
Revisiting Health Regionalization in Canada
International journal of health services : planning, administration, evaluation, 2017
Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused s...
Reorganising health and social care in Québec: a journey towards integrating care through mergers
London journal of primary care, 2018
Two reforms (2014, 2015) characterised by the merger of public health care establishments profoundly shaped the current organisation of Quebec's healthcare system. In 2015, 22 megastructures called Integrated Health and Social Services Centres/Integrated University Health and Social Services Centres (IHSSC/IUHSSC), were created and mandated to organise care delivery to their local populations. To describe the service configuration of the 2015 healthcare system reforms, emphasising on how it shaped the organisation of primary health care (PHC) in Quebec. With the creation of IHSSCs/IUHSSCs, Quebec's healthcare system passed from three to two levels of governance, leading to a centralisation of decision-making powers. Most health services are delivered by the new organisations, while most PHC is delivered by semi-private medical practices, mainly Family Medicine Groups (FMGs). The FMG model is the preferred strategy to develop interdisciplinary team-work and inter-organization...
Canadian health system reforms: lessons for Australia?
Australian Health Review, 2005
This paper analyses recent health reform agenda in Canada. From 1988 until 1997, the first phase of reforms focused on service integration through regionalisation and a rebalancing of services from illness care to prevention and wellness. The second phase, which has been layered onto the ongoing first phase, is concerned with fiscal sustainability from a provincial perspective, and the fundamental nature of the system from a national perspective. Despite numerous commissions and studies, some questions remain concerning the future direction of the public system. The Canadian reform experience is compared with recent Australian health reform initiatives in terms of service integration through regionalisation, primary care reform, Aboriginal health, the public?private debate, intergovernmental relations and the role of the federal government.