The integration challenge in Canadian regionalization

Abstract

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.

Typology of Indigenous health system governance in Canada

“…For the PT governments, services and benefits include universal health coverage (Medicare) for hospital, diagnostic and medical care services. These are services PT governments must provide all residents, including Indigenous residents, based on the original agreement which established national hospital coverage in Canada in the 1950s and national medical care coverage in the 1960s (Lavoie 2018;Marchildon 2014). However, there is nothing stopping PT governments from delegating the administration and delivery of these core hospital and medical services to Indigenous governments and organizations.…”

“…Social care services including long-term care and home care are provided or subsidized to varying extent by PT governments. What holds these systems together are PT legislation, regulations, policies and, in the case of Medicare services, the federal Canada Health Act (Marchildon 2014).…”

“…In the Canadian context, ten provinces and three territories manage their own systems, with a narrower band of hospital, diagnostics and medical care services governed under the broad parameters of the Canada Health Act and provincial Medicare laws (Canada 2004; Marchildon 2014). Service provision is coordinated at the levels of the provinces and territories, with some measures of regional coordination in some provinces (Lavoie et al 2016; Marchildon 2016, 2019). Universal health coverage (i.e., Medicare) services such as hospital care and physician services are entirely publicly funded.…”

Regionalization for health improvement: A systematic review

“…According to Marchildon [7] the goal of regionalization is to integrate and rationalize healthcare services, to promote evidence-based practice, to decentralize resources and decision-making, and to switch focus and resources towards the prevention of illnesses and promotion of health. For regionalization to take place, a number of basic requirements are necessary: to regulate the responsibility of each level and its units, to match supply with the demand of the population, to establish the gateway to the regionalized system, to establish a referral system of the lowest to the highest level, to establish a continuous flow of cross-information, to establish scientific and technical support mechanisms, and to establish a partnership between health professionals and technicians [8].…”