Regionalization of Health Services in Canada: A Critical Perspective

Abstract

Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.

Governance, Health Policy Implementation and the Added Value of Regionalization

“…Ambitions have been high: redefining accountability rules, democratizing decision-making, enhancing responsiveness to public needs, increasing the fairness of resource distribution among regions, developing a more comprehensive approach to health problems, using resources more efficiently and improving continuity of care. Opinions on the effectiveness of regionalization are, however, divided (Church and Barker 1998;Davis 2004;Levine 2004;Sullivan et al 2004). Even if some progress has been made (Gosselin 1984;Lewis and Kouri 2004;Denis et al 2004), regionalization' s full potential has not been realized (Church and Barker 1998;Lamarche 1996;Lewis 1997;Hurley 2004;Lewis and Kouri 2004).…”

Of Silos and Systems: The Issue of Regionalizing Health Care

“…1 The formation of a regional health board shifts the responsibility for decisions about funding and allocating health care resources away from both individual organizations (for example, a community hospital board) and the provincial ministry of health. The main goals of regionalization are to help contain rising health care costs (through economies of scale), to improve responsiveness to and accountability for population health needs, and to increase public participation in health care decision-making.…”

“…The main goals of regionalization are to help contain rising health care costs (through economies of scale), to improve responsiveness to and accountability for population health needs, and to increase public participation in health care decision-making. 1 In essence, the responsibility for providing health care services moves away from the "silos" of fragmented, individual organizations (as just one example, before regionalization in Saskatchewan, the province had more than 400 individual health care organizations, such as acute care hospitals and community care groups 2 ) to a "system" of health care that is delivered in an integrated fashion by a single regional organization.…”

“…1 Each province has developed regional health boards that vary in number, scope of responsibilities, and membership. While some provinces have separate boards to oversee institutional and community services, most have regional health boards with a wide range of responsibilities, including medical clinics, health promotion and prevention, youth and family services, public health, cancer care, mental health, hospitals, and residential care programs.…”

Vases clos et systèmes : Les enjeux de la régionalisation des soins de santé

“…Toutefois, de telles formules requièrent de grandes quantités de données individuelles, ce qui met en perspective la seconde difficulté : bien que les données individuelles nous permettent de définir et de tenir compte d'importants facteurs qui influencent les besoins en soins de santé, il est souvent difficile d'obtenir des données épidémiologiques fiables et de grande qualité 6 . Ironiquement, les ressources humaines et l'infrastructures nécessaires pour collecter et interpréter efficacement cette information pourraient en fait exacerber le problème des coûts élevés des soins de santé 1 . Une troisième difficulté au fonctionnement efficace des conseils régionaux de la santé est le fait que beaucoup d'entre eux n'ont que peu de contrôle sur les principales dépenses, comme les honoraires des médecins et le coût des médicaments, et un pouvoir limité sur la création de politiques 4 .…”