Health planning in Ontario

Stephen C. Hanson's article, "Health Planning: The Fourth Generation," (Hospital and Health Services Administration 27/4, 1982, pp. 55-65) comments on the possible "downsizing" of Health System Agencies (HSAs) because of severe budget cuts. Hanson suggests that they shift from regulatory to planning agencies. A relatively recent development in Ontario, Canada, involves the establishment of area-wide planning agencies known as district health councils (DHCs) which may provide a model for HSAs of the future. Although DHCs operate in a government-sponsored healthcare system and are advisory rather than regulatory in nature, the DHC concept can be adapted to HSAs in order to become true planning agencies. This article outlines the salient features of the Ontario DHC Program and compares its similarities and differences with Hanson's "Fourth Generation" model of HSAs. While Hanson proposes a model, Ontario's experience for which comparisons and insights are offered has gone beyond the conceptualization stage and has been operating for over ten years. The DHC Program is still evolving, tentative in some areas, and searching for the most appropriate role and means in other areas. As HSAs will be transformed out of necessity, a close look at the Ontario DHC program may prove to be both instructive and timely.