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The crisis of regionalization
1Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. greg.marchildon@utoronto.ca.
Healthcare Management Forum
|September 9, 2015
Summary
Canadian provincial governments are reconsidering health regionalization, with many dismantling regional health authorities. True regionalization, including physicians and primary care, may be more effective than abandoning the approach.
Area of Science:
- Health Services Research
- Public Health Policy
- Healthcare Management
Background:
- Canadian provincial governments are currently debating the effectiveness of health regionalization.
- A decade ago, there was strong support for regionalization, but this has shifted towards centralized health structures.
- Political leaders perceive regionalization as having failed to meet its initial goals.
Purpose of the Study:
- To analyze the current state of health regionalization in Canada.
- To evaluate the reasons behind the perceived failure of regionalization.
- To propose recommendations for future healthcare governance models in Canada.
Main Methods:
- Qualitative analysis of policy shifts and government decisions regarding regionalization.
- Review of the historical context and objectives of health regionalization in Canada.
- Assessment of the impact of excluding physicians and primary care from regionalized governance.
Main Results:
- Provincial governments are moving away from regionalization towards centralized health ministries.
- The exclusion of physicians and primary care from regional governance has hindered the success of regionalization.
- The pre-regionalization status quo was suboptimal and difficult to reinstate.
Conclusions:
- Provincial governments have not given regionalization a genuine opportunity to succeed by excluding key stakeholders.
- Abandoning regionalization might be premature; a more comprehensive approach is warranted.
- Consideration should be given to implementing a more robust model of regionalization, integrating primary care and physicians, before discarding the concept entirely.
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