The Big Swing: Reforming Governance Authorities in Canadian Health Systems

The governance of publicly funded health systems in Canada has attracted attention for decades. Governance refers to the steering of the whole health system and goes beyond the role of healthcare boards for hospitals or regions. In this article, we analyze the potential of system-level reforms of governance that have been implemented in seven Canadian provinces since 2008. These reforms involve a movement toward greater centralization of the governance of health systems with the creation of province-wide governing agencies. These reforms of governance are not, by design, a panacea nor an absolute policy mistake. The potential of these governance reforms, as with any structural changes, will largely depend on how actors in power inhabit these new agencies and how patients, citizens, non-governmental organizations and communities relate to them. To assess the potential of these reforms, we first review works on challenges faced by these new health authorities. We then explore the literature on high-performing health systems and on contemporary approaches to governance, offering guidance for leaders of these organizations.