Canada - World Health Organization Regional Office for Europe

6. Principal health reforms
Since 2005, when the first edition of this study was published (Marchildon,
2005), there have been no major pan-Canadian health reform initiatives.
However, individual provincial and territorial ministries of health have
concentrated on two categories of reform, one involving the reorganization or
fine tuning of their regional health systems, and the second linked to improving
the quality and timeliness of – and patient experience with – primary, acute and
chronic care.
The main purpose of regionalization was to gain the benefits of vertical
integration by managing facilities and providers across a broad continuum
of health services, in particular to improve the coordination of “downstream”
curative services with more “upstream” public health and illness prevention
services and interventions. In the last ten years, in an attempt to capture
economies of scale and scope in service delivery as well as reduce infrastructure
costs, there has been a trend to greater centralization, with provincial ministries
of health reducing the number of RHAs (see Table 2.3). Two provinces, Alberta
and Prince Edward Island, now have a single RHA responsible for coordinating
all acute and long-term care services (but not primary care) in their respective
provinces.
Influenced chiefly by quality improvement initiatives in the United States
and the United Kingdom, provincial ministries of health established institutions
and mechanisms to improve the quality, safety, timeliness and responsiveness of
health services. Six provinces established health quality councils to accelerate
quality improvement initiatives. Two provincial governments also launched
patient-centred initiatives aimed at improving the experience of both patients
and caregivers. Most ministries and RHAs also implemented some aspects of
performance measurement in an effort to improve outcomes and processes.
Patient dissatisfaction with long waiting times in hospital EDs and for certain
types of elective surgery such as joint replacements has triggered efforts in all
provinces to better manage and reduce waiting times.
6. Principal health reforms