Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
health’s authority and responsibility for the health system is delegated to RHAs,
which are responsible for allocating resources for a range of health services for
populations within a geographically defined region.
Regionalization combines devolution of funding from provincial ministries
of health to the RHAs with a centralization of governance and administration
from individual health care facilities and organizations to RHAs. In most
provinces, RHAs act both as providers and purchasers of hospital care and
long-term care as well as other services delegated by provincial law. In Ontario,
RHAs known as LHINs (Local Health Integration Networks) do not provide
services directly; instead, they allocate resources among hospitals and other
independent health organizations. While in some cases RHAs facilitated
horizontal integration, in particular the consolidation of hospitals, the main
purpose of regionalization was to gain the benefits of vertical integration. By
coordinating or integrating facilities and providers across a number of health
sectors, RHAs were expected to improve the continuity of care and reduce
costs by encouraging more upstream preventive care and, where appropriate,
substituting potentially lower-cost home, community and institutional services
for more expensive hospital care. With funding from provincial ministries
of health, RHAs are expected to allocate health resources in a manner that
optimally serves the needs of their respective populations. However, no
provincial government has delegated physician remuneration, including
remuneration for family doctors who are responsible for the majority of primary
care provision, or the administration of public prescription drug plans to RHAs
(Lewis & Kouri, 2004) (Table 2.3).
2.3.2 The federal level
This section and the following two (2.3.3 and 2.3.4) provide a catalogue of
federal, intergovernmental and nongovernmental national agencies and
associations relevant to the health care system and their duties (see also Fig. 2.1).