Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 31
Table 2.3
Regionalization in the provinces and territories
RHAs first established
(year)
Number of RHAs when
first established
Number of RHAs
in 2011
British Columbia 1997 52 5
Alberta 1994 17 1
Saskatchewan 1992 32 13
Manitoba 1997 12 11
Ontario 2005 14 14
Quebec 1989 18 18
New Brunswick 1992 8 2
Nova Scotia 1996 4 9
Prince Edward Island 1993 6 1
Newfoundland and Labrador 1994 6 6
Northwest Territories 1997 8 8
Sources: Axelsson, Marchildon & Repullo-Labrador (2007) and current provincial and territorial ministry websites consulted
in November 2011 (see section 9.2).
Notes: Year of RHA establishment based on calendar year in which law establishing regionalization was passed; jurisdictions with
one RHA have separated RHA governance and mandate from ministry of health governance and mandate, similar to other
regionalized jurisdictions.
While the provinces have the primary governance responsibility for most
public health care services, the federal government plays a key role in setting
pan-Canadian standards for hospital, diagnostic and medical care services
through the Canada Health Act and the Canada Health Transfer (see section
3.3.3). The federal department of health – Health Canada – is responsible for
ensuring that the provincial and territorial governments are adhering to the
five criteria of the Canada Health Act. Although conditional transfers are a
common policy tool in most federations, the use of the federal spending power
in health care has been more controversial in Canada, in large part because of
the desire of some provincial governments and policy advocates for an even
greater degree of fiscal and administrative decentralization (Marchildon, 2004;
Boessenkool, 2010).
While provincial and territorial governments must provide universally
insured services to all registered Indians and recognized Inuit residents, the
First Nations and Inuit Health Branch of Health Canada provides these citizens
supplemental coverage for “non-insured health benefits” (NIHB) such as
prescription drugs, dental care and vision care as well as medical transportation
to access medicare services not provided on-reserve or in the community of
residence. In addition, Health Canada and the PHAC provide a number of
population health and community health programmes in First Nation and Inuit
communities. Health Canada is also responsible for regulating the safety and
efficacy of therapeutic products, including medical devices, pharmaceuticals