Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong> 39<br />
it involved both decentralization and centralization. While P/T ministries of<br />
health delegated considerable administrative decision-making to quasi-public<br />
RHAs, in many (but not all) cases this structural change also involved the<br />
abolishment of a number of more local (municipal and quasi-public) health care<br />
organizations and their boards of directors, with these organizations folded into<br />
the RHAs (see section 2.3.1).<br />
Since 2001, there has been a trend towards increased centralization in<br />
terms of reducing the number of RHAs, thereby increasing the geographical<br />
and population size of individual RHAs. In 2005, the same year that Ontario<br />
introduced its particular brand of regionalization, the government of Prince<br />
Edward Island eliminated its two RHAs (Axelsson, Marchildon & Repullo-<br />
Labrador, 2007). In 2008, Alberta disbanded its nine RHAs in favour of a single<br />
RHA in an ambitious ef<strong>for</strong>t to gain economies of scale and scope by creating<br />
what was in effect a single health management organization <strong>for</strong> its more than<br />
3.5 million residents. As a single RHA, Alberta <strong>Health</strong> Services has some<br />
operational autonomy from the provincial ministry of health (Duckett, 2010;<br />
Donaldson, 2010).<br />
At the same time, however, the delivery of the majority of primary health<br />
services is private and there<strong>for</strong>e decentralized. The vast majority of family<br />
physicians are profit-making professional contractors and are not directly<br />
employed by either the RHAs or P/T ministries of health. While hospitals are<br />
divided in ownership – some are owned by RHAs while others remain private,<br />
largely non-profit-making, corporations – specialist physicians who provide<br />
acute services are also private, independent contractors. In most provinces, a<br />
significant number of consultants (specialist physicians) have been incorporated<br />
as professional corporations mainly to increase their after-tax income. Most<br />
services supporting primary and acute care, including ambulance, blood and<br />
laboratory services as well as the ancillary hospital services (e.g. laundry and<br />
food), are private. Long-term care facilities are divided between public (P/T<br />
and local government) and private (profit-making and non-profit-making). The<br />
majority of dental care, vision care, psychology and rehabilitation services are<br />
privately funded and delivered by independent professionals.<br />
2.5 Planning<br />
As a consequence of the constitutional division of powers in <strong>Canada</strong> and<br />
the relatively decentralized nature of health administration and delivery,<br />
there is no single agency responsible <strong>for</strong> system-wide national planning.