Canada - World Health Organization Regional Office for Europe

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