Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
Instead, pan-Canadian initiatives are often the product of intergovernmental
agreements, committees and agencies that do a limited amount of high-level
strategic planning, most often on a sector-by-sector basis such as HTA, EHRs,
and administrative data collection and dissemination. There are two notable
exceptions to this: the first is the F/P/T Councils of Ministers of Health and
Deputy Ministers of Health and their respective working groups; and the second
is the Health Council of Canada, although its mandate is limited to producing
progress reports on the health reform priorities identified by participating
governments (see section 2.3.3).
Most system-wide planning is actually done within the provincial and
territorial ministries of health and each provincial and territorial ministry has
a policy and planning unit. In regionalized provinces and territories, some
planning has been delegated to RHAs but P/T ministries continue to be
responsible for major new capital (e.g. hospital) as well as some infrastructure
planning. Health human resource (HHR) planning tends to be divided between
the ministries and RHAs, with the responsibilities varying among provinces.
In smaller non-regionalized jurisdictions such as Prince Edward Island, Yukon
and Nunavut, HHR planning is done at the ministry level. Due to the mobility
of health professionals in Canada, P/T ministries and RHAs are sensitive to
changes in remuneration, working conditions and regulatory requirements
in other jurisdictions. In the 2000s, a number of provinces established health
research agencies and health quality councils with a mandate to help improve
health system processes and outcomes as well as to influence, if not reshape,
physician practice and clinical decision-making.
Perhaps the single most important initiative in system-wide planning
has been the creation of RHAs by provincial governments. Operating at an
intermediate level between health ministries and individual providers, RHAs
have a legal mandate to plan the coordination and continuity of care among a
host of health care organizations and providers within a defined geographical
area (Denis, 2004; Marchildon, 2006). While a broad strategic direction is set
by P/T health ministries, detailed planning and coordination is actually done at
the RHA level. RHAs set their priorities through annual budgets (occasionally
supplemented by multi-year plans) that are submitted to provincial health
ministries. Some budget submissions are required before the ministry budget
is finalized while others are submitted only after funding is announced in the
provincial budget, with each approach having different implications for the
planning process (McKillop, 2004).