RT Journal Article
SR Electronic
T1 Devolving authority for health care in Canada's provinces: 1. An introduction to the issues
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 371
OP 377
VO 156
IS 3
A1 J. Lomas
A1 J. Woods
A1 G. Veenstra
YR 1997
UL http://www.cmaj.ca/content/156/3/371.abstract
AB In 9 of Canada's 10 provinces, much of the decision-making in health care has recently been devolved to local authorities. Provincial governments want this new governance structure to at least contain costs and improve service integration. However, there has been little evaluation of devolution to determine whether these and other goals are being met. Although devolved structures in the provinces vary somewhat with respect to the number of tiers, accountability mechanisms, degree of authority and method of funding, the only structural element that varies substantially is the scope of services under the authority of local boards. The real authority of the boards depends, however, on their negotiated compromises among 3 areas of tension: the provincial government's expectations, the providers' interests and the local citizens' needs and preferences. The boards' abilities to negotiate acceptable compromises will largely determine their effectiveness. This article introduces a survey of the members of 62 boards in 5 provinces for which the response rate was 65%, with 514 of 791 board members responding.