Political and Administrative Organization

THE PROVINCIAL HEALTHCARE SYSTEMS

 The organization and delivery of health and social services is recognized as a provincial jurisdiction under section 92(7) of the Constitution Act, 1867. However, the federal government is able to influence the provincial healthcare systems through its spending power, which is also recognized in the Constitution. Thus it has contributed to the funding of provincial health systems to varying degrees at different periods. Such, then, is the context surrounding the efforts by the federal government to frame the action of provincial governments when it adopted the Canada Health Act in 1984. Under the terms of this statute, in order to qualify for full payment by the federal government of its healthcare funding contribution (through the Canada Health Transfer), provincial health systems must guarantee :

  • public administration;
  • comprehensiveness; 
  • universality; 
  • portability;
  • accessibility.

Regionalization of healthcare in canadian provinces

 

 

NFL

PEI

NS

NB

QC

ON

MB

SK

AB

BC

Official name of regional entities

Regional Integrated Health Authorities

 NA a)

 Districts Health Authorities

Regional Health Authorities

Agences de la santé et des services sociaux 

Local Health Integration Networks

Regional Health Authorities

 Regional Health Authorities

 Regional Health Authorities

Regional Health Authorities 

Number of health regions

4

 NA a)

 9

 2 b)

 18

 14

 11

 13

 9

5 

Date of first regionalization

2004

 2002

 1996

 1992

Between 1989 and 1992

 2006

 1997 et 1998

1992 

 1994

 1997

Date of latest reform

2005

 2005

 2001

 2002 et 2008

2003 et 2005 

 NA

 2002

2001-2002 

 2003

 2001

Boards of administration: size and mode of appointment

15 to 18 members, appointed by the Minister of Health

NA a) 

12 to 15 members, appointed by the Minister of Health following consultation with Community Health Boards

17 voting members appointed by the Lieutenant-Governor in council and three non-voting members**

minimum 16 members, appointed by the Minister of Health

minimum 9 members, appointed by the government

9 to 15 members, appointed by the Minister of Health

12 members, appointed by the Minister of Health following public consultation

variable, members appointed by the Minister of Health

6 to 9 members, appointed by the Minister of Health

Source : Statistics Canada (2007), "Health Regions: Boundaries and Correspondence with Census Geography"; Canadian Centre for Analysis of Regionalization and Health (2004-05) and the 2004-05 annual report on Canada Health Act enforcement activities.
NA: Not applicable
a) In 2005, Prince Edward Island disbanded its four health regions. Since that time, the territory of the province is covered by a single health region that is centrally administered by the Department of Health.          
b) Following changes made under a bill adopted in 2008, the previous eight regional health authorities were reduced to two -- i.e., Regional Health Authority A and Regional Health Authority B.

Aside from questions pertaining to the relations between the federal and provincial governments, the organization of healthcare in Canada’s provinces (with the exception of Prince Edward Island, from 2005) has been marked by a phenomenon of regionalization. As of 2006, when Ontario set up its Local Health Integration Networks, all Canadian provinces (aside from Prince Edward Island) have now implemented a regional structure for managing their healthcare system. As the result of numerous innovations undertaken by the provinces since the late 1980s, at which time Quebec became the first province to regionalize its health and social service system, an organizational model has taken shape having the following two main characteristics :

  • the regionalization of health administration by the creation of entities charged with the administration of healthcare in a clearly delimited geographic area and responsible for the funding and delivery of services at the community level or in public institutions;
  • a certain degree of managerial autonomy attaching to these regional entities. This autonomy is framed by various prerogatives of the provincial government and its representatives, particularly respecting the allocation of budgetary resources among regional entities, the implementation of performance measurement mechanisms, and the mode of appointment of members to their boards of administration. In two provinces (New Brunswick and Ontario), these members are appointed by the provincial government at a meeting of the Cabinet. In the other provinces, they are appointed by the provincial Minister of Health. The discretionary power of the government or the health minister concerning the selection of board members varies depending according to the provisions of provincial legislation bearing on these regional entities. Thus, in Nova Scotia, for example, members are appointed following consultation of Community Health Boards, which bring together various groups of citizens and healthcare professionals. Likewise, in Quebec, the ministre de la Santé et des Services sociaux appoints the members of the board of the regional agencies known as Agences de la santé et des services sociaux upon the recommendation of various bodies involved in the management of institutions and services.