Revisiting Health Regionalization in Canada

2016 ◽  
Vol 47 (2) ◽  
pp. 333-351 ◽  
Author(s):  
Paul Barker ◽  
John Church
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Systems ◽  
Health Care Expenditures ◽  
Regional Health ◽  
Health Authorities ◽  
Care Systems ◽  
Physician Care ◽  
Regional Health Authorities ◽  
Regional Authorities

Twenty years ago, many of Canada’s provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused some provinces to abandon their regional authorities, but this article argues that the provision of greater autonomy and a better public appreciation of their role and potential may lead to more successful regional authorities. Accordingly, the objective of this article is to reveal the shortcomings of regional health authorities in Canada while at the same time arguing that changes can be made to increase the chances of more workable authorities.

Assessing the Removal of Regional Health Authorities in Ontario

2021 ◽  
pp. e2020105
Author(s):  
Paul Barker
Keyword(s):  
Health Care ◽  
Health Authority ◽  
Effective Control ◽  
Local Health ◽  
Regional Health ◽  
Health Authorities ◽  
Connected Set ◽  
Regional Health Authorities ◽  
The Many ◽  
Regional Authorities

A little more than a decade ago, a series of regional bodies were introduced throughout Ontario to help resolve difficulties with the province’s health care system. The Local Health Integration Networks, the name given to the new health entities, sought to create a connected set of health services and to achieve more effective control and distribution of health care finances. A third intent was to engage the community when setting priorities for health care. Recently, the new government of Ontario replaced the LHINs with a single health authority. It asserted that the single authority was better equipped to handle the many problems that still prevailed. An assessment of this decision offers some grounds for disbanding the LHINs. However, the findings offer stronger support for the alternative of keeping the regional authorities and providing them with greater autonomy.

The Municipality as Negotiator in Multilevel Governance of Health Care

2015 ◽  
Vol 11 (2) ◽  
Author(s):  
Gro Sandkjær Hanssen ◽  
Marit Kristine Helgesen ◽  
Ann Karin Tennås Holmen
Keyword(s):  
Health Care ◽  
Health Services ◽  
Chief Executive ◽  
Multilevel Governance ◽  
Regional Health ◽  
Health Care Coordination ◽  
Health Authorities ◽  
Regional Health Authorities ◽  
Political Steering

AbstractThis article focuses on the new role of municipalities–as negotiators in multilevel governance of health services. The 2012 health care coordination reform in Norway involves a partnership between health services at the national and municipal levels. Negotiations in these regional partnerships result in regionally different solutions concerning the provision of health services. What does this new role of municipalities require with regards to political steering and administrative management? From interviews in nine municipalities and two regional health authorities, the authors find that the formal cooperation agreements have affected the interaction between municipalities and regional health authorities, with a shift from professional deliberation to strategic negotiations. The new negotiating role of the municipalities requires political will to clarify the room of maneuver for the negotiating actors and support the negotiating solutions when these are within the defined frames. The negotiations stimulate integration between management and professionals, in order to inform the chief executive officer, who is often the negotiator. The negotiators assume an essential role as bridge-builders between the political and professional world in the municipalities, and the professional world of the hospitals and regional health authorities.

Utilization of dental health services by Danish adolescents attending private or public dental health care systems

2002 ◽  
Vol 60 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Lisa Bøge Christensen ◽  
Poul Erik Petersen ◽  
Annelise Bastholm ◽  
Lone Laurberg
Keyword(s):  
Health Care ◽  
Health Services ◽  
Dental Health ◽  
Health Care Systems ◽  
Dental Health Services ◽  
Dental Health Care ◽  
Care Systems

The Untold Story: How the Health Care Systems in Developing Countries Contribute to Maternal Mortality

1992 ◽  
Vol 22 (3) ◽  
pp. 513-528 ◽  
Author(s):  
T. K. Sundari
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Health Services ◽  
Maternal Mortality ◽  
Health Care Systems ◽  
Health Services Delivery ◽  
Services Delivery ◽  
Life Saving ◽  
Referral Hospitals ◽  
Care Systems

This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.

scholarly journals Formal priority setting in health care: the Swedish experience

2016 ◽  
Vol 30 (6) ◽  
pp. 891-907 ◽  
Author(s):  
Peter Garpenby ◽  
Karin Bäckman
Keyword(s):  
Health Care ◽  
Priority Setting ◽  
National Level ◽  
Regional Health ◽  
Bottom Up ◽  
Content Type ◽  
Political Conflicts ◽  
Health Authorities ◽  
Financial Pressure ◽  
Regional Health Authorities

Purpose From the late 1980s and onwards health care in Sweden has come under increasing financial pressure, forcing policy makers to consider restrictions. The purpose of this paper is to review experiences and to establish lessons of formal priority setting in four Swedish regional health authorities during the period 2003-2012. Design/methodology/approach This paper draws on a variety of sources, and evidence is organised according to three broad aspects: design and implementation of models and processes, application of evidence and decision analysis tools and decision making and implementation of decisions. Findings The processes accounted for here have resulted in useful experiences concerning technical arrangements as well as political and public strategies. All four sites used a particular model for priority setting that combined top-down- and bottom-up-driven elements. Although the process was authorised from the top it was clearly bottom-up driven and the template followed a professional rationale. New meeting grounds were introduced between politicians and clinical leaders. Overall a limited group of stakeholders were involved. By defusing political conflicts the likelihood that clinical leaders would regard this undertaking as important increased. Originality/value One tendency today is to unburden regional authorities of the hard decisions by introducing arrangements at national level. This study suggests that regional health authorities, in spite of being politically governed organisations, have the potential to execute a formal priority-setting process. Still, to make priority-setting processes more robust to internal as well as external threat remains a challenge.

scholarly journals The importance of intervening in adult mental health services when patients are parents

2014 ◽  
Vol 3 (6) ◽  
pp. 56 ◽  
Author(s):  
Camilla Lauritzen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Health Care Systems ◽  
Theoretical Background ◽  
Parental Mental Illness ◽  
Adult Mental Health ◽  
Care Systems

This article addresses the issue of parental mental illness. The theoretical background and rationale for developing new routines to change clinical practice is described, suggesting a policy change in which a child focus is implemented in adult mental health services. Furthermore, proposed strategies that have the potential of being effective within existing health care systems are discussed.

Countering Moral Hazard in Public and Private Health Care Systems: A Review of Recent Evidence

1989 ◽  
Vol 18 (2) ◽  
pp. 235-251 ◽  
Author(s):  
Cam Donaldson ◽  
Karen Gerard
Keyword(s):  
Health Care ◽  
Health Services ◽  
Moral Hazard ◽  
Financial Incentives ◽  
Care Delivery ◽  
Health Care Systems ◽  
Health Care Financing ◽  
General Effect ◽  
Health Maintenance ◽  
Care Systems

ABSTRACTWithin both publicly and privately financed health care Systems different funding mechanisms have evolved, or have been proposed, to deal with the problem of ‘moral hazard’. Moral hazard arises when financial incentives within the health care System lead to either inefficient demands for care by consumers or inefficient supply of care by providers. In this paper the problem of moral hazard is outlined in more detail, and different ways of countering moral hazard are reviewed in terms of three criteria: effect on patient utilisation of health services in general; effect on utilisation by different groups of patients; and effect on health status. It is concluded that evidence on different methods of funding health services can only be judged in the context of objectives. If the objectives of health care delivery are ‘maintenance or improvement of health’ and ‘equal access for equal need’ then charges and finance of care through health maintenance organisations both appear to be less favourable than ‘free’ care at the point of delivery whilst the latter is not necessarily more costly as a resuit. Research on other suggested alternatives is required, otherwise radical changes to health care financing in the UK will simply result in movement from one unproven system to another.

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