Regionalization and Its Effects

The health care system of Canada was restructured in 1996 to streamline the delivery system making it less fragmented. This would make it more responsive to local needs such as increasing community-bases services, improving public participation, and promoting health lifestyles through programs and policies. The system needed to be restructured because of the way it was being managed and delivered. The most persistent problems were the following: difficulty accessing some services in a timely manner, unpredictable and unacceptable long waits for treatments and inconsistent coordination of the system. The only way to establish the patient-centered and sustainable Health Care system was to reorganize it. A clear definition of regionalization is given in the revised edition of Canada's Health Care System: Its Funding and Organization by Anne Crichton, David Hsu and Stella Tsang. "Regionalization is a way of improving the rationalization of services by increasing accountability, improving cost control, setting priorities and getting the professions, institutions and public service departments to work together better at the local level "(pg.293, Canada's Health Care System).

Regionalization was suggested at first by the Royal Commission on Health Services in 1964 and by the Task Force on the Cost of Health Services in 1969 ( pg 297, Canada Health Care System). There were four primary reasons why regionalization was needed. The first was better health through increased health promotion and prevention of injury and illness. There have been many strategies suggested to promote and prevent healthy lifestyles. Some include education, communication, community development, and public education. The second was to involve the public more through participation and responsibility. The author of Public Health and Preventative Medicine in Canada, Chandrakant P. Shah states three initiatives that will increase citizen involvement: knowledge about the cause of disease, participation in the formulation of health care policies and the creation of citizen voluntary groups. The third reason is to bring health closer to home with more services in people's homes, local communities and regions. The fourth was to establish effective management with increased emphasis on accountability and more efficient use of health care resources. In 2001, Minister of Health Planning, Sindi Hawkins, announced that the 52 regional health authorities would be cut down to one provincial health authority, five geographic health authorities and 15 health service delivery areas. The five health authorities are: Northern Health Authority, Interior Health Authority, Fraser Health Authority, Vancouver Coastal Health Authority and Vancouver Island Health Authority. This would improve efficiency, strengthen accountability and allow better planning and service coordination for patients (see http://www.healthservices.gov.bc.ca/socsec/pdf/new_era_sustain.pdf). Included in the restructuring of health care management was the appointment of six Board Chair members, one for the Provincial Health Authority and one for each of the geographic health authorities (see http://www.healthservices.gov.bc.ca/socsec/pdf/new_era_ sustain.pdf). Below the Board Chair members are CEOs, who are responsible on making the administrative and corporate change decisions (see http://www.healthservices.gov.bc.ca/socsec/pdf/new_era_sustain.pdf).

The structure change and responsibility transfer to the Regional Health Authorities (RHA) were one of the biggest changes made in the health care system. The Ministry of Health still holds the most power being responsible for setting provincial goals and standards, holding health authorities accountable for their responsibilities and ensuring proper health outcomes for the province. Although the MOH has withdrawn from the direct provision of health care services, they still manage many services such as the Medical Services Plan, the BC Ambulance Service and the Fair Pharmacare Program. The Provincial Health Authority works together with other Health Authorities to plan and coordinate provincial and specialized programs. Some programs are the BC Cancer Agency, the BC Transplant Society, Children and Women's Health Centre and the BC Centre for Disease Control. The Health Authorities, consisting of 6-9 members that have been appointed by the MOH, have the responsibility of identifying the health needs in their region, planning appropriate services and programs, ensuring the funding is properly conducted and managed, and are in charge of hiring a CEO to manage the health delivery services. They are fully accountable for their region; they are accountable for the system design, care, and treatment and for regional populations. Lastly, the Health Service Delivery Areas, who are in charge of the hospitals and community-based health services, report to the CEO of their region regarding performance objectives, and patient input. All four of these groups make up the Provincial Health Care Management Structure. This structure change has been a huge benefit in the delivery of health care. In April 2002, inaugural Performance Agreements were signed by Health Authorities and Ministry of Health Services to take on the responsibilities and to take on full accountability for health regions (see http://www.healthservices.gov.bc.ca /socsec/pdf/haagreement0203.pdf). This agreement will emerge as a strong accountability tool that will allow British Columbians to assess their health care dollars and services. British Columbians have easy access to services at local, regional and provincial levels regardless where they reside. The community-based services, such as community health clinics, have accessible hours which have helped reduce the waitlist numbers in hospitals, making it convenient for patients and hospital staff.

The Health Authority Region in my area is the Fraser Health Authority. The Fraser Health Authority oversees the operation of 12 acute hospitals, maintains more than 7,000 community residential beds, and accounts for about one-third of BC's population. The communities within the Fraser Health Authority are divided into three areas. The first, Fraser South, consists of Surrey, White Rock, Delta and Langley. The second, Fraser North, consists of New Westminster, Burnaby, Coquitlam, Maple Ridge and Pitt Meadows. The third, Fraser East, consists of Abbotsford, Mission, Chillwack and Hope. The services provided by the Fraser Health Authority are hospital care, home and community care, public health promotion and strategic priorities. One of the hospital services includes a Geriatric Acute Program that provides short-stay specialty care to acutely-ill older adults that are admitted from the emergency department at Royal Columbian Hospital.