British Columbia’s Health Reform: “New Directions” and Accountability

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“…Why, for example, did the government think more consultation was necessary? Extensive public consultations occurred in British Columbia during the New Directions healthcare reform in the mid-1990s (Davidson 1999) and continue up to the present, albeit mainly at the micro-level of health programs and services, through the Regional Health Authorities' Community Health Advisory Committees, patient focus groups and various ongoing regional and local public consultations (Vancouver Coastal 2006). Moreover, major public consultations on macro policy issues were conducted by the National Forum on Health in 1996 and the Commission on the Future of Health Care in Canada in 2002.…”

But Is It Good for Non‐Urban Women's Health? Regionalizing Maternity Care Services in British Columbia*

“…However, compared to inhabitants of metropolitan areas, non-urban residents can still be seen as comparatively "remote" due to such factors as substantial distance from tertiary referral centres for specialized medical care, and the relatively small number of general practitioners, medical specialists and other health providers, including midwives, practicing in their local community (Leduc, 1997). This is discussed in more detail below emphasis from reactive treatment to proactive health promotion; and 2) increasing local decision-making and community control (Davidson, 1999;Chomik, 1999). In 1993, the Health Authorities Act established regional health boards (RHBs) and community health councils (CHCs), which were designated to take over responsibility from many of the existing hospital and long-term care facility boards within designated geographic regions of the province.…”

“…While not without ambiguities with regard to how to define "population health," "health care" and "health services,'' and also containing contradictions such as how to improve access to universally funded Medicare while saving health dollars and reorienting community thinking in a population health direction (Davidson, 1999), New Directions nevertheless established a structure whereby citizens in their geographic communities gained a crucial voice in health services planning, a voice that did not previously exist and was to be lost in later revisions of regionalization (Haley, 19991.' As Davidson (1999: S35) explains: "The intent [of New Directions] was to devolve substantial power over health services to citizens at the community level, not only to counter the power of the health professional elites, but also to foster a community orientation to wellness."…”

“…However, the regionalization model that was actually implemented in 1996 (and more recently reconfigured, as mentioned above) has lessened central government control but has not delivered on the promise of greater government accountability to local citizens in their own communities. Instead, increased control and accountability have been placed in the hands of an appointed managerial elite (Davidson, 1999). While a few of the women stated that their local health authority was working hard to get better maternity and general health care in their community, the majority of the women reported a lack of opportunity to discuss their concerns about substandard delivery of maternity care services in their community.…”

“…Hollander (1992) notes some benefits, such as increased local input into decision making, greater overall democratization, increased accountability and better co-ordination and planning of local services. Yet Hollander, as well as others, at the same time note that the principal paradigm shift for health reform has been based on a business model where governments have removed themselves from direct service delivery, leaving it to the health authorities to organize and deliver health care services appropriately (Davidson, 1999;Armstrong et al, 2000). As a result, diversity in the scope of services provided by regional health boards across Canada is also apparent.…”