Regionalization of Health

In 1992, a major component of New Democratic Party government health reforms was the creation of thirty regional authorities (a much higher number than the fifteen recommended by the Murray Commission in 1990), to deliver health programs and services. These replaced over 400 health care boards, which had lacked a coordinated approach to planning and delivery of services. Two additional districts in Northern Saskatchewan were formed in 1998. This sweeping but contentious structural reform made Saskatchewan a leader in Canada. By the end of the 1990s all provinces except for Ontario had regionalized.

The regions were funded by the provincial government, and had no power of taxation. The regional focus was intended to create an integrated and responsive system, responsible for a wide range of health services, including mental health, community, long-term care, residential and acute care services, health promotion, and public health.

With the passage in 1993 of The Health Districts Act, the Union Hospital and the Ambulance Boards were disbanded and their assets transferred to the districts. There were also voluntary affiliations. The structure and composition of the health boards were designed to increase public participation. The district health boards had twelve members (fourteen each in Regina and Saskatoon), including eight elected members. At the time, Saskatchewan was the only province to elect board members by universal suffrage. The first board elections were held in 1995 and the second in 1997. However, the stress of change was exacerbated by an unprecedented era of restraint in health care funding in the mid-1990s, owing to federal policies as well as the continuing trend of rural depopulation.

The 2001 Fyke Commission nevertheless concluded that regionalization had been positive overall. The thirty-two health districts were collapsed into twelve regional health authorities. Board members would no longer be elected, but appointed by the province.

Although regionalization continues to pose problems, there is far less fragmentation in the system. There is now an important group of senior managers attuned to the needs of the whole, not just its constituent parts. There is less duplication of services among agencies. Admission to long-term residential care is more streamlined and needs-based. There are improved partnerships with education, social services, and municipal governments. Health care has been enabled to become a system.

Denise Kouri