DEVOLVING AUTHORITY FOR HEALTH-CARE IN CANADA PROVINCES .1. AN INTRODUCTION TO THE ISSUES

IN 9 OF CANADA'S 10 PROVINCES, much of the decision-making in health c are has recently been devolved to local authorities. Provincial govern ments want this new governance structure to at least contain costs and improve service integration. However, there has been little evaluatio n of devolution to determine whether these and other goals are being m et. Although devolved structures in the provinces vary somewhat with r espect to the number of tiers, accountability mechanisms, degree of au thority and method of funding, the only structural element that varies substantially is the scope of services under the authority of local b oards. The real authority of the boards depends, however, on their neg otiated compromises among 3 areas of tension: the provincial governmen t's expectations, the providers' interests and the local citizens' nee ds and preferences. The boards' abilities to negotiate acceptable comp romises will largely determine their effectiveness. This article intro duces a survey of the members of 62 boards in 5 provinces for which th e response rate was 65%, with 514 of 791 board members responding.