REGIONALIZATION OF HEALTH-SERVICES IN CANADA - A CRITICAL PERSPECTIVE

Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountabilit y of decision-makers, A plethora of government royal commissions and t ask forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalize d health system with an intermediary body responsible for functions pr eviously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participati on in health care decision-making, All provincial governments except O ntario have introduced regional structures for health care, with the h ope that these changes will increase efficiency, equity, and responsiv eness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordin ating services in a manner that produces economies of scale; it requir es an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.