THE REGIONALIZATION of HEALTH CARE in BRITISH COLUMBIA: DOES 'CLOSER to HOME' REALLY MATTER? By
Total Page：16
File Type：pdf, Size：1020Kb
THE REGIONALIZATION OF HEALTH CARE IN BRITISH COLUMBIA: DOES 'CLOSER TO HOME' REALLY MATTER? by Paul Kevin Weaver B.A. Simon Fraser University, 2003 RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS In the Department of Political Science O Paul Kevin Weaver, 2006 SIMON FRASER UNIVERSITY Spring 2006 All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. APPROVAL Name: Paul Weaver Degree: Master of Arts, Department of Political Science Title of Project: The Regionalization of Health Care In British Columbia: Does "Closer to Home" Really Matter? Examining Committee: Chair: Dr. Tsuyoshi Kawasaki, Associate Professor Department of Political Science --- Dr. Daniel Cohn, Assistant Professor Senior Supervisor Department of Political Science Dr. Michael Howlett, Professor Supervisor Department of Political Science Dr. Olena Hankivsky, Associate Professor Internal Examiner Department ol'Politica1 Science Date DefendedIApproved: April 1 1th, 2006 Zq SIMON FRASER &&261 UNlvERslTYli brary DECLARATION OF PARTIAL COPYRIGHT LICENCE The author, whose copyright is declared on the title page of this work, has granted to Simon Fraser University the right to lend this thesis, project or extended essay to users of the Simon Fraser University Library, and to make partial or single copies only for such users or in response to a request from the library of any other university, or other educational institution, on its own behalf or for one of its users. The author has further granted permission to Simon Fraser University to keep or make a digital copy for use in its circulating collection, and, without changing the content, to translate the thesislproject or extended essays, if technically possible, to any medium or format for the purpose of preservation of the digital work. The author has further agreed that permission for multiple copying of this work for scholarly purposes may be granted by either the author or the Dean of Graduate Studies. It is understood that copying or publication of this work for financial gain shall not be allowed without the author's written permission. Permission for public performance, or limited permission for private scholarly use, of any multimedia materials forming part of this work, may have been granted by the author. This information may be found on the separately catalogued multimedia material and in the signed Partial Copyright Licence. The original Partial Copyright Licence attesting to these terms, and signed tly this author, may be found in the original bound copy of this work, retained in the Simon Fraser University Archive. Simon Fraser University Library Burnaby, BC, Canada ABSTRACT Driven in large part by the increasing costs of health care delivery, the majority of Canadian provinces initiated a series of commissions or task forces to investigate the status of their health care systems in the last two decades. Emerging from these discussions, regionalization was thought to be the best remedy to address the respective financial and organizational challenges of the various provinces. Yet, despite widespread adoption by almost every jurisdiction, very little is known about the impact of this phenomenon on provincial health systems. This project evaluates whether regionalization in British Columbia's health system was able to overcome a number of challenges with this method of health care reform identified by Church and Barker. Taken from their important appraisal of regionalization across Canada, these authors identified several problems with regional health systems that must be surmounted if provincial health systems are to change the way in which they operate rather than merely be reorganized. Based on this investigation, the project argues that although regionalizaticon has somewhat improved health care operation in British Columbia, the health system still suffered from a number of difficulties during the 1990's that prevent regionalization from being described as an effective reform. DEDICATION For Sandra Louise. ACKNOWLEDGEMENTS Both directly and indirectly, a great number of people have helped me complete this degree. Specifically, however, I would especially like to thank my very good friend Sandra Louise. 'Without her continued grace, patience and understanding, I would not be the man I am today. I must also acknowledge the significant contributions Dr. Stephen Phillips and Mary Goldie from Langara College and Dr. Michael Howlett of Simon Fraser University have made to my education. It has only been through their insight, wisdom and continued words of encouragement, that I have been able to accomplish things I never imagined possible. I am in their debt. Finally, I would also extend my gratitude to my supervisor Dr. Daniel Cohn and my friend Andrea Balogh. During my time at Simon Fraser University, both have willingly devoted their valuable time and energy to ensure I stayed the course. They will always be a continued source of motivation and inspiration. TABLE OF CONTENTS .. APPROVAL ......................................................................................................11 ... ABSTRACT .....................................................................................................111 DEDICATION .................................................................................................iv ACKNOWLEDGEMENTS ..............................................................................v TABLE OF CONTENTS .................................................................................vi .. LIST OF FIGURES .........................................................................................vli ... LIS'T OF TABLES .........................................................................................vlll INTRODUCTION: MOVING BEYOND PROVINCIAL HEALTH CARE ... 1 Layout of the project .............................................................................4 Data and Methodology ..........................................................................5 PART ONE: REGIONALIZATION IN CANADA .......................................10 Regionalization defined .......................................................................16 Regionalization in British Columbia ...................................................18 PART TWO: ASSESSING REGIONALIZATION ........................................26 Hypothesis one ...................................................................................29 Testing hypothesis one .........................................................................30 PART THREE: HAS REGIONALIZA'TION MADE A DIFFERENCE? ..... 35 Hypothesis two .................................................................................... 36 Testing hypothesis two .....................................................................37 Problem one: integration ..................................................................... 38 Problem two: funding consolidation ................................................... 42 Problem three: information requirements ............................................ 47 Problem four: accountability ...............................................................52 CONCLUSION AND OPPORTUNITIES FOR FUTURE RESEARCH ...... 62 APPENDIX A: PARTIAL REGIONALIZATION TIMELINE .....................66 APPENDIX B: MINISTERS OF HEALTH IN THE 1990's ......................... 68 BIBLIOGRAPHY ...........................................................................................69 LIST OF FIGURES FIGURE ONE: Flow of Care and Accountability Pre-Regionalization ........ 20 FIGURE TWO: The Authority and Responsibility Feedback Loop of Regionalization ......................................................................... 22 vii LIST OF TABLES TABLE ONE: Health Expenditures in British Columbia. 1990 -2000 ....... 27 TABLE TWO: Measuring Regionalizat.ion in British Columbia .............. 32 TABLE THREE: Operationalizing Integration .................................. 40 TABLE FOUR: Operationalizing Consolidation ................................ 45 TABLE FIVE: Operationalizing Information .................................... 49 TABLE SIX: Operationalizing Accountability ................................. 55 TABLE SEVEN: Mentions of Problems with Regionalization in the Three Dailies ................................................................................. 60 INTRODUCTION: MOVING BEYOND PROVINCIAL HEALTH CARE Faced with a common set of problems, countries across the developed world embarked on a wave of health care reform in the 1990's. Confronting a rise in public expectations, the restraint or retrenchment of public and corporate spending, increasing costs of' care and the proliferation of new and expensive medical technologies, a range of proposals were brought fo~wardto deal with these problems. Though considerable progress has been made to alleviate their attendant tensions in recent years, significant chiallenges remain. Canadian health care has not been immune to these waves of reform. A review of the literature indicates that the provision of health care is taking place in a significantly different context than it has in years past. Driven in large part by the restraint of government expenditures and increasing costs of health care delivery, the majority of Canadian provinces initiated a series of commissions or task forces to investigate the status of their health care systems over the last two