Neville Doreen, Barrowman Gwynedd, Fitzgerald Brenda, Tomblin Stephen
Division of Community Health, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
J Health Serv Res Policy. 2005 Oct;10 Suppl 2:S2:12-21. doi: 10.1258/135581905774424528.
To describe the context and key drivers for regionalization of one provincial health care system in Canada; to document the original expectations of regionalization on governance and the extent to which these expectations were met; to identify the perceived successes and weaknesses of the process; and to examine the key issues and concerns that warrant further consideration and action in the future.
Forty-five CEO/senior administrator or senior health department officials in the period 1993-2001 were invited to participate, of whom 35 were interviewed (67% of senior health officials and 85% of CEOs/senior administrators).
For the most part, key informants felt that expectations of reform with respect to reduction in the number of boards and integration of services under each board's mandate did occur. However, ongoing financial restraint, failure to include the full range of health services under the regional board mandate (including physician and pharmaceutical services), uncertainty regarding the level of authority the regional boards had for decision-making, and unclear accountability mechanisms between the regional boards and the provincial Ministry of Health limited the extent to which broader expectations related to development of a population health focus, and improved continuity of care for individuals and families was achieved.
Implications for policy-makers were identified in four main areas: alignment between health policy goals and the governance structure; clarification of authority and accountability relationships; clarification of roles and responsibilities among all key actors; and strengthening of mechanisms that support accountability.
描述加拿大一个省级医疗保健系统区域化的背景和主要驱动因素；记录区域化对治理的最初期望以及这些期望的达成程度；确定该过程中公认的成功之处和弱点；并审视未来需要进一步考虑和采取行动的关键问题和担忧。
邀请了1993年至2001年期间的45位首席执行官/高级管理人员或卫生部门高级官员参与，其中35人接受了访谈（占高级卫生官员的67%，首席执行官/高级管理人员的85%）。
在很大程度上，关键信息提供者认为，在减少董事会数量以及整合各董事会职责范围内的服务方面，改革期望确实实现了。然而，持续的财政限制、区域董事会职责范围未涵盖所有卫生服务（包括医生和药品服务）、区域董事会决策权力水平的不确定性，以及区域董事会与省级卫生部之间不明确的问责机制，限制了在以人群健康为重点的发展以及改善个人和家庭护理连续性方面更广泛期望的实现程度。
确定了对政策制定者的四点主要启示：卫生政策目标与治理结构之间的一致性；明确权力和问责关系；明确所有关键行为者之间的角色和责任；以及加强支持问责制的机制。
