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加拿大省级和地区卫生系统中的卫生系统区域化:公民治理委员会是否具有代表性、能否参与并赋予权力?

Health system regionalization in Canada's provincial and territorial health systems: do citizen governance boards represent, engage, and empower?

作者信息

Chessie Kelly

机构信息

Interdisciplinary Studies, University of Saskatchewan, Saskatoon, Canada.

出版信息

Int J Health Serv. 2009;39(4):705-24. doi: 10.2190/HS.39.4.g.

Abstract

Regionalization of the health care system, through the creation of sub-provincial service-delivery regions and governance authorities (i.e., regional health authorities, RHAs), has been a key part of Canadian health reform initiatives of the past two decades. Increased public participation in health care planning and service delivery is one of the explicit goals of regionalization. Based on a reanalysis of data from a 2001 survey of health system governors from 134 RHAs throughout Canada, this study explores the overall demographic composition of the citizen governance boards, as well as their responses to various opinion and attitude questions. To enable consideration of the extent to which these sites may support public deliberation and community development, overall responses are examined, as are responses within two subtypes of governors: system-experienced citizen governors and lay citizen governors--governors with or without previous health-system employment experience, respectively. The findings suggest that attention needs to be paid to these citizen governance boards if they are truly meant to be sites of citizen engagement in health policy and governance.

摘要

通过创建省级以下服务提供区域和治理机构(即区域卫生当局,RHAs)来实现医疗保健系统的区域化,一直是加拿大过去二十年医疗改革举措的关键部分。增加公众对医疗保健规划和服务提供的参与是区域化的明确目标之一。基于对2001年加拿大全国134个区域卫生当局的卫生系统管理者调查数据的重新分析,本研究探讨了公民治理委员会的总体人口构成,以及他们对各种意见和态度问题的回答。为了能够考虑这些场所支持公众审议和社区发展的程度,我们研究了总体回答情况,以及两类管理者的回答情况:有医疗系统工作经验的公民管理者和非专业公民管理者,即分别有或没有医疗系统工作经验的管理者。研究结果表明,如果这些公民治理委员会真的要成为公民参与卫生政策和治理的场所,就需要对其予以关注。

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