Marchildon Gregory P
Ontario Research Chair in Health Policy and System Design, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
Healthc Pap. 2016;16(1):8-14. doi: 10.12927/hcpap.2016.24766.
Regionalization is arguably the most significant health reform in Canada since medicare. Although a majority of provinces continue to have regionalized systems in Canada, the policy is more contested today than it was a decade ago. Since Ontario's implementation of local health integration networks (LHINs) in 2006 and Alberta's elimination of regional health authorities (RHAs) in favour of Alberta Health Services in 2008, Canada has had differing approaches to regionalization. However, due to the centralization of physician budgets in provincial health ministries, primary care has not been integrated into any regionalization model in Canada. This factor has severely constrained the performance of RHAs and their ability to meet their respective legislative mandates. Moreover, the lack of research on regionalization has meant that provincial governments are working from an extremely limited evidence base on which to make critical decisions on the structuring of health systems in Canada.
区域化可以说是自医疗保险制度以来加拿大最重要的医疗改革。尽管加拿大大多数省份仍实行区域化体系，但如今这项政策面临的争议比十年前更大。自安大略省于2006年实施地方卫生整合网络（LHINs）以及艾伯塔省于2008年取消区域卫生当局（RHAs）并支持艾伯塔省卫生服务局以来，加拿大在区域化方面采取了不同的方式。然而，由于省级卫生部对医生预算的集中管理，初级保健尚未被纳入加拿大的任何区域化模式。这一因素严重制约了区域卫生当局的绩效及其履行各自法定职责的能力。此外，对区域化缺乏研究意味着省级政府在为加拿大卫生系统结构做出关键决策时所依据的证据极其有限。
