Church J, Barker P
Department of Public Health Sciences, Faculty of Medicine, University of Alberta, Edmonton, Canada.
Int J Health Serv. 1998;28(3):467-86. doi: 10.2190/UFPT-7XPW-794C-VJ52.
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 accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously 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 participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires 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.
自20世纪60年代末加拿大引入全民医疗保险以来，联邦和省政府一直关注成本节约、服务提供效率、服务提供的公平性、增强公民参与以及提高决策者的问责制。大量政府皇家委员会和特别工作组针对解决这些问题提出了一系列类似的方案。改革的核心是提议建立一个区域化医疗体系，由一个中介机构负责以前分配给地方或中央机构的职能。对于其支持者而言，区域化提供了一种更好地协调和整合医疗服务提供以及控制支出的方式，并有望更有效地提供服务，为公民参与医疗决策提供途径。除安大略省外，所有省政府都引入了医疗区域结构，希望这些变革能提高效率、公平性和响应能力。然而，尽管有这些所谓的好处，区域化也带来了重大挑战。它在以产生规模经济的方式整合和协调服务方面面临障碍；它需要更高水平的信息，而这可能难以实现；它不太可能让公民参与医疗决策；而且实际上可能导致成本增加。
