Regionalization of Health Services in Manitoba

Why Regionalization?

Northern/Rural Health Advisory Council

The Regional Health Authorities and Consequential Amendments Act

The Role of Regional Health Authorities

Region-by-Community Index PDF) (06_28_2006)

In Manitoba we spend approximately 34 percent of our total budget on health care. On a per capita basis our expenditures on health care, in Canada, are second only to the United States. There are a number of countries around the world that spend less on a per capita basis. There is no evidence that because we spend more, we are healthier. On the contrary, there is evidence that countries such as Japan, Sweden and France, who spend less, have a healthier population.

In May 1992, following a number of Health Advisory Network reports, the Minister of Health announced Quality Health for Manitobans - The Action Plan. This plan outlined a strategy to assure the future of Manitoba’s health services system.

There are a number of advantages to regionalization:

• Linking Prevention, Population Health and Treatment into a Seamless Continuum of Care:

Lifestyle, socio-economic determinants and environmental factors all play as large a role in the health of populations as do health services. A regional model will more easily link prevention and promotion, alternative community-based care and actions on population health determinants into a seamless structure of service delivery than the current institution/physician oriented system.

• Evidence-Based Decision Making:

Through a regional governance model, regional health authority boards will analyze and evaluate the health status and related health issues of their communities and make decisions about needs, services, programs and delivery models, based on evidence.

• Broader Base for Service Planning and Delivery:

The larger population base of regions (as opposed to individual communities) will have a number of advantages. For example:

- capital planning can be rationalized to optimize use of capital resources

- a larger data-set will facilitate evidence-based decision making

- health human resource and service need projections will be more reliable

for a larger aggregate population

- scarce resources can be shared within a larger population

- a broader base on which to establish specialty services

• Enhanced Consumer Choice and Involvement:

A regional governance structure will:

- provide opportunities for more local input for health service planning and delivery

- afford a broader range of consumer choices based on unique regional characteristics

- promote a regional perspective rather than only a local one

- promote moving services closer to home where people live and work

- enable alternative service delivery options

• Physician Recruitment:

Recruitment of physicians to rural areas will be enhanced through a regional structure. Rural and remote physicians have cited lack of collegial interaction and support as a key reason for choosing a more urban location. By permitting the pooling and consolidation of resources, the regional structure will provide for a more effective support system. In addition, scarce specialty resources will be more easily shared within a region.

• Getting Government Out of Service Delivery:

Regionalization will permit government to minimize its involvement in direct service delivery. The role of government would be confined primarily to standard-setting, program monitoring, bench-marking, evaluating and auditing fiscal accountability measures.

• More Efficient, Effective Service Delivery:

Regionalization will increase opportunities to reduce duplication and overlap through rationalized service delivery.

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Following the announcement of Quality Health for Manitobans - The Action Plan, the government established the Northern/Rural Health Advisory Council. This Council had the majority of its membership recommended by the northern and rural communities.

The Council’s recommendation to move towards a regional governance model was accepted by government. Guidelines were circulated, and by Spring of 1993, twenty northern/rural health association proposals were submitted. Following the Council’s review and recommendation, eight northern/rural health associations were announced.

An appeal process allowed any of the original proponents to appeal to The Manitoba Health Board. Five appeals were received and heard at public hearings. Subsequent to these hearings by The Manitoba Health Board and their further recommendations, ten northern/rural health associations were approved by the government. These were:

• Burntwood Health Association
• Central Health Association
• Churchill Health Association
• Interlake Health Association
• Marquette Health Association
• Norman Health Association
• North Eastman Health Association
• Parkland Health Association
• South Eastman Health Association
• South Westman Health Association

Both the urban centres of Brandon and Winnipeg were left as separate entities.

In October 1993, the Northern/Rural Health Advisory Council held a special meeting to discuss goals, principles, roles, mandates, governance, administration and service delivery for health associations. The consensus reached on these various issues was detailed in a discussion paper that was widely circulated throughout the province. Through direct mailing and newspaper advertisements, the public was invited to provide input at public hearings. These hearings were held during October 1994 in Thompson, Flin Flon, The Pas, Ste. Anne, Brandon, Dauphin, Lac du Bonnet, Carman and Gimli.

In all, 119 presentations were received. By the following Spring the Council reviewed all the material presented and made its recommendations to government in May 1995. The recommendations were accepted by government in principle.

The governance structure has at its centre a Regional Health Authority (RHA) board. Each board may have up to 15 members with the exception of Churchill which has up to nine. Of these, three are optional appointments, two chosen by the Minister of Health and one as recommended by the RHA. The Brandon Regional Health Authority has up to 14 members, the Winnipeg Hospital Authority 21 members and the Winnipeg Community and Long Term Care Authority 15 members.

Each RHA board may have up to four District Health Advisory Councils (DHAC). The Minister of Health may vary these numbers. The Councils are representative of a smaller geographic area within each of the RHA’s. They allow for grassroots input to the RHA board. The RHA boards determine the number of DHAC members and requirements for Council membership.

The Council recommended that health care providers, due to a potential for conflict of interest, should not qualify for RHA board membership. Therefore, each RHA board must put in place at least one multidiciplinary Provider Advisory Committee. Other Advisory Committees may also be established. These committees will provide the board with expert input.

It was recommended that health facility boards be allowed to evolve into the regional system rather than using a legislative mandate to accomplish this.

Governance is the board’s job, management is the Chief Executive Officer’s job. The board sets out a clear vision and mission for health in the region whereas the Chief Executive Officer manages the process to achieve these goals. The board deals with the "ends" and the Chief Executive Officer with the "means".

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This Act creates Regional Health Authorities with responsibility for providing for the delivery of and administering health services in specified geographical areas.

The Act requires that services will be provided and administered in a manner that complies with the criteria set out in section 7 of The Canada Health Act for the provision of insured services. Those criteria are comprehensiveness, universality, portability, accessibility and public administration.

Consequential amendments relating to the operation of regional health authorities were required in six other acts to bring them into compliance with the provisions of this Act.

The Act came into force on April 1, 1997.

Subsequently, The Regional Health Authorities Act was amended to allow for two Regional Health Authorites for the City of Winnipeg. This amendment also provides for the Minister of Health to appoint an interim manager, if in the minister’s opinion, it is in the public interest to do so.

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The primary responsibility is to ensure that all the residents of the region have fair and equitable access to necessary health services. Within the scope of this overall responsibility, the role can be summarized as follows.

The RHA:

• through its health plan, develops and maintains a statement of mission and sets direction for its yearly operations;

• sets the policy framework for its region;

• defines the CEO’s duties and evaluates performance;

• ensures the consumer comes first and maintains the quality of care and health delivery;

• makes provision for and maintains a qualified regional health staff;

• assesses community needs and provides a process for evaluation of

• ensures the region operates on sound financial management principles and ensures availability and accessibility of core services, which are being delivered in an integrated, effective and efficient way;

• ensures reasonable access to quality health services provided in and throughout the region.

• determines priorities for the provision of health services in the region and allocates resources according to those priorities;

• promotes and protects the health of the consumers living in the region and works towards disease and injury prevention; and

• in developing its objectives and priorities, will do so within a framework which is consistent with Provincial objectives and priorities.

  
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