In 2019, the Ontario government announced major structural changes to the health system including a consolidation of regional planning bodies (Local Health Integration Networks) into a single province-wide agency (“Ontario Health”). This change was the most recent reversal of the restructuring efforts across Canada in the 1990s towards “regionalization" (localised planning and delivery). The first province to reverse this trend, and to abolish the regional entities, was Alberta, in 2008, which consolidated all regional health authorities into Alberta Health Services (AHS) a central, province-wide organization of public health services under their provincial health insurance program. This centralization to a single province-wide health authority has launched what appears to be a trend as Prince Edward Island, Nova Scotia, Northwest Territories, Saskatchewan, and Ontario have followed suit.
Governments who have engaged in centralization have pointed to gains in efficiency, patient-care outcomes and experience, and cost savings which they expect to yield. Although the evidence on such improvements is extremely limited.
This reform seeks to leverage economies of both scope and scale in the delivery of health services to improve delivery and outcomes while capturing efficiency gains, which theoretically may lead to cost savings. Such centralization also ensures equitable treatment and care of all provincial residents, standardizing processes and protocols irrespective of geography or regional priorities, but only a few governments have made this an explicit aim of their reform.
The provinces have taken different approaches on the inclusion and exclusion parameters of what is centralized and the timeframe in which it is operationalized. Ontario has taken several intermediary steps such as the establishment of interim and transitional regions and delaying the transfer of the provincial organ and tissue donation agency. This is in contrast with Alberta, who dissolved the existing regional health authority boards upon announcement of the creation of AHS and delayed formal integration only to align with the fiscal calendar (Duckett 2010). This process is not always transparent and is only indirectly observable from the outside.
There is a dearth of analysis on the impacts these reforms have borne. After over 10 years with a single delegated authority in Alberta there is little known about the extent to which the objectives of centralization were met. Nova Scotia has only seen steady increases in health care expenditure with no change the percentage used for health administration since the establishment of the Nova Scotia Health Authority (NHSA) (Fierlbeck 2019). Although it would be presumptive to close the book on these reforms, there is little to inspire hope that they are achieving the cost-savings and quality improvements governments promised upon implementation.